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HYLEN CREST #3 BLK 6 LT 11
Onsite File Hylen Crest #3 Block 6 Lot 11 #050-474-37 kmev UD/U/-/!O) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221066 PID Number: 050-474-37 Dwelling: ❑® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name Michael &Susan Guillory ABSORPTION FIELD E] Deep Trench E] Wide Trench E] Bed E] Mound Site Address 10343 Stewart Drive, Eagle River, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 251-591-9645 7 4 Existing GPD/SF JTotal Ft. LEGAL DESCRIPTION to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Hylen Crest #3 Block Lot 6 11 Fill added above origin ade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number es Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. be trenches From Tank Field Tank Line Ft2 Well N/A N/A N/A N/A N/A TANK ❑E Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer 1250 Gal. Surface Water >1 N/A N/A N/A Material Plastic Number of compartments 2 Lot Line *2.0' N/A N/A N/A NA Foundation *8.0' N/A N/A N/A LIFT STATION Man er Capacity Gal. Remarks *See waiver and justification Alarm location Ere- 'stalled by Installer PIPE MATERIAL House to tank Tank to D3034 drainfieId D3034 ACES Drainfield Existing Co/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspect 1- 5/25/22 Location and description 3rd 2ion °' Bottom of siding 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp ®FA��lt Conditional Approval: Date p : A IH •.>� Septic S tem '. Benjani�'a5chiller ¢j •, �`�� Approve A —�-`- _ Date ^�� �, CE 12592 .• Q 'pRO1E3/?2NP����� \ Fp ' Note: this approval does not include well permit requirements. kmev UD/U/-/!O) PERMIT # OSP221066 \ \ LOT 13 ( LOT 12 PID # 050-474-37 NOTE: SEE ATTACHED JUSTIFICATION/WAIVER LOT FOR FOUNDATION & SEPTIC AREA LOT 11 PROPERTY LINE ENCROACHMENT 1250 -GAL SEPTIC a TANK w/ 20" MANWAY 5' MIN FROM EXISTING ,y TRENCH CONFIRMED AT CONSTRUCTION B 4-13DRM HOME • MH • SV \ EXISTING TRENCH TO LOT10 I L®� REMAIN IN SERVICE \ri WATER SERVICE LINE ��5 i&E�AS�ti1�N `k s. \ \ ENGINEERING OF :49TH Benja i Schiller f �F� •. CE 2592 611312022�.����� %e_ PROFESSION` .� WERM0011 0 50 100 hE FEET 111=50' B `17— 2CO1 24.1 T 11. MH 27.7 11.4 SV 32.0 13.0 2CO2 34.6 1 14.1 LEGEND 2CO — DOUBLE CLEANOUT FCO — FOUNDATION CLEANOUT MH — MANHOLE MT — MONITORING TUBE SV — SEPTIC VENT HYLEN CREST #3, BLOCK 6 LOT 11 PERMIT # OSP221066 PID # 050-474-37 BOTTOM C FOUNDATI, 95.4 100.0 (BENCHMARK) Gf ,EE TICS TANK ma WIN qtA4-' .......... .......... Benia • Schiller CE 12592 ii�W.- PROFESSOt,® HYLEN CREST #3, BLOCK 6 LOT 11 TH . �% Ben Schiller PROFILE AS—BUILT `+��cnC•. CE 12592 .•��`�® E N G I N E[ 0. I N G (NO SCALE) �1�TFgFOP si 1rzozztlP���� t\�� ROfESS1a0 _.m June 13, 2022 UYE E E R I N G PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) FORGECIVIL.COM MOA Development Services, On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Hylen Crest #3 Block 6 Lot 11— Stewart Drive Waiver Request Dear On -Site Services Engineer: Due to the difficulty of installation in a confined space, as well as efforts to distance the tank from the foundation and existing drain field as much as possible, the tank was placed 2' from the property line. Since the neighboring septic is more than 10' from the property line, this encroachment is not likely to have any adverse effect. We therefore request a waiver for 2' separation from septic tank to property line. Sincerely, BenjaminSchiller, PE Municipality d Anchorage- P.O. 'rr' P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Del2artment On -Site Water and Wastewater Section Waiver#: OSV221038 COSA#:OSC221288 Permit#:OSP221066 PID#: 050-474-37 Legal Description: Helen Crest #3 Block 6 Lot 11 Engineer: Forge Engineering Applicant: Michael & Susan GuillorV r,enr S Department Your request for a waiver of the required 5.0 feet horizontal separation from the septic tank to the property line has been approved. The approved separation distance is 2.0 feet. See engineer's waiver request for justifications. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: ? 0 Approved by: Q�_6� (�U� Name of Reviewer Lot 12 SEPTIC PIPES—<•.E 2.0' CANT - RETAINING WALLS -----z 1 "rpt t Loi 11 21,294 s.f. 6.0'x14.0' DECK .0'x15.5' CANT 18.1' 48.0' in 2 STORY 61 12 N SPLIT—LEVEL 12.0 RESIDENCE 34.0' .- Y � N Wa 26.0' 12 �N .ASPHALT DRIVEWAY `1 WA ®RIVE 0 O d- N to 9' o Lot 10 0 0 V) 9' 6' DECK 15' T&E EASEMENT PLOT PLAN AS BUILT JL SCALE 1" = 40' GRID NW 0057 Project No. 22-240/R1 ¢¢,r Associates, 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & s s o C 1 a t e s inc. C. (907) 522-6476 Phone 9 (907) 522-4625 Fax o©o®`aoOO� Q Professional Land Surveyors ken@langsurvey.com jonathanAlongsurvey.com I hereby certify that i have surveyed the following described property: CJ�� LOT 11, BLOCK 6, HYLEN CREST SUVDIVISION, UNIT No. 3 (PLAT 83-114) * : 491H • �'*Q� Anchorage Recording District, Alaska, and that the improvements situated thereon are""""""""" """"""'� within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed Q.. . • • • • • • • • • • • • • • • • • •� premises and that there are no roadways, transmission lines or other visible Q s.,� KENNETH LAN�- easements on sold property except as indicated hereon. Dated this the �Da of G a` ES -520•• 5J4a Day , at Anchorage, Alaska Q©A • "1O d lLl It is the responsibility of the owner to determine the existence of any easements, °404©ate" covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 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: OSP221066 Effective Date: Work Type: SepticTank Upgrade Tax Code Number: 05047437000 Site Legal Address: HYLEN CREST #3 BLK 6 LT 11 G:0057 Site Mailing Address: 10343 STEWART DR, Eagle River Owner: GUILLORY MICHAEL E & SUSAN M Design Engineer: FORGE ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Expiration Date: ry llct�artnunt 3/30/2022 3/30/2023 Lot Size in Sq Ft: 21294 Total Bedrooms: 4 ❑ 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 Veronica Pope GE 2022.03.30 Received By: pp 15:42:45 -08'00' Date: Issued By: _ v�� Date: 31 r MUMUFAL UT ll OF J` HCHORAGE Community Development Department �` Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-474-37 Property owner(s) Michael & Susan GUillory Day phone 251-591-9645 Mailing address 10343 Stewart Drive, Eagle River, AK 99577 Site address Same Legal description (Sub'd., Block & Lot) Hylen Crest #3, Block 6 Lot 11 Legal description (Township, Range & Section) Lot Size 21,294 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Multiple Dwellings El Privy El and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / 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) Permit/Rush Fees: Date of Payment: 31 ag a .� Receipt Number: 0 5 (Og Permit No. O5/�ZZIOtiti Permit App_'- : .'-:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. March 28, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 3/28/22 Subject: Hylen Crest #3 Block 6 Lot 11 – Stewart Drive Septic tank replacement Dear On-Site Services Engineer: The septic tank on the subject property has reached the end of its useful life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the new proposed septic tank location. No conflicts exist between this proposed tank location and any other septic system, whether on this lot or adjacent lots. The subdivision is serviced by a community water system. The new septic tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the property line and existing septic trench. The tank is located within the required 10’ separation of the foundation of the home; however, we intend to take elevation measurements of the footing at the time of installation to ensure that the tank is installed outside the 1:1 soil bearing prism of the foundation. Please refer to the attached plan page for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221066, Rebecca Carroll, 03/30/22 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND CO HYLEN CREST #3, BLOCK 6 LOT 11 FEET 0 50 100 NOTE: NO SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC TANK LOCATION NO EXISTING WELLS - PROPERTIES ARE ON PUBLIC WATER SYSTEM STE W A R T D R I V E 4-BDRM HOME 3/28/2022 15' T & E EAS E M E N T LOT 12 SEPTIC AREA WATER SERVICE LINE 1250-GAL SEPTIC TANK w/ 20" MANWAY MAINTAIN 5' MIN FROM PROPERTY LINE & EXISTING TRENCH SPECIAL NOTE: AN ELEVATION OF THE BOTTOM OF THE FOUNDATION FOOTER MUST BE TAKEN RELATIVE TO BOTTOM OF TANK ELEVATION AT TIME OF INSTALLATION IN ORDER TO ENSURE THAT THE TANK IS INSTALLED OUTSIDE OF THE SOIL BEARING PRISM OF THE FOUNDATION 2COEXISTING TRENCH TO REMAIN IN SERVICE INSTALL CO AT BEGINNING OF TRENCH Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221066, Rebecca Carroll, 03/30/22 MUNICIPALITY OF ANCHORAGE DEl .TMENT OF HEALTH AND HUMAN SER~ .:S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Address [Permd NO. No o~eOrooms Phone(s) LEGAL DESCRIPTION Township, Range, Section 7"/~?.,q/_/_ /e /t.~,'.., -~'~<-, TANKS ~r SEPTIC J~ HOLDING iV~anulao;uler Capacity IR gallons 4,uC /-/ 'FA*,.'/< /~ TYPE OF SYSTEM J~'FRENCH [] BED [] W. DRAIN [] OTHER original grade '~' ~'~' ~FT ,// Fnl added above ungmal grade Giave~ depth beneath p~pe 3 ~ ET /--¢/ FI 67Z ~b ~o~n ~ ISorl rat,nO / /~E; SQFT WELLS [~ PRIVATE [~OTHER fldentifv} Classification (A,B,C) lotal Deplh Cased to REiVIARKS: DISTANCES ~% T{] SEPTIC ABSORPTION FROM ~ TANK FIELD WELL WELL ~ ~0 _ LOT LINE 1o" I0 / /¢///~ FOUNDATION '~- /o.'L" /v/4 AS-BUILT DIAGRAM (Show Ioo.hon or weU. sepIic system, properly I.nes, foundation, driveway, water bodies, etc.) Scale: Inspections Performed by: Caglo ~ivor Engin~ering Sewices P, O, Box 773294 Dale: E~glo RiVer, AK 99577 ~/~6 694-5195 Municipal and State guidelines hi ellecl on this date: Health Pepadment Approval: . 6 72-013 (3/85) cedily that tills inspection was perlormed according Io all r q~ :E'NGINEER'S SEAL t...I;IT i:!i .[ Zlii: :: i:,.~. I ?.i ,I J. :irl.:';L~a.I.] '!',.l/~.:;.) ~'v'~:it.e;,m :J,l'l ~:~":l:::(::)l'(Ji: '~::~:':') ~..~;i.'Lh ;:11 t¥1(.]F~ c:cl('Je)sl ~;:~l"ll::l ~':;tl"ll:J Jl"iC:C)iili::)].:.,~,.FIC;i,:.:,;, t.,'~j.'~'.,l"i 'ILI"H:.:' (::ll:'~.:i,~:~l"l E:r:Lt.(~:)r':[,:~ c)l' -f:.l"i:is~ ;:,.~,.;[ ~,,x~:i.:l,:l, ~:;d::ll"t(~:.~r~[,~) '!;,I;:) ~i:l].]. H.ff, ~i"~::l !B'l',.,':'~'Ll,:~ t:lt' (.~].~d~ik,':';'~ r.l~qL.l:i.l'"l~,)fll(-:'l'l'l',,~il t'(::il'~ t. hc:(' ~ici)'i:. ~:1. ,, J: L~l't ct (::' r' ~ !'., ~'~t r3 d 'L I1 ,'~t 'L t.. l'i :i. !Z, Il.) (':'~' F' iii :i. '~'., :i: ~E~ V ~;~ ], .i, d ~' C) I" ~:~ [ii~'E~ )'i :[ iill..~ I1~ C) ~' /~, I::i E':')d [" (:)C)I'~ riel ;:':t I'1 ~':,~1 i 'y' iDl'i ]. ~::i !' I'~ N)l'fl(.)l 'l" >l i ]. ] t' C'? E~L.I ~. I" (':",' ~:':tl'l ~':~CI I:~ :[ '1., :i . ?~l ~: I I::~ ~.) I~ iii :L '1: .... .[F: ~.'~ I....!.i:::1 !~E:l'Ffl II.:)l',l Ii]E:; ]:I',.iiBfPiI.I..ELD J:lxl ~lxl (~fl:;:EE:t I:;tLVI:::i'.E) i:tY I¥1[:h?~ BLJ]:L.DIhtE') Il'liEN i :1 ) Ffl,I IE:l..l::CIl';:]tf:hql.. F:'E:RI'4];'I F'~t'q~;) :l:N~i:il::'l~J:; I"]:[ll',l I¥1LI!~:iT :1: EIt~I (>~II',IIE)E)~ (;::'.) F~fE;""BL.I:t:I....T!B N.[I..L I'l:li .F.ff: (:d::'F'F~DL,q::D NII'IIE)I.!I' PiN ILI...E[:;IR.E[:;F:'&~ 'I'Nfi. F'F:E:] ",.1 I:;!IZI::'EIFiI'?, (~I',IL) (;.:~;) TI'"II~:: ~~ DB',I, ~: -.. ~_ ~. :,,, .......... ....... ............... MunicipahtYo Anchorage P.O. B. ,, 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES June 23, 1986 Robert J. Hamann P.O. Box 617 Eagle River, Alaska 99577 Subject: Lot 11 BLock 6 Hylen Crest Subdivision On-site Sewer Permit #860130 - Issued May 16, 1986 On May 20, 1986, The Anchorage Assembly approved a new ordinance regulating on-site wastewater disposal systems (septic systems). Ail septic systems constructed after the effective date of this ordinance are subject to the provisions of this ordinance. Our records show that you currently hold a permit for the installation of a septic system. We strongly urge that you contact this office prior to constructing your system. Any changes in the code that could impact the construction requirements of your septic system will be identified and brought to your attention. Please contact the Environmental Services Division at 264-4720. Thank you for your cooperation. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/SSM/ljw PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 COMMENTS '~' SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST SLOPE SITE PLAN WAS GROUND WATER ,/~ S ENCOUNTERED? L IF YES, AT WHAT ¢-(~.,~.s E DEPTH? Gross Net Depth to Net Reading Date Time -rime Water Drop cf ', 7o ~.~ /o ~,/~ ~ / PERCOLATION RATE ,/~/~ (minutes/inch) TEST RUN BETWEEN ~'~* FT AND 7 FT PERFORMED BY: CERTIFIED BY: ~/~'4, ~2.~ DATE: 72-008 (6/79) EAGLE RIVER ENGIlNEERI ,NG SL ¢ A .,,,. ~~ Eagle River, Ah~ska ~9577 ~ May 8, 1986 Mr. Steve Morris Civil Engineer~ On-site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99619 REF: Lot 11, Block 6, Hylen Crest Subdivision Dear Mr. Morris: The enclosed site plan is submitted for issuance of on-site well and septic permit for the above referenced lot. The plan as shown will require approval of 5' separation distance to lot line from trench, and a location 2'adjacent to the driveway. This will allow a future replacement area without use of a lift station. The neighbors septic system should not be affected as it is > 30' distant. The design has also been adjusted to allow 8.5' of gravel in order to shorten the trench length to 39'. We realize that this will require an additional 1.5' of mounded cover as a finished grade. If 'there are any questions or if additional information is required please feel free to contact me at 694-5195. Sincerely, Lou Butera, P.E. Encl: soil log site plan specifications SITEPLAN SEPTIC SYSTEM DESIGN Trench 166 soil, 4 bedroom ~ 664 sq. ft. absorbtion arda Total Depth-il' Gravel Depth-8½' Trench Length-39' 1½' mounded cover WAVIERS REQUIRED 1. 5' trench to,prop, line 2. 2' trench to edge drive. ZONING NOTE ~ ~ his lot is zoned R-lO. However,' the lot was an ~conformin9 ]ot'Qf record at the .time of areawide ,15 5"7 LAITb:'$U RVE, y COMFA~Y Fx). Bok 671089 Chu§lak, Alaska DD567 (907) 688-4499 ezoning from U to R-10. Th'erefore, required setbacks ::.:,:,...:...~....~%~%%~. re as if this lot was zoned R-7. ' '{;:?'::::' ~.~'~_ '2!, ~,$_'%1, '" , ~,~.." ',', "...,6".JL .' ~.o~ ~,~.~.." %.". .*. ',~0,:~ '..'~ ~t. · :-:. -H Y~/ ~ sT- ~ ~z~/~,o~/, . ~/~w z-~ .~ ~.~$, ~*.. ~ ~. W,m:~'"'N,. ~ ~0' ............ ~""~" ,:~:'~'~" '~'a proposed ~-pr6~a'~fi~':.'.:'~yabe to be as shown hereon ~CC'LI~TOCK EAGLE RIVER ENGINEERING SERVICES P.O. BOX 773294 EAGLE RIVER, ALASKA 99577 694-5195 SPEOIFIOATIONS FOR ON-SITE SEPTIO SYSTEM LEGAL: Lot 11, Block 6, Hylen Orest A. GENERAL 1. The drawing and or site plan shall be a part of this specification. 2. All materials and workmanship shall meet the requirements of the Anchorage Department of Health and State D.E.O.. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 4 All excavations and depths are advisory and are to be verified or mod±fled in the field by the contractor to meet MOA, D~E#O require- ments. 5. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any ad3aoent multi-family wells. 6. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. DRAINFIELD "' 1. The bottom of the trench shall be level, plus or minus 1.5". 2. The trench excavation shall bend to follow the natural contour of the land so that the total depth of 11' or less is maintained. The effective gravel depth may be increased by backfilling with sewer gravel within the GM soil layer. 4. Soil or combination of soil and extruded board insulation tO a depth of 4' or equivalent is to be placed over the trench. 5. The area over the trench is to be finished graded to prevent ponding of surface water runoff. The septic tank and leachfield must not be closer than 100 feet to any existing private well, 150' to any Class "0" well, or 200 feet to any community well. MUMUp��LJTY O ° HCHOR,AM "- }�re 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. 050-474-37 Expiration Date: 1. GENERAL INFORMATION Complete legal description Hylen Crest #3 Block 6 Lot 11 Location (site address) 10343 Stewart Drive 3 -22 -2 02 V Current property owner(s) Michael & Susan GUIIIOry Day phone (251) 591-9645 Mailing address 10343 Stewart Drive, Eagle River, AK 99577 Real estate agent 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑■ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System Q Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5-50 Waiver Fee $ V 2 5 Date of Payment J.5 A Date of Payment Receipt Number 640 9 Receipt Number COSA 4 0 S C9 ? 1 g 6 Waiver # O � v� O j 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 Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 6/13/22 6. DSD SIGNATURE . X System #1 Approved for L/ bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, ,: 4� of ACq til i •' :9 �' /*.49— TH •* . . • Benja ' tSchiller �t ��'�•. CE 12592 .•�`�i �� is�F�' • 06/13/22 ,lkF, OFESSlONP4� with the following stipulations: JJ, k�PPLITY pF,o WATERr c IIA ANn 4li PROS ATER � -= J�iJ�J SERVICES�'Nl\l i 1.., Original Certificate Date: r�- 2.02 Z 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 COSA Checklist blue sheet Legal Description: Hylen Crest #3 Block 6 Lot 11 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA log is filed with Onsite (or attached) Date drille-a Total depth 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 PUBLIC WATER B. TANK DATA Age of tank(s) <1 years Tank type/material Septic/Plastic Measured operating fluid level in septic tank N/A © Standpipes/foundation cleanout per record drawing Date of pumping Tank installed on 5/25/22 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/1986 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.9 ft (max) Measured depth to pipe invert from grade 6.3 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5.6 ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 050-474-37 Structure served by this system Well production at time of test 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) senic ug/L ❑ Arsenic less than MRL (ND) Date of Sample C. LIFT STATION maintenance completed Age of lift sfgtiau years Lift station material Comments: Adequacy test date 3/22/22 Results [DPass For 4 bedrooms Fluid depth prior to test 41 in Water added 1039 gal New depth 58 in Elapsed time 1440 min Final fluid depth 46 in Absorption rate X600 gpd Any rejuvenation treatment (past 12 months) N/A If yes, enter date N/A 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 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft 0 Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100'✓❑ Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' El Yes if No ft M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' Q Yes if No ft 2 Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' 0 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' Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10'✓❑ Yes if No ft Community Wells > 200' [Z] Yes if No Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS See waiver request Ak1 G. ENGINEER'S CERTIFICATION V1, OF,iS%��� l certify that I have determined through field inspections and review `*; 49 ' -Di of Municipal records that the above systems are in conformance with '• • • • • 7, MOA COSA guidelines in effect on this date. . .. >:� ........ BenjarrW5chiller �$ �'c'G, •. • CE 12592 �� /fT��' • 06/13/22 • • ��� PROFESSIONP .� COSA Checklist yellow sheet ft M Municipality of Anchorage • On-Site Water and Wastewater Program `.___ '<c_ 1— (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-474-37 Expiration Date: / _Z I — t 1. GENERAL INFORMATION Complete legal description Hylen Crest # 3 Block 6 Lot 11 Location (site address) Iii 1031(i SfewaA 1 * 0.4. Current Property owner(s) O'ROURKE Day phone 694-4994 Mailing address Same Real Estate Agent Partners _6 I s 9 1?1?a,_,•hone 694-4994 2. TYPE OF DWELLING: E OCT 2 7 Z017 \ ® Single Family (w/wo ADU) N, E Duplex �2� �\� ❑ Multiple Dwellings (Single Family and/or Duplex) << Di 6 9 L°' 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Received ' iDate: c--2.-- t / ( 7 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 6-0.6Date: Date of Payment /0/36//7 Date of Payment Receipt Number 66 Ca,10 Receipt Number COSA# (Th( 17-" C. 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. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 10/27./2017 6. DSD SIGNATURE ` ' L11lC• ' System #1 Approved for ' bedrooms. �._ ' . System #2 Approved for bedrooms. • • 3 1' �./.4; Disapproved. .0 ,<, Conditional approval for bedrooms, with the following stipulations: S ;c �c k is 3 1 -, a AV•vvi-thaT 1/ ..a0AA ' , wON-sirc �! WASTEWq ND m T P ERj 'GF?AMti.,(471 - �-- v.SERVICES By: Original Certificate Date: j O -`3(`( 7 The Municipality of Anchorage Devlopment 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 COSA blue sheet 9-1-12.cloc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certo rucate of On-Ste Systems Approvall Checklist Legal Description: /'yL OA/ C,C1 J 7 3 Re" L// Parcel ID: QSG-'/ 74/- 37 A. WELL DATA / C../54/ C t.-�•-t"T�/t Well type If A, B, or C provide PWSID# Well Log (YIN) Date completed Sanitary seal (Y/N) Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material S 45P%iL,STe-EL Date installed .5/ceir Tank size /2 50 gal. Number of Compartments 2 Cleanouts (Y/N) Y' Foundation cleanout (Y/N) Depression over tank (Y/N) tv High water alarm (Y/N) /`/ _ Date of pumping //.s// 7 Pumper J S C. ABSORPTION FIELD DATA 6e-e Date installed SAC Soil rating (g.p.d./ft2 or ft /m) / (C System type i.sN C161 Length 3 R' ft. Width ft. Gravel below pipe S ft. Total depth /( ft. Eff. absorption area 6 'T?ft2 Monitoring tube Depression over field Ai Date of adequacy test 70//7// 7 Results (Pass/Fail) p / For bedrooms Fluid depth in absorption field before test 2 / in. Water added COO gal. New depth 36 in. Elapsed Time: 6- 6 min. Final fluid depth 21 in. Absorption rate >= ,COC g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION n1A Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: p clue wit-re R Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout • Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation S 1* Property line 5 14- Absorption field s 11- Water main l0 r'f Water service line / G r4" Surface water /GO 'r- Wells on adjacent lots 00 ° '.4" ABSORPTION FIELD ON LOT TO: Property line 407lf" * Building foundation /6/ Water main /0 Water Service line /G (f Surface water /vu 't Driveway, parking/vehicle storage s Curtain drain ll4t//e- Wells on adjacent lots 204 '14- F. COMMENTS i,J4fV/f-Z- G. ENGINEER'S CERTIFICATION / certify that I have determined through field inspections and Lr 70,j) review of Municipal records that the above systems are in I� ;'•. •; P conformance with MOA COSA guidelines in effect on this date. u „ ; : 'A Engineer's Printed Name c.7---•:_5t/G Date /12 2 7//7 - •• r 7k COSA yellow sheet_2-6-15.doc . : '-' MUNICIPALITYOFANCHORAGE · 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 1. GENERAL INFORMATION Complete legal description Location (site address or directions) /O PrOperty owner Mailing address Lending ageno Mailing address Day phone... Day phone Address Day phone Unless otherWise requested, HAA w~be he~ld for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well 'Public water NOTE: 4. TYPE OF WASTEWATER DISPOSAL: NOTE: . If community well system, provide written confirmation from state ADEC attest- ing to the legality and status of system. . :.;~ ,".': Individual on-site Holding tank ' COmmunity on'site Public sewer 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* -~> :~ T · - '~- ' · * .. . ~'].~ ~" T'~ ~. ' ' As certified by my seal affixed hereto and as of the valrdation 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. NameofFirm / ~/'J~/ u~.-I~.~ ~- Phone Address (~.0~ //~//O'-/-~ /=/,~4) .-% ' Engineer's Signature 6. 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 DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) Back MOA~I Municipality of Anchorage ,~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LII tP~ t¢"/LJ~.N, C2E.¢'I'~ _Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height A. Well Data Well type Log present (Y/N) FROM WELL LOG Total depth Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION ; On adjacent lots .g.p.m. ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESIJLTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B, SEPTIC/HOLDING TANK DATA Date installed ~'/~&,, J Cleanouts (Y/N) ~ High water alarm (Y/N) f'/~N Date of pumping ~ ,~. L//.. Tank size I,P. 50 Foundation cleanout (Y/N) 7 Alarm tested (Y/N) Pumper 3 ~;~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~"~,'~ On adjacent lots b//'/5~ To property line I ~ .-~ Compartments Depression (Y/N) Sudace water/drainage Foundation Water main/service line Absorption field 72-026 (3,/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION ~/~,~;~ Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Su dace water Length ,~ Q~ Total absorption area Date of adequacy test D. ABSORPTION FIELD DATA Date installed "'~/~'~, \ Width t~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) Gravel thickness Cleanout present (Y/N) Results (pass/fail) System type T'~ Total depth Depression over field (Y/N) for t~ Bedrooms After test ,~- ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: We, o, lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots '1'~,/~, Property line To existing or abandoned system on lot Cutbank N ~ H ~- Water main/service line Driveway, parking/vehicle storage area 0 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe~ton the date of this inspection. Date ~/~ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH &HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 11; BlocE 6; Hylen Cre~t '~-~ Location (site address or directions) 10343 Stewart Drive Property owner Mailing address Marry Steinriede Day phone (h),'694-4776 10343 Stewart Drive Eagle River, AK (w) 694-4200 Lending agency Mailing address Day phone Agent same. - OWNER/AGENT REMAX REALTY Day phone Address 16600 Ce.n~.e~f~d D~J.u~. Eagle River, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 --4 TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water XXX w 694-4200 AK If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WAS'TEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XXX ~ Public sewer 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. Name of Firm s & S ENGINEERING Phone I/034 Eagle River Loop Road No, 204 Address Eagle River, AlesEa 9~577 Engineer's signature DHHS SIGNATURE ~._ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date completed Cased to FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ADEC water system number Driller Casing height Wires properly protected (Y/N) AT INSPECTION g.p,m, ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC~TANK DATA Date installed ~"/OP~ ~//~/~/~/~ Tank size Cleanouts (Y~) High water alarm (Y/~_~- Date of pumping Foundation cleanout (~)N) Compartments ~ ~ Depression (YN~ /(./5 Alarm tested (Y/N) .-'/--///~ Pumper t ¢''' /~O/t-/~ ,~z~',//~'5 SEPARATION DISTANCES FROM SEPTIC/~ TANK TO: Well(s) on lot /'""1~'~ To property line /0! Surface water/drainage On adjacent lots /'~/,~ Absorption field ~. r Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION /L.)c~,,t,'E- ~ Manufacturer Size in gal lons~'"'""'~ _ ' Manhole/Ac~ Vent (Y/N)___~~ ',,Pump off,, level at High water alarm level _ J % Cycles tested Meets MOA electr~__. SE~A~TANCEFROMLIFTSTATIONTO: __ On adjacent lots We~ lot Surface water D. ABSORPTION FIELD DATA Date installed ~'/~ Length '--~ ' Width Total absor'pti~n area Depression Over field (Y~ Results ~ail) Soil rating Gravel thickness o(~" / Cleanouts present(~N) Date of adequacy test Peroxide treatment (past 12 months) (Y/N) System type "~/~-/LJC Total depth /L),~/~T ,¢~,~JO~-~/'-/' If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ."°'///'~ On adjacent lots ~--//~- Property line /~/ To building foundation / Z'/' o e, xi.~t T lng or abandoned system on lot /4Jo,4-~E /¢,~¢'~--'TUC-- On adjacent lots ~¢/¢ Cutbank /~//4 Water main/service line Surface water Curtain drain E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area ~-~ ¢ Signature Engineer's Name Date I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this in~ S & $ ENGINEERING 17034 Eagle River Loop Road No. 204[ Date of Payment Receipt Waiver Fee: $ uection. Date of Payment Receipt Number 72-026 (Rev. 3/91) BaCK MOA 21 tVIUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEAI.,TH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O GENERAL INFORMATION (a) Application Date ~=ptelllb~r ~ 1%86 Legal Description (includ~ lot, block, subdivision, section, township, range) Lot ]2L__BiLock 6 HY~ Crest '~14N R1W Sec. Location (address or directions) (b) ApplicantNameChanlbers Construct Telephone: Home 694-4058 __ Business Applicant Address _P.O. Box 777;294 Eagle _River, Alaska 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); 694-4058__ (d) Lending Institution Alas_~cn- P~3. c%fic Mortgage Telephone Address ?.O=Box 100420 A_DJ~_~c_~C_~_~.C.~SJSj~ 99~z~L0 (e) Real Estate Company and Agent ~ Address ~ __ Telephone _~T_/A (f) Mail the HAA to the following address: pi nk~ip by engi TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms 4 Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community L--I Holding Tank. lq 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 z~-025 m/84) ENGINEERING FIRM PROVIDII,~G INSPECTIONS, TESTS, FILE SEARCH, Dt~TA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of thins Health Authority Approval 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, t further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address EAGLE RIVER ENGINEERING SERVIOES Date ~Y'-/~ EAGLE RIVER, AK 99577 p;-O,-B 0X-7-7-32-94 694o5195 Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health ane Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their, lending institutions in order to satisfy certain federal and state requirements. Em ployees of DHEP do not conduct inspections or analyze data before a certificate is issue, cl, The Municipality of Anchorage is not responsible for erro['s or omissions in'the professional engineer's work. , Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: // Cr~-/'- WELL DATA Well Classification ~ ~ ~" ~''''''~-/y 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: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROfEcTfON SEP 4 lgSli RECEIVED ~./~-~Jh/) If A, B, C, D.E.C. Approved (Y/N) Y Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ,~¢¢'~.4'. Size /,~25"~ ..~ ¢, / No, of Compartments Standpipes (Y/N) _ .~ Air-tight Caps (Y/N) Y Foundation Cleanout (y/N) _ Depression over Tank (Y/N) /u/ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) /~',/'~ ; for Holding Tank High-Water Alarm (Y/N) "¢~"" Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well '¢¢~¢'~ / To Property Line /~/' To Water Main/Service Line Y'/o ' Course /J/ct / To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72~026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorl~tion Strata Date Installed Width of Field '~__2 '''/ Square Feet of Absorption Area Depression over Field (Y/N) /'~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well "~"~ '~¢ To Building Foundation /'~- ' Lot To Water Main/Servioe Line ~"~0 / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design /'"~¢"'¢¢/-' Length of Field ~ ~, z' Depth of Field ,// / Gravel Bed Thickness ,--zc' /¢ / Standpipes Present (Y/N) ,~' Date of Last Adequacy Test To Property Line /o To Existing or Abandoned System on ; On Adjoining Lots '¢'~" ~ To Cutbank (if present) LIFT STATION ~,~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** 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. Signed Y~ Date Company ~/~""'¢'~--~' MOA No. Receipt No. /,,"~O / ~)(~),_~ Date of Payment % ~'~¢ Amount: $ ¢%-~ Page 2 of 2 72-026 (11/84) Eagle River Engineering Services P. 0. Bex 773294 Eagle Rlve~ AK 99577 6~4-5195 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE: September 4, 1986 PWS I.D.~ 213289 To Whom it May Concern: According to records on file in this office the Water Regulations Hylen Crest Water System is in compliance with the State Drinking Sincerely,