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HYLEN CREST #3 BLK 4 LT 6
Hylen Crest #3 Block 4 Lot 6 #050-474-20 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: OSP241058 Work Type: SepticTank Renewal Tax Code Number: 05047420000 Site Legal Address: HYLEN CREST #3 BLK 4 LT 6 G:0057 Site Mailing Address: 10235 STEWART DR, Eagle River Owner: SHEARER SAXTON O & CAMLYNN J Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: gent 0 e n n V r f J Depa1*ti„elit Lot Size in Sq Ft: Total Bedrooms: 4/24/2024 4/24/2025 20027 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing - �: n cA Issued By: Date: Date: I Z 4 MUNICIPALITY OF ANCHORAGE 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. 050-474-20 Property owner(s) Shearer, Saxton & Camlynn Day phone 907-223-9787 Mailing address 10235 Stewart Dr, Eagle River, AK 99577 Site address 10235 Stewart Dr Legal description (Sub'd., Block & Lot) Hylen Crest #3 Block 4 Lot 6 Legal description (Township, Range & Section) Lot Size 20,027 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 Septic Tank ❑X Upgrade El(w/wo ADU) Holding Tank ❑ Renewal RX Duplex (D) El Privy ❑ Multiple Dwellings ❑ (SF 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: c/�q.5 / Waiver Fees: Date of Payment: I ! Xl 2-D 2 y Date of Payment: Receipt Number: Receipt Number: Permit No. 05P2 g1058 Waiver No. Permit App_::- : . _.,:c April 18, 2024 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Hylen Crest #3 B4 L6- 10235 Stewart Dr Permit OSP221303 RENEWAL Dear On-Site Services Engineer: Permit OSP221303 for Hylen Crest #3 Block 4, Lot 6 has expired. There have been no substantial changes to this lot or the surrounding area since the permit was originally issued. The current design and permit condition meet all code requirements. We therefore request the renewal of the permit for the tank replacement on this lot. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241058, Deb Wockenfuss, 04/24/24 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: OSP221303 Work Type: SepticTank Upgrade Tax Code Number: 05047420000 Site Legal Address: HYLEN CREST #3 BLK 4 LT 6 G:0057 Site Mailing Address: 10235 STEWART DR, Eagle River Owner: SHEARER SAXTON O & CAMLYNN J Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: o1R,11Acnt S CN n 9160 llepaitmenr 8/12/2022 8/12/2023 20027 Disposal Field Q Septic Tank Holding Tank Privy Private Well Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: IV MUHMPAUTY OF ANCHORAGE ikrf , Community Development Department' -j 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. 050-474-20 Property owner(s) Sherarer, Saxton & Camlynn Day phone 907-223-9787 Mailing address 10235 Stewart Dr, Eagle River, AK 99577 Site address 10235 Stewart Dr Legal description (Sub'd., Block & Lot) Hylen Crest #3 Block 4 Lot 6 Legal description (Township, Range & Section) Lot Size 20,027 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x Septic Tankx❑ Upgrade ❑x (w/wo AD U) (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF 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: 4 ,2 a 5 Waiver Fees: Date of Payment: 9 1 12,02 -2 - Receipt 20ZZReceipt Number: 6122-` t Permit No. O S? d -a 1 :j0 3" Permit App_::- : , _.,:c Date of Payment: Receipt Number: Waiver No. July 28, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Hylen Crest #3 B4 L6- 10235 Stewart Dr Septic system design Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the well and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. The new septic tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the absorption field, and adjacent deck. Please refer to the attached plan 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 OSP221303, Deb Wockenfuss, 08/12/22 // Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' 1250-GAL SEPTIC TANK w/20" MANWAY CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO HYLEN CREST #3, BLOCK 4 LOT 6 FEET 0 50 100 870 NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM NO EXISTING WELLS - PROPERTIES ARE ON PUBLIC WATER SYSTEM STEWART DRIVE 3-BDRM HOME 7/28/22 DECK BLOCK RETAINING WALLS 10' UTILITY EASEMENT 15' T&E EASEMENT 880 890 900 910 920 930 940 950 EXISTING TRENCH TO REMAIN IN SERVICE DECOMMISSION EXISTING TANK PER U.P.C ASSUMED WATER SERVICE LINE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221303, Deb Wockenfuss, 08/12/22 NOTE: THE SHED ENCROACHES AS SHOWN. STEWART DRIVE Lot 5 PORCH 89'45'00"E 0 2.43' S 81'15'00"E 37.00' U1 15' T&E EASEMENT Un RETAINING WALLS %CANTORY ENCE2LKOUTMENT�5.3•OECK15.7' m Lot 6 20,027 s.f. Lot 16 NAY NLI SHED ._. _J 1_ Lot 7 6'. 8.0' STORAGE 'WOODEN FENCE 2.0' X 5.2' CANT PIPES 10' UTILITY EASEMENT — — — Lot 2 PLOT PLAN AS BUILT —2L SCALE 1" 330' GRID NW 057 Project No. 22-373 Rt 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone oo�Op�O (907) 522-4625 Fax =gyp F q Professional Land Surveyors kenolangsurvey.com c ��4 ,9 � jonathan*langsurvey.com 4� .• S Q I hereby certify that I have surveyed the following described property: LOT 6, BLOCK 4, HYLEN CREST SUBDIVISION, UNIT No. 3 (Plot No. 83-114) 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 premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated this the 15 Day of Tu ',4 'b'2,L at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH �••.N*q KMNET G.LA,N•Q7 0 4P,�p•.j.S-5202.•'o�JOG 40����SSIONA� �o AECC963 M �,,4\4° �I�9 Municipality of Anchorage Page of 0\1, �OARTMENT OF HEALTH AND HUMAN SERVICES Vc�ENVIRONMENTAL SERVICES DIVISION . Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: _,SW 9L,018,4 PID Number: 0 5 - 41 "- ZO Name: CRANIc-EAKEP, Wastewater System: C$ New ❑ Upgrade Address: + /j /� / 32 Er� d 995 ABSORPTION FIELD Phone, 94 /9,5 MSS No, of Bedrooms: _ RYDeep Trench ❑ Shallow Trench ❑ Bed ❑ Mound O Other LEGAL DESCRIPTION Soil Rating: O� Total Depth from original grade: GPD/S . Ft. Lot: /BSubdivision: 6 #__� Depth to pipe bottom from original grade: Gravel depth beneath pipe 4/lock: /r'IYLLR % Ft. 9v Ft. Township: / I Lf—JY Range: / Section: Fill added above original grade: Or S Gravel length: r Ft. Ft. WELL: El New ❑Upgrade Gravel width: Number of lines: Distance between lines: / 113 Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area:// Pipe mater l: ; D DELI � Ft. Ft. 5l0 SQ. Ft. Driller: Da Static Water Level: Installer CGC i�ONST. Date installed: 0�/9 9la Ft. Yield: ump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES iSeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lin Holding RYWWPrivate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines g. I r 40 well - I i 2 v � Z12o N/A NIA r/00I Material: TEE L Number of Compartments: wai re f /00 r N A LIFT STATION Lot Size in gallons: Manufacturer: Line J Foundation /O/7 _O / V . //� /v "Pump on" level at: "P 'level at: High water alarm at: Curtain ^'/A Pump Make el Electrical Inspections performed by: Drain / Remarks: BENCH MARK Location and Description: Assumed Elevation: 1(�901 o �NGIN�ER'S S�A4,, i,.k J �pp Inspections performed by: /2 S Dates: 1 s � � 13 2nd C. e J Department of Health and Huma=Date: es approval Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 Permit No. SW 960184 Page 2 of 2 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: HYLEN CREST a3 L6 BLK 4 PID No.: 050-474-20 STEWART DRIVE 62.43 37.00 S 89'45'0' W N 8(•15' 0' W 15' ELEC. l4 TELE. EASEMENT 1 SWING TIES 9\� A -C = 16.3 3 �\O B -C = 40.3 X A -D = 31.4 Z` B -D = 46.2 �N N W �o N �0 HOUSE 1250 GALLON 9 A _.i SEPTIC TANK • - MONITOR TUBE o - SEWER CLEANOUT — — - EASEMENT - LEACHFIELD ReNCN SCALE 1"=40' 10' UTILITY EASEMENT 97.00 N 89'59'0' W 7/2.3/96 ELEVATIONS n TOP OF REHAR, sw cGR ENGINEER'S SEAL 00000Op�4 Asu SLIMED ELEv = 100.00 0 (NOT TO SCALE) _o O ORIGINAL a oo�P'' F. q'�S�O4 GROUND 14 LEVEL AT, m O rt J; 49 TH '�d000 0.5' ADDED FILL Q ....: ...... ..... .:. ............ ...D 3' NO GWT P -7 TANK96.4 0'.LOUIS A. BUTERA �O 119.3 19.1 111.4 111.4 004 S CE -6786 �QO 102.3pRDFESS��NP����o 4 0 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES 1S� P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960184 DATE ISSUED: 7/11/96 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES. EXPIRATION DATE: 7/11/97 OWNER NAME:HYLEN CHARLES S OWNER ADDRESS:10235 STEWART DR EAGLE RIVER, ALASKA 99577 PARCEL ID:05047420 LEGAL DESCRIPTION: HYLEN CREST UNIT #3 BLK 4 LT 6 LOT SIZE: 20027 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 `PHIS PERMIT IS FOR THE CONSTRUCTION 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 (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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: RECEIVED BY:"t' DATE; ISSUED BY: 7- / / - ; 6 DATE : 7` /( -� Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax May 17, 1996 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Hylen Crest #3 Lot 6, Block 4 Narrative & Permit Application Dear Mr. Cross: The proposed septic ystem will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity and public water supply. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. 'r Sincerely, Louis Butera, P.E. \1996\96 -027A -NAR SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Hylen Crest #3 Lot 6, Block 4 05/17/96 A. GENERAL 1. The septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot tine position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. B. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 12' at any point. 4. The effluent line within the trench shall be laid level within 0.03' . 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any connnunity well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 12' GRAVEL DEPTH = 9' under pipe, 2" over pipe TRENCH LENGTH = 42' TRENCH WIDTH = 3' SOIL RATING= 0.8 GPD/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK = 1,250 gallons, MOA approved Twenty-four (24) hours notice required for all inspections. \ 1996\96-027a-spe o�Z NO WELL SEPTIC +30' A ti m / +10' 2,06 RESERVE AREA STEWART DRIVE o N o - SEWER CLEANOUT 62.43 S 89°45'0' W EASEMENT DRI Vf b, y NO WELL SEPTIC +30' NO SURFACE WATER NO KNOWN CURTAIN DRAINS o�z 250 GALLON iEPTIC TANK 15' •J UV.)cIln ELEC. & TELE. EgSEp1ENi— 2o - PRIVATE \ \ � 4cc ESS egSEMENT 10' UTILITY EASEMENT - TEST HOLE • - MONITOR TUBE o - SEWER CLEANOUT — - EASEMENT — — - PROPOSED LEACHFIELD - EXISTING LEACHFIELD ,SEPTUC UC S� Il E 'i --)LAN LEGAL: HYLEN CREST #7 LOT 6, BLK d - OWNER: N/A CONTRACTOR: NIKE QUINN CONSTRUCTION JOB# 96-027A DATE: 05/17/96 SCALE 1" = 40' EAGLE DIVER ENGINEERING SERVICE'S P.O. Box 773294 EAGLE RIVE'R, AK. 99577 (907) 694--5995 FAX: (907) 694-3297 Aw '%P, ofAV i * : 49 49TH i.........� ....... ...0. �A jo �O c LOUIS A. 13UTERA e CE -6736 �_= • dl PROFESSIONN\' ♦' Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-32.97 fax Hylen Crest ##3 Lot 6, Block 3 05/17/96 Single Family, 4 Bedroom Residence 4 BR x 150 gpd = 600 gpd Percolation rate 8 min/inch = trench application rate 0.8 gpd/SF 600 gpd / 0.8 gpd/SF = 750 SF 750SF / (9 x 2) = 42' trench length Recommended trench dimensions: Total depth = 12' Gravel depth = 9' Gravel width = 3' Gravel length = 42' \1996\96 -027A -au. M1 se aaxpn ¢ '? G ¢Ann ee®e.o 90 n¢aaom Au oAA Avon•.. '�} iP "a Ci SYS;:$ 'siyr \1996\96 -027A -au. it t clN PrNE EAt) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES - - 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG , PERCOLATION TEST D 4 III.INRY II IYIU90N Q PERFORMED FOR: C-/4� LL' " A l DATE PERFORMq @; nn0:5sI0"l LEGAL DESCRIPTION: L-Ao L) t DEPTH (FEET) 0i3QY1^C. /I 0c10, 1 15t�� 2 3r 3 , 4 5 6 i 7 PerC LL 8 9 10- 11 12- 13 14 15- 16 17 18 19- 20- COMMENTS 920COMMENTS — Township, Range, Section: 5Ut%q 58 -M-N FIlk) SLOPE 0� 0 SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT 0 DEPTH? — _ P — E — Depth to Water Alter Monitoring? Date: Reading Date Gross Time Net Time Depth to Net Water Drop _T-- Y'\Nry- - pt 7317-L S rn I C� M I r 05/66" fi 5A 6" r r bl PC-RCOLATION PATE _ (minutesn n/Lch) PERC HOLE DIAMETER TEST RUN BETWEEN __ — FT AND -L--- FT PERFORMED BY: CERTIFY _ �- � � J-��-� 1s-- I — � CERTIFY THAT THIS TESTq WAS PERFORMED'IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72.008 (Rov. 4/85) Municipality of Anchorage _ DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ® VJC ©© 0. PERFORMED FOR: G/�LL' "Al.t-�l�i '"jam C-U� /� ®p" ��. �' ,s a� (�NM n DATE PERFORNT$ (o a40,� c'5e,/4�- Townshim Rance. Section:'5e,/4SR Tl4 N �IL� LEGAL DESCRIPTION:__�1 DEPTH (FEET) 3 0y3QyNC/((DY), l�- 2 3 4 5 6 7 C --L• 8 9 10 11 12 13 14- 15 4 15 4 16 17 4 13 - E �a 19- 20 COMMENTS a t 14, s':�y,c1 140. 173" kaw4&j9" SITE PLAN ■EEE EEE MEN mmm AN IMPEE IMMEN MEMO MEMO EEE MMES WAS GROUND WATER ENCOUNTERED? N J s t. IF YES, AT WHAT DEPTH? P E Depth to Water After Monitoring? — 1'*7 Dale: �61 - PERCOLATION RATE � (mmutesmch) PERC HOLE DIAMETER _ T5T RUN BETWEEN S FT AND -L--FT ,,,/� LG7SV4IL�-h IPERc, 1 -ote ?t rZIDOL_ TO TSS%' //IA) PERFORMED BY: S c �J�l3'1 f I LC _ CERTIFY THAT THIS TEST WAS PERFORMED'IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 314-194- MUNICIPALITY OF ANCHORAGE Development Services Department rte Phone: 907-343-7904 On-Site Water & Wastewater Section — Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 050-474-20 Expiration Date: 7" 2- I q 1. GENERAL INFORMATION Complete legal description Hylen Crest #3 Block 4 Lot 6 Location (site address) 10235 Stewart Dr Current property owner(s) Rami & Heather Jasser Day phone 230-9390 Mailing address 10235 Stewart Drive, Eagle River, AK 99577 Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 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 Q Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment /6-/�- /57 Date of Payment Receipt Number 07 q Q Receipt Number COSA# ( M 3 S 0 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 Forge Engineering Phone 907-522-7773 Address PO Box 240773, Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 10/15/18 .��®0000 OF �k . • ,0 �d0,P. ' 9 / •.• .. 6. DSD SIGNATURE .t-1 1 ?. rp_ XSystem #1 Approved for bedrooms i ! 5;.! I,Benjarrttri chiller . System #2 Approved for bedrooms �� �`�%•••. 10/15598,.••��• ��� Disapproved � kI�F�/'ROFESSO.\ Conditional approval for bedrooms, with the following stipulations: ...- ..,./.. ,___t_el; f n��tC.. t Z2 ewes 0(a� A- vo-IL0.-9-0 ...V-00 oal a ‘‘...zo .c.fric--t,,,v1• 7& 2_,D,,,av, 6 5)1...ci Q '��� Ur AND., WPRPNRD Ro ,m 1GE ASiR a . s:. P � �-o -go, A\G NT SE =y: C t� r- Original Certificate Dated D/(—le 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—ctiv& 1-d&Sr'afy 1.t COSA Checklist blue sheet If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Hylen Crest #3 Block 4 Lot 6 Parcel ID: 050-474-20 A. WELL DATA Well type Public If A, B, or C provide PWSID# Well Log (Y/N) Date completed Sanitary seal (YIN) Wires properly protected (Y/N) • 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 Septic/Steel Date installed 7/19/96 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) NA Date of pumping 7/2/18 Pumper One Stop Services C. ABSORPTION FIELD DATA Date installed 7/13/96 Soil rating (g.p.d./ft2 or ft2/bdrm) .8 gpd/sqft System type Deep Trench Length 42 ft. Width 3 ft. Gravel below pipe 9 ft. Total depth 13 ft. Eff. absorption area 756 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10/10/18 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 65 in. Water added 750 gal. New depth 84 in. Elapsed Time: 1440 min. Final fluid depth 62 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed N/A 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: Septic tank/lift station on lot N/A 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 >10' Property line >5' Absorption field >5' Water main >1 Water service line >10 Surface water >100' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line Building foundation 10 Water main 10 Water Service line X10 Surface water �100� Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION -��d�Z130i I t"®1- 144. �4� certify that 1 have determined through field inspections and d • rJ ���"•• t review of Municipal records that the above systems are in Ak;f-� YI conformance with MOA COSA guidelines in effect on this date. w Ø . j tt-; Benjamin Schiller, PE .,..,•,-;-:-:, -- Engineer's Printed Name41, ;,._.._.. , 10/15/18 :-. -. .: MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT �' • I' �ti ,..1.. 907-343-7904 On-Site Water and Wastewater Section ` Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181550 Subdivision: Hylen Crest#3 Block: 4 , Lot: 6 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 22 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. ' -vot,ir -..;, ,,,,r7—:;174-ck-S---4Mici .,:— '':,Ifilt —' :1'4: — ,‘;': , I Y �ti? hem AC: 1116C.."''' w-;%' d' -w A ' t 0 F' .°`..,---0. ° rr " '? .baa 1.4t, ir y..-a'. , . , *N-40.., - tot i, , -1,,,-,, , -11 ', .,.... • , -3 "r 4_. 44:48 .,.. a. t+r tai Y+ • A �/ 'i„ 3la-., e � i�eII Mailing Address:P.O.Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. os0-474-20 COSA #330-M1041 Expiration Date: 1 1. GENERAL INFORMATION Complete legal description Hylen Crest #3, Block 4, Lot 6 Location (site address) 10235 Stewart Drive. Eagle River Current Property owner(s) Stephanie & John McShane Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System KM TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 100217 Anchorage AK g45io Engineer's Printed Name Steven R. Pannone. P.E.Date 2/232012 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail ant satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. S. DSD SIGNATURE �.J / Approved for i bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory By:t�' (Rev. 11105) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: �7 Z Municipality of Anchorage P Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HylenCrest #3 Block 4,.Lot 6 ParcellD: oco-47420 A. WELL DATA Well type AWWU If A, B, or C provide PWSID # Date completed _ Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date t Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L. Well Log (Y/N) Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Arsenic: ug/l Date of sample: Co lle by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Seeptic / Steel Date installed 7/13119a6 Tank size 12co gal. Number of Compartments z Cleanouts (Y/N) Y Foundation cleanout.(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 6/13/2o11 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 7/13Lga6 Soil rating (g.p.d./ff or ftz/bdrm) o.8 gpolsf System type Deep Trench Length 42 ft. Width ft. Gravel below pipe g ft. Total depth 12.25 ft. Eff. absorption area 7-,,6—ftz Monitoring tube Y Depression over field N Date of adequacy test 611312o11 Results (Pass/Fail) Pass For g bedrooms Fluid depth in absorption field before test 5z in. Water added615 gal. New depth64 in. Elapsed Time: 4o min. Final fluid depth r in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION @ate-iactalled "Pump on" level at Datum Size in gallons in. "Pump Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit On adjacent lots On adjacent lots Public Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10 Property line i3 Absorption field 10+ Water main 2c+ Water service line 10+ Surface water 100+ Wells on adjacent lots zoo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line io+ Building foundation 10+ Water main 25+ Water Service line 20+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots zoo+ F. COMMENTS G. ENGINEER'S CERTIFICATION I 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. Engineer's Printed Name Steven R. Pannone. P.E. Date z+21/2012 COSA Fee $ Date of Payment � -/Z� Z� Receipt Number 13 ( ' 7� L( (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number R. Pann< CE 8149 0 I$ Q rr_• pf • 0 • ASBUILT SEWARD 6 ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCh' FOLLOWING DESCRIBED PROPERTY+ HYLE.t�c�f'I�TjGt�Ge✓/Y'No �� OF A��� i �,9 .�Gal6 eSYy AND THAT NO ENCROACHMENTS EXIST EXCEPT AS= DATE+ 9� <<G•...... jr,`P; • '• .5,��� INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID= y • ' •• •••• ••.d EASEMENTS, COVENANTS, OR RESTRICTIONSu..••'�t— WHICH •• DO NOT APPEAR ON THE RECORDED SUBDI- ;%,"e VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FB= m6A S.w. E 1�'•. 15-6918 g Ar FOR CONSTRUCTIONOF . INES, OR FOR ESTABLISHING BOUND- DRAWN: a�� .... ARF LNNES.CE *RMwrt' -qr:l--Ps Municipality of Anchorage ' Development Services Department ##ee Building Safety Division On -Site Water 6 Wastewater Program 4700 Bragaw Street P.O. Box 196650519 7/V /1 Anchorage, AK 9lonsit 650 i __ Q i✓ w (907) 343-7 onsite �` J�^,'(t (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING H Parcel I.D. 7) 5t) -LiaU- COSA# D' L 71 1. GENERAL INFORMATION Expiration Date: I U - ,z w :!_0 S Complete legal description HYLEN CREST 1/3. LOT 6 BLOCK 4 Location (site address) 10235 STEWART DRIVE • EAGLE RIVER AK 99577 Current Property owner(s) CRAIG KEPPERS Day phone 622-1023 Mailing address 10235 STEWART DRIVE * EAGLE RIVER AK 99577 Lending agency Day phone Mailing address Real Estate Agent Mailing address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 riles 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 Finn * GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name DONNA C. MEARS Engineers Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiablo features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may nuctuato during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benofit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for __4_1 bedrooms. Disapproved. Phone 337-6179 Date 10 ZZ 67 * :' 4()IU )IU**'** v'I •'� nno C. Mler's CE- 113 � •a Conditional approval for bedrooms, with the flowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other G� .• O ONSITE WATER AND •; WASTEWATER PROGRAM By: ��' l �F Original Certificate Date: (Rw. 11105) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater program 4700 Bragaw Street P.O. Boz 19WW Anchorage, AK 99519.8850 www.muni.org/onatte (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: _ HYLEN CRK§U,.3 CREST,.LOT 6 BLOCK 4 Parcel ID: 0-5-0 L%' 7 2-0 A. WELL DATA PUBLIC WATER Well type PUBM If A. B, or C provide PWSID# 2132289 Well Log (Y/N) Data completed Sanitary seal (Y/N)_ Wires property pr /N) Total depth ft. Cased to ft. C eight (above ground) In. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. ucdon g,p,m g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./L. Other m Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material _ SEPTIC/STEEL Date installed 7/19/1996 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 7/25/2007 Pumper JRS PUMPING C. ABSORPTION FIELD DATA Date installed 7/19/1999 Soil rating .p.d. ft'/bdnn) 0_8 System type DEEP TRENCH Length 42 ft. Width 3 ft. Gravel below pipe 9 ft. Total depth • 13.1 ft. Eff. absorption area 756 ft' monitoringtube YES Depression over field NO Date of adequacy test 10/18/2007 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth in absorption Heid before test 50 In, Water added 740 gal. New depth 67 in, i Elapsed Time: 900 min. Final fluid depth 48 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed "Pump on" level at_in. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump ofP le 1 �� Hlgh water alarm level at in - Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic lank/lift station on lot Absorption field on lot Public sewer main Sewer /septic PUBLIC WATER On adjacent On adjacent lots sewer manhole/cleanout Holding tank containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 25'+ Water servioe line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 2 Property line 10'+ Building foundation 10'+ Water main tor Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION �C�.• """' �"Is I car* that I have determined through field inspections and .. 491b v review of Municipal records that the above systems are in /r conformance with MOA COSA guidelines in effect on this i! jnn4...... date. .'., Donn., C. ors DONNA C. MEARS 4 CE -11135 Engineer'sPri��A 2 p,+r '•..�o:Zz�?••' � Date 12J r ad Profyssa^d COSA Feet y✓? �'�� Waiver Fee $ Date of Payment I n / L1 % Date of Payment Receipt Number 9 i Receipt Number (Rev. 11105) TOT o +++fi• T ;€! rx' _ } gg y�r Zm v -vu u ur vu4Y,r CC , • 4 F yl ca l ( � •-i LAO. CD -' •—L'J ae 1. ,,_� i c/ ? \ Y cn CD mww • yy 1� a ......... P All R-�L1F � Z � 'i€�3a�a:ap��a�a�avE4EfzRbs Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 05'O - -/744 -9 O 1. GENERAL INFORMATION HAA# ddn�Losczo Expiration Date: te — O 3 Complete legal description 6, / P/ 'I? Location (site address or directions) ��� 3� SfcYl�i9r7� �r ., Z..:Z /--- iii era; 4Z Current Property owner(s) frr9n /-d Re- he 4.41 Day phone e' %y 'Y388 Mailing address Po•&,,e 77/: 3? E.v�/� /Qijr�r, Xlf 495_77 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSO for pickup. 2. NUMBER OF BEDROOMS: -4/ 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System (� TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm _z9nsce,A75 Phone 907-7f/'Z-/09s Address 9"! eo Engineer's Printed Name 19oe" � /43 T 7S e /rH Date -7,71.0 Z a 5. DSD SIGNATURE �I,D000CE8176 Approved for bedrooms. 14�;fi�rc�rSA��� Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments WASTEWATER V. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other In By: /"� Original Certificate Date: (R. , 01=) Municipality of Anchorage •°, • Development Services Department Building Safety Division On-Sfte Water & Wastewater Program • r 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-650 www.d.anchorage.ak.us (907) 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L->' .4e "y A&4 B� e-rW%1 ' �� Parcel 113:0,C7 ' y7i -� — I A. WELL DATA Well type via<�c Date completed Total depth R. Date of test Static water level Well production WATER SAMPLE Coifform sample: If A, B. or C provide PWSID # z/3 Z Of Well Log (Y/N) Sanitary seal (Y/N) Cased to R FROM WELL LOG ft g.p.m. ies/100 mi. Nitrate mg.A. Collected by: B. SEPTICIHOLDING TANK DATA Wires properly protected (Y/N Casing height (a round) In. AT IN TION R. 9— p.m- Other bacteria colonies/100 ml. Tank Type/Material Date installed��� tA,4 Tank size /Z 0 gal. Number of Compartments .Z Cieanouts (Y/N) Y Foundation cleanout (Y/N) ,,,V Depression over tank (Y/N)'il High water alar (Y/N)^ ✓.s Y /B Date of pumping -,ft%= so/ Pumper ✓Afx S/ G C. ABSORPTION FIELD DATA Date installed 7f/ 0 Soil rating (gyp d`Al? or #K%dfm) System type T sa/t4/ Length ;KA R. Width 3 ft. Gravel below pipe 9 R. Total depth /3 `R. ER. absorption area Ze4C IF Monitoring tube y, Depression over field Al Date of adequacy test✓e�AoA Results (Pass/Fail) pass For -/ bedrooms Fluid depth in absorption field before test _Z in. Water added A�Bgal. New depth 6/ in. Elapsed Time: 40 min. Final fluid depth r6yin. Absorption rate >= 440,0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) Al If yes, give date D. LIFT STATION Date Installed Size In gallons Manhole/Access (YIN) 'Pump ono level at _ in. 'Pump air level at i4A—+fi er alarm level al In. Cydes tested Meets alarm b circult requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanWWWtatlen on lot oo "fi On adjacent lots _ zoo ~A -f Absorption field on lot �f� On adjacent Ints Public sewer main �ublic sewer manholeldeanout '�/o Sewer/ ep c service line �l4 Holding tank A�1A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation / / C/-- Property line Absorption field Zojc;A Water main Xs "A> Water service line f Surfacewater i©o siFjl Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / Sof Building foundation 10 ft Water main L S W Water Service line /0 +'`A Surfacewater 147014-4;4 Driveway. parkinplvehide storage 710 AJe.l1d ..C.aJoc7.aJ Curtain drain f S.rts/ Wells on adjacent lots ,�o1F� F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through Reld inspedlons and review of Municipal records that the above systems are In conformance with MOA HAA guidelines in effect an this date. Engineer's Printed Name 4t-104,101'"-hrcA/z E Date `Z� o Z HAA Fee $ —6-76-, co Waiver Fee $ _ Date of Payment%� 3/D 2l Date of Payment Receipt Number a 9,9 a i Receipt Number (Rev. 12/00) Of. A GEMf7® 4. A Parcel I.D. # MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services qti On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-474-20 HAA # 1. GENERAL INFORMATION Complete legal description Hylen Crest #3 Lot 6 Block 4 Location (site address or directions) 10215 Stewart Drive, Eagle River Frank Rakar Property owner Mailing address P.O. Box 771232 Lending agency NorthRim Bank Mailing address 3111 C Street, Anchorage, AK 99503 Day phone Day phone 562-0062 Agent n/H Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site x 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. 1/01) Front MOA X21 LZU NOW HWq M/l'noy) SZO-bL •�aom sdaeul6uo leuolssa}oad ay} ul suolsslwo ao sAoaaa ao} apsuodsai IOU sl a6eaoy0uy }o �llledlolunyj ayaeo a aao}aq elep az/leue jo suoiloodsul lonpuoo IOU op SHHa }o saaAoldw3 •sluawaainbei elels pue leaapa} uleljao A}slles of iepio ul suollnllisul 6ulpuaj jlagl pue sawoy}osaaseyoandol�(selanooeseslylsaopSHHQayl eilsely}oa}elSay}ulpaaalsl6aiaaaul6ualeuolssa}oad luapuodopu! ue Aq anoge 9 ydea6eaed ul uan16 suolleluasaidaa ayl uodn llluo paseq saleolpl.)ao Ienoiddy Allaoylny ylleaH sanss! (SHHa) soolmaS uewnH pue ylleaH po luawliedaa a6eaoyouy }o LCllledlolunW ayl :suollelndlls bulmollop ay} yllM 'swooapaq l �3 i F �`y K ••paeo4+r dw rvr4�; ro 0,�}J n t V sluawwo0 leuolllppy aop lenoidde leuoillpuo0 swooapaq C 7 74 •pano.iddeslp aop panoiddy 3univNJIS SHHa aanleu6ls s,aaaul6u3 ssaappy S61S-b69 auoyd Saozn.aag u-r.zaauT ug zantg a L eg wall p0 aweN •uolloodsui siyl po alep ayl uo loage ul suoilelnbai pue 'saoueulpao 'sapoo alels pue lediolunw Ile yIIM aouelldwoo ul sl walsAs lesodsip aalennalsenn ao/pue Alddns aaleM alls-uo ayl'uolloadsul pue uolle61ls9nu1 AW woap pue sal!} a6eaogouy po AllledlolunW ayl woa} poulelgo uolluwaopui ayl uo paseq leylA}!aanaaylan; I •uiaaay pa}eolpul aanlonals}o adAl pue swooapaq po aagwnu ayl aop alenbape pue leuolloun}'apes sl walsAs Iesodslp aalennalsum ao/pue Alddns aalum ails-uo 9LIl leyl srnoys uolleolldde lenoiddy Al!aoylny ulleaH s!ql po u011e6ils9nul AW ley} A}!aan I 'molaq umoys alep uo!lep!len aql }o se pue olaaay pail}}e leas Aw Aq palplaao sy H33NIJN3 AS N01103dSNl d0 1N3W31t/1S m .9 GNVIRONMENML SERVICES IJIVISIcj,4 CCT 2 1 1996 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERRECSE I VE D Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: �� ti/ (r' /Z��T � Parcel I.D.: Q SO —47,ef 2-o A. WELL DATA .61-0e e /f Well typeU13L• /C� If A, B, or C, attach ADEC letter. ADEC water system number Z/31? - V Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE Date completed Cased to FROM WELL LOG Coliform _'efof Nitrate Date 13. SEPTIC/1'16LIiG TANK DATA Casing height (above Wires properl rotected (Y/N) g.p.m. Collected by: AT INSPECTION Other bacteria g.p.m. Date installed 07 �9Cv Tank size /,- JO Number of Compartments - Cleanouts (Y/N) %S Foundation cleanout (Y/N) _ yL Depression (Y/N) Ate_ High water alarm (Y/N) IVIA Date of Pumping G kl _ pumper C. ABSORPTION FIELD DATA ��� f ))r,cA Date installed r� r %�Ui Soil rating (g.p.d./ft2 er-f 4&--m) (%i System type_%/2zFIle- 1 Length 4 7. Width Gravel thickness below pipe 9 _ Total depth / Z / Effective absorption area 75Ze Monitoring Tube present(Y/N)) E0Depression over field (YM) AOL Date of adequacy test I-VAe5 w Results (Pass/Fail) PA Ss For -4- bedrooms Fluid depth in absorption field before test (in.); IN/LA Immediately after= gal. water added (in.): — Fluid depth IVIA (ins.) Minutes later: Absorption rate = g.p,d, Peroxide treatment (past 12 months) (Y/N) N//k _ If yes, give date D. LIFT STATION /v/ Date installed Manliole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in *Datrun at* "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: /\//A Septic/heltftng tank on lot Absorption field on lot Public sewer main Sewer /sentie-ge'rvice line On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/He6l NG TANK ON LOT TO: i Building foundation Property line _ Absorption field 710 Water main/service line 3S Surface water/drainage HOO Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 710 Water main/service line t1,911 t Surface water 7��� Driveway, parking/vehicle storage area AVE Curtain drain AePARaT Wells on adjacent lots Property line/; F. ENGINEER'S CERTIFICATION f certify that I have determined thru field inspections and review of Municipal t ecoYds• that tl?e ahave ysle/ns are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name �CJU/i UT��4 / °, Eiigii eerixi' LI lbfi Date l '1 Citi' HAA Fee $ 3 " t Date of Payment )D_ hw Receipt Number r�7_ '� 6?—V L2_ ZY_D Rev. 8/95 OSS: liaa.wk.doc Waiver Fee $ Date of Payment Receipt Number