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HomeMy WebLinkAboutHYLEN CREST #3 BLK 6 LT 7Onsite File Hylen Crest #3 Block 6 Lot 7 #050-474-33 Updated as-built survey requirement waived to close out permit OSP211143. Required at time of future COSA. Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211143 PID Number: 050-474-33-000 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name John & Erin Rajek ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 10327 Stewart Drive, Eagle River, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-830-6999 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Hylen Crest #3 6 7 Fill added above original grade Ft. Gravel length Ft. Township Range Section 14N 1 W 8 Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic I Absorption Lift Station Holding I Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well /-1 N/A TANK A Septic [IS.T.E.P. EJ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface water >100' Material Polyethylene Number of compartments Lot Line 17.5' I NA 2 Foundation7 $' LIFT STATION Manufacturer Capacity Remarks 5' separation maintained to front deck Gal. The new tank is —4' east of old tank. The existing drainfield is being re -used. Alarm location Electrical installed by Separation to the property line is not a concern. Therefore, we request the asbuilt survey requirement be waived Installer PIPE MATERIAL House to tank PVCTank to PVC drainfield Dean Construction & Development *All PVC ASTM D3034 Drainfield co/MT PVC Inspector Scott Roelfs, VEI Consultants BENCH DARK (Assumed elevation) 955.50 ft Inspdect �5' 6/8/21 7/6/21 Location and description es: 2�d 3`tl 4th Garage Finish Floor ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp gCgSl�O Conditional Approval: Date OF' ' 49 TH�Pe ......: . 104 ..... ...�TR B� Scott,.� F�j . CE 11824 ,� �00��F P��Sfj�®�?® Septic System Approved Date '7 ( 5 20,2 i Note: this approval does not include well permit requirements. Q.o - buy /f _5"Vy r�e�,.c h. e_," rn�- tJa c:v�J u��' Co 519. - -- LOT 7 H YL EN CREST SUB'D, UNIT #5 BLOCK 6 EXISTING 3 -BEDROOM CONNECTED TO EXISTING 4" PIPING HOUSE REPLACED FOUNDATION CLEANOUT 1 TO 4 FEET FROM FOUNDATION JJPOINT "B" FOR SWING TIES r-7 -;7T/-7.8' TO HOUSE GARAGE FINISH FLOOR ELEV = 955.5 (BENCHMARK) POINT "A" FOR SWING TIES REMOVED EXISTING SEPTIC TANK AND PIPING F - - - EXISTING DRAINFIELD 0' 5' 10 SEE NOTE 1 F//- BEND �- -- 45'DOUBLE CO :ND 17.5' TO PROPERTY LINE _ —(J CONNECTED TO EXISTING 4" PVC PIPING UPSTREAM OF EXISTING DRAINFIELD EXISTING DRAINFIELD 15' T&E EASEMENT � \ �\ SWING TIE DISTANCES (FT) COMPONENT FROM POINT 'A' FROM POINT 'B' TANK MANWAY 14.3 11.8 TANK STANDPIPE 14.8 16.2 DOUBLE CLEANOUT 15.2 18.3 X� c \o��LF NOTES: 1. 1000 GALLON POLYETHYLENE SEPTIC TANK (GREER) WITH MANWAY RISER (20"0 MIN) SERVING FIRST COMPARTMENT. 4"0 STANDPIPE TO OTHER COMPARTMENT. 2" INSULATION IMMEDIATELY OVERTOP TANK. 2. SUBDIVISION IS SERVED BY CITY WATER. WATER MAIN IS LOCATED IN STEWART DRIVE. WATER SERVICE TO HOUSE RUNS ALONG THE WEST SIDE OF THE DRIVEWAY. 3. NO SURFACE WATER OBSERVED WITHIN 100 FEET OF SYSTEM. w w � w STEWART ORIVE RECORD DRAWINGS 960 960 2" TANK INSULATION 4.. INSULATION .. ...:.... :... I MEETING TANK PREVIOUS GRADE REPLACED INSULATION : FOUNDATION . ................... ... ......... ......... ... ... ... 2" INSULATION CO .—.:. ...... FINISHED. .... — RADE ....:....:... ... ....... ...... .......... ..; ;. ................ — MANW 1 Y ........ ... ................ �. STAND ......... 955 —: PIPE 955 ......... . .GQ.. PIPE. .....Ex. ' q".PVA... ... 45° :....:. I MIN .. .. ...... i EX INV E EV = 953. ?az:.... BEND ... .... BEN .. ..: n ... ANIC.INLET..ELEV..:.951,77 ... 4'.Pvc.:... 45' 5% 950 1000 GALLON BEND 950 EX INV ELEV 951.2. POLYETHYLENE .. ....:.... ...... SEPTIC TANK ... (GREER) \..:....:... .............:.... ... OUTLET _ .... _ _ _951,5 .... ... ........... :....:.... .............:....:.... ....:....:.. .... ....:....:.... \ . T A = ..................:B..M .T . NK. ELEV.....947.5 ......... .... .... .... .... :....:....:....:.... ........................ .... ....:....:....:.... ......... . .... ....: 945 0+000+10 LOAD PRISM: NOTE THAT TANK IS J OUTSIDE THE LOAD PRISM AT A HORIZONTAL DISTANCE OF 7.8' FROM FOUNDATION 945 0+20 AV AV : 49th .....::. ............................... .. �. .... ................... .....0 SCOTT T. R LFS C a ♦♦ CE -118 _SAV RECORD DRAWINGS SEPTIC TANK REPLACEMENT — SECTION i � I 10327 STEWART DRIVE LOT 7, BLOCK 6 HYLEN CREST SUBDIVISION, UNIT 3 Consultants PHONE: 337-3330 HORZ SCALE: 1"=4' DATE: 7/15/2021 1 GRID: NW0057 1345 RUDAKOF CIR #201 Pg 2 OF 2 ANCHORAGE, AK 99508 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211143 Work Type: SepticTank Upgrade Tax Code Number: 05047433000 Site Legal Address: HYLEN CREST #3 BLK 6 LT 7 G:0057 Site Mailing Address: 10327 STEWART DR, Eagle River Owner: RAJEK JOHN JASON & Design Engineer: VEI CONSULTANTS This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: `0 U. Department 5/13/2021 5/13/2022 21166 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: ALllele_� Date: 5/)'3/-Z li Date: 5 / 00.7 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 050-474-33-000 Property owner(s) John & Erin Rajek Mailing address 10327 Stewart Drive, Eagle River, AK 99577 Site address Same Day phone Legal description (Sub'd., Block & Lot) Lot 7, Block 6, Hylen Crest #3 Legal description (Township, Range & Section) Section 8, Lot Size 21,166 Sq. Ft. Number of Bedrooms 3 T14N, R1 W, SM APPLICATION IS FOR: APPLICATION 1S AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank El Upgrade Q (D) ❑ Holding Tank El Renewal Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. RAJ202EKJOHNJ.30:56-0 '00 2021.05.1010:30:5&-08'00' (Signature of property owner or authorized agent) Permit/Rush Fees: Aq Date of Payment: —5/13LO'21 _ Receipt Number: 05-7 E -7G - Permit No. D S P1111 1 � 3 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\FormsUient Forms\Permit Application.doc Consultants Civil Engineering and Surveying Consultants 1345 Rudakof Circle, Suite 201 Serving All of Alaska Anchorage, Alaska 99508 FAX: (907) 338-5386 Phone: (907) 337-3330 May 11, 2021 Municipality of Anchorage Development Services On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Re: Septic Tank Replacement for Lot 7, Blk 6, Hylen Crest Sub'd 93 Narrative and Permit Application To whom it may concern, VEI Consultants was contracted to design a septic tank replacement at the above referenced property. The intent is to remove the existing steel tank (30 years old) and replace it with a polyethylene tank. A COSA was performed in 2019 and found that both the tank and the disposal field was operating satisfactorily; however, the homeowner would like to address the tank before any problems arise. We request that you approve the attached permit application for the replacement of the septic tank. Surface Water & Ta o ra h There are no surface waters within 100 feet of the proposed system. Additionally, no seasonal surface water has been observed collecting anywhere on the property. The general slope of the lot is from North to South. Based on survey data, the slope where the tank is being constructed is approximately 20%. Design Information VEI conducted a field investigation that included surveying the house and deck, existing ground, cleanouts, and monitoring tubes. Measure -downs to the pipe inverts and the water level in the existing septic tank were performed. This information is reflected in the design drawings. The existing tank will have to be removed to accommodate the new tank. To minimize the excavation, the proposed tank elevation was determined by using insulation and 2' of cover at the south end. Connections to the existing piping will be made upstream of the existing foundation cleanout (a new foundation cleanout will be installed), and upstream of the existing disposal field. A new double cleanout will be installed downstream of the tank (the existing double cleanout will be removed). The new tank location allows for a 5' clearance from the entry deck, and 7.5' clearance from the house. Site constraints prohibited moving the tank more than 10' away from the On -Site Wastewater Disposal System — Narrative, Lot 7, Block 6, Hylen Crest Sub'd #3 May 11, 2021 Page 2 of 2 house. With the current design, the bottom of the tank will be outside the soil bearing prism. The bearing prism is shown on the section view. Please note that in the section view the tank appears farther away from the house due to the pipe stationing. The proposed tank installation will not alter the existing site topography or drainage patterns. The ground surface above the new tank will be graded to ensure positive drainage. There are no adjacent private wells within 100 feet or community wells within 200 feet of the proposed system. We do not expect there to be any adverse effect on adjacent lots by the construction of this system. If you have any questions, please contact me at 337-3330. Sincerely, VEI CONSULTANTS Scott T. Roelfs, P Attachments: As -Built by Holt Land Surveying, dated 8/19/19 Proposed Tank Replacement Design Drawings Construction and Material Specifications LOT 7 HYLEN CREST SUB'D, UNIT #J BLOCK 6 EXISTING 3—BEDROOM CONNECT TO EXISTING 4" PIPING HOUSE REPLACE FOUNDATION CLEANOUT 1 TO 4 FEET FROM FOUNDATION POINT "B" FOR SWING TIES 7 5' TO HOUSE R+ ' GARAGE FINISH FLOOR ELEV = 955.5Arc 45' (BENCHMARK) POINT "A" F o BEND FOR SWING TIES 5PROPERR TO DECK i SEE NOTE 1 PROPERTY LINE J 955- 0 REMOVE EXISTING SEPTIC TANK. REMOVE OR 45' ABANDON PIPING BETWEEN CONNECTION POINTS 45. BEND BEND DOUBLE CO L - - - EXISTING DRAINFIELD --- _j CONNECT CONNECT TO EXISTING 4" PVC PIPING UPSTREAM OF EXISTING DRAINFIELD 0' 5' 10' \ 95 EXISTING DRAINFIELD - - /v 15' T&E EASEMENT SWING TIE DISTANCES (FT) COMPONENT FROM POINT 'A' FROM POINT 'B' TANK MANWAY TBD TBD TANK STANDPIPE TBD TBD DOUBLE CLEANOUT TBD TBD Ttic � �w w W -mow w NOTES: 1. 1000 GALLON POLYETHYLENE SEPTIC TANK (GREER) WITH MANWAY RISER (20"0 MIN) SERVING FIRST COMPARTMENT. 4"0 STANDPIPE TO OTHER COMPARTMENT. 2" INSULATION IMMEDIATELY OVERTOP TANK. 2. SUBDIVISION IS SERVED BY CITY WATER. WATER MAIN IS LOCATED IN STEWART DRIVE. WATER SERVICE TO HOUSE RUNS ALONG THE WEST SIDE OF THE DRIVEWAY. 3. NO SURFACE WATER OBSERVED WITHIN 100 FEET OF SYSTEM. STEWART DRIVE 960 960 INSULATION : 2" TAN INSULATION TO MEET TANK a REPLACE INSULATION ... ......... .............. .... .... .... .... INSULATE ALL .... CO PIPING WITH LESS ... .... ...... ................... .... :\THAN 3' OF COVER . . . .... .... ......... ... .... . .... MANWAY .... .. .... ..... .. w 955 STAND— 955 PIPE .. ........... .. :EX .... w w ... . . X ........... .. .... .... CO 4' PIPE. .... ... .... .... ................ ...... . .. ...... ..... . .. . .... EX EX INV ELE 953.Q 9 T ..... R TO TANK PV �,C w 45' : 7 N .... ... ... .. . ... .... a MIN w ... .... .. .... 45* 4BEND�_ .I VERIFY PRI INSTAI_L6:TIO 4 ........ .... .... .... ................... .... BEND ... ......... ANK INLET ELEV 951�X-. 45 Pvc: V 950 1000 GALLON 1.37 950 POLYETHYLENE .. .... ...SEPTIC TANK ... .... .... . -EX INV ELEV 950.3. (GREER) ... .... .......... w .... .......... .... .... .... a .... a OUTLET ELEV = 951,0 '= BTM TANKELEV946.9 ......... .... ......... 945 945 0+00 0+10 0+20 LOAD PRISM: NOTE THAT TANK ISJ OUTSIDE THE LOAD PRISM AT A HORIZONTAL DISTANCE OF 7.5' FROM FOUNDATION FIConsultants Civil Engineering and Surveying Consultants 1345 Rudakof Circle, Suite 201 Serving All of Alaska Anchorage, Alaska 99508 FAX: (907) 338-5386 Phone: (907) 337-3330 May 11, 2021 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS LEGAL DESCRIPTION: Lot 7, Block 6, Hylen Crest Subdivision #3, Anchorage Recording District GENERAL: 1. The scope of this project includes the installation of a new 1,000 gallon polyethylene septic tank to serve an existing 3 bedroom single family residence on the referenced property. The existing steel septic tank shall be removed and disposed of properly. 2. Construction shall be in accordance with the approved design drawings, specifications, municipal permit with any special provisions or conditions, and all applicable Municipal Wastewater Disposal Regulations. Any deviation from the design drawings and specifications requires engineer approval. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Contractors installing wastewater disposal systems must be certified by the Municipal Onsite Water and Wastewater Section for systems installations. Owners installing their own systems must also receive prior approval from the Municipal Onsite Water and Wastewater Section. SEPTIC TANK INSTALLATION 1. Septic Tank shall be a minimum of 1,000 gallons. The tank shall be constructed of polyethylene and shall be pre -approved by MOA for installation. The contractor shall ensure that the fill over the tank does not exceed the burial depth rating. 2. Septic Tanks installed with less than 4 feet of cover shall be insulated. Minimum cover with insulation shall be 2 feet. Insultation shall be placed immediately above the top of the tank. 3. Construction shall include a 20 inch (minimum) diameter watertight manway riser serving the first compartment of the tank. The riser, including the cover, shall be insulated with 4 inches (minimum) insulation extending to 48 inches below grade, or to the tank insulation. The insultation shall be of a MOA approved type suitable for below grade applications. Exposed insulation above grade shall be protected from UV damage. The riser lid shall be secured (lockable) to prevent unintended access. The riser lid shall match the final grade. Use a 4 inch (minimum) diameter standpipe with airtight cap to provide effective access to each of the remaining On -Site Wastewater Treatment and Disposal System — Specifications, Lot 7 Blk 6, Hylen Crest Sub'd #3 May 11, 2021 Page 2 of 3 compartments. All standpipes on the septic tank shall extend to a minimum of 12 inches above final grade. 4. All septic tanks shall be fitted with watertight couplings, approved by MOA, at the pump out attachments and on the inlet and outlet of tank. 5. In the line between the tank and the absorption system there shall be two opposing cleanouts (double cleanout). The cleanouts shall be located on undisturbed soil not more than ten feet from the tank. The first cleanout in the line shall be to clean the line toward the absorption system and the second cleanout will be oriented to allow cleaning toward the septic tank. Cleanouts shall extend to a minimum of 12 inches above final grade. 6. The septic tank shall be sufficiently bedded with proper material and compacting to prevent settling or shifting of the tank. 7. The sewer piping from the foundation cleanout to the septic tank shall be 4 inches laid at a minimum 2% slope. If cover is less than 3 feet, insulate with 2 inches insulation. Always maintain 2 feet of cover. 8. The sewer piping from the septic tank to the absorption trench shall be 4 inches laid at a minimum 2% slope. If cover is less than 3 feet, insulate with 2 inches insulation. Always maintain 2 feet of cover. 9. Insulation shall be placed over any wastewater line or pipe over which a driveway, parking, or vehicle storage area may be constructed. MINIMUM MATERIAL SPECIFICATIONS: 1. A MOA approved septic tank manufacturer must construct any septic tank proposed for installation. 2. Insulation shall be at least 2 inch thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI, Insulfoam R -Tech IV, or equal) 3. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 4. The following pipe materials are MOA approved for use in septic system installations: T 120 of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 or F789 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes ASTM D2751 (ABS) Yes No **Use of a type of pipe other than listed above must be approved by the inspecting engineer. On -Site Wastewater Treatment and Disposal System — Specifications, Lot 7 Blk 6, Hylen Crest Sub'd #3 May 11, 2021 Page 3 of 3 INSPECTIONS: Typically, there will be several inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. A preconstruction site meeting. 2. An inspection must be conducted after the excavation of all native material for the tank been completed and proper bedding placed. MOA requires 2 hours' notice for this inspection. 3. An inspection must be conducted after the tank has been set in place with distribution piping and cleanouts installed, but prior to backfill. 4. The final inspection is to occur upon backfill and final grading of the property. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. The engineer shall be notified '/z day prior to a required inspection. A 't�G OF A� 4AW ��� ;1101*:.49'.........:*� ..: ... ........... Scott T. RoeN CR -184 �10 c FO ,1kR4FE55lONA N R9 56' 45" W V 49 rijrri�•wua THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 000DO��� _o OF At��� �0c 49 TH �OD �D OVco O s" SHANE A. HOLT -ISO Q� 0 LS -6914 50 0 rofessiona\ AS—BUILT SURVEY 1" = 20' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY 10T7, NOCK6, HYLEN CREST UNIT3 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 19TH DAY 01 AUGUST 2019 14365, FB 198-76 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 Onsite File Hylen Crest #3 Block 6 Lot 7 #050-474-33 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES / Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-81TE SEWAGE DISPOSAL ~Y~TEM AND/OR WELL INSPECTION REPORT m~ DISTANCES ~ ~ ~E ~ ~O~f ~ SEPTIC ABSORPTION -- A~,~ TANK FIELD WELL LEGAL DESCRIPTION _et ~ Bl°ck G Subdiws~°nH~ ~E~W ~ FOUNDATION Township, Range, Section AS-BUILT DIAGRAM (Show location of well, septic system, properly lines, foundation, sec, e % RI ,j 5, M. Oriveway. waterboOies, elc.) TANKS U ~ SEPTIC ~ HOLDING Manufacturer Capacity in gallo~s KNCd- /4N lO00 Material No. of Compadments TYPE OF SYSTEM - ~ UTRENCH ~ BED ~ W. DRAIN ~ OTHER _ ~ Deplh Io pipe boltom from TolsI depth from original grade originalgrade ~ FT 3.Z FT-- :ill added above odGinal grade Gravel deplh beneath pipe ~ - ~.~ FT J.~ FT Grevel length Gravel width ~ O ET ( FI Total absorplJon area gistance belween lines ~8Q FI ~8 FI Number of lines J Soil rating Pipe material ~ ~ ~ J Installer Dsie installed i ~~ .. ltl WELLS g PRIVATE ~R [Identilv) Classification (A,B,C) Total Depth ~ Cased to ~~ ~ FTj FT Installer Date Installed: REMARKS: ~unk~pa~a.d 8ia~'gdidelJnes ~n ellect 0n mis dam:/ ~¢/ 72-013 (3/85) ~1¥08 ..L'll II~! - G;¥ SCALE DEPARTMENT OF HEALTH & HUMAN SERVIC 825 "L" Street, Anchorage, Alaaka 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~_ H L)r-~k~. . H~t~ DATEI~ PERFORM LEGAL DESCRIPTION:~e~ ~j ~1~ ~'~H~ ~eb~ownship, Range, Section: ~ N I SLOPE 6IT~LAN Hole -"4 5 6 7 ~ 8 9 10 11 12 13 14 15 WAa GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? D~plh t~ t*/aler Nl.~r ~ #on. tt~rinQ? Reading Date Gross Net D~pth 1o Time Time Water III I Net Drop 16 17, H,o, 1457-~ 19- 20- PERCOLATION RATE ~ Imm .E DIAMETER TEST RUN EETW . FT_.,~. FT S & S ENGINEERING - , 170~4 ~gle Riv~ ~ R~d No 2~ '--e ........... 72~8 (Rev. 4/~) -- ~ ' [ '/ MUNICIPALITY OF ANCHORAGE Development Services Department - Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-474-33 1. GENERAL INFORMATION Expiration Date: C - q - 2 ® zo Complete legal description Hylen Crest #3 Block 6 Lot 7 Location (site address) 10327 Stewart Drive Current property owner(s) Patricia Smith Mailing address Real estate agent SAME Stacey Hague 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 907.694.4809 Day phone 907.240.2327 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55Z Date of Payment SVS I/9 Receipt Number 0&al LID COSA # U JCP? W-11 Waiver Fee $ Date of Payment Receipt Number Waiver # 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Phone 907.355.9820 Address 19162 Mountain Road Chugiak Engineer's Printed Name Curtis Townsend, PE Date May 22, 2019 �,cP� � � • Ary`•S'ir'`��1, 6. DSD SIGNATURE .••.. T .. .••. System #1 Approved for 3 bedrooms Toy Date 7 2 / /1 System #2 Approved for bedrooms �t �4� ' No CE 11904 •. �`�-A Y pp oPROFESS10Np��.r � Disapproved ®Z� ESSO Conditional approval for bedrooms, with the following stipulations: By: �.., l=c�c��—t� Original Certificate Date: r� l 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 X Nitrate Advisory Septic System Advisory Arsenics Adv Ory Well Flow Advisory Other .� COSA Checklist blue sheet COSA Checklist Legal Description: Hylen Crest #3 Block 6 Lot 7 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments AWWU, public water B. TANK DATA Age of tank(s) 29 years Tank type/material septic steel Measured operating fluid level in septic tank 51" Al Standpipes/foundation cleanout per record drawing Date of pumping 6/4/18 D. ABSORPTION FIELD DATA Parcel ID: 050-474-33 Structure served by this system _ Well production at time of test T_gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by _ Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 1990 Adequacy test date 5/15/19 X ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 3.7 ft (max) Fluid depth prior to test 2 in Measured depth to pipe invert from grade 1.9 ft (min) Water added 470 gal ❑ N/A — pressurized field New depth 7 in ❑ Monitor tubes go to bottom of effective. If not, state 70 d depth into effective Elapsed time min ® Code -required soil cover over field Final fluid depth 2 in ❑ System presoaked Absorption rate '450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: per inspection report there is 2" insulation over field, no part of field is under driveway COSA Checklist yellow sheet i E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' M✓ Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' 0 Yes if No ft Water Main > 10'✓0 Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft (]✓ Yes if No ft Water Service Line > 10' P(l Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M✓ Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5'✓0 Yes Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' M✓ Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10'✓0 ft Yes if No ft Community Wells > 200' (]✓ Yes if No ft Water Service Line > 10' P(l 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) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that I 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. ,,gc;. , sIDr At COSA Checklist yellow sheet >..• T�*:.r..w.n.s. ....... ., .........Curtis HT Date q4w �No. CE 11904 ��` •�a F E�.lie�pROFESWto . DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC191176 Subdivision: Hylen Crest#3 B 6 lot 7 907-343-7904 Fax: 343-7997 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 29 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. �.. _ . Ma�hng Address P O Box'196650 *Anchorage, Alaska 99519 6650 * www murn org a n ,y. 7-C)^'~S/-~8 ' ---------- A8BU/LT-NO CORNERS SET THIS DATE. 3E1,1ARD @ ASSOCIATES LAND SURVEYING 694-082 | HEREBY CERTIFY THAT | HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY'0 Al DATE: SAND THAT NV ENCROACHMENTS EX|STEXCEPT 4S INDICATED. IT IS THE RESPONSIBILITY OF THE ~ -'Ilk OWNER TDDETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBD|~ VISION PLA'[ UNDER NDCIRCUMSTANCES SHOULD � ANY DATA HEREON BEUSED FOR CONSTRUCTION �Ar OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. FRAWN: / 0 � ! ' � | r i ! | / � i ' / | \ ^ ----^ ^V�`_ 7-C)^'~S/-~8 ' ---------- A8BU/LT-NO CORNERS SET THIS DATE. 3E1,1ARD @ ASSOCIATES LAND SURVEYING 694-082 | HEREBY CERTIFY THAT | HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY'0 Al DATE: SAND THAT NV ENCROACHMENTS EX|STEXCEPT 4S INDICATED. IT IS THE RESPONSIBILITY OF THE ~ -'Ilk OWNER TDDETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBD|~ VISION PLA'[ UNDER NDCIRCUMSTANCES SHOULD � ANY DATA HEREON BEUSED FOR CONSTRUCTION �Ar OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. FRAWN: LEGAL LOT 7i BLK.b HYLEN CRE5T DRAWN CKD. I DATE t SHT. 3 5R H 1115E [Ell 1017 Glut. 5EPTIC `LANK 71111 f _ _ LO 34' x171 k, DRIVE ` z,. (iL5tILAT1IlN `CL7 r EL17 T 2 KEY 8DX 4 r_ T. B.M TH d . • , Curtis E Town �{ �,� • Data No. CE 11 .• Aw (' 0 � ��- ! P� � �` �' -'� j"� .. t*'..� � �, � �� � � ter.,, .,,... �..•.�,. ;. ClE t S { t v'`; 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. # ©~'O - ~/~-/ -~ ~ 1. GENERAL INFORMATION Complete legal description 5ct 7; Elock 6; Hy].en Crest Subdivision ~3 Location (site address or directions) 10327 Stewart '"" ,~.'C 2 V~.~ Eaqle River, A'~ Property owner Joanne Beckowski Mailing address P.O. Box 771866 Day phone 265-3551 (w) Eaql~ River, AK 99577 Lending agency Mailing address Day phone Agent Eva T.oken/ Vista Real Estate Day phone 689-6476_ Address 16635 Centerfie].d Drive ~-~1 AK ....... e River, 99577 Unless otherwise requested, HAA will be held for pickup. 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. 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 & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Address Eagle River, Al. asEa 99577 , Engineer's signature ...... Phone Date DHHS SIGNATURE !//~-- Approved for Disapproved. Conditional approval for bedrooms. 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 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 DH HS 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 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERV~ E IV[ D Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 MAY 2. 0 1996 Legal Descriptiou: Lo'F- A. WELL DATA Well type Oil ~9~' Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services If A, B, or C, attach ADEC letter· ADEC water system number Date completed ~ Cused to Casil~,e ground) Wire, s-Coperly protected (Y/N) FROM WELL LOG/ AT INSPECTION Static water level Well production ~niplc: g.p.m. Nitrate Collected by: g.p.m. Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Foundation cle,'mout Date of Pumping Tank size l¢~--¢(.-> Number of Compartments '~-- Clemiout~r'~y~)..,,._[ Depression (Ye. ~ High water alarm (Y~) ~,~ C. ABSORPTION FIELD DATA Dale installed [ 'Z-~ 7~ fl o Length ~o ¢ Width ~ t Gravel thickness below pipe Effective absorption area q¢~' Monitoring Tube presen~Y,~) y Date of adequacy test ~""["} ---c1'¢, Result~ail) ~0,¢J-ff~G Fluid depth iii absorption field before test (iii.); Fluid depth ;2" (ins.) Minutes later: Peroxide trcatnient (past 12 months) (Y~b'] Soilratmg (g.p.d./fl2 or ft2/bdrm) ~,~-~'~¢~ Systcmtype ~,'l~>~e-~,~ /, ~ ' Total depth -?,,Y~-,~ Depressioo over field (Yt~J) ~ For ~ bedrooms Z% hnmediately Mter6~70 gal. water added (iii.): [/" ~ Absorption rate t/,,,,~ '/" = g.p.d. ,,d.~.,Ot; //-,,'"o ..,0~ yes. give date r"14+ D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) High water alarm level at* ~-' "Panlp oil" level at* ..-------' * Datulll off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tm~ on lot ; On adjacent lots Absorption field on lot Public sewer main _......------~'"'"" Pablic sewer manhole/cleanout ~- Lift station SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: Building foundation 'b~ ~ Property line Io ~ '¢ Absorption field Water main/service line ~,O I-{ Surface water/drainage 10p~.Jc Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 1 ~ ~ Water mare/service line IT> Surfi~ce water ~ ~ ~ ~ 4- Driveway, parkin~vehicle storage area Cu~ain drain ~ ff~ Wells on adjacent lots ~o~ t -~ Prope~, line F. ENG~EER'S CERTIFICATION 1 ceftin, that I have determined thrufield ina~ections and review of Municipal recor& tn confbrmance wtth A.IOA ~,M gutde~es m effect on this date, ~'*0 Engineer s Name _ - - ~ o ~ n~ i'.., ll.g 't't ~ ~ ROBERT C .......................................................................................................... . HAA Fee $ }¢~. Ok9 Waiver Fee $ Date of Paylnent Receipt Number Rev, 8/95 OSS: haa.wk.doc Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 7; Block 6; Hylen Crest Subdivision #3 Location (address or directions) Stewart Drive (b) Property owner Mailing Address Ted Beckoloski Telel~hone:(home) 694-2767 Business P.O. BOX 771866 Eagle River, Alaska 99577' (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ~2df hold for pick up.) List contact person and day phone number below: S & S ENGINEERING Eagle River Alaska 99577 2. TYPE OF RESIDENCE Single-Family EAx, 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 DISPOSAL On-siteT~ 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 · 3JOIA s,JeeuiSue leUOiSSejoJd eql u! suo!ssiwo JO sJoJJe Jo,t elq!suodsaJ ~ou sf @[~eJOqOU¥,tO Xl!led!o!UnlAI eq.L 'penss! s! e~eoiH1Jeo e 8Jo~eq e~ep ezXleUe JO suoRoedsu! lonpuoo ~ou op SHHC] jo seeXOldLU3 'slueLueJ!nbe~ elels pue leJepel u!elJao X~sRes ol JepJo u! suoRm!lsu! 8u!puel ¢!eql pue sewoq ~o sJeseqoJnd ol ~seHnoo e se s!q~ seop SHHC] eqj. 'e~selV to e~e~S eql u! peJe~s!SeJ Jeeu!bue leuoissejoJd luepuedepu! ue Xq e^oqe S qd~J§eJed u! UeA!8 suoileluese~deJ eql uodn ~lUO peseq pe~eoWJeo le^oJdd¥ XHJoq~n¥ q~leeH senss! (SHHQ) s@o!^JeS ue~unH pue qlleeH jo ~UeLUlJedeo eBeJoqouv jo Xl!led!o!u nlAl eqJ_ leAOJddv leUO!l!puoo to sw~eL leUOR!puoo pe^o~ddes!c] ,)( pe^oJddv 'IVAOI:tdd¥ SHHa '9 euoqdele& sseJpp¥ wJ!-t Jo eLU~N 'uoiloedsu! s!q~ to elep eq~ uo loejle u! suo!lelnBeJ pue 'seoueuipJo 'sepoo elels pue I~d!o!unlAI lie q~pA eoue!ldwoo u! s! LUelSXS leSOds!p Je~eA~ms~A ~o/pue/~lddns Jele~A @Hs-uo eq~ 'uo!loedsu! pue uoile6ilse^u! ~LU LUOJI pu~ S@lff eSeJoqou¥ ~o XHledio!UnlAI aq~ woJl peu!e~qo uoileLuJoJu! eq~ uo peseq leq~ ,~!~eA Jeql~nj I 'ui@~eq pmeo!pu! eJnlonJ19 ~o edX~, pue SLUOO~peq to ~eqLunu eq~ ~o~ menbepe puu leuo!lounj 'aIes s! uuelsXs lesodsip ~e~eA~e~seA~ ~o/pue Xlddns ~ele~ el!s-uo eq1 ~eq~ s~oqs le^o~ddv X~Hoqm¥ q~leeH siq~ to uoReBRse^u! Xuu ~eq1 ~¢!JeA I '~oleq uA~oqs e~ep uo!~ep!le^ eql ~o se pue ole~eq pexwe lees ~uJ Xq pey!peo s¥ NOIJ. VIAIIJO:INI aNY v~¥a 'HOI:IV~IS 3'114 '$J.$~I.L 'SNOI.LO3dSNI IDNIOlAOldd IAI~I:I 9NIIJ33NION3 'S ~ MUNICIPALITY OF ANCHORAGE (MOA) (t~-~.,/, Health Authority Approval (HAA) .~i;h,~'/;:,L ~,.r,'v ~C~.G.hlE4GI(LIST' FEBRUARY 1984 ~ 343-4744 ,JAN ]. 6 199[ Legal Description: A. WELL DATA Well Classification 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: R. EC IVED "lA" Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot ~_E~O© ' '~- 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 ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~Size Standpipes (Y/N) L/ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~_~ To Property Line / O To Water Main/Service Line / To Stream, Pond, Lake or Major Drainage Course [~No. of Compartments ;;~. Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) , L~ /k)/~ Date Last Pumped; for A) Temporary Holding Tank Permit (Y/N) ~/~ To Building Foundation 'Fo Disposal Field / ©O /? Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / ~ - 2z¢ Width of Field ~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field _2~. Gr~el Bed Thickness / , ~ ~0 ~ Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ OdD /7L / To Building Foundation / Lot /~)l~ To Water Main/Service Line (' ~ To Stream, Pond, Lake, or Major Drainage Course iL'?© /-/- To Driveway, Parking Area, or Vehicle Storage Area / To Property Line / To Existing or Abandoned System on ; On Adjoining Lots ~,C) To Cutback (if present) Comments D. LIFT STATION Date Installed N Size in Gallons "Pump On" Level'at High Water Alarm Level at__ Tested for Meets MOA Electrical Codes (Y/N) %% Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Signed Company Date MOA No. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. .~ ,7, :'; 17034 i;agl,:; td','ar L.u~;p ik~ad ~Jo, 204 Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ~NC~-IOrL~G~ ~:~m'~r~'~ ~q'~ ~'~ OFF ,~ ..~.,,'~ Dlo .,.~.~ 3601 C ~mm~W, '~ 3 ................ , oUITE 2,~, hNmqO~' ALASKA 9:,. 03 WALTER J. HICKEL, GOVERNOR 563-6775 January_,_~0, 1991 :, & S Engz.,;e, ing Attn: Rodney ,,S : :,r -'., ] ...... 9 ,'.-fy review of the records on file in this office reveals thak the ..:~.'./' ' ..~"'~.._ n ~.r e.~ t'~ ~ Subd ~ ,] ~ s z on' ' ' ' Class n.. m,h't. ~.~ .,.,~" Uater System is in co;npliance. . w'i_th khe ..'orovisions of 12. ..-~,.., ,°0,060, Shake of Alaska Dr'" " : ..... ~gulat:[ons. .,_n~, ing ~'~akr~r '~'~ .-Sincerely, Env~;~onmer~talL Enginee,-