The URL can be used to link to this page

Home My WebLink AboutHYLEN CREST #3 BLK 6 LT 8Uyl n Cre Block 6 Lo'l- 8 #050--47 34 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: ~, ~'~/~ .~- PtD Number:_ N,~'. Wastewater System: ~New ~ Upgrade Address: ABSORPTION FIELD Phone', No, of BeSoms: ~ ~_ ~/~~ U Deep Trench ~ShallowTrench OBed ~Mound OOther DESCRIPTION so, Ratlng:_.~ ~ Total Depth from~dgl,al grade', LEGAL ~ GPD/Sq. Ft. Lot: Block: Subdivision: Depth lo pips bottom from original grade: Gravel depth beneath pipe Township: /4 ~ IRange: / ~ Section: ~ Fill added above original grade: Gravel length*. WELL: D New ~ Upgrade Gravel~6pt~ ~'~ Uumberofllnes: Oislance~[w~nllnes: ' ~ Ft., ~ /~ Ft, Classification (Private, A,B,C): Total Dept~ ~To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: SEPARATION DISTANCES n Septic a Holding ~,T.E.P. To Septic Absorption Lift Holding ~Privste Manufacturer: Capacity in gallons: From Tank Field Stallon Tsnk Sewer Lines ~r~,~ ~ SurfaCewater //~ ~/~ ~/4 ~// W/A LIFT STATION ~ Size Ingallons: Manufacturer: Line Location and Description: I Assumed Elevation: Deparlmenl et Heallh and Human Serwces' app Reviewed and approved by: ~.¢~ Date: / 72.-O13 (1/91) MOA 25 Permit No. SW 92-0062 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Hylen Crest; #3, Lot 8, Block 6 PIDNo.: 050-474-34 ]LEVATIDNS ~ TOP or Lin -- ASSUH[D EL[~/ : ~OO.00' :NUT TU SCALE) O SWING TIES TANK, A-C=9,6' B-C--~3' FIELD: A-D=63,5' A-E=76.6' F-D=74,2' F-E=93,0' + - KEYBOX ~ - TEST HOLE e - MONITOR TUBE o - SEWER CLEANOUT ~mtm+.- PROPOSED LEACHFIELD --:--- EASEMENT SCALE l' = 50' 72-013 A (2/91) MOA 25 FRI 1 :~ :06 Mc~CL INTOOK LS--ER ENG ]: NEER Halmar Eleotrio PO. Box 1745,Eagle River Ak. Ph. or Fax 694-9993 99577 Billed L & B construction 14828 Terrace Lane Eagle River,AK. 99577 Date: I~v: 07-02-92 92038 Legal: Bid: Hylen Crest ( Dave & Tammy Miller) it. 8 bik. 6 ~4,200.00 Rough-in: $3,150.00 Paid: Trim-out: Paid: Poet-It"' brand fax transmittal memo 7671 ~alanoe: $3,150 · O0 ~o.oo Extras= Lighting totals: $0.00 110 CFM fan master bath Seourity RI. Juno IC-2 Recessed Lites ~Wer~t .ration to code $45.00 $175.oo ~25o.oo $200.00 3 additional outlets Wired 2 speaker stations Floor outlet Additional phone and TV jack $43.50 NC NC $56.00 ~xtras total~ $769.50 L~92038 Thank You Total Amount Due: $3;919.50 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HU~N SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920062 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:MILLER A DAVID ~ TA~Y L OWNER ADDRESS:18808 DRIFTWOOD BAY DRIVE EAGLE RIVER, ALASKA 99577 DATE ISSUED: 4/20~92 EXPIRATION DATE: 4/20/93 PARCEL ID:05047434 LEGAL DESCRIPTION: HYLEN CREST UNIT #3 BLK 8 6 LT LOT SIZE: 20704 (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 (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS EC .IVED To EAGLE RIVER ENGINEERING SERVICES P,O. Box 773294 EAGLE RIVER, ALASKA 99577 LETTER Phone 694.5195 p ~ ~,) /~ t2 ~'~7' Subject [] Please reply [~"No reply necessary. SlGNEO Louis Butera, P.E. Registered Civil Engineer April 7, 1992 John Smith, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Hylen Crest//3, Lot 8, Block 6 Narrative Dear Mr. Smith: The proposed septic system will have very limited impact on adjacent properties for the following reasons: 1. The area has large lots allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity, and community well services. 4. Drainage will not be effected and is not a major consideration in our design. 5. We are requesting a lot line waiver to allow for use of one trench for initial system, and also to allow for a partial replacement site without the use of a lift station. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 · F~ (907) 694-3297 EAGLE RIVER ENGINEERING SERVICES P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 9z-u3J JOB Hylen Crest #3, Lot 8 Blk 6 SHEET NO, OF CALCULATED BY L.B DATE CHECKED BY DATE SCALE 4 Bedroom = 600 GPD Soil Rating ~ = 10 min./inch Trench Design (a~ 0.8 GPD/ft2 Required Area = 100/0.8 750 square feet Sewer Gravel Depth = 9' Length Total Depth Trench Width NOTE: = 42' = 11' 2" 35 PSI insulation, in addition to soil cover, to be installed on leachfield located within 10' of driveway LEGAL: SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LOT 8, BLOCK 6, HYLEN CREST//3 Ao 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 or modified 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. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 11' at any point. 4. The trench gravel is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insnlation to a depth of 3' or equivalent is to be placed over the leachfield. 6. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200' to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 11' GRAVEL DEPTH = 9' TRENCH LENGTH = 42' TRENCH WIDTH = 3' SOIL RATING = 0.SGPD/FT2 BEDROOM CAPACITY = 4 SEPTIC TANK SIZE = 1,250 GALLONS NOTE: 2" 35 PSI insulation in addition to soil cover to be installed over leachfield located within 10' of driveway. Twenty-four (24) hours notice required for all inspections. 9l,c~,. ~..~...~-....~c S 89°$6'45' / 9a,49 Lilt 9 .,. LBT 8 / L[3T 7 ~ TH a ~ / -~- ~ ~ ~0, j o ~ ~ REPLACEMENT ~ HBUSE -~ ~ 360' 18,5'~ ~-m-x ~ ~uusr "~ e~ ~ ~ X{ TH 1 ~osS,.LC PARTIAL~EPTIC ~ '~ ~ ~EPLACEMENT AR~BED~ + - / -- o - SEWER CLEANOUT ~ ~ ~~ S 89056'45' ::::xm',~- PROPOSED L~CHFIELD ~=145> ~ 77,91 EASEMENT NB SURFACE WATER +100' CHHHUNITY WELL +800' DISTANCE NO KNOWN CURTAIN DRAINS S E PT I C S I T E P LA N LEGAL: LOT 8, BLK 6 HYLEN CREST fi3 ~.~.., OWNER: A,DAV[D & TAMMY MILLER CONTRACTOR: HAMANN FAMOTDI IATIAM__________..______.____'.'''~-~''xU'.llW'~, INC. JOB ff 92-om~1 DATE: o~/o6/921 SCALE 1 = 40' A EAGLE RIVER ENGINEERING SERWCES P.O. Box 7732~4 EAGLE RIVER, AK. 99577 (90?'.) 694-5195 FAX: (90?'.) 694-3297 PERFORMED FOR: LEGAL DESCRIPTION: Munlclpallly of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: Township, Range, Section: ~/~ ~ ~ SLOPE SITE PLAN 1 2 3 4 5 6 7 g 10 WAS GROUND WATER ENCOUNTER ED? Gross Net Depth to Net Reading Date Time Time Water Drop 11 s L IF YES, AT WHAT / DEPTH? /~' p 12 E Ilh I0 Waler After,. ~///?/q 13 MonltorlnD? /~: Dale,. 14 15- 16 17 18 19 PERCOLATION RATE ~" TEST RUN BETWEEN ~ FT AND ~ Fl' COMMENTS T/..c-5- 7-/-£~;/..z:-- 4,~ / FERFORMED BY: ~ t ,'"~"~ /~,- c, I ~-> ~="~- ':~";'"""~-~'~-"CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: . ~//?/? A. 72-008 (Rev. 4/85) .% PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 Munlcipallly of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE SITE PLAN 6 7 8 9 GROUND WATER 10 ICOUNTERED? lid' IIII 1 , AT WHAT ,/./~ O DEPTH? ~'~ P 12 E ,th Io Waler AIl}r 13 ~g? ,~ Bale: PE Gross Net Depth to Net Reading Date Time Time Water Drop 14 15 16 17- 18 19 20 3OLATION RATE ~E-¢T /-/o/..r5 /¢r¢¢~ /~'C,~Z, ~/~ TEST RUN BETWEEN ~ FTAND ~ FT COMMENTS PERFORMED BY: ~-'/'~W'~'"'¢' I ~~ERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~//?/¢ ~' 72-008 (Rev. 4/85) Louis Bulera, P.E. Registered Civil Engineer April 29, 1992 Dan Roth Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 iV£D APR 0 1992 Munic Dept. He ~ ' ~Chorao~ ' ~ ' '~t~'iat] Set/5-' vice8 Re: Hylen Crest #3, Lot 8, Block 6 Narrative ~ Revised design Dear Mr. Roth: We are requesting a modification on permit number SW920062, issued April 20, 1992, on the above referenced lot. We request moving the primary septic leachfield to the approved reserve area. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 77329,t · Eagle River, Alaska 99577 · Telephone (907) 694-5195 · [,'ax (907) 694-3297 9]'"c" ~'-~_~~'~ 3 89°56'45' E 92,49 ~q 5' x 4o.~' h ~CENENT HBUSE . ~ /5' O~ WATER LINE~ rlLlTy ~ ~ x>~ ASPHALT ~3,00~ ~ o T H 1 + - ~ox ~.~ ~ ~~ ~ o ~ - TEST HOLE N~ · - MONITOR TUBE- ~'0~~ o - SEWER CL~NOUT S 89~56'45' E ~IHIIHH~- PROPOSED L~CHFIELD R=]d~> ..... ~ 77,91 EASEMENT ND YEARRDUND DRAINAGES +100' CDMMUNITY WELL +~00' ~ISTANCE NO KNOWN CURTAIN DRAINS SEPTIC ~ITE PLAN ,-~" ~ "~ LEGAL: LOT 8, ~LN 6 HYLEN CREST ~3 OWNER: A.DAVID ~ TAMMY MILLER CONTRACTOR: HAMANN CONSTRUCTION, INC. ,,~ 92-055i, DATE: 04/29/921 SCALE 1 = 40' JOB ~ N ...... , ~, EAGLE RIVER ENGINEERING SERWCES ~.~.. c.-~ ..,~, P.O. Box 773294 EAGLE RIVER, AK. 99577 (90?) 694-5195 PAX: (90?) 694-3297 LEGAL: SPECIFICATIONS FOR ON-SITE SEI~rlC SYSTEM Revised 04/29/92 LOT 8, BLOCK 6, HYLEN CREST #3 Co 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 or modified 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 tlmt a surveyor locate the nearest lot line position and the location of any easements. LIFT STATION 1. Anchorage Tank lift station to be wired to code by a licensed electrician. Control panel to be placed inside house. DRAINFIELD 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 5' at any point. 4. The trench gravel is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 6. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to m~y Class "C" well, or 200' to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 5' GRAVEL DEPTH = 3.5' TRENCH LENGTH = 81' TRENCH WIDTH = 5' SOIL RATING = 0.SGPD/FT2 BEDROOM CAPACITY = 4 SEPTIC TANK SIZE --- 1,250 GALLONS + LIFT STATION = 1,500 GALLONS NOTE: 2" 35 PSI insulation in addition to soil cover to be installed over drainfield. Twenty-four (24) hours notice required for all i~tspections. EAGLE RIVER ENGINEERING SERVICES P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 92-033 jo~Hylen Cre~J; #3, Lot 8, Blk 6 SHEET NQ OF L.B. 04/29/92 CALCULATED BY DATE CHECKED BY DATE SCALE PRESSURIZED SYSTEM SIZING ~ Flow rate f/tom lift station = 30 GPM .......... 'Ii 'i'""Twc~lat~ral~"fr0m °n~central manif01d i = 15"GPM per latera Lateral length ~ i .~= 40,5' (off Central manifold) 1 5" diameter manifold ;lines With From Figure 7!29 .(EPA): RecOmmend .: · " rlfiCe Lateral distribution holes will bei3/16 (o': ) Asstiming 5' pi:essure :drop from ::across ·orifice Ofificearea (A) i = 0.00021ft2 CdA~ ; ! i (orifice,equation Cd = 0.6) 0.6 (0,Q002) -,/': 6414 (5)' ... (5' head, 3/161' orifice hole) , ................. 0.0021 ft3/gec' '~ " ~ Q = 0 92 GPM ' ' 15 OPM pet lateral recluires:: 15 GPM 0.92 = 16 holes per 40.5.'...:latgral @.2 5!.spacing a!ong,lat.e..ratpipe EAGLE RIVER ENGINEERING SERVICES P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 R2~033 JoB My±en Crest #3, Lot 8, Blk 6 SHEET NO. OF CALCULATED BY L · B, DATE--0 4 / 2 9 / 9 2 CHECKED BY DATE- SCALE SYSTEM DESIGN Revised 04/29/92 4 Bedroom = 600 GPD Soil Rating = 10 min./inch Drainfield Design @ 0.8 GPD/ft: Required, Area = 600/0,8 = . 750 square feet. Sewer Gravel Depth = 35' Total Length = 81' Total Depth = 5~ Trench Width = 5' NOTES: 2" 35 PSI insulation, in addition to soil cover, to be installed on drainfield. Two trenches 40.5' long to be installed with full pressurized distribution. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P,O. Box 196650 Anchorage, AK 99519-6650 www,ci,anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAl_ FOR A SINGLE FAMILY DWELLING Parcel I.D. DS-C, -- ~'-/- ?w GENERAL iNFORMATION Complete legal description ~ ~, 7- ,~;' ,~//~" ~, Location (site address or directions) /~: '.7 :z / Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address HAA # Expiration Date: Day phone Unlessothe~erequested, HAAwNbeheldbyDSD~rpick~. NUMBER OF BEDROOMS: Z-/ Day phone Day phone TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer 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 single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies 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. Eagk River Eng n,eCn¢ Name of Firm P.O. ~x 77~, ~e ~, Address Engineer's Printed Name ~ ~ ~ ,.~ ~%~ DSD SIGNATURE Approved for Disapproved. Conditional approval for Phone Date /b~, J ,~. 7, D--,,.' 3.. bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: (Rev. 12/00) Original Certificate Date: .D;." ' ~ EI,:F'T.$TATIO N Date.:ihstalled ¢',/.P,;,/9.~ Size..i~ gallons. "Pump on" level at ~.Z. in. ' · "P~Jmp~offi!-Ieve~at;::~?: Datum ,~,~.~¢~.'" T~,-, A' Cycles tested ' ;.'.' .Manhq e/Access (y/N) /V' ...... .High.water. alarm level at ¢¢'..¢' ~n. SEPARATION DISTANCES SEPARATION DISTANCES FROM'WELL ON LOT 'FO.: Meets alarm & circuit requirements? S~'ptiC'.tank/liff st.atibn Absorption field: on lot Public sewer main; S~wer-/~epfic.'s~F/i~e; line....; '::'~!.,~/~,¢ - '/~'/~' - ' · .- On ~djacent lots /u',~ On adjacent 'lots Publ'ic'.sewer. manhole/cleanout ,az/4 R0ldir~g 'f~a n.k~.; .... /v/cf ~ SEPARATION':.D.ISTAN'CES"F'ROM-'SEPTIC/HOLDING"TANK ..ON.'EO~-TO: Building.feundation 5- /: Property. line ~ / Absorption field Water main ¢-/~ ~. Water service line ~/~- ' Surface wa~er Wells on adjacent lots /¢¢~" . SEPARATION'DISTANCE FROM.ABSORP.TION FI'ELD...:'ON EOT 71'O: Property line Watb¢'SS'rvi'ce.iine ¢2' ~'~'"'" Gurtain'drain - Building foundation ..5-Y. '/ Surface water :' ~'~'/' '-" Wells.'.on adjacent, lots. '~/*'¢~' ", ' Wa(er mai'n ',".~ Driveway,' pa~kingNetiicle storage.'" '.?~ · F. COMMENTS : : ,~,~ . · ....~ G. ENGI.NEER;S.'CERTIFICA~FION'., ' "'!" . ,.~_~'.~.. O~. ......... : - .~e .... ..-. ~,: ~.,. ~,~ .. f ce/f(ty E~.~ I.h~ve delermieed ti~rougi~ he~dinspectibns.'ahd~.: . .. ~ ~. . .~ review, of Municipal re~ords that the.above System~ ,~e i~ : ' . . .: . ~.,~.~.~ , ~ 'conform~nce'.with ~OA:HAA:. g~id~linbS 'ih.-~ff~'~..¢his.dat~,..--' ' '. ..... ~' ~'~~,~ Engi6eeKs Printed Name' Z'¢ ~,~." ~ . . ' .':'. '~~ Dat~ .].~ ~:;¢-~'..L~ '~:,..".. '.' .'"...' . ';"-: . ::.':': '~ ",' :~E47~".: . .: . ..... :.. ......... . Da~e of Payment ] ~ ( ~ ~ ~ Bate of Payment Be'ceip.t Number....~HS: ~¢~. Receipt Nu~¢.r..._. . .. (Rev. 1'2/~0) [.soT---/- Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchora ge.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLI 1. GENERAL INFORMATION HAA # I"1,~. /'~1011'7 Expiration Date: /.--/ o ~ - C~) ,,O_ Completelegaldescdption ~.~!~1'5 ('!¢~;~3c '~,~; Lc~.t ~ Lo~tion (site address or directions) ~ ~ ~1 ~+EL~-~ ~r I~ ~ Mailing address ~ ~~} ~T'" ~)(~; Lending agen~ ~ ~ Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer 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 A~aska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for proper'des served by a private or Class C well and may be re:ssued with new water sample results less than 30 days eld. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates ere valid for one year for properties served by Class A or B wells or a public water system. The MunicipaIity of Anchorage is not responsible for errors or omissions in the professional engineer's work. e STATEMENT .... ' ' ' '* OF INSPECTION BY ENGINEER : ' :~ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined In the Health Authority Approval Guidelines for this appIication, 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 apptlcable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Firm ~a~le ];~J. ver ]~n~[..-leeZ'~l~ ~ez'~ce~*' -P.O. Box 273~, Ea~le ~yer, Address Phone Engineer's Printed Name 'l DSD SIGNATURE [,-"" Approv(~d for ~ Disapproved. Conditional approval for '-'1"~ ~. b'{' e-. V'~.-,Date bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: /?L .. ~ _ 0 1 Municipality of Anchorage Development Services Department Building Safety Olvialon On-Site Water & Westewater Program 4700 South Bmgaw St. P.O. Box 196650 Anchorage. AK 99519-6650 wwv.ci.anchorage.alLus (9O7) 343-7O04 HEALTH AUTHORITY APPROVAl. CHECKLIST WELL DATA ' Well type ~o. J3h~ if A, B, or C provide PW$1D # 1~ fuji. Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires pmpedy pmt~ ~~'~ Total depth fl. Cased to ft. Casing ~l;m~e ground) in. FROM WELL LOG AT..JNSPECTION Date of test Static water level ~ ft. Well production J / g.p.m, g,p.m, WATER SAMPLE ~'~: Coliform / colonies/100 mi. Nitrate mg./I. Other bacteria colonies/ID0 mi. ~e of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~'~-~ Tank size ~ gal. Number of Compartments Foundation deanout (Y/N) Data of pumping I°lz, loo Date installed ~/~ I~J :::) High water alarm (Y/N) Ce ABSORPTION FIELD DATA Length <::~1 It. Width ~ ff. Total depth _~ It. Eft. absorption aree'7_.~f~ Monitoring tube . Parcel I0: ~.-~ -q 'Tq-~ J3L System type~Ct, tl ow '~"'f~C~ Gravel below pipe -~ 5 ft. y Depression over field /%J Date of adequacy test c'~-jOJ Results (Pass/Fall) P~$~ For Lt bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in, Elapsed Time:,~ min. Fina~ fluid depth in. Absorption rate >= -F (~2~)O g.p.d. Any rejuvenation tmatmant (past 12 mo.) (Y/N & type) 1%O Iq~.. ]Crt OCt> r) If yes, give date D. MF~'. STATION Date installed ~/~/C)~ 'Pump on" level at ~.. in. Datum ~ E. SEPARATION DISTANCES 'Pump off' level at ~ in. Cycies tested ~ Manhole/Access (Y/N) - High water alarm level at Meets alarm & circuit requirements? sEP Tio. D,sTANcEs FRO W .L O. LOT TO: Septic tank/lift station on lot /~ ]{~r On adjacent lots Absorption field on lot ~/[//~ On adjacent lots Public sewer main )'~,~ Public sewer manhole/deanout Sewer/septic service line ~ Holding tank ~ IA r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line I ~ t Absorption field Water main -~ ~ I~ ~ Water service line ~ ID I Su~'face water Wells on adjacent lots in* SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~) Water Service line Curtain drain t~t Building foundation Surface water Water main Jr-~ (::) ~ D~.eway. pa~,g/vehici, storage'V~ 0 ~ Wells on adjacent lots F. COMMENTS H~A~ce $ ~ Date of Payment R ipt .umber (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number 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 (}50-474-34 HAA # '~ ~,0\ .~.('~ L..\ ~\ GENERAL INFORMATION Complete legal description Hylen Crest ~3, Lot 8, Block 6 Location (site address or directions) 10331 Stewar~ Drive, Eagle River, AK Property owner Mailing address David & T~,,uy Miller Day phone msg 694-5195 18808 Driftwood Bay, Anchorage, AK Lending agency N/A Day phone Mailing address Agent N/A Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water 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 NOTE: Public sewer If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025 (Rev. 1/91) Fronl MOA 1~21 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 Eagle River Engineering Services Address P.O. Box 773294, Eagle River, AK Engineer's signature ~ 99577 Phone 694-5195 Date DHHS SIGNATURE Approved for ,~:n4/'L (_~') bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~)25 (Rev. 1/91) Back MOA~f21 Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Municipality of Anchorage /~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ¢-/V££/,4 P-.~¢'F ..CZ Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed Drill, Cased to Casing heig Wires properly protected FROM WELL LOG CIPALHY OF ANCI IORAGE ENVIRONMENTAt. SERVICES DIVISION Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WEL ; On adjacent lots_ ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Nitrate Other bacteria Collected by: Tank size ? ~500 Compartments Foundation cleanout (Y/N) ~'¢ 5 . DePression (Y/N) ~'~ ~ Alarm tested (Y/N) /~/~ ~ /W'~'/.~ Pumper /',//.,4I Septic/holding tank on lot __ Absorption field on lot __ Public sewer main __ Sewer service line WATER BULTS: D'~tte of sample: B. SEPTIC/HOEBtN~ TANK DATA Date installed ~fi/Z ~2//<] Z-- Cleanouts (Y/N) ~"~' ~; High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: / On adjacent lots Foundation Well(s) on lot /¢/~ To property line Surface water/drainage Water main/service line '¢' /0/ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE Date installed Size in gallons Vent (Y/N) High water alarm level ,Z/- 5 /~ Meets MOA electrical codes (Y/N) C. LIFT STATION / oo Ye' ~ "Pump on" level at Manufacturer O~¢N~:~ / Manhole/Access (Y/N) ~/E' ..% "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /M/~ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~' / I Total absorption area Depression over field (Y/N) Results (pass/fail) Width Soil rating ~' ~'6'pD//¢ Gravel thickness 2, '~ / Total depth Cleanouts present (Y/N) Y~' -~ Date of adequacy test /V'///~' ¢ for ,'~ System type .~z,z/,4 /-Lb /,O F'/~£,A/~/ /v £ A) bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /V/A To building foundation On adjacent lots Surface water ~///4 Curtain drain /Al//4 On adjacent lots ¢- ,¢4¢0 / Property line /O / To existing or abandoned system on lot ,/k//¢4 Cutbank ,/,,//,4 Water main/service line ,¢~ ~'¢ / Driveway, parking/vehicle storage area ¢- ~'0 ) E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~ Engineer's Name HAA Fee $ / ~.,'~ 0 0 Date of Payment ~-(~,~9,2-.'; Receipt Number ~-3~F Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21