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Home My WebLink AboutHYLEN CREST #3 BLK 5 LT 4ANyl Cee Block 5 Lot 4A #050-474-52 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171293 PID Number: 050-474-52 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New N Upgrade Name GREG THOGMARTIN ABSORPTION FIELD ❑■ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 10228 STEWART DR, EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 4 0.8 GPD/SF JTotal 10 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.0 Ft_ Gravel depth beneath pipe 7.0 Subdivision Block Lot HYLEN CREST #3 BLK 5, LOT 4A Ft. Fill added above original grade Gravel length Township Range Section 0.5 Ft. 7O Ft. Gravel width 2.0 Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area 'Number trenches Dist. between trenches From Tank Field Tank Line 980 Ft2 Ft. Well * * 50'+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCH TANK Capacity 1250 Gal. Surface Water 1001+ 1001+ I Material Number of compartments Lot Line 10'+ 10'+ NA STEEL 2 Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Remarks * COMM. WATER Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 drainfieid Tank to 3034 MIKE N ANDERSON, P.E. Drainfield 3034 C0/MT3034 Inspector MIKE -N ANDERSON, P.E. BENCH MARK (Assumed elevation) 95.4 ft Inspdeatio 1s' 10/12/17 2"d 10/13/17 Location and description 3'd 4"' GARAGE SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVAL $,tamp 7, Conditional Approval: Date �'��;•''•s 's P. 49TH V...... . ........... y a MICHAEL N. ANDERSC`1 CE - 94 ` Septic System Appro Date 10 'S - ,•'= �I'f• . Note: this approval does not include well permit requirements. kmev uolutf 1 o) Permit No. OSP171293 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: LOT 4A, BLK 5 HYLEN CREST #3 S/D PID No.: 050-474-52 MARK A B C01 14 52 CO2 15 52 Tc01 16 52 TCO2 22 53 CO3 26 55 C04 27 55 C05 97 111 /�� COS —®�_ 1 t -� T== / C04CO3 �T� l BENCH, GARAGE SLAB HOUSE / J WATER SCALE: 1"=50' CO, fOl MIT TCO2 CO3C05 ®®eO� OF• ECO41 AST , 1.5 O ®®�P\••••"' ' '•'•`•: 9S,�o®o v •,. 9 B o ® s OR ®� 491H `®0 INSULATION FILTER FABRIC ....... 00 0. 9 ,GALLON 97 97 STEEL 97 STEEL TANK ®®� ;MICHAEL N. •ANDERSON;® srrtn aooc �" '• No. CE 9469 ; �� 9 .B 9 .8 63 ®®/ •••'•.••9••22 �•21••�•.•°® SEPTIC SECTION NO WATER SEPT 2017 N.T.S. 0 { O N STEWART DRIVE o °F-qtgsoo �:: 49 TH* P SHANE A. HOLT e LS -6914 �` a fessional Leo THE INFORMATION HEREON IS FOR THE USE OFLENDING INSTITUTIONS SPECIFICALL Y TO SHOWANY CONFLICTS BETWEEN EXISTING STRUCTURESAND PLATTED LOT LINESAND/OR EASEMENTS AND 15 NOT TORE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES EASEMENTS OF RECORD, OTHER THAN THOSEAPPEARING ON THERECORD PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTE FENCELINES THATMA YAPPEAR ON THIS DRAWING ARE NOT TORE USED TO DETERMNE PROPERTYLINESORPOSIT/ONADDIT/ONAL IMPROVEMENTS ANYPAVING SHOWN HEREON MA YBEAPPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE AS -BUILT SURVEY 1" =40' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 4A, BLOCK 5, HYLEN CREST NO. 3 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS _23 RD DAY OF —JULY , 2021 11468, FB 143-76,215-14 I0„,„‘,,AL,„0, MUNICIPALITY OF ANCHORAGE 0 c rrr oi :40 On-Site Water& Wastewater Program = 0•S• PO Box 196650 4700 Elmore Road f Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 httpa/www.muni.orglonsite 1111 *NCXOA 0* On-Site Wastewater Disposal System Permit Permit Number: OSP171293 Effective Date: 10/10/2017 Work Type: Septic Upgrade Expiration Date: 10/10/2018 Tax Code Number: 05047452000 Site Legal Address: HYLEN CREST#3 BLK 5 LT 4A G:0057 Site Mailing Address: 10228 STEWART DR, Eagle River Owner: THOGMARTIN GREGORY S & JULIA A Lot Size in Sq Ft: 41476 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4 This permit is for the construction of: RI 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: ;;��14 Date: /0 • Issued By: I;o 6_ Ccr. J 0 Date: 'C -20 1 7 • p .nr P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW ** ** Waiver#: OSV171120 COSA#: Permit# OSP171293 PID#: 050-474-52 Legal Description: Hylen Crest#3 Block 5 Lot 4A Engineer: Mike N. Anderson Applicant: Gregory Thogmartin Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the excessive slope has been approved. The approved separation distance is 30.0 feet. See engineer's profile drawing for justification. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. • Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: W/O/pee/7 Approved by: alle/eI e.avr-e-(0, Name of Reviewer **** VARIAN C EIWAIVE R REVIEW **** MUNICIPALITY OF ANCHORAGE • • ".v !F° 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. 050-474-52 Property owner(s) GREGORY THOGMARTIN Day phone Mailing address 10228 STEWART DR Site address 10228 STEWART DR Legal description (Sub'd., Block & Lot) HYLEN CREST #3 BLK 5 LT 4A Legal description (Township, Range & Section) Lot Size 41476 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: l®all that apply) Absorption Field Q Initial ❑ 0, Single Family (SF) ❑X Septic Tank ❑x Upgrade E1 1'1 15 & wo ADU) Holding Tank III Renewal II,re' I; O El _ D� Qwellings (l Privy ElN l0 and/or D) Private Well ❑ <-'OJJ Water Storage ❑ 0`s Baa g4 R c i f l' THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: '; O 5(op e/ w o tv.a ✓ Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. /44(41 (Signature of property owner or authorized agent) Permit/Rush Fees: 5(A r Waiver Fees: 2I Date of Payment: /D2-/ 1 Date of Payment: /b -2-17 Receipt Number: a I/O4f1 Receipt Number: 21-10t0 Permit No. 05P171ag3 Waiver No. DV1-7-10.6 Permit App__-. :: ,c Oct. 2, 2017 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic Permit and Slope Waiver Legal: HYLEN CREST #3 BLK 5 LT 4A To Whom it may concern: This is a request for a septic permit plus a slope waiver on the above referenced lot. A single test hole was excavated and found 17 feet of silty gravels, GM. The new system will be installed in the same location. The perc rate was 4 minutes, but we will be using the standard calculation with a small safety factor for system longevity( 1.2 vs 0.8). A slope waiver has been requested to allow the new system to be installed in the same location as the old system. The slope of the lot is greater than 25 percent, see the cross section on the 50 scale drawing. This system will not impact any of the neighboring properties due to the lot layout and the type of septic system being installed. Please call me if you have any questions. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 I MOUND OVEK VCRITERIA: GRADE (TH#1) o W- 4BDRMX150 = 600GPD 10 .ORG I SOILS = 600/0.8 = 750 GPD W FILTER FABRIC 750 GA/12 = 63' ,"0 PIPE GM -3.0 �'� (1) TRENCH SEWER ROCK 10.0' DEEP 7.0' EFFECTIVE 10 0 2.0'WIDE I 2.0' I 63' LONG 17.0 SEPTIC FIELD SECTION 1 l I -STEWART DRIVE- ` J r-----T \ ~ I PROPOSED \ 1 DRAINAGE FIELD n PROPERTY LINE • \ I 7TI- EP IC "'alICI'aMiEXISTING \ I HOUSE - - ��I x SSEW ART — ` III,•_/ -11111111 ALL OF THE LOTS / ' SERVED BY COMMUNITY WELL _ / COMMUNITY WELL I I 7'.-1"."7::-.. ' 200'RADIUS 11` I I ( 1 I I i 'L - - -J s . !I r II I - - Septic Design Prepared for +10011%1M14, GREGORY & JULIA THOGMARTIN .' OF + HYLEN CREST #3, BLOCK 5, LOT 4A / 49TH �� \ %t Eagle River, Alaska ; • • '1.h1 +` 1-.: ■ Michael N. Anderson, P.E.• • DATE; 9/29/2017 SI •;MICHAEL N. ANDERSON. i= 1 No. CE 9469 4601 NATRONA AVE 1 DRAWN: DJR 1. •%r/U / 04 ANCHORAGE,ALASKA 99516 / ' (907) 727-8864 J FAX: (907) 345-1391 SCALE: 1"=200' +�f1". DD, �. 5.0' 30.1' EXISTING GRADE. PIV SLOPE OVER 25%. UP SLOPE OF NATURAL SLOPE _ o SYSTEM co ' 4 PROPOSED ui TRENCH W1 3' EXISTING GRADE, COVER,MAX BOTTOM OF TOE s\50 EXISTING PAVEMENT, DEPTH 9' 25° DRIVEWAY PARKING AREA ' SLOPE CROSS SECTION A-A SCALE.1:=20' N NEW SYSTEM TO BE INSTALLED IN THE o SAME LOCATION. ALL BIO MAT MATERIAL TO criro BE REMOVED AND DISPOSED OF PROPERLY. PROPERTY LINE --�#1 °l .f�` `\♦ 4 EXISTIN� TO BE i A Ni CO MIA4 SSIONED AND NEW i l 1250 STEEL TANK INSTALLED I • u,fc_ r�•__ • COi s r HYLEN CREST N3 \ BLOCK 5.LOT 1A Af ---\ Y/-1 �\ r ■ DRIVEWAY EXISTING r HYLEN CREST 43 • nt~ 1 HOUSE /, l BLOCK 5.LOT 2 N SHED _ o A N % �� e � — Ill r e j LOT SERV : :Y COM' . • ITER PUMP HYLEN CREST#3 BLOCK 5.LOT 4A — — STATION 15'UTILITY EASEMENT r ' WATER SERVICE LINE -STEWART DRIVE- _ - - – –w • w w — — _ r HYLEN CREST#3 f HYLEN CREST 03 BLOCK 4.LOT 4 BLOCK 4,LOT 3 I Septic Design Prepared for , ,101%••IN, GREGORY & JULIA THOGMARTIN • . ,`�E•. F.•:�L,, . • HYLEN CREST #3, BLOCK 5, LOT 4A4g m ., riA, Eagle River, Alaska • Michael N. Anderson, P.E. DATE: 9/29/2017 V .MICHAEL N. ANDERSON?• JIB ♦ S No. CE 9469 • 4601 NATRONA AVE •. ,�.,: .'� ANCHORAGE,ALASKA 99516 DRAWN: DJR �f,+I}.. '. (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=50' 414' E i��4. Fr . . ' ~C7F `R � - ....:41).7_,N11._ Municipality of Anchorage ---:\r.- '(tNGIN El'S: 1 Development Services Department ,� •.1' 9 • Building Safety Division / *: Q 9 T N ( • .1 c .,,�,\t On-Site Water and Wastewater Progra /ilk m . I 4700 Elmore Road AK99507 , 4 P.O.Box 196650 Anchorage, www.ci.anchoraqe.ak.us �'r°,'. MICHAEL N. ANDI RECN�, s (907)343-7904 �� CE-9469 • -,:. 14 Soils Log - Percolation Test • t� JPR•' "" r / !o OFEsS10 '' —" Performed For: ('7 7"�/� 5 y�p Y Tt ►-� Date Performed: `` rf �— Legal Description: 4-y/ 6:it7' 3 Township, Range,Section: G 57 1 Slope Site Plan l Depth �� D "' (Feet) Mk tol an te s 4irc.4AcRee h 2- 3- 4- 5- �� N( 6- 7- 4/ /1-y 8- 61 rI WAS GROUND WATER Y 9- WJ/ ENCOUNTERED? fY Cr r S 10- IF YES,AT WHAT DEPTH? ((j f L ae- (v a Depth to Water After P 1 1- Monitoring? E 12- Date: Z$ 1 P- 13- 111 Ptm• "4.00 k- 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- it? 0 mph/4 (i " 1i5-17 16- L �' 7/S ii 17- — D f/t}rvt VI Zi i" 18- - , /' 2,4 I/ 19 L it 7, s i/ 20- • PERCOLATION RATE (/r 'mInutestinch) PERC HOLE DIAMETER Le TEST RUNTWEEN il FT AND !l— FT COMMENTS W a-t__,.0 '(,u kle -‘,4-,,, ►w O(A-, Gje.A4t.2he/ PERFORMED BY: MnPi., I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 1 vl2//7 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ ~ DISTANCES Address / ¢ WELL Pho.~(~) ) JPorm,t No. ) No. of Bedrooms WELL ~'~ ~'~ ~1 ~O ~ ~ LOT LiNE %[~3 ¢'~¢ ~ ~ ~ driveway*AS~B~jLTDjAGR*M(Sh~w~~cat~~n~fw~~~`se~ticsys~em~pr~perty~~nes~f~u~~~at~~"~wa`erbodies.e~c~) ¢ TANKS i I ~'Manufacturer ~ ~ Capacity ,n gallons[¢~ ~aterial No. of Compa~ments %~t TYPE OF SYSTEM - RENCH ~ BED ~ W. DRAIN ~ OTHER original grade ~ FT ~ 0 FT -- 0 F~ ~ ~T Gravellenglh ~ FT X ,~FT ~otal absorption area ~/ Distence between lines ~ ~SQ FTI~/~ FT Number gl lines Son talin Pi e material WELL8 PRIVATE ~OTHER (Ide~tilv) Classification Total Oeplh Cased Io (A,~ FT FT I nspect~~y: .,~ 72-013 (3/85) ILEGAL iDRAWN Municipality of Anchorage DEPART,,MENT OF HEALTH & HUM'~,N SERVICES 825 "L Street, Anchorage, Alaska 99502-0650 /~, SOILS LOG -- PERCOLATION TEST/'~ -' ER'S SEAL) 1 2 3 4 5 6 7 8 9 I0 11 12 13 14 15 16 17 18 19 2O DATE ,~¢l~l-ownship, Range, Section: SLOPE -/ WASGROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Uepth lo Wate..~c,Ak_k_k_k_k_~. Monitoring? r'~-~ Oae: SITE PLAN S L O P Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ {minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN.~FT AND ET COMMENTS ./ / S & S ENGINEERING ~.L / --~ -- 17034 Eagle River Loop Road No. 2 ~ .--~--7--.. / ~ / PERFORMED BY *,..~.,,~'' I // ~~CERTiFYTHAT HIS EST A P : ~a~[~V~i~-- ' ~.. ~ / ~/ TI ~ W S ERFORMEDIN 72-008 (Rev. 4/85) ~ ~ / MUNICIPALITY OF ANCHORAGE ... Development Services Department � Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-474-52-000 Expiration Date: 12/21/2024 Legal description HYLEN CREST #3 BLK 5 LT 4A Site address 10228 STEWART DR Eagle River AK 99577 Current property owner(s) ZERMENO JOSHUA 50% &CARTER ANDREA 50% X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 1/4/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA Approval_June 2022 LI V W U fl V tl ` PA U TX4'1 OF /\ [l V C H O R " �-'J IE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050- 474- 52 Complete legal description HYLEN CREST # 3 BLK 5, LOT 4A Location (site address) 10228 STEWART DR„ EAGLE RIVER AK Current property owners) ZERMENO Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑® Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ®❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 6 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed X Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ �y 0 Waiver Fee $ Date of Payment t Z 5/2o&3 COSA # USc Z 3 l y 9 Z Date of Payment Waiver # COSA Application—June 2022 COSA Checklist Legal Description: HYLEN CREST # 3 BLK 5, LOT 4A Parcel ID: 050- 474- 52 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Measured operating fluid level in septic tank 48 Date of pumping 12/21/23 ❑ Required maintenance completed, if AWWTS Comments: NEW TANK IS 2017 D. ABSORPTION FIELD DATA Which system tested (date installed) 10/13/17 X ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 3 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑! Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) _ If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑N No ❑ Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/LArsenic less than MRL (ND) Collected by Date C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 12/21/23 Results Q Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 0 in Elapsed time 1440 min Final fluid depth 0 in. Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 84 in Effective depth used 0 in Effective depth remaining 84 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No _ ft ❑ Yes if No _ ft Neighboring Tank > 100' ❑ Yes if No _ ft Private Sewer/Septic Line > 25' ❑ Yes if No _ ft Absorption Field on Lot > 100' ❑ Yes if No _ ft Holding Tank > 100' ❑ Yes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No _ ft ❑ Yes if No ft _ Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Yes if No _ ft ❑ Yes if No _ ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No _ ft Surface Water > 100' Yes if No _ ft Tank to Property Line > 5' ❑s Yes if No _ ft Wells on Adjacent Lots: Field to Property Line > 10' RE Yes if No _ ft Private Wells > 100' Yes if No _ ft Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS 0 Yes if No _ It E Yes if No _ ft Community Wells > 200' 9 Yes if No _ ft If tank or field is under driveway comment below G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm !`' t lnei A 14r, A, aP s [1N (E. Phone 727-8864 Engineer's Printed Name COSA Checklist June 2022 _ Date e. f "7 AAI ,.- N At"tp'„111•: te: ` C 4469 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 050-474-52 ANCHORAGE Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: Q` i` 2.. Q Z 3 Complete legal description HYLEN CREST #3 BLK 5 LT 4A Location (site address) 10228 STEWART DR, EAGLE RIVER AK Current property owner(s) GREGORY THOGMARTIN Day phone Mailing address SAME Real estate agent Day phone 2. TYPE OF DWELLING: E 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 El Water Storage ❑ Holding Tank ❑ Community Well ED Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 2 87 Date of Payment 12y A � Receipt Number O2. 'i 5310 COSA# 05LL 1576 Date: Waiver Fee $ — Date of Payment Receipt Number Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 9-15-21 49T1-1 6. DSD SIGNATURE JI "'•••••••• ••.... IIII �. System #1 Approved for 4 bed�• • •L ......... F y pp rooms MICHAEL N. ANDERSON •',^c r% System #2 Approved for bedrooms p J ••f.� CE -9469 Disapproved f9 • • • • •'•�`��' Conditional approval for bedrooms, with the following stipulations: /"))))))li,, �-� Original Certificate Date: r- 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 Weil Flow Advisory Other COSA Checklist blue sheet r Legal Description: HYLEN CREST #3 BLK 5 LT 4A If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments COMM. WATER SERVICE B. TANK DATA Age of tank(s) _201 7 years Tank type/material SEPM''STEE Measured operating fluid level in septic tank 48"NEw ❑ Standpipes/foundation cleanout per record drawing Date of pumping 1 01, 1 _ Z D. ABSORPTION FIELD DATA NEW IN 2017 Which system tested (date installed) 10112/17 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.5 ft (max) Measured depth to pipe invert from grade 4*5 ft (min) ❑ N/A —pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 050-474-52 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/411 Results [ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600+ gal New depth 0 in Elapsed time 1440 min ❑ Code -required sail cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 0 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No ft Neighboring Tank > 100' QQ Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' M,/ Yes if No ft Q Yes if No ft if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓Q Yes if No ft Q Yes if No `___ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10'[]✓ Yes if No ft Surface Water > 100' []✓ Yes if No ft Property Line > 5✓Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10'Q C✓] Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' Q Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' C✓] Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10'✓Q Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water > 100'✓0 Yes if No _ ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with ; 4 9 Ed! MOA COSA guidelines in effect on this date. e"- • ' • ' shy • • • • • MICHAEL N. ANDLRSQ-41 C 94 { COSA Checklist yellow sheet 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 FAMIL~ DWELLING Parcel I.D. # ~(") ~ ~I'3L~ - ~ HAA # GENERAL INFORMATION Complete legal description ~' Location (site address or directions) Property owner /~c~,,¢/,//~ / /~4r',~/,~ .~4~,¢e"¢7~/7-~ Day phone Mailing address /o~z¢ ..¢~,,¢4,,~ ~'~, ~.~¢.~-~ /"~,¢¢.~ /¢'ZE Lending agency Day phone Mailing address Agent C,uc.,< .~/~(~., /'~,/,¢;x, 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~¢s ¢P// /~. ~a,7,q,¢.,'/ ~ ~ Phone Address ~'.,"/_~,T ~.~ /;~.c.,,,~£ ,~/¢. /,v'c/FC,~,C'~,G/ Engineer's signature ..-"~/.¢'-~--¢'/ '~-' ~_~//c.-.-------~. Date / ..?..~._x_xx.\\. Joseph M. Dorava ,% NO. 7827 '~"~ bedrooms. DHHS SIGNATURE Approved for 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. 72-025(Rev. 1/91) Back MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Z,¢/~ ~' //~y~ ~-~ ~' ~--~ Parcel I.D. A. Well Data Well type '~,oc/c ~",*~//- If A. B. or C. attach ADEC letter. ADEC water system number Log present (Y/N)~'~ Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) ~ Wires properly protected (Y/N) '~M WELL LOG Date of test Static water level "~ Well flow '~ Pump level1 ~'~ · SEPARATION DISTANCES FROM WELL T g.p.m. AT INSPECTION Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ; On adjacent lots XX,; On adjacent lots Publi~wer manhole/cleanout ~ Other bacteria Collected by: % B. SEPTIC/HOLDING TANK DATA Date installed /~ Cleanouts~l) y .Foundationcleanout Y~) High water alarm (Y~) Date of pumping '7 - Tank size /~- ~'0 Compartments /V' Depression (Y~ Alarm tested (Y/~ ~ Pumper /~+ /-//~ ,*-t ~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) oh Iqt - :/~/~ ~'; On adjacent lots //./','~ To property line ' //,..5' / Absorption field S / Surface water/drainage /¢¢ /(.-/~/.-'~- /~, ~¢ ~ 72-026 (3/93)* Front Foundation /"~ Water main/service line /¢ ' ~ CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump'~l at x Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANCE FROM LIFT STATION T'~ Well on lot On adjacent lots "~ D, ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Date installed /o -2/. ?,~ Soil rating (GPD/FF) Length 5"0 / Width ?, ~- /' Gravel thickness Tolal absorption area (o00 F'7' ~ Date of adequacy test 7 -7 - ~' '~ Water level in absorption field before test Surface water Peroxide treatment (past 12 months)(Y~...~"~ System type ~ ' Total depth Cleanout present (~N)~ Depression over field (Y~ Resuit~a,l) '~.'~:J.5' for '~ ' - ' '"~/ ~/~,,1///~=o .J/~z~ Aftertest SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation ~, ! On adjacent lots ~..~' Surface water /¢0 ' '/'- Curtain drain If yes, give date On adjacent lots ~ ~ Property line To existing or abandoned system on lot Cutbank ~D ' 'f' Water main/service line //~¢/-'~" ~¢¢.~- Driveway, parking/vehicle storage area Bedrooms E. ENGINEER'S CERTIFICATION I cerb'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on th~da!,e, of this inspection. / / / / H~ Fee $ .~ ,od~ Waiver Fee $ Date of Payme~ '~ --/; ~ ~ Date of payment Receipt Numar ~' ~:~ ~ ~;~ Receipt Number 72-026 (3/93)' Back LOGARITHMIC 46 7282 MUNICIPALITY OF ANCHORAGE Deparlmenl of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4?44 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4A; block 5; Hylen Crest #3 Subdivision; Location (address or directions) Stewart Drive (b) Property owner Mailing Address (c) Lending Institution Mailing Address Eagle. R.f'u¢_r Vallc,.y D¢-u¢_~np~rr~l~hone: (horne) _694-9681 Business $III C Street Anchorage, Alaska 99503 Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here.~ if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 1 ~'J034~F_a g leJ~L~, ~:J,o.o p R o e 4_No~.O4 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Number of bedrooms Single-Family,~ 3. WATER SUPPLY Individual Well [] Community ~x Public [] Nole; If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Nole: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Iverifythat my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end 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. $ & $ ENGINEERING Telephone ~ ~:~'~Z ~ ~ Name of Firm 17o3~ ~agl~ R;~r L~cp R~. ~4 Address Eagle River, Alaska 99577 Date D..S ^PP,OVA, Approved for ,~"'/c(¢'./)bedrooms by Approved /~ Disapproved Oonditional Terms of Conditional Approval Date //- 29- 90 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer 'registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate Is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 7/88) Back Page 2 of 2 Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Descrii~tion: ~ Flectrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot '~i:~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approve0rd~) y__ Date Completed Yield _Depth of Grouting _ Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots "Z'~¢c~¢~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~_~"'z~--~OSize_. ['~"o No. of Compartments 'Z- Standpipes(~.5~/N) '~/ Air-tight Caps~N) '~ Foundation Cle~n, Dut~.'C~'N) _,../ Depression over Tank (Y/:J:~ r---t a/c'~,A~ e Last Pumped Pumping/Maintenance Contact on File (y/N)/.,]/~ ;for Holding Tank High-Water Alarm (Y/N) _/ Temporary Holding Tank Permit (Y/N) . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field /o'4- 72-026 (Rev. 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata \¢~'"'L%~ , ~ Type of System Deslgn Date installed ! o ~ -2.~ _ ~1 o Length of Field ~'"'~ ~ I Width of Field "'~"¢~ Depth of Field L Gravel Bed Thickness Square Feet of Absortion Area ~ c:>~=, '¢~ Statndpipes Presentd~E~N) Depression over Field (Y(~ ,7',/ Date of Last Adequacy Test Results of Last Adequacy Test /"/¢¢ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well '?.,~5i:2 t.¢.. To Property Line _ //¢ ~,.)L To Building Foundati~//,~ Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots ~:~ t..,L / c, l~ To Cutback (if present) Comments D. LIFT STATION Date'"~~ Size in Gallons ~ "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~ Vent (Y/N) cles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & '5 p. NGINF~R~NG Signed i'7034 ~:.a,qle River Loop Road No. 204 Eagle River, A~ask~ 995~7 Company Date ///~¢~ MOANo. ~ ~ ~o~ Receipt No. O ,.~-~ ~, '--~ ,,~ ,.~--~--, (~ Date of Payment ///~ -'- ¢ ('') Amount: $ ,/ 72 026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION / ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 November 21, 1990 STEVE COWPER, GOVERNOR 563-6775 S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 ATTN: Ray PWSID: #213289 According to the records on file in t~is office, the Hylen Crest Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VEC:bas