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Home My WebLink AboutHYLEN CREST #1 BLK 3 LT 7Hylen Ceest Block 3 Lot 7 #050-474-03 Permit Number:OSP261214 Tax Code Number:05047403000 Work Type:SepticTank Upgrade Effective Date: Design Engineer: Site Legal Address:HYLEN CREST #1 BLK 3 LT 7 G:0057 Owner:KIRK'S CAPTAIN TRUST Site Mailing Address:10136 LOON CIR, Eagle River Lot Size in Sq Ft:20008 Total Bedrooms:4 This permit is for the construction of: Disposal Field Septic Tank Holding Tank Privy Non-Public Water 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. Coodinate with On-Site staff regarding preferred method. 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 7/14/2026 7/14/2027 FORGE ENGINEERING Expiration Date: ¨þ ¨¨¨¨ Issued To: Issued By: Date: Date: 7/14/2026 7/14/2026 FORGE ENGINEERING Isatou B Njie 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 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-474-03 Property owner(s) Kirk's Captain Trust Day phone 907-247-9488 Mailing address 10136 Loon Circle, Eagle River, Anchorage, AK 99577 Site address 10136 Loon Circle, Eagle River, Anchorage, AK 99577 Legal description Hylen Crest #1, Block 3 Lot 7 Number of Bedrooms 4 Engineering Firm Forge Engineerin Building Permit Number Not Applicable ❑■ APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Disposal Field ❑ Initial ❑ Septic Tank ❑x Upgrade x❑ Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: 7 7—C) Date of Payment: / / s Z �= Permit No. S �' L �__ % Z l `1 May 2025 Waiver Fees: Date of Payment: Waiver No. Distance: June 30, 2026 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Hylen Crest #1, Block 3 Lot 7 - 10136 Loon Circle Septic tank replacement Dear On-Site Services Engineer: The owner of the above-referenced property is requesting approval to replace an existing septic tank that has exceeded its useful service life. The existing tank will be removed or decommissioned, and a new septic tank will be installed as shown on the attached site plan. The existing on-site wastewater system serves a single-family residence and will remain unchanged except for the tank replacement. No increase in wastewater flow is proposed. The attached site plan identifies the residence, existing septic components, the decommissioned tank, and the proposed replacement tank location. Required setbacks to structures, property lines, and other site features are maintained. The contractor will ensure the replacement tank maintains a minimum 5-foot horizontal separation from all deck supports. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261214, Isatou Njie, 07/14/26 EXISTING TRENCH TO REMAIN IN USE Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=60' APPROXIMATE LOCATION OF WATER LINE EXISTING 1250-GAL SEPTIC TANK EXISTING TANK TO BE REMOVED/DECOMMISSIONED CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND HYLEN CREST #1, BLOCK 3 LOT 7 FEET 0 30 60 LOON CIRCLE 4-BDRM HOME SEPTIC PLAN 6/30/26 15' UTILITY EASEMENT NEW 1250-GAL SEPTIC TANK CONTRACTOR TO ENSURE ALL REQUIRED SEPARATIONS ARE MET CONTRACTOR TO INSTALL 2CO BEFORE TANK APPROXIMATE LOCATION OF WATER LINE CONNECTED TO PUBLIC WATER CONNECTED TO PUBLIC WATER CONNECTED TO PUBLIC WATER CONNECTED TO PUBLIC WATER CONNECTED TO PUBLIC WATER Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261214, Isatou Njie, 07/14/26 UNDER NO V*CUMVAMCIM MCUW AN AS - XLT VC UM PW COMM= OR FOR:=rAM6M4M BOUMART OR MOM UNGt THE SUaLw. TAKCS R--il5ftilr" FCR 1HE lHnk iR RSALT70r+1 O&Y AM AMMM F"C& U!#MTY ONLY. FM IME CMT OF THE SXW'4 =TIM OtST"= FRCVATL OVER StAwn LOT llu* ew OFF rfflE 10,MArCH AL,�T et%OL 8t71tfCtm As.duLT otDT RIN ... AL.BAIT .. , iDT aw r ... TLAOmwy IT IS T04C RCW40NM ILJTt t CONSTRUCTION. IV vot" To MMSHED GRADE ANC Ul THE DOST Cl Or ANY ICA, WHICH DO NOT APRf.AR O SURWY CEKIIF1CAIM PLOT F6W ftUPl 'D0A AS-WLT fw+asM• w �.. t.t .0 1w M w. �...r.. a t.t...rr~. •.1.- -.�.. oil .,ft. MAL 31VVC7W9 AS..NM'r LI— G •� J. r•.4 rr.} trt s �. MAw'., m r..re w_Mkwo f/V M i_F_ �_•�i r Y rl.-w-Pfa � ..� BUXDER OR CY*Mfl Ppm TO ISD 9UPIDTND CRADB RELATIVE �NNCCIMM AND TO D£TERM4M • MTM MAR DRAINAGE ` �-� ASPKALT o FOM ROAR Fina 3 CQNCR£TE ® Ahsim tay.--iF-lE- McrAL FLNCC ® - yogy m CWI.Y Tpm= M►PPOVDAENTS ABOVE ORCU NI) *NO vIIeLS VAU HE 6"WL R?i= •MlAA wwwC t7.LANOUM 3MEWALOM OFAVCWATS. ETC.. • ARE 3 MC" JN THWIR APPSIMYAIT WCATSON. VNL.r: SNOW MAY PREY@IT 301C MWMT 000ZXM FMM M)NO ?tEH AND LOCAMM Robert E. ..... sbd. ". 30' ...� �•» 3II 5; 2002 4121—S a ��t zs; a0a2 ns, Jr. & Assoc. Land Surveyors F- TZ Aw. ;L ALIMA IM tat SF tpAr- Plat no Ma NW,'S7 F- 22116 ..... .."•••'�.► _ �LQT.' 7, BLOCK -3, HYZ;EN CREST UNIT 1 � °twvivr+i � . . " Municipality of Anchorage Page / of ~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~L. LJ O/~OO~-~ PIP Number: O~-"O ¢?/7,'~) ~ Name: L ~_ ~ ~o~J-5'r"~.~6;~a,,J Wastewater System: .,~New [] Upgrade i Address: /~ .¢¢/¢--' ABSORPTION FIELD Phone: ~/~...~..~1' No. of Be~oms: /~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other L E G AL D ES C R I PTI O N so, Rating: Total Depth from original grade: /, ~ ~/sq. ~. Lot: Block: Subdivision: Depth Io pipe bottom from original grade: Gravel depth beneath pipe Range: Section: ~ Fill added above original grade: Gravel leng~ Number of lines: Distance betwsen lines: WELL: B New Q Upgrade Gravel width: ~ Ft. / ~ Ft. Classjfica.~ion (Private. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Orgled: Sta,,c Water Level:Ft. Installer:~~ ¢,¢~¢ Date instal[ed:¢/~¢ -- Yield: Pump Set at: Casing Height Above Ground: o*~ ~,. ~. TANK SEPAHATION DISTANOES ~eptia ~ Holding ~ TO Septic AbsoCpllon Lift Holding ~ublic/Private Manufjcturer: Capacity in gallons: Material: Number of Comp~ents: Well ,~ ~ ~ ~ ~ ~ ~ Surface Wate~ i~,~ I~+ .-- ~ -- LIFT STATION LineL°t ~ ~ ¢ ~ ~ ~ Size in gallons: Manufacturer: Foundation /~ J ~ ~ ~ ~ "Pump on" level at: "Pump of~" level at: High water alarm CurtainDrain .... ~ Pump Make & Model Electrical inspections performed by: Remarks: BENCH MARK Location and Description: Assumed Elevation: ENGINEER'S SEAL Inspections performed by: ~. ¢- ~ *¢ Bates: 1st ¢/"~ ~, *~~% ' . ~S Dawd R. Dayton Department of Health and Human Services approval ~),,, ....:.s~%o Reviewed and approved by: .~c~t4~ ~ Date~ ~ ~.-u~, ..~ 72-013 (Rev 9/91) MOA 25 Permit No. ~,'OJ ~ ~ O O Z..c.~' Page ~" of ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PID No.: ENGINEER'S SEAL 72-013 A (2/91) MOA 25 PermitNo, _,.,~OJ cl' "~OOZ~' Page ~:~ of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Rox 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report LegalDescription: /..~Y~ ~c~ /'-~/,u-~'-~,"~':/ PIDNo.: Dept. .F~N~C~N~F~.J~ ~.S SEAL ¢~'~'"[ ..... ~"'" ..... David R, Dayton ~ ,~ NO. 2205-E ,, ~ 72-013 A (2/91)MOA25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930028 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:L & B CONSTRUCTION INC OWNER ADDRESS: 14828 TERRACE LANE EAGLE RIVER, AK 99577 DATE ISSUED: 3/15/93 EXPIRATION DATE: 3/15/94 PARCEL ID:05047403 LEGAL DESCRIPTION: HYLEN CREST #1 BLK 3 LT 7 LOT SIZE: 20000 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE TRENCH MUST BE 9.5 FT DEEP WITH 6.0 FT OF GRAVEL BELOW THE PERFORATED P//~E. / / / , ? Municipality ot Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 7'-/'/- ~¢/ PERFORMED FOR: LEGAL DESCRIPTION: '¢"'~' ~'' ./~'~,~4J ~'~7" lO 11 12 13 14 15 16 17 18 19- 20- DATE PERFORMED: · SLOPE SITE PLAN - f WASGROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth Io Water AFter v'/ Monitoring? ,A~a' ~.A~ Dale: I' Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ tm~nutes/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN -"'(""" FT AND ~ FT COMMENTS PERFORMED BY: '--"~, ~., · '~'¢~ '"4"~'::~'~ I ~ ,~/~'~--CERTIFY THAT THIS TEST WAS PERFORMED tN /_../_ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: ~ ~/ ~t ~/~ 1 2 3 4 5 6 7 8 9 10 12 ~4 16 17 18 19 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT 0 DEPTH? p E Monitoring? ~x'r~' Date: , Gross Net Depth to Net Reading Date Time Time Water Drop / ,, i/? /o ,, /o?,~ PERCOLATION RATE ~/,T-/j~ lmlnutes/mch) PERC HOLE DIAMETER __ TEST RUN BETWEEN '~-- FTAND ~ FT PERFORMED BY: ~ "~"~~ I -~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AN DMUNICIPALGUIDELINESINEFFECTONTHISDATE. DATE: 72-008 (Re,,'. 4185) MUNICIPALITY OF ANCI..~yRAGE D~PARTMENT OF HEALTH AND ENVIRO,NMEI'4?Ai. PROTECTION SOILS LO'~ - PERCOLATION TEST , o.,, ..,o..,o, Cz/..,/,.,- _ 6 7 8 9 10 11- 12- 13- 15- 16'~ 17 18 19 20 COMMENTS ENCOUNTERED? IF YES, AT WHAT DEPTH? R~dt~ D~te Time , FT ^1 p~ RATE SITE PLAN PERFORMED BY: 72.006 (6/70) £agle ~lver, AK g9577 GO4-SIg5 P.O. BoX 6650 ANCHORAGE. ALASKA 99502-0650 (907) 264-4111 TO~~, Y ~' NOWLES. DEPARTMENT OF HEALTH & HUMAN SERVICES, January 10, 1986 TO: Permit Applicant Subject: Permit # 850729 Lot 7 Block 3 Hylen Crest Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit LILT: '7 BLOCK:~ 3 RANGE: :I.W I...:ils't'..(.:.~cl t;::,elc)~/,~ a~'(l"(.:;.~ 'l'.l"li:,? clp'I:..i.c)FiS available 't'.(:) 'you in d6?s:i.l.:]r'l:i.r'ig yl])Lll'" sep'l:.:ic systl..~.mi. []l"ic)c,!~=i(.::,, 'l:..h¢:~ Ol:rLior'l tl')ai', best l':ii:.s yot..ir, s:i. te,, 'T IF;i,". IIEE: !l"ql E:]: II.-..'11 b,,,!l .... :Eli, IF;i: ¢'::'.~h % II"dl :OIEI:::"I'H '1"O F;]:I:::'E BJ]'T']'[)i¥I (F:"t".) GRAVIEI.... DE]::'-FH (I="T. TOTAL. DIEF'TH (I='T,,) GRAVI:ZI_ M ;1: DTH , ,; F:'T. [.:.~RCrtVEI.... Lliii:NE.)'I"H (I:::"F,,) GF;.'AVliE]...VOLLJME ,;CU,, YDS,,' ) 'r'AI',IK S I Z!..~: (GAI....S) SO :1: [.. I:RATI NG ¢, !:.<;! ,, F:'T ,, /BI::~ ) ¢,'..x. TANI::: M,US'T HAVE A'f' I...I:fi:AS]' "l'l,,.J[I C,[IMI:::'ARTr,IENTS I c (.'.~r' 'L :i. ~:' y 't.l"l a t: f'c~r'.th by 'Ll'~e Iqlr.U]:i.c:J.'pE~l&ty C:)f' Aricl"u::irage (MOA) and the State of' Alaska,, : 2. :l: v~:i.;I. 1:i.r'is't'.al]. t'..I-ie sys'Lem in ac:ccir~dance wi'Ll~ all I"IOA cc:ides ar'id r'egulat:i, or'u~i~ ,:~r'l(::J :i.l"t cl::)ml;)].~.ar'tc(.:~;, with 'L J"/ E.:.:, des;i, lj.:jl"i (::r'i'LE~r':~a I:i¢ tl]:i.s j:)er'rliJ.'tL. 3,, :1: v¢:i. ll adhere 't:.c:i all MOA and State c:ll' A:laska r'equ:i.r, emen'Ls Fop the s6rL back c:l:i, stanc:o:,s ¢Porn al'ty ~:~;4is'L:J. ng we].l~, was'Lewater' d:i. spc~sa]. ~ys't:.em i:3i" pt..d:)].i(::: sE.~/,~6..:r'age systo~ltl Cll'] 't'..l't:i.s o1' ar]y ac:l.jac:ent (:)p near'by 4.. :[' t.q"l(::J(;.]r'~i~t¢:u]d tl'ta'[, th:i.s j::) (:9., p /fl i '[ :J.s v~'~].J:d ~'op (:?~ IfJE&x~liiLt/fi E)J' 4 bedr~;~oms any eE~:t, arger/l(~,~ni:, wiJ. 1 r'equ:i, re ar'l addit:i, cn"~al peJ"m:i.t,, :IZF' A I...IF:'"f' S'I"ATI£1N ]:S INS"f'AI.J....ED II',.l AN Al:REA COVERED BY HOA BLJIL. D):I',JG THEIxl (1) AN EI....ECTI::;;]:CAI.... I:='EI::;;MZ[T AND ]:I;.tSPI~Z[TT'Z[]I',I' MUST BIE OBTA.!;NED; (2.) AS.-..EIUII.TS MILL NO'f: BIE AF'I::'F;;OVEO WITH[0UT AN IELECTRI:[;AI... ]:I'qSF:'EC'f't[)N F;;I:i::PUR'I"; AND I!!i:LI!ii:CTF:;;]Z[i;AL MORI< MUEN' BE DOI'41E BY A I...]:[]i'~ZIxlSIE]) IEI...E]:;"I'R ]: [; ]Z AN . AI='FI... I CANT: [..OVIEI....ACIE E XCAVAT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 254-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR; LEGAL DESCRIPTION: SLOPE DATE PERFORMED: /:/ SITE PLAN 5 6 7 8 9 10 11 12 13 15 16 17 18 19 20, COMMENTS ~-~¢ ~'~ -"~,~' ,'~; ,~ Gross Reading Date Time WAS GROUND WATER ENCOUNTERED? . L O P E IF YES, AT WHAT DEPTH? P E ~%C G'~-A~T1OI~ RATE TEST RUN BETWEEN FT Al PERFORMED BY: 72-O08 (6/79) Eagle River Engineering Services P, O, Box 773294 Eagle River, AK 99577 694-5195 CERTIFIED BY: MgNI~.IPALIT¥ OF ANCHOP, AG,~ I~I~J~T, C.I~ HEALTH & t[N¥1t~NMENI'AL PROTECTION ECEIVED LO'T c,, ..t. P 'OF FOUNDATION WALL ELEV.. IT SHALL SE TNE RESPONSI'BILITY OF ..THE · ':~ C3.~:)~:3. BUILDER OR OWNER TO VERIFY THAT £VATIONS BASED ON/"'%'~'Or't~"~;~) BUILDING LOCATION SHOWN MEET8 ALL ~ OD · C~,C:~ DATUM. SUBDIVISION COVENANTS AND LOCAL EPARED FOR: ZONING CODES AND ORDINANCES, LOT PLAN . .LOT-7 , BLOCK ,,,o,T ,jO_l hdC, AWN .DATE ECK J GRID J k-I '~.',.' c~-/ ), BK, J JOB NO. I HEREBY CERTIFY THAT ALL PROPERTY CORNERS EXIST THIS DATE AS SHOWN. Municipality of A.chorage Development Services DeJJdrJment Building Safety Division On-Site Water and Wastewater Program ~J700 South Bragaw St. P.O. Box t96650/~nchorage, Al( 995 t9-6650 www.cLanchorage.ak. Us (907) 3,J:~-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-474-03 1. GENERAL INFORMATION Complele legal description Lot 7; Location (site address or directions) Expiration Dale: /-J o ,~' O - O 3 Blnrk q; RylPn 10136 Loon Circle Current Property owner(s) Sharon Cardoma Day phone 580-1400 Mailing address Lending agency 10136 Loon Cir. Ea~le River. AK 99577 Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding tank [] Community On-site Public Sewer 'l'he Municipality of Anchorage Development Servlces Departmenl (DSO) Issues Certificates of Health Aulhorily Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In Ihe Stale of Alaska. Certificates of Health Aulhorlty Approval are required for the transfer of ti!le (except between spouses) for propedies served by a single [emily on-sHe wastewater disposal and/or waler s.pply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are volid for 90 days from Ihe date o[ issue for properties served by a private or Class C well and may be reissued with new waler sample results less than 30 days old. (Certi[icates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality o[ Anchorage Is not responsible for errors or omissions In the professional engineer's work. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewator Program 4700 Soulh Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.enchorage.ek, us (~07) ~-?~0~ HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type Date completed Total depth Data of test Parcel ID ~2:~:~ ff A. B. or C provide PWSlD # J Well Log (Y/N) Sanita~ seal (Y/N) / Wires properly protected (Y/N) ft. Cas. to y Cas. lng he,bt (above ground) FROM WELL LO~,/// AT INSPECTION Static water level / ft. Well production / g.p.m. WATER SAMPLE RESULt.' Coliform ,~esJl00 mi. Nitrate Date of sample: ~ Collected by: B. SEPTIC/HOLDING TANK DATA g.p.m. mgJI. Other bacteria __ colonies/100 mi. Tank Type/Materiel ~ Tank size ~ gel. Number of Compadments ~ Foundation cteanout (Y/N) '7/ Depression over tank (Y/N) /~ ~;l~;Io( ~ ~'~ Data of pumping ABSORPTION FIELD DATA Date installed ~..~ Soil rating (g.p.d./fta o~ ~/bclrm) I. Len~h ZJq' '.. w.~th ~ ft. To~l d,pth I~Y ft. E,. apso~,on araa.¢~ ~ Mon,o~.g ~,be '/ Fluid depth in absorptiou field before test ¢~ in. Water added~,'gal. Elapsed Time:/~4 min. Final fluid depth ~ in. Absorption rata >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) ¢~J Data installed cteanou= (Y/N) High water alarm (y/N) /'"J System type Gravel below pipe ~- ~ ff. Depression over field ~,,!.. F~ ~ b~moms N~ dep~-~n. ~ g.p.d. If yes. g~e da~ ' T'~.~ 15:34 FAX 907 258 0005 \ Agent Service center ~]005 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 GENERAL INFORMATION Complete legal description Lot 7, Block 3, Hylen Crest S/D ~ / Location (site address or directions) 10136 Loon Circle Property owner Mailing address Lending agency Mailing address Agent Address ,.Charles Clanton Day phone 696-0651 10136 Loon Circle, Eaqle River, AK 99577 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: z~ -~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: X~L~ 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 ........ ,. ,~: .... , ...... u ,,_ ,,,,,, Address Eagle River, Alaska 99577' Phone ~-)-¢1-7¢ Date DHHS SIGNATURE Approved for /r~ [y/~ 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 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. 72q325 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage JUL 0 1999 DEPARTMENT OF HEALTH & HUMAN SERVICES ..... ~4UNICIPALITY OF ANCHURAGE Environmental Service8 Division F' VIRONMENTAL SERVICES DlVISl~lt~l II._J.~ 825 L Street, Room 502 · Anchorage, Alaska 99501 ~:~g07) 343-4744 Health Authority Approval Checklist Legal Description: ~T g/ ~'L~¢/'(' ~,J ~//,Y'/cg¢/C~/ Parcel I.D.: 05-0- 4'~Z:~--O~.=.~ A. WELL DATA Well type'~/.,//~L,/C If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Cased to FROM WELL LOG Date of test Static water level / Well production / g.p.m. WATER SAMPLE RE~:~'. · · Coliform ~ Nitrate Date s~ample: Collected by: Date completed CaS~ve ground) Wire~p'roperly protected (Y/N) AT INSPECTION B. SEPTIC/HOLDING TANK DATA g.p.m. Other bacteria Date installed z¢-///~_:~ Tanksize /2~----~)~'' Number of Compartments ~ Cleanouts((~'N) Foundation cleanout ~N) ~ S Depression (Y~ A/O High water alarm (Y/N) Date of Pumping ~ / ~ ~ Pumper ~ ~ C. ABSORPTION FIELD DATA. Date installed ¢/~5 '" : _ Soil rating (g.p.d./fF or fF/bdrm) /, 2 System type , _ Length "T-! Width Gravel thickness below pipe ~': ~" Total depth /~- Effective absorption area -'~'-'¢8 ¢ Monitoring Tube present (~;//N) 1~--~ Depression over field (Y~ Date of adequacy test ~//¢0//~'+ Results (Pass/Fail) ~r~ For ~ bedrooms Fluid depth in absorption field before test (in.); ////// Immediately after~ZZ/~'gal, water added (in.): 2/~'// Fluid depth Z",-~ ~' (ins) Minutes later: Absorption rate = ~¢?(:~ ~ g.p.d. Peroxide treatment (past 12 months) (Y/N) ~//~)K//~, ~/f~¢~lf yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested /~//,~c .~'¢zeq~al Ion s ",~mp on" level at* ~ *Datum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /~//1//P¥' ~/_..//'~/-~(-' On adjacent__~ _ lots Absorption field on lot _ .OfYa-dja~cent lots Public sewer main ~'~ Public sewer manhole/cleanout Sewer/septic serviced:re~'~''~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /(~ /~' Properly line / (~/'~ Absorption field Water main/service line ,//'~ ~ Surface water/drainage //~2 ~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /(~) t"/-' Building foundation Surface water /f~"~/7/. Water main/service line Driveway, parking/vehicle storage area Curtain drain A/(~/V~ /~,A,/~/'v",/V/ Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal record, /,,F'.; .....,..'., d,~_i,s are in conformance with MOA HAA guideli~nes in effect on this date. ~,~ ~ .,.,,, ~,,,,,.q-..?~ Signature Engineer's Name /~ 0/3 ~,'¢~- (~". ~"0 ~ Date ~/'~ / ~ ~ '1'~" 6E'880i /~ HAA Fee $ Date of Payment- "~/~ /~/-~ Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev, 3/96)* 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 5'0 ~7 4fo5 1. GENERAL INFORMATION Complete legal description Location (site address or directions) (_~.~, ~J (?,~fzo. t.~ ~ ~ ~.~r ~v,~,"~ Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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 s~uewwoo leUO!~!ppv :suol~elndljs 8U!MOIIOJ eq~, qj!M 'SLUOOApeq 'swooJpeq JoJ. le^o~dde leUO!l!puoo 'pe^o~dd~s!Q ~o,t pe^oJdd¥ ~ ~4n.LVN!DIS SHHO '9 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Parcel I.D. RECEIVED ~jl'U[.. 1 1993 Municipality of Anchorage Dept, Health & Human Services Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) MUNIOP^LITY OF ^N6HOPC~GE Date of test Static water level Well flow Pump level1 FROM WELL LOG .g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line AT INSPECTION J[NVlRONMENTA~ SERVICE8 DIVISION JUL 0 2 g.p.P E. CE VED ; On adjaeent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Col'iform Date of sample: Nitrate Other bacteria Collected by: S. SEPTIC/HOLDING TANK DATA Date installed ~/ t / ~ b Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size i ~"-') Compartments Foundation cleanout (Y/N) ~ Depression (Y/N) /k'///dr Alarm tested (Y/N) /~/C-~u' ~'V 5 ~3'44'~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /U///~- On adjacent lots /(///~L Foundation i 7.. TO property line ~'/'S-' Absorption field J¢~ Water main/service line Surface water/drainage J ~ ~ 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed /f'"////~ Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Well on lot Date installed Length ¢~ Total absorption area Date of adequacy test On adjacent lots D. ABSORPTION FIELD DATA Width Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Surface water Soil rating (GPD/Ft2) (// Z.... Gravel thickness Cleanout present (Y/N) Y Results (pass/fail) After test If yes, give date System type Total depth Depression over field (Y/N) for Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation / '~- On adjacent lots ,,~"b .-/:- Surface water Curtain drain On adjacent lots /~¢'~/z.,¢r~ Property line To existing or abandoned system on lot Cutbank A.//,~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA c David R. Dayton P.E. 20210 Donalar St, Signature Chuglak, ~a~,~ 99567 Engineer's Name ,,(//~ //~",,--------~ Waiver Fee $ Date of Payment Receipt Number