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Home My WebLink AboutHYLEN CREST #3 BLK 6 LT 2n Block 6 Lot 2 #050-474-28 Municipality of Anchorage.- Development Services Department ~-E :- := *.o Building Safety DMston I~ On-Site Water & Wastewater Program. 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99519-6650 ~' www.cLanchorage.ak, us (907) 343-7904 Page I of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:. SW000505 PID Numbe~ 050-474-28 N°me:DICK NAOY Wastewater System: [3 New · Upgrade Addrels: 14~00~ j~vrrP~C[ · BLOOM~.~TO... e1704 ABSORPTION FIELD No. of Bedrooml: Ph°ne:(`309) 96,3--5656 ,3 rlDeep Trench · Shallow Trench n Bed LEGAL DESCRIPTION 2.o ~/~ 2 6 HYLEN CREST #,3 (0.45-1.45) ABOVE - - - 3.7-4.7 WELL: [3 New [3 Upgrade 6 r, ,~ 228 ~. Ft. D-~O34/ r-at0/SC~ 40 PVC/HDP£ r, EAGLE MTN. EXC. 2/5-10/2001 SEPARATION DISTANCES =s.p~= n Hold~ng · S.T. EP. ~3 Other ~'a ~puc A~,o uon uft Ho~d~,g .~,~,,~ ANCHORAGE TANK 1250 Well 200'+ 2aa'+ 2aa'+ - 2.5'+ STEEL 2 S~,~a~e ~ote, ~00'+ ~00'+ 100'+ - - LIFT STATION Lot Une 5'+ °5'+ .5'+ - - 1250I ANCHORAGE TANK/ORENCO SYSTEMS Foundation 5'+ 10'+ 5'+ - - TIMER T]IdER 45" Curtain Dmln N(~N£ KNOW~I 20 OSI O5 CARCEL ELECTRIC Remarks: *SEE LOT LINE WANER ~WRI06 BENCH MARK · *~HIS IS A BOTTOMLESS INTERMHII:.~,~' SAND FILTER (ISF'). BO¥1'OM OF SIDING ON CANT. NEAR POINT "B" · *"2.0 I.I. LI' OF M.O.A. APPROVED SAND FILTER WAS ADDED BELOW TOTAL DEPTH. 100.00 ^wwc. Dato : 2/5/2OOl ......... 3rd 2/15/2001 Health and Human Services approval Department of R~vlewedandappmvedby;~e~----/'f--'~-~_Date:-~-/-~?/-/c=F'~-;"~--/l ~"~'7~/ PER)lIT NUblB~R: AS B"L~L~T D]~.~G pARCEL ID NUMBER: SW000505 - 050-474-28 I ~ ~ ST1 26 19 27,76 I / ~ ~ ST2 32.18 23.84 ; ~// ~ , ~ ~ ~, . OF K~ BOX ~T~ 2/1 4/2001 ALASKA WATER & WASTEI~ATER J.LM. CONSULTANTS, lNG., DICK NAGY (309) 963-5636 2 OF 3 HYLEN CREST SUBDIVISION ~l$; LOT 2, BLOCK 6 AS-BUILT OF SEPTIC SYSTEM UPGRADE (BOTTOMLESS ISF) A B FCO 11.52 38,59 ST1 26.19 27,76 ST2 ,.'32,18 23,.84 MH ,34.40 22.62 MT1 21,09 47,50 MT2 51,88 42,57 pERMIT NUMBER: AS B'L]'~T D~.~G PARCeL ID NUMBER: SW000505 - 050-474-28 F1NAL GRADE ~--TOP OF MANHOLE TOP OF TANK ~TOP OF TANK ~ / // u.~s - ~o~.o~ (~vo.) INSUIJkTION ~ / // ~--ORIGINAL GRADE ALASIC~k WATER & WASTEWATER ~ , ,.co? d~ ~r1 '~Z~{ GONSULTANT$, IN~, PREPARED FOR: pHONE NUMBER: PAGE NUMBER: DICK HAOY (309) 963-56:56 3 OF HYLEN CREST SUBDIVISION ~3: LOT 2, BLOCK 6, ,~,** ......... ~.~,,:~ PROFILE AS-BUILT OF SEPTIC SYSTEM UPGRADE (BOTTOMLESS ISr) MUNICIPALITY OF ANCHORAGE Department of Health end Human Services On.Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Dec 22, 2000 Expiration Date: Dec 22, 2001 Permit Number: SW000505 Legal Description: HYLEN CREST UNIT #3 BLK 6 LT 2 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Dick Nagy Owner Address: RR 3, Box 453 Bloomington, IL 99577- Parcel ID: 050-474-28 Site Address: 010307 STEWART DR Lot Size: 23511 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 end 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 caIling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day, B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Services Waiver Review Worksheet WR#: WR000106 PID~: 050-474-28 Date Received: December 4~ 2000 Legal Description: Hylen Crest #3r Lot 2r Block 6 Engineer. Alaska Water & Waetewater Coneultant~ Inc. 6901 DeBerr Road~ Suite 2-B~ Anchorager AK 99504 Applicant: Dick Nagy Waiver Requested: 5 foot Iot41ne waiver Permit~: Criteria: 1. Geology Poinls: A. Water Table B. Soil Sorption C. Permeabilily D, Water Table Gradient E, Horizontal Separation 2. Special Conditions: 3. Olher: To~al: Waiver is Granted: ~( Waiver Is not Gr~nted: List Conditions er Reasons for above: SEE E,~l/VEl~ ~,ST~F~¢~'.,,v p~;'~.~' ~/ov. ~0~ 2000 Date: / Z - 2 2 ' OO Rec~: 06471 Amount: $115,00 Name of Reviewer Date Paid: 12-4-00 Municipality ,of Anchorage G~. lVtwrch, Mayor Building Safety Di~qston I'.O. lk~x l!Xi(k-50 * 47(X) S, llragaw Street Anchorugc, Alaska ig.)519-C'('~50 * (907) 8-~3-8k;01 http://www.ci.anchoragc.ak.u.'i .Public Works December 22, 2000 Jeffrey A. Gm'ness, PE Alaske Water & Wastewater Cnosultants, Inc. 6901 DeBarr Road, Suite 2-B Anchorage, Alaska 99504 Subject,* Waiver Request for Hylen Crest #3 Lot 2 Block 6 Waiver Request #WR106 Parcel ID #050474-28 Permit Number SW000505 Dear Mr. Garness: Your request for a waiver of the required I0 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. The approved separation distance is 5.0 feet from the east property line. This waiver approval applies to the existing on-site wastewaterdisposai system to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Daniel J. Roth Civil Engineer On-Site Water & Wastewater Program MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Sewer/We I Permit Application O ~;O __ 4-/~ -- ~_~ NOTE: A~f~iication must be fl~led out completely SINGLE FAMILY DWELLING Parcel Idenl~hcat~on Number Property Owner Name [~l~_.,I/~ ~]~Gy ¢/o ~JO~..~ J~,~J~' DayPhone'~'~-~'-~/.~Zoo '"'/ Mailing Address I Legal Description lot Bleck Lot Siz~~'~'.~ Number of Bedrooms -~ '~"'~'" "l.~jr~Z./)/; ''~ ~ "' ~"~LL~"""~ - /~ nspe~,ons~e con'by: ~Approved Engineering Firm ~ Municipali~ (permit fee included) 5 Does your house contain any of the following: D Hot Tub D Swimming Pool D Therapy Pool D Jacu=i D Water Softener Unit This application is for: [] Sewer Only [] Sewer and Well 'l~ewer Upgrade J in accordance with applicable Municipal Codes, [] Well Only [] Water Storage I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and Waiver Fees: //,~', ~;~0 72~12 (Rev. 4~J8)° t. 'ooo / OLe CONSULTANTS, INC. November 30, 2000 Municipality of Anchorage Department ofHealth & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 2, Block 6, Hylen Crest Subdivision//3 (Bottomless Intermittent Sand Filter - ISF) To whom ~t may concern The existing 3 bedroom house is served by public water and a private septic system. Thc existing septic system consists of a 1000 gallon septic tank and a deep trench type drainfield. Thc existing drainfield is surcharged and must bc upgraded for thc sale of thc house. We arc proposing that a 1250 gallon S.T.E.P. tank and a innovative Bottomless Intermittent Sand Filter (ISF) system bc installed. Comments regarding the proposed upgrade are summarized as follows: 1. GENERAL: A test hole was excavated north of thc house in order to determine an area suitable for a septic system upgrade. Given thc location of thc house, thc location of the documented diversion drains, thc presence of groundwater and bedrock, and the steep slopes over the majority of thc property; it is our opinion that a Bottomless ISF system is thc most viable option. 2. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, a application rate of 2.0 gallons/day/ft2 should be used.. 3. DRAINFIELD DESIGN: Bottomless Intermittent Sand Filter (ISF) a. Percolation Rate: 24 minutes/inch b. Allowable Application Rate for ISF: 2.0 gallons/day/fl2 c. Number of Bedrooms: 3 d. Des!gn Flow: 450 gallons per day e. Mimmum Absorption Area: 225 ft2 f. Effective Depth below pressure pipes: 3.0+ inches g. Width: 5 feet .h. Length: 50 feet total length (2 (~_25 feet long each). ~. Effective absorption area = 250 ft2 j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank". k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank". 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwe.com I. Sand Material: In accordance with M.O.A. latest standards m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than 1% passing the/18 sieve. We are proposing to excavate down to a depth of 2 feet (maximum - below original grade), place a minimum of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand, we will place 6 inches (minimum) of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 4. SURFACE WATERS AND DIVERSION DRAIN CONCERNS: A diversion drain was installed in 1994 that was designed by Michael E. Anderson, P.E. and installed by Whitters Excavation. During several site visits by our firm, it was our determination that the diversion drain is not functioning properly. Also, it was our determination that there is a perched water table in the area of the diversion drain. Our determination was based upon the following findings: · There are several cutbanks and steep slopes directly downhill fro/n the diversion drain and also south of the house; and there is no indication of groundwater surfacing out any of these steep slopes or cutbanks. · The foundation on the north side of the house is over ten feet deep. There is no indication ora foundation drain and no outfall for such a drain could be found. · The ditchline at the base of the steep slope along the road has not had any surface water during our site visit. We are proposing to excavate the area where the diversion drain was installed and fill the area with fiver rock. The fiver rock is to be covered with filter fabric and than 12 inches of native material. It is our opinion that this should resolve any surfacing groundwater concerns. 5. TOPOGRAPIIY: As can be seen on the design drawing, the drainfield is to be installed on a slope that ranges from 15 to 25 percent slope that runs from north to south approximately. In short, we do not anticipate any slope concems. 6. LOT LINE WAIVER REQUEST: We request a 5 foot lot line waiver from the proposed ISF drainfield to the east property line. We are unaware of any adverse effects on the neighboring property with the granting of this waiver. 7. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction. Copies are available at the Municipal Onsite Services office (Sth floor, 9th & L St.). 8. CLOSING: I am open to any suggestions from your department, which would be an improvement to t e proposed design. I am unaware of any adverse !mpacts this installation would have o~,~ tcent wells or septic systems. If you have any questions, please contact us at 337-6179/.~ [tl(/~L~' rou for your assistance. President t 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com t HYLEN CREST PARK NOTE: ALL THE PROPERTIES SHOWN ARE SERVED BY PUBLIC WATER. I ~ ~ ~ PROPOS£O $£PTIC UPGRADE . - ~, ~'o \ ~ ~ (SEE DESIGN. PAGE 2 OF 3) ............. ----~ SIT'WART,~ S/D2_O 12 ~~ / /~ , B~w. ,v: a.5;~.~'*.~'~I ' ~ ~1 '.9~r, J.L.M. ~ ~ fill ~. ..~,~. ~S~ WKI'ER & ~ASTE~ATER CONSULTANTS, INC. ~,,~ '.. ~-79s~ .~ ,~ HYLEN CREST SUBDIVISION J3; LOT 2, BLOCK 6, SITE P~N FOR SEPTIC SYSTEM UPGRADE (BO~OMLESS ISF) NOTE: THE CONTRACTOR SHALL HAVE THE EAST AND WEST PROPERTY UNE$[ FLAOOED BY A RECISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. i THE ~A~[NENT m THE G~RA~. TH[ CI~TRACTER tt I _ X ~ ~ ~O nL~R (~ ~VA~ 2 mENCHES ~T ~ ~~ ] ~!1. ~ ~ // ~E 2 F~ UEEP ~M (ON UPHI~ SIDE) ~P~ NOT TO BE / ~ ~ ' ''~ ~ / ~ ~ ..... uPrmeoR ~NED IN ~E FOR ~ 5 B~ROOM CO~ ~ ~Er CO~L_~ NO~: ~Y ; ....... ~ ~ x ~ )l~C[ ~OM ~[ P~ED S.T.~P. ~ / UR~yE - - ~SI~ ~TER & WASTE~TER CONSULTANTS, INC. ~ ....... I~ 1~: ...... DICK NAGY (509) 96~-5636 2 OF .~tu c~s~ ,u~ws~o~ ~ to~ t. ~[oc~ ~ ~r,._~ ............ ~E OF WORK: DESIGN OF SEPTIC SYSTEM UPGRADE (BO~OMLESS ISF) I= 25' [.{}NC · ~ ~AIR UN£ COIL SPACED AT I /APPROX. 2 FEET. ORENCO / '~VASTEFLOW' TYPE PROV1D~D ~--FI. USHINO DI~TRIBU~ON UNE$. PIP£ SIZE: ~r~.~.~r.~,,~' YAI_V~ AND HOLE SPACING PER '~ ---- --FROM S.T.EP, TANK \\ // /APPROX. 2 FELT. ORENCO . 29' LONC ' I LOM AiR COMPRESSOR FINAL GRADE ~--FINAL OR&DE. or cov[~x~:~ [HO~S, S~£U~S. ANO ~USH~NO ~T / ZOP Or TOP OF ~Tb~C .~ VALV~r.S pER ORENCO OEStGN)~ I ' · ~TERALS \ I~STALL pLYWOOD AND X~ /ORtGINAL GRADE--~ 3/4 DIA. SON. 40 PVC IJ~ \ ~ISQU/EN BARRIRER. USE ~ -- ~ (HOLES, $HIO. DS, AND rLUSHIN. G \ BRACING AS NEE:D[D.--~ ~ ,---INSULATION Z~-~F IN~'FALL U E: ~ ~ t$ INCHr~ BELOW ~ ~S~ ~TER & WASTEWATER ~ i ': DICK NAGY (309) 963-5636 3 OF ~ '~o ~ffet A. Gamessf HYLEN CREST SUBDIVISION ~5; LOT 2, BLOCK 6, .'"' DETAIL AND PROFILE OF BO~OMLESS INTERMI~ENT SAND FILTER (ISF) ALASKA WATER & WAS'IEWATER CONSULTANTS, INC. _~'.'~ PHONE (907) 357-6179 · FAX (907) 358-3246 l SOIL LOG - PERCOLATION TEST I i OR~AN,CS I TEST HOLE #11 .......... 'o, I I A \ \~ ISlTE PLANI / ~ ow ~ OR~ \ \ ~t "='oo' ~ GP ' ~ HL ~ \ % v--PROPOSED L ....~ $£PT1C ~. c~ \ \ ~ ~po~ GM GC SW OL NH ~ ~ TH.~_~ ~ ~ SP CH o" DEPTHTO J s~- ~ , ~ / / 5' ~ 0/9/00 '- 10 11 DATE RE.lNG CLOCK NET TIHE WATER LEVEL NET DROP TIHE (HINGES) RE. lNG (INCHES) 12 10/9/00 1 3:11 6' 2 3:41 30 4 1/2" I 1/2' 13 3 3:41 ~ 6' 4 4:11 30 4 3/4' 1 1/4' 14 5 4:11 ~ 6 4:41 ~0 4 3/4' 1 1/4" 15 16 17 18 19 PERCO~TION ~TE 24 .(HIN./INCH) PERC. HOLE DIA. 6" (INCHES) 2 TEST R~ BETWEEN 1.5 FT. ~D 2.0 COHHENTS: PERC-HOLE W~ PRE-SO~ED FOR 4+ HOURS PERFORMED BY A~ WATER & W~ATER I, JE~ ~ GARNES, CER~ T~T ~IS W~ ~ERFORMED IN ACCORD~CE WEH ~L ~ATE AND MUNICIPAL GUIDEUNES IN EFFECT ON ~IS DATE: DEPTH TO DATE ~ROUNDWATER 5' lO/9/oo 4.5' 10/31/00 Sent EY: Alaska Water and Wastewater Con; 907 338 3246; PRO~ O3 This agreement, dated Anchorage Department c This agreement is rnad¢ on the subject property. The property owner(s) a The property owner(s) w professional engineer. T alarms arc functioning as statement that the system Property Owner Name (Notarize Here) Dec-l-O0 16:35; Page 2/2 iRTY OWNER MAINTENANCE AGREEMENT r-SITE WASTEWATER DISPOSAL SYSTEM Dec.. ~ ,2000, is made between the Municipality of 'Health dnd Human Servi-ccs (DHHS) and the property owner(s) of ~r the purpose of maintaining an on-site wastcwater disposal system roe to the following: ll have an annual inspection of the system performed by a registered ~is inspection shall verif~ that all effluent and air pumps, timers, and designed. Any deficiencies shall be corrected and the engineer's is functioning as designed shall be fil~d annually with the DHHS. Prop'erty 'Ok, nc r (.Name ~ / State of~ ;udicial District $S. On this _~ay of ~ in the year .--~0~, before me, the undersigned notary ~...~.tblic, personally appeared: ('~a/l~L_ kfiO:XiA known to me to be thc person(s) whosc',.~e(s) h/arc subscribed to thc within instrument and acknowlcdEcd that he/she/they executed thc same for the purposes therein containcd. la witness whereof· I hereunto set my hand and My comildsston expires: KIMBERLY LYNCH} Notlt~ Public, Statu of Illinois ~ Municipality of Anchorage Page ?__~_,of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~bJ ~J g'~/'~ P1D Number: O~O ~L7 ~ Name: T~JC~/~/~,~.,~ ~ ~A~Y Wastewater System: a New ~pgrade Address: /D~07 ~m~A~ b~W~ ABSORPTION FIELD Phone: No, of Bedrooms: ~eep Trench g Shallow Trench ~ Bed g Mound ~ Other L E G A L D E S C R I P T I O N sci, Rating: Total Oeplh [rom origina, grade: ' ~ GPO/Sq. Ft. ~, ~ ' /~. ~ ' Subdivision: 3eplh Io pipe bottom from original grade: Gravel depth beneath pipe Township: Range: Section: I Fgl added above original grade: Gravel length: WELL: ~ D New D U~ erave~width: Number of ~in~s: Classification (Private, A,B,C): ~Depth: Cased TO: Total absorption area: Pipe material: ~ / Ft. Ft. /, O7~ SQ. Ft. Driller: / Oate Drilled: StalicWater Level: Installer: Date installed: / Yield: gPM Pump Set at: Casing Heighl Above Ground: Ft. ~t. TANK ~¢;s ~¢ / SEPARATION DISTANCES ~ptic a Holding ~ S.T,E.P. TO Septic Absorption Lilt Holding Public/Private Manulacturer: ~ ~ . Capacity in gallons: From Tank Field Station Tank Sewer Lines Well ~ Material: ~ ~ Number of Compartments: Su~f~ew~ter ~4~l ~ /~ ~Q~ ~ LIFT STATION ~ Lot Size Jn gallons: Manufacturer: Line ~/ .j31 ' ' "Pump on" level at: ~~vel at: High water alarm at: Foundation C 7 / / 0 I Cudain *¢' >~0' __ Pu~ J El~td~, ,~pect,ons pe,ormed by: Drain Remarks: /~ b~¢~ s~oW " ,BENCH MARK Location and Description: / J Assumed Elevation: Inspections performed by: /* i Dates: 1st ~/~*'~/~: Department of Health and Human Services approval ~, ....,., ...... ,..~:~,,, ',. ~ev~ewed and aporoveO by: Date: [~-2~ ~ 72-013 {Rev. e/91) MOA 25 Permit No. 5~J Page ~- of ..~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ~ Z.~ ~uo~,. ~ /~yr.~l ~...~-r' '~ ~ PI[) No.: 0.~'0 ~?~l Permit No..~/gq-O ~t~ Page $ of ,.~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.Oi Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well InsPection Report Legal Description: PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 6 7 8 9 10 11 12 13 14 15- 16- 17- 18- 19- 20~ DATE PERFOR~ Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? THAT ~THIS T~ST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: '/~/~'-~/~"~/: S L IF YES, AT WHAT O DEPTH.;' p E Depth to Water Alt~r ~0nJl0rJng? Dale: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE _ ~'~"~ {minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ _ ET AND ~ FT 72-008 (Rev. 4185) PAGE 1 OF 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940319 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:NAGY RICHARD A OWNER ADDRESS:10307 STEWART DR EAGLE RIVER, AK 99577-9514 DATE ISSUED: 8/25/94 EXPIRATION DATE: 8/25/95 PARCEL ID:05047428 LEGAL DESCRIPTION: HYLEN CREST UNIT ~3 BLK 2 6 LT LOT SIZE: 23511 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHOP~AGE 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) 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: DATE: DATE: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 August 23, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 2, Block 6, Hylen Crest Subdivision Well and Septic System Design hnpacts to Adjacent Properties Dear On Site Services Engineer: The existing drainfield on the subject lot overflows from the upper trench to the lower trench during periods of heavy use. The lower trench was placed under the driveway and has less than a foot of cover. At times effluent has been noted on the driveway surface and is apparently coming from the lower trench. We propose to extend the upper trench a total of 10' and completely block off the lower trench by placing impervious material at the end of the upper trench. In addition, we intend to relevel the lateral in the upper trench and check the drain rock for any matting. If necessary, the matted rock will be replaced. The drainfield extension will be designed based on the percolation test completed during the original system design. During construction, the percolation rate will be verified. Adjustments will be made if necessary. Once all construction is complete the area will be revegetated to preconstruction condition. The lot is currently served by a community water system. If the system is completed as designed the following statements can be made: The system, if constructed as designed, will have no adverse impact on the wells currently in use. The subdivision is now served by a community water system. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. Lot 2, Block 6, Hylen Crest Subdivision August 23, 1994 Page Two The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. Sincerely, Michael E. Anderson, P.E. Lot 2, .Block 6, Hylen Crest Sub., Unit No. 3 Lot 2, Block 6, Hylen Crest Subdivision, Unit No. 3 NOTE: System Profile Scale 1" = 20' Relevel existing lateral from CO #2 to CO #3. Extend upper trench a distance of 10' in the westerly direction. Match existing Invert elevation at CO #2. Place 8' of dralnfleld rock beneath lateral. Place Impervious material at end of upper trench to prevent migration of effluent to lower trench. Provide 3' of cover over lateral or 2" of direct burial Insulation. Revegetate area to preconstructlon condition. Lot 2, Block 6, DESIGN FACTORS: Three Bedroom Home Pere. Rate: 53 Min./Inch Application Rate: .45 GPD/SF Hylen Crest Subdivision SYSTEM REQUIREMENTS: Deep Trench System 1,000 Gal. Septic Tank (Exist.) 8' Drainfield Rock 3 Bdrms. X 150 GPD / .45 GPD/SF = 1,000 SF 1,000 SF / 16 SF/LF = 62.5' LF of Trench - 55 LF of Trench Existing Therefore: Intercept the Existing Trench as Shown on the Site Plan and Extend it 10' in a Westerly Direction. ? z- o ........ ......... NOTE: TYPICAL DEEP TRENCH SYSTEM (No Scale) Maintain 4' Separation from Bottom of System to Groundwater. Grade Area Around Drainfield to Drain Away From Field. Place 3' of Fill Above Lateral or 2" of Direct Burial Insulation and 2' of Fill. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME EGAL DESCRIPTION LOCATION [~UPGRADE NO, OFBEDROOMS DISTANCE TO: Manufacturer Absorption DISTANCE No. of lines ~ Top of tile to finish grade Length Type of crib Width WellCrib diameter Foundation Total len g~,~f¢-~i nC Material beneath tile Depth Dwelling Material IWidth . Material Nearest ]~t~e / Trench wid~.~(~) inches inches No, of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT N~)~I Distance between lines Total eff6cti.y_e absor, p,tior~i~fea ,/ / Z.~ '~~ ~. PERMIT NO. Crib depth Total effective absorption area ~Suilding foundation Nearest lot line DISTANCE TO: C,ass E)t ?l-~ I DeptI'/~ Driller ; Distance to lot line PERMITNO, · ~ '-J ' ~uil~in~ndation Sewer line Septic tank Absorpt Da area(s} DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER /JAb- ~EMAAKS ~ebert A. Shrd~r APPROVED DATE 72-013 (Rev. 3/78) Ni,!,I ::; I-i::; ::'.:.:f' 'II ,['}~,l.~::l ~. l?.i:'i:~l,.ll ;~ / / Hi.~*NICIF'ALITY OF' ANCI-I .... AGE C, EPflRTMENT OF HEALTH AND ENVIRONMENTFIL PRGTECTION 825 L STREET,, RNCHORI=IGE,, AK DLa.50:L 264-4720 F'ERMIT NO: [:,RTE ISSUED: F FLI_.HNT: r. CONTRC:T F'HONE: C,/O S & S ENG~G. SRB t96X 'ERGLE RIVER., AK 694-2979 .JR',' [:,R',/IES LERL~,~.--,_.,...~r'='~"P:'~r:". _,___.'--I IF:P'I',,,'ISION: HYLEN L. EEz, T-' ' ~ LOT: ~' BLOCk.' ' ': 6 SECTIOH:' 8 TOWN5HIF': $4N RANGE: ~W LOT ~IZE: ~:~$~ ,::SO. FT. OR HI_.RES) I"IF:I2: BE[,RC GMS: ~ LI_,TE[ BELOH ARE THE.OPTIONS R',/RILRBLE TO YOU IN ~)ESIGNING Yn I~' SEPTIC SYSTEM. CHUJ=,E THE OPTION THAT BEST FIT~ 'T']LIR S.ITE. DEPTH TO PIPE BOT]'OI"I (FT.) GRRVE:L [:,EPTH <FT. )' TOTAL. DEPTH (FT.) GRRV'EL WIDTH ,;:FT. ::, GRR',,,'EL LENGTH '.'.FT. ) GRFIVEL VOLUME (CLI: YDS. ::, TFINK SIZE (GRLS.'., SI]iL RATING (SD.. FT. /E:R::, 'T F...' E ~-~ E: H BE[:, L,-L [:, F-: R 8.0 0.5 Z-:.5 :Li.O 4.5 7.5 2."5 27. 0 5. ?'La.. 0 ** 53:. 0 ±]:6. 62. ' :1. 52.'.. 0 t00. 000. 0 :+::+: :L., 000. 0 :+::l-: 1., 1-1100. 4:l. 9 5: J..:-Z: 4::L9 ,+:* DEF'TH TO PIPE BOTTOM <: 3:. 5 FT. REQUIRE:---, INSULATION ** DEPTH TO PIPE BOTTOM < 4. 0 FT. MAY REQIJIRE R LIEf STATION · *:+: GRAVEL LENGTM :::. ,.'?5 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) :+:* TANK MUST HR',,,'E RT LER'-]T TWO COMPRRTblEN'rS I CERTIFY THAT: t AM FAMILIAR WITH THE REQUIREMENTS FOF..' ON-SITE SEWERS FIND WELLS AS SE'~ ' FORTH' lB,',' THE MUNICIPALITY OF FINCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALl_. THE SYSTEM IN ACCOR[:,FINCIE HITH ALL MOA COl}ES FIND REGULATIONS., AND IN COMPLIANCE HITH THE DESIGN CF.'.ITIERIA OF THIS PERMIT. 2:. I WILL FI[:,HERE TO ALL. MOA AND STATE OF FILASK. A RE~]]UIREHENTS FOR THE SET RACK DISTANCES FROI"I FINY EY, ISTING WELL., WASTEWFITER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR AN',' RDJRC:ENT OR NEARBY LOT. ]: BE[.',ROOHS AND 4.. I UNDEF.._,TRNB. ,c ,THRT THIS PERMIT IS VRL. ID FAF.'_ . R MRXIMUM OF RNY ENLHRaEMENT WILL REQLIRE FIN ADDITIONAL PEF.'.MIT. IF R LIFT STFITION IS INSTRLL. E[:, IN RN AREA C:CI',/ERE[:, B'T' MCR E:LIIL[:,ING CID[:,ES., THEN (-1) FIN ELE6TF..IL.y'IL FERMIT I'-IN[.~ IN_,FEL. TIOI',I I1U.:,T E,E UE, TRINE[J., (2) H_, BUILT_, WILL NOT BE RPPRO',,,'E[:'¢'H!THOUT~ RN ELECTRICAL INSF'ECTION REPORT.; FIND ,'~:) ]'HE EL~EbTF..IL. HL P.IORK MLIST E:E. DONE B',r' FI LIL. EN-,E[ ELECTRICIFIN. .-.-. :, i bNE[. _~_ APPLICFINT:..','].. _q ;..: '-]: ENG"G. ,,TAY [',FIVIE_~. _ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] SOILS LOG PER CO LATI ON TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 ,4 · 7 , 8 '9 SLOPE _/ SITE PLAN 10 '-'11 13. -14 :.~_:;j 5 16 17 18 19-- 20- ~~ or~ COMMENTS PERFORMED BY: 72-008 (6/79) WAS GROUND WATER IN. J ENCOUNTERED? J'"~ (.~ IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop 5-.:7 PERCOLATION RATE TEST RUN BETWEEN .~. FT AND 'iL F T (minutes/inch) _ .;>..*'¢~.. , · , Municipality,of :Anchorage~ __ .. ,,_ .,.., .... ..,-.,. _. '''r.. ..' ,' . ..,.-.,s~:,l~. :'-:" ,. Development'.o.e.rvi_ce~.'~Pa. ,Lm.,.~.n~ :::.'.':.::'., : :: ~.'..:,~F~/J: .' , \\~.*~.~gqll., .., ..... .,..... ~. ..-,, Bu~g'S.~e~DMsbn:~. ':;. . '.:,., .:,'-,.-.,:~-.~.~.. .' . ~'~.,-z~.J'// ~ ' · ": ': :<-'- "" -' -'"*ast~"---~a~ ~- '.,., . ': :." :4 ,.: ,' '~ j; .,~, · , . , . ~ ' ~ , . ,On-~llewater~w .... r-pag .., , . . . · , . . ... - ' - .4700SouthBragawSL. . ,.. . . · . ' "": P.O ' ,' ..-., ....... .. ,.,..,, .,.. : ...... .... , ,. ... C~T~:~ '~~ , '-.-' · · '"'""" .... ~ ~LLI~' ,:~ .'.'" .... ' .... :O~:~'~ ~I~E ~I~Y" .... " ~ ' ~" ~ :~'-:-:-~"O~/~'/~ ~.~' ' ' PaOli.D: '".050-474-28'-. - -:..- -: -~- .. ..; , r. , . :-. .... ~;... ........:.-.....~.~ "1.' GEN~LINFOR~TI" ' ON? .... -' ; '"'-: :':'"':": ~Plmfl~nDat~:'- .. ,. ~mplet~ I~al ~es~pfion HYLE~ '.CREST' SUBO~SION '~3; LOT. 2,' BLOCK '6,: .'. Lo~on (site. address, or. di~ons~. '. :. 1. 0307.. STUART.; .,.' OR~-' * ..~GLE' RNER, AK~99577..... Curr~nt property Owner(s) Ma!ling address Lending agency' " . Mailing addr6~ Real Es~te Agent ' Mailing address ' "Day ph i309) g~3;5636 DICK: NAGY ' ' .... , one ' · 1~,100 jEANTRACE * 'BLOOMINGTON,' IL.' 61704 ' "' - Unlessotherwlserequested. HAAwillbeheldbyDSDforplckup. 2. NUMBEROF BEDROOMS: 3 Day phone 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 H~alth Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent pmfesslonal civil engineer raglsterad In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for pmperUes sewed by a single faintly on-site wastawatar disposal and/or water supply system. DSD also Issues ~ upon request fl3 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 less than 30 days old. (Certificates may be reissued for a I~edod 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 omission§ In the pmfesslonal engineer's work. Note: Alaska Water and Wastewater Consultants, lnc. shall be pald $ .OO at, or prior . I to closing for the engineering eervfces provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as Of th~ velidab'on date shown below, I verify that my invesb'gation, based on procedures outlined ln the Health AuthoriO/ Approval Guidelines for this application, shows that the on-site water supp~' and/or Wastawater disposal system is(are) safe, functional and adequate for the number of bedreores and ~ of structure indicated herein. I further verily that based on the information obtained from the Municlpali(y cf Anchorage tiles and frere my lnvestigab'on and thspection, the on-site wster supp~/ and/or wastewatar disposal system is(are) In compliance with ail applicable Municipal and State codes, ordinances, and regulations in effect at the timdof lnstallation. Name of Firm ALASKA* WATER & WASTEWATER CONSULTANTS, INC. .Address * 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Phone. 337-6179 Date ,~-/..~D/~O, Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provfde a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guldetines & Regula#ons. The reperted results described the perton'nance of the sTstom under the cond~ons encountered at the b'me of the test, and esparation distances measured to readily identifiable features. The operational life of all wails and septic s~tems depend on the Iocal soils condition, groundwater levels that may fluctuate dudng the year, and the water usage of the family being sen/~d by the system. These conditions are outside the control of the e~,aluator of the system. ,Satisfacfocy test results do not guarantee future performance of the system, nor do they guarantee Ihat there are no hidden defects or encroachments. AWWC, Inc. can therefore not prevldo any warrenO/ or future estimate of how long the system will continue to mcot tho operational requirements of the ADEC er MOA DSD. The content of this report Is for tho sole benefit of the owner listed abow. Any reliance upon er use of this report by any other pe~on or parly ls not authorized, nor wilI it confer any legal right whatsae~er. 5. DSD SIGNATURE ~ Approved for Conditional approval for bedrooms, with the fl ov~ng stipulatio~.'"~ ~ WATER AND ' ~' . WASTEWATER · ~. .t, PROG~U .- %y '... ...- '~,.¥~ _ -~ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Odglnal Certificate Date: Municipality of Anchorage Development Sen/Ices Department On-Bite Water & Wastewater Program 4700 8outh nmgaw 8L p,o. Box 1~6850 Anchorage, AK ~eS~0 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Oesc~p~on: A. W-gl.L DATA Weft bl)e Date completed Total deplh HYLEN CREST SUBDMSION ~3i LOT 2~ BLOCK 6~ Parcel ID: 050-474.-28 PUBLIC WATER SYSTEM IfA, B, OFC provide PWSI~ Well log (Y/N) FROM ~ ff. ff. g.p.m, g.p.m. WATER SAMPLE RESULTS: Collfomt - colonies/100 nd. Nitrate - mgJl.. Date of.ample: - Collected by:. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL TankMze 1250 gal. Number of Comparlmente Foundafion deanout (Y/N) YES Date of pumping NEW Other bacteria - colonies/100 mi. Date Installed 2/5-10/2001 2 Claanouts (Y/N) YES Oepressinn over tank (y/N) NO High water alarm (Y/N) YES Pumper - ¢. ABSORPTION HELD DATA ~ ~ oF M.O.A. APPROV~ ~4ND FILTER e~ ~ D~ ~ 38 ~ ~ 6 ~ G~I ~1~ pl~. *0.45 ,fl, Totaldepth ,*3.e It. Eff. al~mptlanarea 228 ft' Monltmtngtube YES Date of adequacy test NEW Re~ulla (Pass/Fall) - Water added - gel. RuM depth In absof1:)fion field beforo test - in. Elapsed Time: - rain, Final fluff depth - Any mJuvenauon treatment (p~t 12 mo.) (Y/N & type) In. Depression over field NO For 3 bedrooms New depl~ - In. Absorption rate >-. - g.p.d. It' ye~, give date - UFT STATION Date installed 2//5-10/01 'Pump on' level et 'm4lm In. Datum BOTTOM OF TANK E. SEPARATION DISTANCES Size in gallons 1250 'Pump off' level at 'nuERin. CycleS tested NEW SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/tllt station on lot Absorption field on lot. Public eswer main Manhole/__.N:'~e_ _ ss (Y/N) YES High water alarm level at 45 in. Meets alarm & clrcuti requirements? YES PUBLIC WATER SYSTEM On adjacent lots Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation $'+ Property line 5% Water main 10'+ Water service line. 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *5% Water se~ce line 1 o'+ Absorption field, Surface water. 5'+ 1(~0'+ Curtain drain NONE KNOWN F. COMMENTS *WAIVER WRy106 Bulldlng foundation 10'+ Surface water 100'+ Wefts on adjacent Iota. loo% Water main 100'+ Driveway, perldng/vehlcle eturage 5o'+ G. ENGINEER'S CERTIFICATION I cerffy that I have determined through field Inspections end conformance with MOA HAA guidelines In effect on this date. Engineer's Printed N. ame JEFFREY A. OARNESS ~-} Date HAAFee$~ Data of Payment - ~_..~.~~ Receipt Number Waiver Fee $ 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 1, ~ENERAL INFORMATION Completelegal:description ~ ~, ~ ~ '~y~ ~ Location (site address or directions) /O ,~ 0 7 ~-r'G'~,J/~Fc¢' '~/~1 ~J~ Property owner "~.1 ~ A4~. t~ /~. ~ ¢,G,,/' Mailing address Day phone. /4.G q Lending agency Mailing address,,, Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ' '~ TYPE OF WATER SUPPLY: Individual well Community well x: X, ~, NOTE: Public water 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 ',<: Y- X , , -%' .- t'kan "-',;'~'-': - ' ' ' - ' -~ "~' '" Holding '.. I ~ t ' '' ~ ~'~ ' ~".::) ' '- communi~ on;~ite_. .... "" ~' ' ;~ ~ 4 ¢'. . . . , Public sewer:;?..; '.. ,, ,.~/',~; ..... ",',''~'~','r- . . ~ ' ' ' ., . ') ~ . ' g',~ ~/~/:"-'.: NOTE: system, prowde wn~en confirmation from State ADEC attesting to the legali~ and status of system. - ~ ~..~.: ~ - .... 72~25 (Rev, 1191) Front MOA ~1 : ' ' ' ' " [~'' ,r,.; 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 /~r/'J b~Fz'~ 0 ~/ -~'-N~f,M~c'r'41r4~ Phone "~:Engineer'ssignature' ~ ~ ~_4~o~ Date ' /0/ 6. DHHS SIGNATURE Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments · ,¢';, .,' ?" ~;!'T'he ~0~ic~,ali~ of'~orage Depa~ment of Health and Human Se~ices (DHHS) i~u~s Hea[th.Auth~r,~ '?'~;pWoval 8e*itic~{~'~s~ only upon the representations given in p~ragraph 5. abo~e Dy '¢<~rSfe~bnal e&~[~r Cegistered in the State of Alaska. The D H HS does th~s as a cou ~esy [opu rcnasem of nome~ a~Sthei~'~'nding institutions ~n order to ~t~s~ ce~am federal and state r~ u~rements. Employ~ of DHHS do no[ conduct inspections or anal~e data before a ce~ifi~te is i~ued. The MunicipaliW of Anchorage is not 'responsible for errom or oral.ions in the profe~ional engin~fs work. ,'; .:., · ;. 72~(R~.1~1) ~ck MOA~ Municipality of Anchorage ,~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) Total depth If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Z.13 7-~c/ Sanitary seal (Y/N) Wires properly protected (Y/N) ~~ FROM WELL LOG AT INSPECTI~~'~- ~, Dateoftest ~__ ~- ~~- ~: Static water level J ~~ ~ ._ ~Z! ~ ~________~...~~- ~~'~ .~ g.p.m. ~:~ ~ ¢'~"~ o '"¢ '~ ~- ~g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: ~ ~ % Coliform Nitrate Date of sample: Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~'/~ ~ Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping Compartments "-'7-7~ o Foundation cleanout (Y/N) "~ Depression (Y/N) P~] Alarm tested (Y/N) /'J Tank size SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ~0~ / On adjacent lots /'J/~ Foundation To property line '~ Z.(¢ ' Absorption field ~i Water main/service line Sudace water/drainage '~ Z-O /"-r-~ ~"~,~.,,J c~.-I ~ D~AIrJ 7 y z~~ 72-026 (3/93)' Front CONTINUED ON BACK PAGE Manufacturer Date installed Size in gallons Manh~ Vent (Y/N) "Pump on" level at .....--'~ "Pump off" Level at High water alarm level ~ Cycles tested Meets MOA electrical codes (~ SEPARATIO~FROM LIFT STATION TO: .....~/~t On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed /-,'/4~'/ ~ c~/¢] ¥. -X~ SOil rating (GPD/FF) Length ~,'7 / Width ~ ~Z.' Gravelthickness Total absorption area /jO'TZ__ ~'~ E'~ Cleanout present (Y/N) ~" Date of adequacy test /",J/,h Results (pass/fail) for Water level in absorption field before test 0 After test Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: cf Well on lot ~/~ On adjacent lots /"//A Property line To building foundation /O To existing or abandoned system on lot On adjacent lots ~" 5-O / Cutbank ~'/ ~. Water main/service line Sudace water ~ ~ ~ '-/~ ,~-t~-~c~/ ' unveway, parking/vehicle storage area /~. Curtain drain ~, 2'..0 / /'~Jo~; system type J~ -~---c~p'-T-'ccc~c_.,H Totaldepth ~z / ~ j~ Depression over field (Y/N) /X~ Bedrooms ! · ~ I0 ! I=. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines/n eff~.t:~fl I~'~te oftb/s inspection. Engineer's Name Date HAA Fee $ Date of Payment ' ,t~. ' (;2 / /> Rece Number ' /:'"' ": 72-026 (3/93}° Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4?20 GENERAL INFORMATION (a) Application Date_ "~- !~_1 ~ ¢'~/,¢ Legal Description (include lot, block, subdivisi.on, section, township, range) Location (address or directions) (b) Applicant Name ~'~¢~L .'~//~T~ .__ Telephone: Home /~'J" '~' ~J~'OJ~ Business Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder~'TBuyer E3; Other [] (explain); (d) Lending Institdtion __~'-~ "~/~ _ . Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: $ & $ ~NGIN~ER~bl~ SP.B 1196X F-J~GLE RIVER, AK 99577 TYPE OF RESIDENCE Single-FamilyJ~ Multi-Family I-] Number of Bedrooms ~ Other WATER SUPPLY Individual Well [] Community'E] Public¢ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsit¢ Public[] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA'rA AND INFORMATION As certified by rny seal affixed hereto and as of the validation date shown below, i verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, 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 inspections ENGINEERING Name of Firm _ S~,~_~( Telephone Address ~'~-,~{~~~9 ~ ~, ,, jU~'-{~,(~)~(¢ Date Approved for '-~/~['~, bedrooms by Approved I/ -- Disapprov/L ' Conditio~a'~P~' Terms of Condition/~al Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84} i~ALiiqiCIPALITY OF AI4CHORAGT; DEPT. OF HE/,I.TH & ENVi EONMEiXI1'AL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) : ~!_ '1 i-:;1986 CHECKLIST- FEBRUARY 1984 264.,4720 R E C E i V ~ D Legal Descripti L....c:~¢ '7.-- '1~.¢_~ ~ WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/~g Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~ ~ , .~---~ ' !~'~. If A, B, C, D.E.C. Approved l~/N) Date Completed Yield ~e~ of Grouting /~ Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~ ~ ; On Adjoining Lots '?--~D ~--~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Date Installed ~;'/~t~ Standpipes (~/N) Depression over Tank S E PTI C/J:I.OL-DtNG' TAN K DATA Size \ C:r~PO NO. of Compartments Air-tight Caps,/N) Foundation cleanout ~"~')/N) .~ Date Last Pumped ""~- ~.~ Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High-Water Alarm (Y/N) _ Temporary J_Holding Tank Permit (Y/N) Separation Distances from Septic/I--~Tank: To Water-Supply Well .7....~¢~.~ I¢¢ To Building Foundation ./.~,~ To Property Line 1~ I¢' To Disposal Field To Water Main/Service Line "~c, / ~ To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field "~" Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well "~'¢~ To Building Foundation ~ Lot ~/R To Water Main/Service Line / D ! '¢~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~N) Date of Last Adequacy Test To Property Line / ~ 14- To Existing or Abandoned System on ; On Adjoining Lots To Cutban~ (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions ~t~~ Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certif.~ t.h. at_ I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signe§i~S~,lj ENGINEERING DateJUL 17 1986 196X C°mp~LE ,iViliR AK 99577 Receipt NO. '~C( L~ ~% Date of Payment ~]- I~-~ Amount: $ G ~ Page 2 of 2 MOA No. ~.~"j'---d¢o3 72-026 (11/84) ANCHORAGE/WESTERN {)ISTRICT OFFICE 437 I'E" STREET, SUITE 303 ANCHORAGE, ALASKA 09501 LIILL $ttEFFI£LD, GOVEItNOR ?~lephone: (.907} Addr(~,¢,~: 274-~533 DATE: July 17, 1986 PWS [.D.~ 213289 To Whom it May Concern: According to records; on fi]e ~n this off~ce the Water Regulations Hylen Crest Water System is in compliance w'itl~ the State Drinking MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL ~ALTH DEPAKTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date Lo ation (addr ss or directions)t~ '' ' ' /~ (b) Applicants Name__~ ~~ Telephone - Home -~usiness Applicants Address ~ //d~ ~/__~ ~ (c) Applicant Lis (cheek one) Lending Institution ~--~; O~mer/builder ~ uyer Other (explain); (d) Lending Institution ~/~,~/~/~ 2z:~// Telephone Address ~~ ~/ Real Estate Co. & Agent Address (e) (f) Telephone Mail .the HAA to the following address: .2. Type of Residence Single-Famtly~ Number of;Bedrooms 3. Water Supply. Individual Well~--~ Multi-Family ~--~ Other (describe) Community~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal 0nsite~Y~ Public~-~ Communtty~-~' Holding Tank~_~ · Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] E._n~ineering.Firm Providin~ Inspections~ Tests, File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, verify that my investigation of this Health Authority Approval shows that the 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 regula- tions in effect on the date of this inspection. Date DHEP Approval Approved Approved ,~ bedrooms Disapproved Telephone Condition~ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~EALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGR~d?H 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES-OF DHEP 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. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) Well Classif icatio~ ~' Well Log P=esent (Y/N) Total Depth Cased to Static Water Level Casing Height Ak~ve Ground Elect=ical Wiring in Conduit (Y/N) Separation Distances f~cm Well: TO Septic~ Tank on Lot ~d~CD ~-- CHECKLIST - FEBRUARY 1984 Legal D/e~ c r~p~ionj~ If A, B, c~ C, D.E.C. Approve~(Y/W) Date Completed Yield Depth of G~outing Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (_Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~?~P...9.,.~ ; Ca~ Adjoining Lots To Nearest Public Sewer Line Cleancut/Manhole Water Sample Collected By Water Sample Test ~sults To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Com~e nts S EPTIC/~a~ag~--T. ANK DATA Date Install9~. ~/~ ~ Size /~ O'O No. of C~,~artaents Stan~i~s ) Ai=-tight Caps~) Foun~tion Cleanout~) ~ession ~ Ta~ (~ ~te ~s~ ~d P~ing~i~te~a~ ~n~a~ ~ File (~- ; fJ- Holding Ta~ High-Wate= ~a~ ~~ ' ~ra~ Holdi~ Tank ~r~t (Y~/$~ Sep~ation Distan~s ~ ~ptic~Ta~: To Wate=-Supply ~11 ~ O O ~ To ~ilding Foundation /c~ / To Property Line /~ To Water--Service Line Course To Disposal Field ~-- { To Stream, Pond, Lake, c~ Major D~ainage Corments [Page 1 of 2] ReceiPt # Date Paid: Amount: 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed 6 /8 ~ Width of Field ~'~O ~ Square Feet of Absorption A~ea Depression ove~ Field ~f~ Results of Last Adequacy Test Eepth of Field ~ ~ Standpipes.. ,Present Date of Last Adequacy Test Separation Distance from A~sorption Field: To Wate=-Supply W~ll 2eKD '7~- To ~o~rty Li~ /~ ~ To Building Foun~tion ~ f To Existing or ~ndo~d System Lot ~ ~ ; ~ ~joining ~ts ~ ~ To Water~Main/~vi~ Line ~ ~ To ~t~(if pre~nt) ~ ~'/~ To Stre~ond~ke/~ ~jo~ ~aina~ ~se ~'~ ~ To ~i~way, P~ki~ ~ea, ~ Vehicle St~a~ ~ea /~ ~ D. LIFT STATION Date Installed Size in Gallons' "l~t~ O~" l~vel at High Water Alarm level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) /~"~k~mm Off" Level at /~=_ vent (Y/N) I/ Pumping/~ycles during Adequacy Test. Meets MOA Conments ** Check Permitted Bedroom Rating Against HAA Request certify that I have checked, v~rified, or confor,ted to all MOA HAA Guidelines in effect on the date of this inspection. 8 & ~ i~{31~IZi~FIINC~ Signed f. l-,,,l,., . .G=RB 198~ . Company / 'PI'l, '~O4-,P.979 KB1/d5/s MOA No. [Page 2 of 2] 2-15-84