HomeMy WebLinkAboutHYLEN CREST #3 BLK 4 LT 7Hylen Ceest
Block 4
Lo1- 7
#050-474 21
Municipality of Anchorage Page / o! ~--'-,
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: '.-~/ ~' ~-~ ? PID Number: 0~;0 - ~ - ~ /
~"~:Wastewater System: ~New D Upgrade
Address:
/~ ~c~ ~, ~ ~/~ A~ ABSORPTION FIELD
~ NO, of Bedrooms:
Phon ?~ . ~ ?~] ~ ~ Deep Trench ~hallow Trench ~ Bed ~ Mound ~ Other
Total Depth from original grade;
LEGAL DESCRIPTION so,,.,,~: ), ~ ~s~.~. ~,0 ~ '
Lot: ~ Block: ~~/~ ~ ~Subdivisl°n: ~ ~ Deplh to pips bollom~/from~origlnal glade: Fl, Gravel depth beneath pipe~ ~ Ft,
~ Range: ~ Fill ~dded above original grade: Gravel length:
Township: /~/ / ~]Sectl°n: ~ /, ~ Fi, 5U Ft.
WELL: U New U Upgrade ~ Gravel ~: N}~z~ Ft. Number of lines:/ Dist.; ~lw~n lines:~ Ft.
Classification (Private, A,B,C): rotal ~' Cased To: Total absorption area: Pipe materiel:
- ~' Date Drilled: SlaticWater Level: Installer: Date Installed: /
~leld:~/~GPM Pump Set at: Fl, Casing Height Above Ground:Ft. TANK
SEPARATION DISTANCES ~¢ic u Holding D S.T.E.P.
To Septic Absorption Lilt Holding ~rivale Manufacturer: Capacity in gallons:
Material: Number of Compadments:
Sudace
w.t~r ~/~ ~/~ ~/Z ~/~ ~// LIFT STATION~~
Lot / Size In gallons: Manufacturer:
Line ~ / /~/ ~ ~)~ ~1 _ I ~ ~'~
Foundation 7 / / ~/ ~/~ ~//~ ~/~ "~ump °n" level at: [~nP'~if" level ah I High water alarm at:~
Curtain ~/~ ~/~ ~/// NJ/ ~/~ Pum~]" [El~trical Inspections performed by:
Drain
Remarks: BENCH MARK
Locallon and Description:
A~umed Elovatlon:
ENGINEER'S SEAL
Inspections performed by: ~ ~ ~ ~ Dates: 1st ~/~ Z / ~
:? ~p,¢:, '.';;; ,~,'.' h ' ~:
Department of Health and Human Services approval
Reviewed and approved by: -~ ~(~ Date: ///4/,~ '~'
72-013 (I/gt)MO^ ~5
Permll No,
2 2
$W930259 Page ol
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Sile Wastewaler Disposal System and/or Well Inspection Report
Legal Description: Hylen Crest ~3 Lot 7, Block 4
PIDNo.: 050-474-21
ELEVatiONS
15' ~£C, &TELf. E4S~t,IENT
10' UTILITY EASEHENT
i 11000
l! 89°59'0· w
(NOT TO SEALE)
~ Iflp oF REBAR ~ S~ L~!
^BSUNED ELEV = leO,O0~
'
m
SWING TIES
A -E = 41,8
g - E = 88,6
/~ - ~g = 49.5
B - "D = ~5,6
A - E = 18.6
B - E = 60.8
A - F = 68.1
B - ~- = 30.1
· - MONITOR TUBE
o - SEWER CLEANOUT
~,- - WATER KEYBOX
~n+H++~- LEACHFIELD
.... EASEMENT
SCALE 1" = ~0'
724) 13 A {2/91) MOA 2,5
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930259
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:EAGLE RIVER VALLEY DEV
OWNER ADDRESS:P.O. BOX 141907
EAGLE RIVER, AK 99577
DATE ISSUED: 7/27/93
EXPIRATION DATE: 7/27/94
PARCEL ID:05047421
LEGAL DESCRIPTION: HYLEN CREST UNIT #3 BLK
7
4 LT
LOT SIZE: 20229 (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 (18AACS0).
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:
INSTALLED SYSTEM SHALL HAVE 3.5 FT. OF GRAVEL BELOW THE
BOTTOM OF THE PERFO~T~D~ PIPE~/~._/~
RECEIVED BY: fz3~~'~
DATE:
DATE:
Louis Butera, P.E.
Registered Civil Engineer
July 16, 1993
John Smith, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Ancfiorage, AK 99519
Re:
Hylen Crest//3, Lot 7 Block 4
Narrative
Dear Mr. Smith:
The proposed septic system will have very limited impact on adjacent properties for the
following reasons:
1. Lot sizes are large allowing sufficient room for septic sites and limited
contamination potential.
2. This lot and surrounding developed lots utilize a public water system.
3. Immediate neighboring septic systems are all +30' distance.
4. Reserve space is adequate, due to lot size.
5. Drainage will not be affected and is not a major consideration in our design.
The septic system for this lot is designed to be installed on a 30% (16°) slope. We require a
variance from the 25% maximum as there are no areas on this tract that are below 25%. The
30% area is the best possible area for septic field installation based on our on-site investigation.
The soil type shows an adequate percolation rate and the slope is not overly excessive as to
where effluent surfacing would be a concern. It has been our experience that 5' wide systems
on similar slopes operate satisfactorily on existing systems in Eagle River. The slope below the
system is naturally vegetated and there are no homes or wells below the proposed site. Based
on this we would support your approval of the system as designed.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\1993\93~047A.NAR
P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 , F~ (907) 694-3297
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Lot 7, Block 4 Hylen Crest #3
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
and State Department of Environmental Conservation 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, Department of Environmental
Conservation 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 line position and
the location of any easements.
Bo
DRAINFIELD
1. The drainfield is to follow the natural land contour to maintain uniform total
depth of the drainfield bottom.
2. The bottom of the drainfield shall be level, plus or minus 1~5"..~-~)
3. The total depth of the drainfield excavation is not to exceed.. 6.0' a~J..dny
point.
4. The sewer line is to be stepped down the hill at 45° steps tb6"Ia-'fik location, 10'
section preceding tank to be at 2% maximum.
5. The drainfield gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 4' or
equivalent is to be placed over the leachfield. Insulate sewer line under
driveway.
7. The area over the drain field 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 co~nmunity well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 6.0' GRAVEL DEPTH = 3.5'
DRAINFIELD LENGTH = 54' DRAINFIELD WIDTH = 5/_~
SOIL RATING = 1.2 GPD/ft2 BEDROOM CAPACITY =it/~4J
SEPTIC TANK = 1,250 mini~num
Twenty-four (24) hours notice required for all inspections.
\1993\93-047A.SPC
EAGLE RIVER
ENGINEERING SERVICES
P.O, Box 773294
EAGLE RIVER, AK 99577
(907) 694-5195
JoB Hylen Crest #3 Lot 7, Blq~ok 4
SHEET NO.
CALCULATED BY.
CHECKED BY,
SCALE
OF
L.B. DATE 07/16/93
DATE
Septic Design Calculations
4 Bedrooms = 600 gpd
Percrate= 1.2- 1.9 rain/inch
Application rate for 5' trench system = 1.2 gpd/ft2
Four bedrooms = 1,000 + (4-3) (250) = 1,250 gallon tank' ': ....: i .... : ....
Waste generation = 150 gpd x 4 bedrooms := 600 gpd
~2~fsq
Required area = 600 + 1.2 = uare feet
/
For a 60'~ wide trench with 42" of rock~ reduction is ~/%
500 + 5 x 0.54 = 54' of trench
Drainfield dimensions:
Depth of gravel = 3.5'
Total depth = 6.0'
Length 22_ 54'' ' ' '
Width = 5'
/ eo, o~. -~__
~ , TH~ TH~I~
N 89'59'0' ~
UNSUBEIVIDE~ ~ - T~S~ HOLE
VACANT · - MONITOR TUBE
o - SEWER CLEANOUT
NO SURFACE WATER +100' ~ - WATER KEYBOX
~',]]]',~]~- PROPOSED LEACHFIELD
NO KNOWN CURTAIN DRAINS EASEMENT
S E PT I C S I T E P LA N '
LEGAL:
LOT
ELK
4
HYLEN
CREST
OWNER: E.R. VALLEY DEVELOPMENT
CONTRACTOR: HAMANN CONSTRUCTION, INC.
JOB ff 93-0471 DATE: 07/16/951 SCALE 1" = 40' "'~-V~ ...
P.O. ~o~ 773294 ~,~/~x ...... -,t~ ....
EAGLE RIVER, AN. 99577
(SOU eS4-5~5 r~X; (SO~)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEER'S SEAL)
2
3
4
5
6
7
8
9
10
11
12
13-
14-
15-
16~
17
18
19-
20-
rm~r>lu~l
COMMENTS
DATE PERFORMED:.
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED;'
SITE PLAN
IF YES, AT WHAT kl/,-. 0
DEPTH? I ~ p
E
Bepth Io Waler Aller ,
Monllorino? [:;~Y--'I"' Bale: "7-I~,
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE / / ~'' tmJnules/Jnch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~" FT AND ~ FT
MP~IrI'61~.TUI~F. IqJT41~£D 'fo
PERFORMED BY: ~ I ~ , CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; ~////~/~' J~
72-008 (Rev 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG-- PERCOLATION TEST
(ENGINEER'S SEAL)
PERFORMED FOR: ~'~' 9'~l~'l'~Y
· E~A. OE~..,T.ON: H~-¢M ,:::r-c-~'r'¢,5,, L1 6/-t
1
'3
4
5
6
7
8
g
10
11
12
13
14
15
16
17
19
20
COMMENTS
DATE PERFO"MED:, ~-q'q5
:township, Range, Section:
SLOPE
Ol'Z..~A hU C.
6.H Flbb~url ~)[HSF.
SITE PLAN
'FF,,$1- Ho~-¢ ;¢ I,
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
,TA
Depth to Water Altar, ,
m,,o,,¢ MT
Reading Date Gross Net Depth to Net
Time Time Water Drop
so^~- '7-I~'q:3_ ~%ql 4~orll~ TwtCC
,-t ~' I~~?$''&~ ~' _ ' q~¢l~ ~
PERCOLATION RATE I ?;1 (minutes/inch) PERC HOLE DIAMETER __
TES~ RUN .ETWEEN
611
PERFORMED BY: ~L{ I ~~-- CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCO.DA.CE W.'. AL,. ST ^ "E A.D .U.,O,.A' GU,.EL,.E$ ,. E.EOT O. T.,$ CA TE. CATE'. ~//f/~ '?
72-008 (Rev. 4/85)
:. p.o, Box196650 Anchorage, AK 99519-8850 .~. _ "-'" ': ....~*', '~' ...
· ,"'. .... -. ....."'"_:' ""*' '"
· . '.,_ . . :- ~ ~'..,~.,,(907)343~_.,7.904,: ',:,'. ',.. ::~-. , : ,. - ..... :, ....
.: :.': ., · .... ~. · . .
: , CERT FICATE OF:: HEADTH AUTHOR T,Y."APPROVAU .-,: ;'..- ¢.
0.50-474-21 , , , -..:~ . '~HAA~, .-,, .;/~.' l~-7'/~');:,,,~.~, ~, ' .
¶, GENERAL:INFORMATION :,. "., ," :' ' ." :,' '.; Expiration Date; -:'.,'(~'- ',.~ "-'. c~ .;4_ ....
. .. :., , .......... - . ,. ~...;.' .. -. ,, !,,.::.,, ,.,,,...',.*.,,!~ ~
Complete legal description HYLEN CI~ES¥ .SUBDMSIO'N "#'3; ;LOT-'7,. BLOCK,';I-?- .
Loe~t~on(sltea~ldrassordir~ions) '-..'10239.STEWAETXDEI~-*:E~OLE:RIV~E,-.AK~9957:7'~ "'" ~' '
Current Pro wner(s) JAMES',S:TIS, ANCE ~: ....' ...... ' ': Day phone .... 696-4604 -
Mailing add,mss i 10239 .STEWART DRIVE' * EAGLE' RIVER, AK 99577?. - :
...... ' ' ~.."";,.-,,'.t~. , ' · .:~.,..,:..:'.h'--~.'.~
:Lendin'a_~encv'. ~,'" "" ' ' "-',:"-
Malli~g'addras~ -
Real Estate Agent HAL JACKSON
.Mailing address 10928 EAGLE R~
Unless'otherwise requested,
2. NUMBER OF BEDROOMS: 4 " . ..
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Ind!vidual On-sita ..
Indlvidt~al Holding tank ~
Community On-site B
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 5 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 slngle family on-sita wastewater disposal and/or
water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority
Approval am valid for 90 days from the date of Issue for properties sewed by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a pedcd of
up to one year with valid water samples.) Certilicatas are valid for one year for properties served by Class A or B
wells or a public water system. The Munlclpality of Anchorage Is not responsible for errom or omissions In the
professional engineer's work.
Note: Alaska Wa ter and Wastewater Consultants, Inc. shall be paid $700.00 at, or pdor
to dosing for the e~glnee#ng satvfces provfdad. ~
4. STATEMENT OF INSPECTION BY ENGINEER .....
As certified b~ my seal affixed hereto and as of the ~lidaUo~ date shown below, I verf~' that my
· investigation, based on procedures outlined in th~ Health Authori~yApproval Guidelines for this application,
shows that the on-site water supp~f and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and O~pe of structure indiCated herein. I further verify that based on t~e
Information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the
on-site water supplj/ and/or Wastewater'disp~al system Is(a~e) In compliance i~tth all appliCable Munldpal
and State codes, ordinances, and regulations I.n effect at the time of Installation.
NameofFlrm · ALASKA WATER'&: WAsTEWAT£R CONSULTANTS, INC. Phone ,357-6179
Engineer's Printed Name JEFFREY A. CARNESS,' P.E. Date /
Engineer's Comr~ents:
In conducting this eva/ua~bn, AWWC. Inc. attempted to pn:rvide a thorough.'
consdonlious engineering anal/sis of the system In accordance with ADEC and MOA
DSD Gu/d~ines & Regulations. The teperted results desotlbed the perfom3ance of the
sJ~tem under the concl't~ns encountered at the time of the test, and separation
distances measomd to reedi¥ lden~liabte fea~ume. The operalional life of all wells and
septic systems depend on the local soils condition, groundwater leveis that may
fluctuate during the year, and the water usage of the famity b~ng sent~d by the ~,~tem.
These conditions are outside the control of the evaluater of the ~7stem. Satisfacteo/ test
results do not guarantee future pedormance of the system, ~ do lhey guarantee that
there are no hidden defects er encroachments. At41WC, Inc. can therefore trot i~:wlde
any warranty or future esUmate of how ~ the system ~11 continue to meet the
operationa! reguirementa of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the i~wner listed abo~. Any reliance upon or use of this rep¢~ by any
5. DSD SIGNATURE ~ ~. ~r
.,~:b~-.-' ......-~
~ ~pmved for ~ ~d~ms. ~: ON-SITE ~
Disapproved. ~: WA~ER AND
~ ~ WASTEWA~ER
Condi~onal approval for bedrooms, wi~ ~e ~lowlng s~pula~ons: ~ ~. PROG~M .~..
..
'J))))))))))}l)p
Attachments: HAA Checldist
Septic System Advisory
Well Flow Advisory
(~,. s~e)
Manitenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date: ~ - .~'-- 0 ,/
Municipality of Anchorage
Development Services Department
6uM~ng ~;.~y OIv~on
On.Site Water & Wastavmter Program
P.O. Box 196650 Anchorage, AK g9519-6650
WELL DATA
HEALTH AUTHORITY APPROVAL CHECKLIST
HYLEN CREST S,/D ~3; LOT 7~ BLOCK 4~ Parcel ID:
flA. B, orC provide PWSlI~t
050-474-21
wen Log (Y/N) ~
wen type pu~c _~
Date completed ~pedy protected (Y/N_)
TOtel d Cased to It, Casing height (above gmund)
FROM WELL LOG
Date of test --~
StaUc water level ~ it.
~ g.p.m.
WATER SAMPLE RESULTS:
AT INSPECTION
..J g.p.m.
Conform ~ colonies/100 mi. Nitrate __mgJl.. ~,.~es/100 ,,d.
o · __ C~ected by:. ~
SEPTIC/HOlDING TANK DATA
Tank Type/Material STEEL
Tank$1ze 1250 gal. NumberofComparlmente 2
Found~oncteanout(Y/N) YI[S Dapmsslonovertank(Y/N) NO
Date of. pumping 5/'28/01 Pumper
Oate E-~ed e/o5~3 ~ mtlng (~)r ft'~3dnn) 1.2
Date instated ~/5/93
ch~uxx~ (Y/N) YEs
High water alarm (Y/N) N/'A
JR'S PUMPING
System type ~B~L'P TRENCH
Total depth
Dateofadequacytest 5//29//01 Resu~(Pass/Fan) PASS
Fluid deplh in el3sorpflolllleld beforetest 19-5 in. Wateredded 685 gal.
Elapsed"rime: 1245~11n. Flnalflulddepth 18 In. Abeo~pUon rate >-
Any mJuvenatlon treatment (past 12 mo.) (Y/N & type)
56 . It. Width 2.5 It. Gravel below pipe 3.5 lt.
"/'~t~ Eff. al:~o~Uonarea 518 ft' Monltorlngtube ~ Dapmsslonoverfleld NO
For 4 bedrooms
New depth 3o.51n.
600+ g.p.d.
NONE KNOWN If yes, give date -
D. UFT STATION
Oete Instelled 81ze in Gallons Ma~.~/
'Pump on' level et in. 'Pump n. High water elen~ level et In.
~ Cycles tested Ideete elarm & circuit requlmmente?
~epUo tank~ station on lot.
Absorption field on lot.
Publlo sewer main
E. SEPARATION DISTANCES PUBLIC WATER
SEPARATION DISTANCES FROM WELL ON LOT TO:
On adjacent lots
~ Publlo sewer manhole/deanout
Holding terfl<
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5% Property line 5% Absorption field 5%
Water main lO'+ Water sen4ce line. lO% Surface water, lOO'+
Wells on adjacent lots 100'+
Proper~y line 10'+
Water sewlce line 10'+
Curtain drain NONE KNOWN
F. COMMENTS
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 10%
Surrace water 100'+
Wells on adjacent lots 100'+
Water main
10%
Driveway, parldngNehlcie ~temge 50'+
ENGINEER'S CERTIFICATION
I cergfy that I have determined through field Inspec~ons end
review of Municipal mce~:ls that the above systems am In
con~rmance with MOA HAA guldeflnee In effect on this date.
E ineee, c .Ess
HAA Fee $
Date of Payment ~,~../~J_
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 05" - q?'/- z/
1. GENERAL INFORMATION
Complete legal description
Lot 7; Block
Hylen C~est Subdivision #3
Location (site address or directions)
10239 S~ewart Drive
Eagle River, AK
Property owner __
Mailing address
Glenn Holmdahl Day phone 696-2717
CO/~AmeriSpec Relocation
860 Ridge Lake Blvd. 3rd floor Memphis, Tennessee 38120
Lending agency
Mailing address
Day phone
Agent Shari Boyd/ Jack White Real Estate
Address
Day phone
762-5863
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
XXX
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
Fielding tank
Community on-site :
NOTE:
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.
S & S ENGINEERING
Name of Firm
Eagle River, Alaska 99577
Address .
Engineer's signature
Date / /~'/¢7'7
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
r ' o
p ofess~onal 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 fedsral 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 MOAf¢21
Legal Description: ~,'"'~T "7 ~---J~
Mumclpality of Anchorage . ~ ~.~.,~ v~Ib,~
DEPARTMENT OF HEALTH & HUMAN SERVICES ~'44/¢7" ~(~
Env ronmental Services Div s on ,:'.)~. ' 7~/o~
825 L Street, Room 502. Anchorage, Alaska 99501 · (907) 3~¢~7~/¢ ,
Health Authority Approval Checklist '- t~
A. WELL DATA
Well type ~'0 ¢~ V.~ d.
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production ~
WATER S~E RESULTS:
Co. ,m
r"~Date of sample:
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~...~.~ ~..~..~"'"-'~'~"~--
Cased to ~~ght (above ground)
....-"'~ires properly protected (Y/N)
FROM WELL LOG..~- AT INSPECTION
g.p.m, g.p,m.
Nitrate Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed
Foundation cleanout-~N)
Date of Pumping
C, ABSORPTION FIELD DATA
Tank size /,2 C-z:, Number of Compartments 7--- Cleanouts~//N)._)/_~
"{ Depression (Y~> ~ High water alarm (Y/N)
Date installed
,¢' - 5-
Length 5-G ~ Width
Gravel thickness below pipe
Effective absorption area .5"-/~ / Monitoring Tube present.)N)_F
Date of adequacy test /
. Depression over field (Y~[:) ,O
For V bedrOoms
Fluid depth in absorption field before test (in.); /0 Immediately after~~/'¢'gal. water added (in.): __
Fluid depth ~¢ (ins) Minutes later: ~? ~/~' Absorption rate
, = .g.p.d.
Peroxide treatment (past 12 months) (Y~) /~,).,v)..¢- i/-./~,~'~D If yes, give date
/7
72-026 (Rev, 3/96)*
LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N) "Pump on" level at*
High water alarm level at* _~-'""~-~*Datum
E. SEPARATION DISTANCES
F.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
On adjacent lots
Absorption field on lot ~
Public sewer main ~ Public sewer manhole/cleanout
S~ Lift station
FROM~HOLDING TANK ON LOT TO:
SEPARATION
DISTANCES
Foundation '7 / Property line /D Absorption field
I--~
Water main/service line /O Surface water/drainage /oo Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
! ~ ~ Building foundation / :~ /
Property line
Surface water
Curtain drain
Water main/service line / O )'j'
Driveway, parking/vehicle storage area /'d i'4''
Wells on adjacent lots '2..-o~, I ~
ENGINEER'S CERTIFICATION
-~'~%,~,, ..
I certify that I have determined thru field inspections and review of Municipal records~li~f, th~;~b~¢:.s~f~(ns are
in conformance wit~ MOA ~AA guide~es in effect on this date.
Signature , ~ ..... ,~,'~, ~: ',~ ~, ~,~,
Engineer's Na e
Date /
HAA Fee $ ~' ~
Date of Pa ,ment
Reoeipt Number ~ .c:~/~ (
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev, 3/96)*
Parcel I.D. #
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
050-474-21
GENERAL INFORMATION
Complete legal description'
Hylen Crest #3
Lot 7, Block 4
Location (site address or directions)
10239 Stewart Drive, Eagle R±ver
Property owner L & B Construct±on Day phone
Mailing address 14828 ?efface ~.oope, ~agle R±ver, ~ 995?7
696-3249
Lending agency
Mailing address
Agent
Add ress
Nn~W~ Mortgage Day phone 694-1144
P.O. Box 172347, Anchorage, AK 99514
N/A 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:
x
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 1~21
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Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Parcel I.D. P-~O - ~r?2¢ - ~'/
Well type /)6/~t1¢~
Log present (Y/N)
if A, B, or C, attach ADEC letter. ADEC water system number
Date completed Drille~
Total depth
Sanitary seal (Y/N)
FROM WELL LOG
Cased to C~ height
Wires properl (Y/N)
.~TION
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM W
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service
WATER; RESULTS:
Colil
D/ate of sample:
· B. SEPTIC/HO'- DIN'G TANK DATA
Date installed ~?,/D5 / ~73
Nitrate
Tank size
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
MUNICIPALI'[y OF A
ENVIRONMENTAL SERVICES DIVISION
g.p.m.
0CT 2 0 1993
REC£!iVED
Collected by:
Other bacteria
/ .~- ~ ¢ Compartments
Cleanouts (Y/N) /V£~ Foundation cleanout (Y/N)
High water alarm (Y/N) /,//,4
Date of pumping /,///t ~ ,/V,5./,,¢ Pumper
SEPARATION DISTANCES FROM SEPTIC/HeEBtN6 TANK TO:
Well(s) on lot /%///~ On adjacent lots
To property line ,3 / /
Surface water/drainage
Alarm tested (Y/N)
/,//,~
Depression (Y/N)
Foundation "? '
Water main/service line
Absorption field
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer ///
Size in gallons Manhol~
Vent (Y/N) "Pump on" level at _//"/ "Pump off" Level at
High water alarm level J4./~/''''''',~ Cycles tested
Meets MOA electrical co~
SEPARATION D~E FROM LIFT STATION TO:
~ On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed
Length
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF)
Width '~ / Gravel thickness
Cleanout present (Y/N)
/W/4 - /./¢//~ Results (pass/fail)
System type
,.~. z~ ' Total depth
~/~ S Depression over field (Y/N)
P/L% for
After test
If yes, give date ~/~
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water /~/
Curtain drain
On adjacent lots 'f ¢-(2E) ' Property line
/,'~ ' To existing or abandoned system on lot
Cutbank A///I Water main/service line
Driveway, parking/vehicle storage area r/o
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA gu/defines tn effect.¢l~h~'~ ~,'f:tb~¢s ~nspect~on.
Signature
Engineer's Name ~ ¢ ~ ' ¢ /-~¢. ~ ~'~ "~:::<":~,,; o..~ t.,~ ~;~' ¢:~.~.-~,/.~5'" ':::¢'''':':'~:t' ¢ .-~0 ~' ,,::",."'
Date
HAA Fee $ ,~0o, cO
Date of Payment
Receipt Number
72-026 (0/93)* Sack
Waiver Fee $
Date of Payment
Receipt Number