HomeMy WebLinkAboutBROADMOOR HEIGHTS BLK 1 LT 3Broadmoor
Heights
Block 1
Lot 3
#010-083-13
Job No.: 05-156
• Well Owner. _
• Legal Description:
M -W Drilling, Inc.
•P.O.Box 110378#Anchorage, AK 99511•
•907-3454000 ♦ 907-345-3287 Fax*
Parcel No.: 010-083-13 Permit No. SWO50453
Groundwater Well As -Built A Lor
Mathias
Fi:141RIX- i
Construction
• Use of Well Domestic
*Hole Depth: 319' ♦Casing Size: 6" ♦Cased Tu: 318.64' ♦hlarerial. A 53 Steel
♦Drill Alethod. Air Rotary
♦ Well Completion- Open end X Screen Perforated Afethod:
•.Screenl Perforation drscripNnn: None
• Grout Notes: (1) Sack- No. 8 bentonite granules
• Notes.
♦ Well Development. Afefhod: Air surge Notes:
♦Static water level (S1PL) 27.5' (above) (below) top of casing (TOC).
♦ Well yield test at 50 gallons per minute (GPA1)/ge11ons�ee-Jteaf fGP/!) jor I pours
with 100% of drawdown (DD) from static level (.SfPL).
♦Afelhod: Airlift
• Date of completion: 17 November 2005 ♦ Pump Install:
Well LoY
Depth In feet from
top
orcaala
.
Details of furmatiuus ptisetrated, size of material, culur and hardness.
0
TO
2.5
Casing stickup
I2.5
TO
11
Surface organics
11
TO
25
Silty gravel: grdy, small
-
25
TO
54
Silty: gray, slightly silty, "muck"- wet
54
TO
102
Clay: dark, gray, silty, dense
Sand: gray, very fine, wet, clay layers
_
102 TO 225
225
TO
270
As above: gray -black, silty, wet and heuvin I
270
TO
310
As above: coal seams, finer
310
TO
319
Water ravel: coarse
I
TO
TO
TO
WAYNE UEPBERG—�
TO
.
aresident,-M—W-Drilfing, Inc. --I
TO
—----.__._--_....--
NGWACenl!ied C^r;r.:c;or
ertificate-Nf mTO �}loC�
_
TO
TO
-�
Conttacto*. Ucense No_1000
Development Services Department
Building Safety Division
l On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 a c
Mark Begich Anchorage, AK 99507 s a E T Y
Mayor www.muni.org/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue: 7-6-16
Parcel Identification Number: 010 - OS3-13
Legal Description
Brocx-dmoo r- �t�,�, g � �3
Property Owner Name & Address:
%ra�sq
Z601� /.
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: ZA)
feet
Pump Manufacturer's Name: Y&D 3CrLle ,
Pump Model: 8 5 1 6
Pump Size .3/y hp
Pitless Adapter Burial Depth: IP feet
Pitless Adapter Manufacturer's Name: �(
Pitless Adapter Installer:
Well Disinfected Upon Completion? FYes ❑ No
Method of Disinfection:
Comments:
�/%
Pump Installer Name: i' (\ J
�N°++ ANCHORAGE WELL & PUMP SERV.
TH
330 EAST 76 AVENUE
.,rya ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Renewal
Date Issued: Dec 16, 2005
Expiration Date: Dec 16, 2006
Permit Number: SWO50453 Parcel ID: 010-083-13
Legal Description: BROADMOOR HEIGHTS SUBDIVISION BLOCK 1 LOT 3
Design Engineer: 0000 None Required
Owner Name: MATHIAS CONSTRUCTION
Owner Address: 2801 W 36TH AVENUE
ANCHORAGE. AK 99517 -
Site Address: 2801 W 36TH AVENUE
Lot Size: 12250 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 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 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.
5. The following special provisions.
-THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55.
PLEASE SEE THE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IT IS
THE BURDEN OF THE PROPERTY OWNER TO DETERMINE WELL LOCATION DOES NOT ENCROACH ANY
SEWER LINE OR SEWER MANHOLE. IF THERE ARE ANY QUESTIONS PLEASE CALL THE MUNICIPAL ON
SITE WATER AND WASTEWATER PROGRAM AT 907-343-7904.
Received By.
Issued B .
Date:
Date: f 2, 2 b'r
Municipality of Anchorage
1 Development Services Department
\ - Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. k5 t�610-d3-t3 Permit Number SW
Propertyowner(s) AA- Mras
Day phone Sq __ -Z)
Mailing address topLrg
gsgo
Zip Code 6
Site address
Code
y
Legal description (Lot, Block & Sub'd.) /o_l 3
rZip
@ Rrooc Aioor { eir 14S
Legal description (Section, Township & Range)
Lot Size Acres/Sq.Ft.
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only
Sewer and Well
❑
Water Storage ❑
Sewer Upgrade
❑
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
Swimming Pool
❑
Water Softening Unit ❑
Therapy Pool
❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Qwelling and is in accordance with applicable Municipal Codes.
Of property owner or authorized agent)
Permit/Rush Fees: '/Z5 --r ) 7S '''"Vlaiver Fees:
Date of Payment: /2- 7S -o Date of Payment:
Receipt Number. 5 % Receipt Number.
(Rev. 09/04)
USE ZONE
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MOA B6nrc14MARK
SD No, 6305z,?)
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BASE ) tcXp E/ev. - 46, 00
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is 2.00' a6ave 13. F. E.
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BASE ) tcXp E/ev. - 46, 00
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is 2.00' a6ave 13. F. E.
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Ca?:
All Le der,3 as s lc.,n Ln ih:S
;;j2SS i'"i rS{td^ h f 7-.fy AVE•
SUBVITT
6771 X
Ty
!r
OV 14 2005 Rev(sed 11-4-04(JY 7- zG-a5?k
PROPOSED CONSTRUCTION PLAN
` . 11 NV.Yr:L7
f
77L�A' 1✓ o��'tnL
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON.
0
.
scale: P,-30'
CR
I hereby certify that I have surveyed the following described
pert 107- 3, BLOCK !;
BROADA100R HV6/(7S &I&D.
Anchorage Recording Precinct, Alaska, and that the Improve-
ments situated thereon are within the property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no Improvements on property tying adjacent thereto encroach
on the premises in question and that there are no roadways,
transmission lines or other visible easements on said property
except as indicated hereon:
Dated at Anchorage, Alaska
This 3 O day ofAugus, ,0 09
FRED WALATKA & ASSOCIATES
(907) 248.1666 Engineers and Surveyors
of
N
ti
ZS° -
J Q
I I
li
OV 14 2005 Rev(sed 11-4-04(JY 7- zG-a5?k
PROPOSED CONSTRUCTION PLAN
` . 11 NV.Yr:L7
f
77L�A' 1✓ o��'tnL
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON.
0
.
scale: P,-30'
CR
I hereby certify that I have surveyed the following described
pert 107- 3, BLOCK !;
BROADA100R HV6/(7S &I&D.
Anchorage Recording Precinct, Alaska, and that the Improve-
ments situated thereon are within the property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no Improvements on property tying adjacent thereto encroach
on the premises in question and that there are no roadways,
transmission lines or other visible easements on said property
except as indicated hereon:
Dated at Anchorage, Alaska
This 3 O day ofAugus, ,0 09
FRED WALATKA & ASSOCIATES
(907) 248.1666 Engineers and Surveyors
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519.6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: Oct 21, 2004
Expiration Date: Oct 21, 2005
Permit Number: SW040445 Parcel ID: 010-083-13
Legal Description: QBROADMOOR HEIGHTS SUBDIVISION BLOCK 1 LOT 3
Design Engineer: 0019 Flattop Technical Services Site Address: 2801 W 36TH AVENUE
Owner Name: MATHIAS CONSTRUCTION Lot Size: 12180 SO. FT.
Owner Address: 2801 W 36TH AVENUE Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE. AK 99517 -
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 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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. ZZ 1;te� Date: 70 / Ziiar
Issued By. X71 Date: o zr 1Or
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.enchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0 0 — 063 — / 3 Permit Number SW
Property owner(s) Ma Fh (acr Corr brue—hC-? Day phone 2 fo —6Y32
MMailliinng address (1) 13120
N91 graddress (2) C`ana a) .10
it/I,/, F• r, Zip Code 995_
Legal description (Lot, Block & Sub'd.) V L C. f T_ B/k /, C #&
Legal description (Section, Township & Range)
Lot Size IN90 Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms 3
Sewer Only ❑ Well Only R
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
�i cG c 1_4� 9r,6-el�
(Signature of property owner or authorized agent)
Permit Fees: 1-75 c—G— Waiver Fees:
Date of Payment: 1011% Date of Payment:
Receipt Number: Receipt Number:
(Rev. 12/00)
LAT 04P.TEG�HNIGAL- SER�ICM
CIVn.6 ENVatONMENTAL ENGINEERING • ENERGY CONSERVATION 6 ANALYSIS
THEODORE F. MOORE. P.E. 14530 ECHO ST.
PH: (907) 345.1355
October 18, 2004
M.O.A. DSD
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
ANCHORAGE, ALASKA 99516
The purpose of this letter is to provide the required design narrative in support of our application for
permits to drill 3 private wells - on Lots 3 & 4, Block 1, Broadmoor Heights and on Lot l OD, Block 2,
New McRae SID. Site plans are enclosed for your review.
While each of these lots will be served by AW WU public sewer, no public water main is available.
The proposed well sites have been selected to achieve a separation distance of greater than 100 feet from
any public sewer line or manhole, and to maintain a separation distance of greater than 25 feet from their
private sewer service lines.
The proposed project will have no significant impact on present or future water supply and
wastewater disposal systems serving adjacent properties, nor will it have any significant impact on
reserved space -surface and subsurface, or on drainage.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
�
Ted Moore, P.E.
WELL
LOT I OC, BLOCK 2,
NEW McRAE SID
LOT I,BLOCK I
BROADMOOR HTS. SID
HOUSE
UNDER
CONST.
--------------------
LOT 4. BLOCK I
BROADMOOR HTS. SID
g41
%
PROP.
a::Lu
O.L� WELL
MIRAE AVENUE
L0T2, BLOCK I
BROADMOOR HTS. SID
LOT 3, BLOCK I
BROADMOOR HTS. SfD
HOUSE
UNDER
CONST.
AWWU
PUBLIC7�,,
SEWER
--------------
TP
LOT 3, BLOCK I
BROADMOOR HTS. SfD
TP
0
R 0.',r
W
lo"jk��WELL
WEST 36th AVENUE
— — — — — — — — — — — —
L
LOT 21 OT 22
A%.
0
r T�
49n' 1�
• .....................
THEODORE F.MOORE
CE -3589 �oAr0
III
PUBLIC
SEWER
LOT 3, BLOCK 1, BROADMOOR HEIGHTS
PROPOSED WELL INSTALLATION
SITE PLAN
FLATTOP TECHNICAL SERVICES I INCH = 50 FEET
14530 ECHO STREET DRAWN BY TFM
ANCI IORAGE, ALASKA 99516 OCTOBER, 2004
NOTE: THIS IS NOT A SURVEYED PLAT.
Municipality of Anchorage i
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
plo g A
Parcel I.D. 1�A-083-13 Expiration Date: Y —
r
1. GENERAL INFORMATION
Complete legal description BROADMOOR HEIGHTS BLOCK 1 LOT 3
Location (site address) .2801 WEST 36TH
Current Property owner(s) BRENT ALEXANDER Day phone
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
WaiverNanance request for:
Day phone
244-9414
EErmam I
AUG 1 8 2014
3
TYPE OF,WASTEWATFIRPt§Pp .. .
Individual On-site
❑
❑
individual Holding tank
❑
❑
Community On-site
❑
❑
Public Sewer
�J
'G dares
Received by: '6.Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 15 ab ry
Date of Payment l l�- I Iq t�
Receipt Number C�,55,q
COSA# C35c-t`41`(2_Z
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.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
in conducting this evaluation, GEG, LfD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that +�
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approve:f for :3 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 337-6179
Date It /q_
_ooboo �
4
OF..
flO ef-yA. rues
Q 9. CE 7900� 3
M �I
bedrooms, with the following stipulations:
X4`4 pP���V OF AVy�� rrfir
a ON-SITE
WATER AND
WASTEWATER
i; im
By: Original Certificate Date:
The Munic pality Anchorage Develop,emt Services Division(DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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.
ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev_11105)
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: BROADMOOR HEIGHTS BLOCK 1 LOT 3
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 11 /17/2005 Sanitary seal (Y/N) YES
Total depth 319 ft. Cased to 319 ft.
FROM WELL LOG
Date of test 11/17/2005
Static water level 27.5 ft.
Well production 50gpm
WATER SAMPLE RESULTS:
Coliform J511,colonies/100 ml.
Arsenic: 14- a ug./L.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material
Nitrate NP mg./L.
Date of sample: 8/5/14
PUBLIC SEWER
Tank size gal. Number of Compartments
Foundation cleanout (Y/N) _ C
ParcellD: 010-083-13
Well Log (Y/N) YES
Wires properly protected (YIN) YES
Casing height (above ground) 18+ in.
AT INSPECTION
08/05/14
27
8.98 g.p.m.
Collected by: GEG. Ltd
Date installed
(Y/N) _ High water alarm (Y/N)
mping Pumper
C. ABSORPTION FIELD DATA PUBLIC SEWER
Date installed Soil rating (g.p.d./ft or ft2/bdrm)
Length ft. Width ft.
Total depth ft. Eff. absorption area_ ft2 Monitoring
Date of adequacy test Results _
System type _
Gravel below
ion over field
For bedrooms
Fluid depth in absorption field before t _ in. Water added _gal. New depth _in.
Elapsed Time: Final fluid depth in. Absorption rate >= g.p.d.
An enation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YM
"Pump on" level at in. "Pump off' level at High water alarm level at
Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanknift station on lot NSA On adjacent lots 100'+
Absorption field on lot NSA On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer /septic service line 25'+ Holding tank
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main
Wells on adjacent lots
Property line Absorption
Water service line Surface
SEPARATION DISTANCE FROM ABSORPTION
Properly line Buildin nffa
Water service line Surface water
Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 9)I (0)"V
(Rev. 11/05)
Water main
Driveway, parkingIvehicle storage
Municipality of Anchorage o ,
' Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Arsenic Advisory
Certificate of On -Site Systems Approval # 141422
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 3 of
Broadwater Heights Subdivision. This inspection revealed an arsenic
concentration of 14.2 micrograms per liter (ug/L) for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Information on
arsenic is available from the On -Site Water and Wastewater Program
website (www.muni.or onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site, Systems Approval,
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water d Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS
FOR A SINGLE FAMILY DWELLING
FILE
COP...
Parcel I.D. _ 01(} - n5m- )
COSA#`� OI(
1. GENERAL INFORMATION Expiration Date: Z 3 — (J ,S;
Complete legal description BROA06100R HEIGHTS LOT 3 BLOCK 1
Location (site address) 2801 W. 36th AVFHt1F . erui+une.nr
Current Property owners) RICK SCOTT
Day phone 748-7759
Mailing address 2801 W. 36th AVENUE •ANCHORAGE AK 99517
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing address
Unless otherwise requested, COSA will be held by DSO for p/ckup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Water Storage
0
11individual
Individual On-site
13fndivfdual
Community Class Weil
❑
Holding tank
❑
Public Water System
❑
Community On-site
❑
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
engineer egiistered Int a based Styat pof Alaskan the . Certiffiicattens of On-Sitiven in Systems paragraph4 by Approval Independent Professional sfer
of title (except between spouses) for properties served by a single-family osite Wastewater disposal dispouired sal the mer
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems
Apreissued with proval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
reissued for a
be
Certificates arewater
valid for onsamples.e yearficates for properties served erved by Class nor B wod Of ells or a public water to one year with systewater
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
FILE COPY
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validaUoh data shown below, f verify that my
investigation, based on procedures outlined in the Certificate of Ort -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 vedfythat based on the
information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
on-site water supply and/or wastewater dispdsal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations In effect at the time of Installation.
Name of Finn GARNESS ENGINEERING GROUP. Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE. AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation. GEG. LID. attempted to.provide a thorough,
conscientious engineering anaysis of the system in accordance with ADEC and MOA
DSD Guldefines b Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test and separation
distances measured to readily IdenbYable features. The operational fife of all wells and
septic systems depend on rine tical sale condition. groundwatorlevefs that may
suctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory lost
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system wX continue to meet the
operational requirements of the ADEC or MCA DSD. The content of this report Is for
the sole benefit of the ownerlisted above. Any reliance upon or use of this report by any
other person or party is not euthorfzed, nor will it confor any legal right whatsoever.
5. DSD SIGNATURE
Phone 337-6179
Date 5 2 t?
�� Approved for bedrooms.
Disapproved.
Conditionat approval for bedrooms, with the filowing stipulations:
Attachments:
COSA Cheddist Arsenic Advisory
Septic System Advisory Maintenance Adreements
Well Flow Advisory Supplemental Engineet's Reort
Nitrate Advisory 'Other
By. Ong"Inal Certificate Date: �' .3 0
(n«. +itis)
FILE COPY
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Silo Water& Wastewaterprolyam
4700 Bragew Street
P.O. Box 198850
Anchorage,AK 995198850
"O'dMuni.org/onsile
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal DOsoriptlon: BROADAt00R HEIGHTS L07 3 BLOCK 1
A. WELL DATA
WON type JeMLAN_
If A, B, or C provide pWSIDtt N/A
Date completed 11 17 O5 Sanitary seat (Y/N) YES
Total depth 319 ft. Cased to 319
ft.
FROM WELL LOG
Date of test — 11/17/2005
Sta1t water Ievel 27.5
Welt productIon 50
g.p.m.
WATER SAMPLE RESULTS:
Paroe; It): -0J 0- 3" /3
WOII Log (Y/N)-- YES
Wires propsrty protected (Y/N) —YES
Casing height (above ground) I$+ In.
AT INSPECTION
N/A g.p.m.
ColNorm –!E�— 0010nhW100 mi. Nitta% AlanVA_ //yy
Areanicllja Other-�Looloniea/1o0ml.
�'�' Date of sample; 5 1 S 2007 Collected
8. SEPTIC/HOLDINO TANK DATA �' GEG Ltd.
PUBLIC SEWER
Type/Material
Date IrtstaNed
Tank site gal. Number of Compal{menta `
Foundation Cleanouts (Y/N)
Depression over tank (YIN) High water /N)
Date of pumping p.
o.
C. ABSORPTION FIELD DATA
Date installed Son rating
Lamm —__ft. 1Anri
System type
IL Gravel below pipe
Total depth R Eft., rea, ftr — ^ft.
MonMpn Depression over field
Date of adequacy test Raub (PasyFag)
Fluid abao For�_pedtoo+rls
depth in
Held before test , in. Water added _ gal.
Elapsed —min. FirreF fluid New ._!n.
depth ` in. Absorption rete >=
hetabnant (Past 12 mo.) (YIN S type) If Yes give
D. LIFT STATION
Sim Ingallons Menhole/ArxXsas (YIN
Date installed
"Pump on" level at Pump oft lav .. High water alarm level at � i^•
Cydes tested_–__– Meets alarm &circuit requiremenb?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: N/A –
Septic tankila station on kA On adOWt lots
75'+ On adjacent lots
Absorption fletd on lot
age + i k Public sewer manhdafdeanout –
Public $""et main --
Sewer /septic service line2— -- 5 +-- Holding tank
50'+ Manurelanimal excrete swrep areas
Animal containment areas---
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: tleki
Building foundation Prop"Nne Absorption
Water main
Water service line Surface water
Wells onadjacent WPUBLIC SEWER
SEPARATION DISTANCE FROM ABSORPTION F
LOT TO:
,..�. .A.ff ,,, _ water main
Property line o ro
Water service line
Surface water_�DnveweY. padunglvetade storage
y Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I cerNy oral 1 Nave delemdned dnaugh AW inspec oons and.......
review of Mu *od records oral die above 41 o i
conformance MOA COSA gWda& es ..............
y Goro
date. —
Engineer's Printed Name JEfFREY A. GARNISS — +>Z, �IZH ,
Data Sf z _ _ ^'dJbrofes
COSH Fee S ��3t7 1 —
Date Of Payment S n 7
Receipt Number
(RW. 11/06)
Waiver Fee
Dale of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Arsenic Advisory
Certificate of On -Site Systems Approval # 070161
water was recently conducted on the well water supply on Block
A Certificate of On -Site Systems Approval inspection and test of potable
1Lot 3 I,
Broadmoor Heights Subdivision. This inspection revealed an arsenic
concentration of 9.02 micrograms per liter (ug/L) for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Information on
arsenic is available from the On -Site Water and Wastewater Program
website (www.muni or on, te) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
40S,&
Z>e
Parcel I.D. O 10 - 083 - 13 COSA # DGS
1. GENERAL INFORMATION Expiration Date:
Complete legal description L 3, C lec k r, 6 ro eree. &o e M t,r -C/.D
Location (site address) 2 8a r w 36 r" /) �tnu� /fin cymr-Oil e
Current Property owner(s) Ma Hi t a e Con rh ,,c f,:,, Day phone Z Y 0 -,& V2,0
Mailing address 13r2a Lar,,.. R.0 AAC60.-;,fg, Ak 99s-ig,
Lending agency Gln k. Day phone
Mailing address
Real Estate Agent tu,-y Cox-, Re r`1 k K Prni Day phone 27d-2-70-/
Mailing Address
Urdess otherwise requested, COSA will be held by DSD for pickup. p& cer f f Rye H u ffii of
2. NUMBER OF BEDROOMS: ? @ 2Y0 - BH3o "*.en r ror ey
for picfc-.1)
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 19
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, 1 verify that my investigation,
based on procedures outlined in the Certificate of Onsite 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, aannd' regulations in effect at the time of installation.
Name �oof Firm Ftc* i -k0 T'.e4 n;ehf SStv
..er Phone 3 y -r. ? ss-
Addfess I N520 Et4o 6-),011 n e!y An5A 99rV
/ Engineer's Printed Name T"Ata de, -e r=• ov Date
5. DSD SIGNATURE
J,-*� Approved for .3 bedrooms.
Disapproved.
Conditional approval for bedrooms,
� l �1J41• •�
A' L"'i •rw
� Je r. � �,�.�, phi �'••.��
ix
• �• TI'i CDL'.^'. F. A:CCRE; A
. 1. � . '• 7.. r� .'may.^' Cf
with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
gy Original Certificate Date: ' l - O
(RevAIM)
Municipality of Anchorage
• Development Services Department
Building Safety Division
Onsite Water & Wastewater Program ' • "
4700 Bragaw Street
P.O. BOX 196650
Anchorage. AK 995196650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: - 3, Oil, $ ew in ao NICY t /D Parcel ID: 0/0-087-.1-7
A. WELL DATA
Well type P v If A, B, or C provide PWSID # A • A, Well Log (YM) Y
Date completed t rr / e,Y Sanitary seal (YM) ti' Wires properly protected (YM) `r
Total depth 3 / I_& Cased to 3 l,ft. Casino height (above around) _ 2 7 in.
FROM WELL LOG AT INSPECTION
Date of test tt / t / &S-
Static water level 2 7. f ft, ft
Well production SO g.p.m. 9—
p.m-WATER SAMPLE RESULTS:
Coliform ! colonies/100 mL Nitrate 401.1 mg/L Other bacteria — & colonies/100 mL
i
Arsenic: 4 • e o S' m%4 Date of sample: t yo / e 6 Collected by: F /4 k1&J0 Tors, S� c
B. SEPTICIHOLDING TANK DATA N• 4. 6K 4 /i c Ce ower ,
Tank Type/Material _
Tank size gal.
Foundation ctesnout (Y/N)
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Number of Compartments
Depression over tank (Y/N) _
Pumper
N.A. C Pa5/1c riw«J
Soil rating (g.p.dJfe or fte/bdrm) —
Date installed
Cleanouts (YM) _
High water alarm (YM)
System type
Length ft. Width ft. Gravel below pipe ft.
Total depth _ ft. Eff. absorption area ftp Monitoring tube _ Depression over field
Date of adequacy test Results (Pass/Fad) For _ bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date
D. LIFTSTATION N• A••
Date installed
Size in gallons
Mantwle/Access(Y/N)
'Pump on' level at _ in. 'Pump oft level at _ in. High water alarm level at in.
Datum Cycles tested Meets alarm to circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot N• A. On adjacent lots N• �.
Absorption field on lot N• A On adjacent tots N• A.
Public sewer main > t Cio'
Sewer /septic service line > 2 S'
Animal containment areas N• A.
Public sewer manhole/dearlout > tow,,
Holding tank _ N • A.
Manurelanimal excrete storage areas M. A.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: N• A.
Building foundation Property line Absorption field
Water main
Wells on adjacent lots
Water service line
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: N. 4.
Property line Building foundation Water main
Water Service line
Curtain drain
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Surface water
Wells on adjacent lots
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines In effect on this date.
Engineers Printed Name TAeo ador)e r=• r-rw.z-
Date 3 Ft-li r -u t •-y 2 a o G
COSA Fee S •tRQ;+ .9 1-7
Date of Payment 2 /37 / b6
Receipt Number
(Rev. 11105)
Driveway, parking/vehicle storage
Waiver Fee $
Date of Payment
Receipt Number
.........
`. i:,zCLOrt: F. ►'.GORE,
oa 1;.
. �
Lot 1 I Lot 2 8271 X I I
East 87.50 30
ss---- 10' CEA Aerial Easement SS
----------------
LOT 3
Lot 4
I
CD g2*0
31. '0
C)H t) m
C5 O pt -
Elevations: c mGarage Slab=46.22 Finish Floor -47.81 Z O
Base Flood=46.00 Z9.7 SCALE: 1•= 30'
we, I
— — — ITU
30
East 87.50
M cI
_ $ W. 36th Ave.
o • •`aCA
>Jr AZ do
7:
r 0,
t FredFYo4ct4a 9,i' i
NO. 32„ Z .'r �.
EASEMENTS OF RECORD, OTHER THAN `� int•
THOSE SHOWN ON THE RECORDED -a •�
PLAT ARE NOT SHOWN HEREON. FbOS•7, pg 15 BE
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have perfomred a Mortgagee's Inspection
of the following described property:LOT 3, BL OC
nonenunna uctntaTs SUBDIVISION
Improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no Improvements on the property ly4tg
adjacent thereto encroach on the premises In question and
that there are no roadways, transmission lines or other
visible easements on said property except as Indicated
hereon.
Dated at Anchorage, Alaska
this 31st day of 2st.ober .2005
FRED WALATKA d ASSOCIATES
Engineers and Surveyors