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HomeMy WebLinkAboutHYLEN CREST #3 BLK 6 LT 10Onsite File Hylen Crest #3 Block 6 Lot 10 #050-474-36 (Nev u5iulii u) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211224 PID Number: 050-474-36 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name DARYL & BEVERLY SMITH ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 10339 STEWART DRIVE, EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 4 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. HYLEN CREST #3 6 10 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft' Ft. Well 200'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer JRS drainfield Drainfield CO/MT 3034; Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1s` 8/11/2021 8/12/2021 Location and description Znd 3`d 4'" BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL OFA Conditional Approval: Date ��Q►�-•'• .,,��� 49 7H Lac • ' ' • e Apptic roved edstem Pp Curtis Huffman, ��'c6; %• CE 128991 .' i`�/ _' _ I Date 2 ��'slF�•. 8/12/202J.•��C�� `l, F�PROFESS00- `,i\��`11�z Note: this approval does not include well permit requirements. (Nev u5iulii u) PID: 050-474-36 PERMIT- OSP211224 U) 7.8' x 16.0' DECK 1.2 X 7.5 CANT 0 0 1.2' X 7.6' 0 O 0 23.0' O 16.0' m CANT Z 10.5' 12.8' P . 12.9' 2.0' x 5.4' CANT DFCO C SPLIT—LEVEL MH D4BR RESIDENCE Lot 11 CO E Lot 9 DCO F B 10.0' OFC 41 EXISTING FIELDS 26.3' A—C=9.0' B—C=15.0' A—D=15,4' B—D=15.9' A—E=18.0' D—E=13.8' A—F=18.2' B—F=10.5' Lot 10 21,294 s.f. WATERLINE STAKED I PRIOR TO CONST. KEY BOX ASPHALT PAVEMENT RAVEL 1 15' T&E EASEMENT WOOD RETAINING WALL 00 SEPTIC SECTION SCALE NTS HYLEN CREST #3 BLOCK 6, LOT 10 SUPPORT,@ SERVICES: A_,� PREPARED FOR: < — c: 2 OF I 'S�" � DARYL & BEVERLY SMITH 4 L. -If �4 10339 STEWART DRIVE 9 T1j* EAGLE RIVER, AK 99577 FIRST WATER CONSULTING DATE: 8/16/2021 SURVEY .4 KGLF tis Huffman CE 12891 13030 SUES WAY DRAWN: FWCS 8/16/219, Ik ANCHORAGE, AK 99516 SCALE: 1" = 30' 907-350-9566 firstwaterAK@gmoil.com PAGE: 1 OF 1 MUNICIPALITY OF ANCHORAGE On-8Ite Water &Wi1 st�-uusiter Program ISD BOX I 9V40 4 X F.Irr.we Road Anchorage, Alaska 55;19 6050 Phone; (947) 3:f3 7904 Fax; (907 X43.7997 h pJAwAm nuni.org�onr.�e On- it.e Wastewater Disposal System Permit Permit Number: Q,510211224 Work Type: $eplicTsnk Opgrade Tax Code Number: 05047-430QOQ Site Legal Address; HYLEN CREST 93 ELK B LT 10 G: 00 Site Mailing Address: 10330 STEWART DR, Eagle River Ow ne r. SM17H DARYL T & BEVERLY J Design Engineer; rIR T WATER CONSULTING This permit i:k fpr the con 7ptru ction of: Effact ivc Date: Expiration Date Eet5ize in Sy Ft: Total Bsdroorns, 112021 e 21/2022 21294 ❑ DiSposa l Field 0 Septa c Tank ❑ >d0Itlidg 7a rik ❑ Privy ❑ PFi nate We II ❑ Water Storage All construction s n ail be! In ac Dor-dance with: 1. Thi attached eppfoved dosign. 2. All requirements specaffed in Anrhoraoe Mtjnlcfpal code Chaptgns t5,50 -and 15,65 arid the State of Alaska Wavewaler Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) The wastewater Gaile requl res In speci lops during the lmtnl latlon_ The engIneer s h all n-oury mot DevelopnldrlL rvices ao§partrnant per AMC 15.65. Provde notif oalion by oallir+g (007) 343-7904 (240). 4. From Ortuber 1:5 to April 1$, a $utnurface still aWorptiun systerrr under construction durlIng freezing weather shall be either_ a. Openad and Closeci ori the Berne d0y, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Wafer serviceline shall be located prior to installation Of SWIC 1;ank ire wrier to confirm rrtilnlmum 1i� ft separation to septic system- Mter:gervice line routing shall be shower Dn record dravAng, Reiv&d By: Issued By:1OH"e-C-4, 6121/2021 Date: Date: 7 z 3 >' � t `a..1 ) � � t S :� I f e � E� � �•y � , � 8 $ '� Development Services Department On -Site Water &Wastewater Section ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 050-474-36 Property owner(s) DARYL & BEVERLY SMITH Day phone _ Mailing address 10339 STEWART DRIVE, EAGLE RIVER, AK 99577 Site address 10339 STEWART DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) HYLEN CREST #3 B6, L10 Legal description (Township, Range & Section) Lot Size 21,294 Sq. Ft. Number of Bedrooms 4 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: Waiver Fees: (® all that apply) Date of Payment: Receipt Number: 315 190 Receipt Number: Permit No. ©S P a 1 1 �a q Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo AD U) Septic Tank 0 Upgrade Q Duplex ElHolding (D) Tank ElRenewal ElMultiple 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. (Signature of property owner or authorized agent) GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Permit/Rush Fees: v2 � 5 Waiver Fees: Date of Payment: 6// Date of Payment: Receipt Number: 315 190 Receipt Number: Permit No. ©S P a 1 1 �a q Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com June 10, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: HYLEN CREST #3 BLOCK 6, LOT 10 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. The lot and area are served by public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211224, Rebecca Carroll, 06/21/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211224, Rebecca Carroll, 06/21/21 Municipality of Anchorage " I'age _ I_ DEPARTMENT OF HEALTH AND HUMAN SFRVlCES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 o Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report of _Z~ LEGAL DESCRIPTION Lei: Block: Subdivision: township: . Range: WELL: [] New ;lassiflcalion (Privale, ]~LJmp S~.I al: Yield: GPM El Upgrade Wastewater System: [] New El Upgrade SEPARATION DISTANCES To Sepltc Absorption Lifl Holdina Public/Private Surface i . ---- --- !_ *1. _ . Remarks: (~tl~ ~ t?~'_Y' Ccl-~l_~v,,-,i v:7_ ABSORPTION FIELD Deep Trench [] Shallow Trench [] Bed [] Mound [] Other Soil Itating: Delflh ,o ,film hal,era hem arigieal grade: Fill added above original grade: Gpavel depth: Total absm ptiou area: _ _~.~,',;'_ so.F,. hlslalll!r:--,, / ) Gravel depth beneath pipe Gravel lens,h: F,. Number ol lines: Dis,anco be,ween lines: TANK ~ $ol)lic L] I lolding LJ S.T.E.P. Ma,erial: % '['~,~L,. Capacity i.n gallons: Number o, Co~artlneets: Assumed Elevalion: ENGINEER'S SEAL 72-013 (1/91) MOA25 Localion and Description: %~ Co,~ o~ __ Size in gallons: [Manufac,urer: "Pump oil" level al: ["Pump off" level at: I High water alarm at: Ihenp Mare & Model [ Electrical Insl)ections pe~lormed by: BENCH MARK LIFT STATION Municipality of Anchorage P,ge DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report N~e: ~ ~ Wastewater System: ~ New D Upgrade Address: Phone: ~''Z~O'~ .o. of B~rooms: ~ Deep Trench ~ Shallow Trench DBed ~Mound DOther LEGAL DESCRIPTI ON so, Rating: Total Depth fr~m~riginal grade: Lot: Block: Subdivision: Depth to pipe botlom Irom original grade: Gravel de~h beneath~pi~e Township: Range: Section: Fill added above original grade: Gravel length: Gravel ~th~ Number of lines: Distance belween lines: WEt. L: g New ~ Upgrade ~1~7~ ~Z R. ~ ~)l~ssification (Private, A,B.C): Total Depth: Cased To: Total absorption area: Pipe materJ~ Driller: D~te Drilled: Static Water Level:Ft. Installer:~,~ ~ /~,~ Date installed~..~O` ~ield: Pump Set at: Casing Height Above Ground: SEPARATION DISTANCES ~ Septic D Holding D S.T.E.P. To Septic Absorption Lilt Holding Public/Private Manufacturer: . Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~IA~t~G~ ~ Surface I Water jO0~ Ioo ~ ~1~ ~1~ uJh LIFT STATION Lot I I Size in gallons:J Manufacturer: I Foundation ~ ~, lO' ~l a ~ h M ~ "Pump o." level at: 'PunT;[f'F~oi at: .,gh water alarm al: ~ DrainCurtain j~/¢ ~/~ ~ ~j~ ~ ~ Pump Make & Model Electrical Inspections performed by: Remarks: ~ltE SE~vb~ ~Y CONhu~t~ BENCH MARK ~.~% %~ Location and Description:% ~ CO~%~ O~ I Assumed Elevation: ENGINEER'S SEAL Inspections performed Reviewed and approved by Date:/~'/~ ~Z~/,z ..... 72-013 (1/91)MOA 25 Permit No. ~-J ~i 'O~:~'l Page f~ of 4 Municipality of Anchorage DEPAR'I"MENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Lo~- [O ~1~ G I'~-~ C;~d U.,,,, ~ PID No.: ~do-C~ t 72-013 A (2/91) MOA 25 Permit No. ~IL~ ~ I -O~.~1 Page 3 of 4 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SFRVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report LegalDescription: LoT ~(~ ~'o1~ l'4"/Lc~ C~r-~sl- 0¢,.,~- 3 PIDNo.: 72-013 A (2/91} MOA 25 IEAL LOT l/ IL Z LoT JO L LO'F °1 PL.4N I I ! -,.~/,~1~ o' a "'~'"'"'""_1m I'°/x,,','' I, ~ " I H£REBY GERT/FY THAT/ t/AVE PERFORMED ,4 MORTG,4GE INSPECT/ON ON THE FOLLOII//NG D£SURIBED PROPERTY/ Lo?- /~, ~LO~K ~ HYLHA/ CR~$'F 5LI~DIVISIOA/,LINIT /v'£ EASEMENTS OF RECORD OT/t£R TI/AN T//OS/~ St/OWN ON Tt/£ ED P/~,4T ARE NOT St/OWN tfE'REON. DATED AT PALMER; ALASKA TttfS. IqTM DAY OF, AUGUST ~. 19ql 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:SW910271 ~z~.~'~/Q~J~ ~.~$~ DATE ISSUED: 9/05/91 DESIGN ENGINEER:H~(~,~PH~J~N~&~OR~N~N--~NS~-~N~.R~. EXPIRATION DATE: 9/05/92 OWNER NAME'SMITH DAZZL '.' . OWNER ADDRESS:P. O. BOX 8858 BIG BEAR LAKE, CA. 92315 PARCEL ID:05047436 LEGAL DESCRIPTION: HYLEN CREST UNIT #3 BLK 10 6 LT LOT SIZE: 21294 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: / DATE: DATE: ~ ~ ~/ Phone (907) 745-0222 F~ (907) 746-3299 P.O. Box 2749 Palmer, Alaska 99645 August 29, 1991 Mr. John Smith, P.E. Department of Health & Human Services Municipality of Anchorage 825 "L" Street Anchorage, Alaska 99502 Re: Lot 10, Block 6 Hylen Crest Subdivision, unit 3 Request for approval to construct on-site septic system Dear Mr. Smith: Transmitted under this cover are an executed application with $90.00 fee, two each soil logs and percolation tests, vicinity map and plot plan. As you can see, we are proposing to install a dee~ trench type system on the above referenced lot to serve a single family residence. The proposed septic system will not adversely impact the adjacent properties. I did not note any streams or curtain drains within two hundred feet of the proposed system or replacement systems. The only established drainage course is in the roadway approximately fifteen feet south of the south property line. This area is served by a community water system so setbacks were not a major consideration. As you can see from the attached plot plan, the proposed system and replacement systems are at least ten feet from the lot line and building foundation. The replacement systems will not require a lift station and could be constructed without interrupting treatment. The proposed construction will not significantly alter drainage in this area. All of the neighboring lots are fully developed, so there will be no adverse affect on them. Specifications: The design is for this lot only and is meant to serve a single family four bedroom residence only. The design is based upon a application rate of 0.8 gpd/SF (188 SF/BR). Ail materials and workmanship shall meet the Municipality of Anchorage, Department of Health & Social Services requirements. Engineers · Planners · Surveyors 3. The attached soils tests are advisory only. The soils at the point of installation shall be verified by the Engineer. Construction is to take place exactly where shown on the attached plot plan. Any deviation must have prior approval of the Engineer. 5. The Engineer shall be notified prior to construction to assure that the proper inspection is performed and as-built information obtained. The bottom of all trenches shall be level (+/- 1 1/2") and the trench shall follow the contours as show~._~ The trench shall have an effective depth of ~t feet (~) and a minimum cover of four feet (4'). The combination of the two trenches shall provide an effective length of sixty-four feet (64'). Two feet of cover may be replaced by insulation with prior approval of the Engineer. Septic rock shall be covered with a filter fabric layer prior to the placement of the backfill. The backfill shall be placed in such a manner so that differential settling will not occur. Also, surface runoff shall be directed away from the trench and not allowed to pond in the area of the trench. The septic tank shall be a steel two compartment 1250 gallon tank as manufactured by Anchorage Tank or an approved equal. The tank shall be placed no closer than ten (10') feet to the building foundation and five (5') feet from the deep trench. We would like to start construction as soon as possible; therefore, any thing that would expedite the permit process would be greatly appreciated. If you or your staff have any questions or desire any further information, please feel free to contact me at any time. Thank you for your time and prompt consideration. Sincerely, John T. Felton, P.E. Partner JTF/sl Encl: cc: Daryl Smith, Owner/Builder Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Ancllorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEG^L. DESCR,PT,ON: biO, FS\~Z~...~_.. Iqyu="~ Q~J' -row,ship, r~a,ge, SeoUo,.: .TI4_I'J ~_~ ~c:_.)_.~ SLOPE SITE PLAN 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- WAS GROUND WATER ENCOUNTERED? s IF YES, AT WHAT / L DEPTH? N_r~ . ~ E IJeplll Io Waler Aller J~).;~ ~1 ~ r~IoniteHr~g?_ ~., ~,t(_ Date: _._ ~/~5 Z(~Jo{ I___ Reading Date Gross Net Depth to Net Time Time Water Drop 5¥n" s/z.-z._. 152o1,~ '~o,,,;. 9 '~7~" PERCOLATION;IA'TE _LO ~_ (roinules/inch) PERC HOLE DIAMETER ~ES~RUN.E~-WEEN ~ ri'AND__lO [- ' ' ~'~-,~OlA,-,,,,, 'T ~'~"l..'T~'r-,,2 CER11FY 1HAT I'HIS lES] WAS PERFORMED IN ACCORDANCE WITit ALL STATE AND MUNICIPAL GUiDELiNES iN EFFEC1 ON TtlISDAIE. DALE: '~'"~"~"<~ J 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, ARchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: LIO, I%b. (~ I~v~,~ Cr~'~T 1 2 3 4 5 6 7 8 9 10 11. 12 13 14 15 16 17 18 19 2O Township, Range, Seclion: T~4~ ,~1~ ¢~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? NO IlZo DEPTH? t~' j J'~ p Ik I s L IF YES, AT WIIAT O E Oeplh t~ Waler Aller Reading Date Gross Net Depth to Net Time Time Water Drop PERGOLATION RAIE J4 6 '~ (minutes/inch) PERC HOLE DIAMETER rES] RUNBETWEEN 9 _F]AND. !O~__F1 PERFORMED BY: RL~'~* ~1~ ~6,~=11-~ , ~O,,,~ T K~'~ OER'IFYTHATTHIS'rESTWASPERFORMEDIN ACCORDANCE WllH ALL STA~E AND MUNICIPAL GUIDELINES IN EFFECT ON TrtlS DATE. DATE: 72-008 (Rev. 4/85} ~ 21,294 S.~ [ ~, ~ ~ ~,/ / .... s.~ ~'/~ I~ ~/ I~-1 ~'--~ ~P ~ '. ~~ / ~~/~ ~o,oo~ ~.~ , VICINITY MAP ~' ..~ee.~;~ HYLEN CREST SUBDIVISION LOT I0, BLOCK 6 Box 2749 Polmer, AK 99645 Pho.e .' ( 9o7 ) 745-o~22 SCALE I DATE: SCALE I cK: [DWN: -00257 AUG. 1991 AS SF OWN JiM.C, lAS-BUILT I I I ~ I I I I I?0 Box 2749 Pol/nez. ' ..... ~ ................. ~ ...... ~ ............ ~..: ............ ~ .......... , .......... ~ ..... ~ ......... ....................................................... ~ ...................................... / HENEBY CENT/FY 17t~T I ItMVE PENFORMED A MOrTGaGE INSPE'GTION ON T/tH FOLLOWING IPESGHIBEO PROPERTY. EASEMENTS OF RECORD OIl/ER TI/AN T/lOSE St/OWN ON HIE RECORD- ED PLAI' ARE NOT SHOWN HEREON. DATED AT PALMER, ALASKA, THIS. I~''~ DA Y OF._ ~US~ , 19 r- Fn�•— ��4 t y�� � K� i � Development Services Department On -Site Water & Wastewater Section Certificate of On -Site Systems Approval Parcel I.D. 050-474-36 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: 6 — / _Z OZ3 Complete legal description HYLEN CREST #3, BLOCK 6, LOT 10 Location (site address) 10339 STEWART DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) DARYL & BEVERLY SMITH Day phone Mailing address Real estate agent 10339 STEWART DRIVE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5570 Date of Payment/31ZJ Receipt Number 11:3116- COSA# 0�G21ILI77 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 811112021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the r •�(i '�Q well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or fig•' '9 discrepancies exist can be given by First Water Consulting & Fks TH • ...:* / . . .. .. 6. DSD SIGNATURE Curtis Huffman System #1 Approved for bedrooms • c/sT . CE 128991 l FpF� p$l11 /z NQ`c��i System #2 Approved for bedrooms 11 ROFESSIO Disapproved Conditional approval for bedrooms, with the following stipulations: ku fYfOFr(���i Vo fl: -ITE WAT o� JJJ�11�T SFR\/+.G�-�'^� I� y: Original Certificate Date: 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 Arsenic Advisory Well Flow Advisory Other OSI Checklist Legal Description: HYLEN CREST #3 BLOCK 6 LOT 10 Parcel ID: 050-474-36 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA — PUBLIC WATER ❑ 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 B. TANK DATA Age of tank(s) NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NEW TANK Structure served by this system _ Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ 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: D. ABSORPTION FIELD DATA (LOWER / UPPER TRENCH) Which system tested (date installed) 9/10/1991 Adequacy test date 6/1/2021 ® ALL standpipes present per record drawing Results 0 Pass For 4 bedrooms Total measured depth from grade *11.8 / 8.3 ft (max) Fluid depth prior to test 10 / 3 in Measured depth to pipe invert from grade 5.4 / 6.7 ft Water added 600 gal (min) ❑ N/A — pressurized field New depth 32 / 5 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1395 min depth into effective 5.6' / 1.4' OF 6' ED Final fluid depth 10 / 0 in ® Code -required soil cover over field Absorption rate 600 gpd ❑ System presoaked Any rejuvenation treatment (past 12 months) N (Required if vacant for greater than 30 days prior to date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: *AT MT — EFFECTIVE DEPTH BASED ON ELEVATION SHOTS TAKEN MTs / COs. NO KNOWN ISSUES WITH TRENCH PARTIALLY UNDER DECK. ALL SEPTIC PIPES PER MOA RECORD DOCS LOCATED AT TIME OF TESTING - SURVEYOR MISSED SOME DURING AS -BUILT SURVEY. FW'rS THE DECK IS SUPPORTED BY SONA TUBES & ARE INSTALLED V OUTSIDE THE TRENCH PER VISUAL OBSERVATIONS OF CO/MT FIELD ORIENTATION. THERE IS & HAS BEEN NO KNOWN OR ANTICIPATED IMPACTS OR ADVESRSE AFFECTS GIVEN THE INVERT DEPTH OF 6.7'& THE SONA TUBES OUTSIDE THE FIELD. F 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' ® Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75; ❑ Yes if No ft ❑ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ___ ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® 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' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® 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 Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l 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. Z�� . , Curtis Huffman CE 1 Fa B116/21. .������� �lj PROFESWOIW . ft ft `W v 0,.: V N d' ON —j N ui x N 00,*2Z M„ 9 U0.00 S n x� � N x N N 6.2 0) J V 16.9 74� a� .2• / 1 / / `0 0� tM / / ,00'-VCZ 3.9 L,C0.00 N ( �/ / W / / / FL/ W / W U I Ln ova �s 0 o:z °yp0 LC) Qom( o 1TN C%j 01 La cin po. �,. :Zoe L z Q�� a L' � 4Qp�,�'• d- � •Y N C �4�0 /S� . • G.,�Ea� m 40oo©ate O Z a LO – C1 0 N n ° V C C p Em O U C O 4 and 0 X 00 o'to00 h ' a.Ld . .. ,• ..� 3 >nN>.a�i a �$ c c v 0 -It (0 rn t0�'Z° Q my to N N 00 P'�w +d- . .L, 030 00C '0 0C °A ,00 z tM / / ,00'-VCZ 3.9 L,C0.00 N ( �/ / W / / / FL/ W / W U I Ln ova �s 0 o:z °yp0 LC) Qom( o 1TN C%j 01 La cin po. �,. :Zoe L z Q�� a L' � 4Qp�,�'• d- � •Y N C �4�0 /S� . • G.,�Ea� m 40oo©ate O Z a LO – C1 0 N n ° V C C p Em O U C O 4 and 0 X 00 o'to00 h 4 >nN>.a�i a �$ c c v 0 -It (0 rn t0�'Z° Q my to N N 00 tn''Ct7 +d- . O oC 030 00C '0 0C °A ,00 z oO m oh0aeto° -,= 0nE c 0 Yocn O)O a.-� ,> y •CO - A> > E t- �y C 'E CD 0 0 o 6-�"' E C "t 0 m X L tJ Z 0 L T7 I m 0 tIl O .0 gt '00 O 0== O at C) ®— me �O �°:– ° MO C Z, p yL 0 G° II n >0 0 p Sr- a01 0 6i 1 E p ALJ t^ m m C m a L '00 O V! N v $ 3 y O O t3 I "' U�-� Ix 0 or O V C- H U c+ m O 0 >Ji'ONpa r //y vd L= n O O C= O C y��� V _ D O O �•y S � O w . t0 01 ® 0.0 t3 r{' � 0 O { = � v -E, cc a a q W C7 0 7;:,o00mac �® c`a fn C� e� m� n � � 0. m F- �% .0D C; m0� m ®y _ _tom C c m :3 o °m L -0 J •C L y. ° -0 0 C 0) O �J L O et I- O 0 O L •c C O 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 legaldescription Lol-I0 ['Z-'o~-v,. ,~' i"~¥Le-"~ Ccc~..-~ (..~,,,,'~-% Location (site add'ress or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address 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 cornmunity well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WAS'rEWATER 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. 1191) 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 su'pply 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. NameofFirm [7~L~'(-~ ~'"~,'~ ~--I~,~C~,,~.~- Phone Address ~. ~z~j [~ L ~ ~r'~_ ~'~r ,c Engineer's signature DHHS SIGNATURE ~ Approved for Date ~0 (cf (c~ /~¢ ~ ~.'/~ bedrooms. DisaPproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH_HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-825 (Rev. 1/91) Bac~ MOA ~21  Municipality of Anchorage Departrnent of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: tO C WELL DATA Well type A If A, B, or C, attach ADEC letter. Log present(Y/N) Date completed Total depth Cased to Sanitary seal (Y/N) uep~. I'Io~ith & Human Ser~'~ces ADEC water system number PPs~b" ~ 15'g~~) Orillor. Gasin~ hoi~ht Wires proporly protocteO {Y/~) Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION g.p.m, g,p,m, SEPARATION DISTANCES. FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots_ ; On adjacent lots Public sewer rnanhole/cleanout Peholeum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~' \1-c~{ t Cleanouts (Y/N) "'// High water alarm (Y/N) pate of pumping Tank size ~ '~SO _~0~ --__ Compartments Foundation cleanout (Y/N) %// Depression (Y/N) ~-, Jt~. _ Alarm tested (Y/N) ~e~ ~ '~ Pumper SFPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: We'll(si o, lot /'J I ~- On adjacent:lots '/"~ I('¥ Foundation To propertyline J q"~ '~' Absorptic~n field Iq .Water main/service line Surface water/drainage ~ JO(~~i' 72-020 (HEY. 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 ir, stalled Oi- It.)" c~_~ Length ~-'~:~ Width Soil rating O.~ ,~?c~lq[,-c System type Gravel thickness_ ~" '~ ~- Total depth Total absorption area r~(~ ~.~.~,_~ Depression over field (Y/N) ......... Results (pass/fail) Peroxide treatment (pas112 months) (Y/N) Cleanouts present (Y/N) __ Date of adequacy test for If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /"-" .lF:~ __ On adjacent lots____ t'~/t~t Property line To building foundation I '~ ~ To existing or abandoned system on lot On adjacent lots I~~~, 5- c~(~) -E~,~ Cutbank :,~)(TJ Water main/service line Surface water I C)C) ~' Driveway, parking/vehicle storage area Curtain drain /"--~e. 'l~o~.,~, ~./,~ IbrD' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed lo all MOA and HAA guidelines in effect on the date of this inspection. ~?~?~¢-~.~ · Signature ¢.~. Engineer's Name HAA Fee $ Date of Payment Reqeipt .Number Waiver Fee:'$ ' Date of Payment Receipt Number 72-026 (Rev. 3/91)Brick MOA 21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT t~ ~OL~Z. ~ I-~¥LL~'-.jC'~eSJ~ Parcel I.D. A. WELL DATA Well type A Log present (Y/N) Totaldepth Sanitary seal (Y/N) If A, 13, or C, attach ADEC letter. Date completed Cased to PUSlb ADEC water system number Driller Casing height Wires properly protected (Y/N) MUNICIPALITY OF ANCHORAGE Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION ENVIRONMENTAL SERVICES DIVISION OCT 16 1991 RECEIVED g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed c~. ~,~_c~ t Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping Tank size ~ '~-~O %'~-J Compartments Foundation cleanout (Y/N) \/ Depression (Y/N) ~ J/~' Alarm tested (Y/N) N ~.-I~ ~J m~,~¢--- Pumper Surface water/drainage 72-026 (Rev. 7/91) Front SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~-~li'4- On adjacent lots /~-' Jlq- Foundation To property line IS 4- .~p~ion field I ~J Watermain/serviceline ;.¢ /¢ ~.,¢,...~., t~,,,,, ~, ':'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/-~ ~. C~_ lC),.c~ Length/ -~ x ~ Width Depression over field (Y/N) Soil rating O,~ ~ I~Jrz' G rs)vel thickness ~ '~z ~0~ Total depth F'¢~ Cleanouts present (Y/N) '~/ Date of adequacy test '~'~//~ System type Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) for If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ l ('-'4- On adjacent lots Aa [~- Property line To building foundation .I '~ t · To existing or abandoned system on lot On adjacent lots I|~-~-~ (90 E,~[,~utbank ~.~C.~ Water main/service line Surface water IOo ~-:- . Driveway, parking/vehicle storage area Curtain drain /k.~t,,,,e. 1~/~..o~.,~., k./,~_ lO0' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature (~~~--~ Engineer's Name k"~ ~v~ ~-- "~ ~-.~'~'~¢ ,-.-¢ Date [ L"% ~C~ -C'~ '~ HAA Fee $ // Date of Payment Receipt N u m ber~'2~ 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 (907) 563-6775 October 10, 1991 FOR: Jack Felton PWSID: #213289 My review of the records on file in this office reveals that the Hylen Crest Subdivision Class "A" Public Water System is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, Byron Roys Environmental E-'ngineer BR/cf