HomeMy WebLinkAboutBROADWATER HEIGHTS TR D BLK 1 LT 5roadwater
Height
lock I
Lot
Tract b
050- ! 3 !
Municipality of Anchorage Page -'J- ..ot--~-
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage. Alaska 99519-6650 · Telephone: 343-4744
On-Sile Wastewater Disposal System and/or Well Inspection Report
Permit Number: ..c~ (~..~ O ~.lj~ PIDNumber:
N,m,:~ ~ ~ WastewaterSystem: ~New DUpgrade
~ ~o~ ~ ~ ~ ABSORPTION FIELD
I
I
WELL: ~ New ~ Upgrade
SEPARATION DISTANCES i~Se,~c O Holding ~ S.T.E.P.
W,t,r Im+ IO~'+ ~ LIFT STATION
CudainDraln ~ ~
Remarks: BENCH MARK
~;~' a'".~,f- 'h
S l S ~GIN~ING ~ ....................
Inspections p s.
Department st Health and Human Se~ices approval 'h~;~,~.~?~4.~, ,< ::.............,,, ..
PERMIT NO. SW050268
PAGE 2 OF 3
Munic:ip. o[it o~ Anchoracie
DEPARTMENT OF HE~_THAND HUI~AN SERVICES
ENVIRONMENTAL SERVICES DIVISION
p.n. I)ox 196650 ~Anchor(~oe, A~sk~ 99519-6650~ Telephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LOT 5, B1, TRACT D, BROADWATER HEIGHTS P.LD. NO. 050-151--28
p~R~r~ i~o. SW030268
Municip. cdPt oF Anchor'c~Qe
DEPARTMENT OF HEA~THAND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.B. Box 196650 ~.Anchoc'~,ge, Ataske, 99519-6650 ® Telephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LOT 5, B1, TRACT D, BROADWATER HEIGHTS P.l.D. ~o. 050-1.31-28
C01
C02
,~C02 = 88.2'
COt 86.6'
,,,,,,,---FINAL GRADE
.,,~,,,~,~,-- 2" INSULATION
H CO?. = 83.3'
CO1 = 83.1'
X-MT1 = 81.4'
·
~tATER FOUND
74.4' B.O.H.
77.4'
A B
FCO 20.0' 15.0'
ST1 30.5' 22.0'
ST2 33.5' 21.0'
DBL1 35.5' 21.0'
)BL2 57.0' 21.0'
CO1 49.0' lS.S'
MT 48.5' 24.5'
C02 60.5' 48.0'
by
DOC CO* ~ba
. SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 * TELEPHONE 688-2750
OWNER OF LAND: ~ ..~.¢~.1~ J ~ C/../~-/~ ~¢.. BORE HOLE DATA
DEPTH
ADDRESS: , r,~,~ To
LE~3AL DES~IPTION:" ~/"~/~ O ~ ~ ;t'~ ~ r~lz ~.~
Is well I~at~ at app~v~ pe~it lo,alien2 ~ ~ No
~Jh~ of D~lling: ~o~w ~ cable tool
Casing Type ~ ~¢OWall ~ickness 2 ¢0' inches
Diameter (2 Ii
' · inches, depth 2 ~ feet
Lin~ Type: e.',) ~¢ ~ ·
Casing Stickup Above Ground: ~ ' ' feet
Static Water Level: ~ O feet
R~over Rate: q ~ ~ ~
Method of Testing: Cd~P ~F~ ~ ~¢~ ~E{~i
Well Intake Opting Type: g o~n end g open hole
~ Scr~n~; . S~d feet Stop~d feet.
~J Perforati~s Start feet Stop~d feet
G~utType: f)e~ ~"¢ ~Volume [¢
~pth: from ~ feet, to ~ 0 feet
Well Disinf~t~ Upon Completion? ~ O No
Meth~ of Disinfection: ~//~ d~*v ~ ~0
Commits: ·
Driller's Name
A'I-FENTION: Jt is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Renewal
Date Issued: Jul 23, 2003
Expiration Date: Jul 22, 2004
Permit Number: SW030268 Parcel ID: 050-131-28
Legal Description~BROADWATER HE GHTS TR 'D BLK .';1 LT 5 ?
Design Engineer: 0003 S & S Engineering
Owner Name: Steve Carn
Owner Address: 11908 BROADWATER DRIVE
Eagle River, AK 99577-0000
Site Address: 011908 BROADWATER DR
Lot Size: 20261 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. Ail 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:.
Issued By;.
Date:~O,~
Ju3-17-03 02=22P Pe'r'mtt Counte~ 907 343 8250 P.O!
Municipality of Anchorage ~~.;.
Development Services Department
Building Safety Division
On-Site Water end Wastewatm- Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 995t9-6650
w~w.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWEPJWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0-~"0 - 131-
o9oZ68
Permit Number ,S~
Property owner(s) *~ P_..tq~'~ S ~ 16~Y~,~ Day phone
Mailing address (1) ~ ~ I
Uailingaddress(2) ~O~I ~ ~p~e
Legal des~ption (Lot, Block & Sub'd.) ~e~ ~t ~5
Lot Size ~O ~ ~ I A~es/~ Number of ~dr~
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPER'P( CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Well Only []
Water Storage []
[]~] Jacuzzi
Water Softening Unit
I ce~fy 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.
(Signature of property owner or authorized agent)
RecelptNumber: 3 ~763
Waiver Fees:
Date of Payn'
Receipt Num
I~o~t4t" brand lax transmittal memo 7b-/1 I ~ "~ ~ ·
~.- ,,,-.,%U %_-)ot0q
c(- { Hqt -.' -aqq-/
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bregaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Jul 24, 2002
Expiration Date: Jul 24, 2003
Permit Number: SW020243
Legal Description: BROADWATER HEIGHTS TR D BLK I LT 5
Design Engineer: 0003 S & S Engineering
Owner Name: Dennis Clark
Owner Address: 2120 C Street Apt. #1
Anchorage, AK 99503-0000
Parcel ID: 050-131-28
Site Address: 011908 BROADWATER DR
Lot Size: 20261 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
construction must be In accordance with:
1. The attached approved design.
2. Ail 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:
Issued By:
Parcel I.D.
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.cl.anchorage.ak.us
(907) 343-7904
ON-SITE SEWEPJVVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Permit Number SW
Properly owner(s) 'ID ¢..1~ .5 C..,Ij~ iL/Y..
Mailing address (1)
Mailing address (2)
Legal description (Lot, Block & Sub'd.) Lo'~' -~,
Legal description (Section, Township & Range)
LotSize ~ ~ Number of Bedrooms ,,~
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Day phone
Zip Code
[] Well Only []
~ Water Storage []
Jacuzzi
Water Softening Unit [~
I certify that the above information is correct. I further certify that this application ts being made for a
Single Family Dwelling and Is In accordance with applicable Municipal Codes.
(Signalure of property owner or authorized agent)
Permit Fees: ]~ ,~.~' O. ' o Waiver Fees:
Date of Payment: '7 / ~ ~ o ~ Date of Payment:
Receipt Number: ¢) ~''33'6 .~ ~ Receipt Number:
(Rev. 1 ?.J00)
~ *~ ~ [~NGINEERlNG
17034 Eagle River Loop Road, No. 204
Eagle River, Alaska 99577
July 18, 2002
ROBERT C. COWAN. P.E.
CML ENGINEERS
(907) 6942979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
De~a:Iopment Services Department
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 5, Block 1, Tract D, Broadwater Heights S/D
It is requested that you issue a permit to install a well & septic system to serve the
proposed three bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test was performed. The approximate location
of the test hole is located on the attached site plan. At the time of excavation 5/15/02 water
was found at eight feet. After seven days of groundwater monitoring water was found at
seven feet on 5/24/02.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties..
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC hm
Enclosure
17034 NORll-I EAGLE RN~R LOOP ~ SUITE 204 ~ EAGLE R~P,, ALASKA 99577
Municipality of Anchorage
Development Sendces Department
Building Safely Division
On-$11e Water end Waste, water Program
4?00 Soulh Brogaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ct.anchoca<~e ak.us
(g07) 343-79O4
Soils Log - Percolation Test
Slooe / Sile Plan
9-
Tb
13-
14-
15-
16-
17-
18-
1g-
20-
COMMENTS
~H
WAS GROIJNO WATER
ENCOUNTERED?
IF YES. AT WtIAT DEPTH?
Deplh Io Water Aller
.o.,,o.,.~?
Pa~e:
Reading Dale Gross Time Nel TimeDepth Ia Water Net Drop
~ ' ~ o ~ o I Z '/~~ ,4 Y~.'
t 0 ~ o /Z" 4"
io (o (~'
PERCOLATION RATE Za~ (,m'~es,',r, ch) PERC HOI. E DIAMETER
lEST RLR~ 8E'I~NEEN-- 'g~ FT AND ~ FT
PERFORMED IH ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
ROBERT C. COWAN, P.E.
CIVIL ENGINEER~
(907) 694-2979
FAX (907) 694-12 t 1
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATE.RIAL SPECIFICATIONS
REFERENCE: Lot 5, Block 1, Tract D, Broadwater Subdivision
April 23, 2002
GENERAL:
The scope of this project includes the installation of a 1000 gallon Premier
polyethylene septic tank and a new trench to serve the proposed three
bedroom residence located on the referenced property.
Construction shall be in accordance ~vith the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary underground
utility locates.
Unless specifically agreed otherxvise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing their
own systems must also receive prior approval from the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
17034 NORTH EAGLE RIVER LOOP ,, SUITE 204 · EAGLE RNER, ALASKA 99577
Page 2
Tract B-l, Broadwater Heights
August 17, 2000
3. All standpipes on the septic tank shall extend a minimum of 12 inches above final
grade.
4. Septic tanks installed with less than 4 ft. ofcover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation.
In the line between the tank and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic tank). These cleanouts
shall be located on undisturbed soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be
to clean toward the septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
ABSORPTION TRENCII/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of
the excavation shall be within 2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer
rock) placement.
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil
backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final grade.
The portion of the monitoring tube extending through the gravel shall be perforated
from the bottom of the trench to the invert of the distribution pipe. This is equivalent
to the effective depth of the gravel as noted on the design.
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent the formation of a
depression after settling.
A subsurface disposal field may not be located on a slope greater than 25 percent unless
there is an approved exception documented.
*'Page 3
Lot ~, 81k 1, Tract D, Bmadwate; His
April 23, 2002
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
.Type ofP pe Perforated. Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (tlDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam tli or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5%2.5" screened gravel with less than 3%
passing the #200 sieve.
When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of flu'ce (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
:Page 4
Lot 5, Blk 1, Tract D, Broadwater Hts S/D
April 23, 2002
The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement ofany other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractors activities.
The o~mer shall contract with the contractor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be
the owner's representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
Municipality of Anchorage
Development Services Department
Building Safety 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
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Complete legaFdescription "7"-~ ~
× ir ion -7 /'q-//
Locatlem(s!te add:ress).
Current~'Pi:operty o~NrRer(s)
Mailing address
Lending agency
Day phone(~
Day phone
Mailing address
Real Estate Agent
Mailing Address
~"~'~e4"C'i ~.qop/~_P~'/Dlf}2~ Day phone OO7)
Unless otherwise requested, COSA will be held by DSO for pickup.
2. NUMBER OF BEDROOMS:
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 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 On-Site 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 On-Site 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 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. ~ 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.
DSD SIGNATURE
~Approved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~'-/7-//
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:'-/'~
A. WELL DATA
Well type ~
Date completed ~/
Total depth ~:30 ft.
Date of test
Static water level
IfA, B, or C provide PWSID #__
Sanitary seal (Y/N)._j~__
Casedto 2~ ft. J~
FROM WELL LOG
Well production (~,~ ~:) g.p.m.
Well Log (Y/N) 1
Wires properly protected (Y/N)
Casing height (above ground)
g.p.m.
AT INSPECTION
WATER SAMPLE RESULTS:
Coliform O colonies/100 mL Nitrate ,.~-J;~ mg/L
Arsenic: ~]J~ ug/L date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Martial.
Tank size ~1~. Number of Compa~ments
Foun~dation c!~nout
Date of pumping
c. ABSORpTIoN FIELD DATA'
Depression over tank (Y/N)
Pumper ----~ ~ ~
Date installed c::~ fi "~ {O~
Cleanouts (Y/N) y
High water alarm (Y/N) /~/
Total depth ~) ft.
Date of adequacy test
Fluid depth in absorption field before test O in. Water added~l/I/~Ogal.
Elapsed Time: ~--C~min. Final fluid depth C) in.
Any rejuvenation treatment (past 12 mo.) (YIN & type)
Date installed c/il"/1~'~'~ Soilrating (g.p.d./ff2cr?.2!b'Jrm) t.,~ Systemtype ~
Length ~-"~ fl. Width ~ ff. Gravel below pipe ~ ff.
Eft. absorption area~7~ fi2 Monitoring tube ~5 Depression over field ~
~/~/1{ Results(Pass/Fail) ~ For ~ bedrooms
Newdepth O in.
Absorption rate >= '~:~(~"(- g.p.d.
~o~rJ If yes, give date
Do
UFTSTATIO.
Date installed Size in gallons
"Pump on" level at~ in. "Pump off" level at~
Datum Cycles tested
E. SEPARATION DISTANCES
Manhole/Access (Y/N)
· in. High water alarm level at in.
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main /~J/~
Sewer/septic service line
Animal containment areas
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout /~)
Holding tank
Manure/animal excrete storage areas I~)O / +'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~' ~' Property line ~ ~'¥'
~ Absorption field 5; ~L.
Water main ~'~ Water service line //O/~- Surface water ,/O~t 4-
Wells on adjacent lots / 0 0 / ~"~P" ~r~-~ ~ ~/o
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line j~) ~-
Water Service line / ~ ~' +
Curtain drain /V~,.,~ ~,~,~
Building foundation JD t 4- Water main
Surface water J ~ 0¢ 4- Driveway, parking/vehicle storage
!
Wells on adjacent lots J430 4--
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
Date
Pin. rd
CE -4793
COSAFee $ ?~0~
DateofPayment il
Receipt Number 1 ~ II) ~'~
(Rev. 4/10)
Waiver Fee $
Date of Payment
Receipt Number
ASBUILT
SEWARD & ASSOCIATES LAND SURVEYING 694-0829
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS~ OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SCALE:
DATE:
GRID.*
DRAWN:
PINARD ENGINEERING
P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
WELL FLOW TEST
LOCATION: Lot 5, Block 1, Broadwater Heights JOB NUMBER: 11-029
DRILLER: Sullivan Water Wells DATE OF TEST: 3/8/11
DATE WELL COMPLETED: 7/25/03 FIELD STAFF: PJ Pinard
WELL DEPTH: 300'
STATIC WATER LEVEL (top of casing): 44.0'
Elapsed Static Flow Cumulative
Time Time Water Rate Gallons Remarks
(Minutes) Level (gpm) Pumped
1:30 PM 44' 3.3 - Start Test - Meter 230200
1:45 15 65' 3.3 50 230250
2:00 30 87' 3.3 100 230300
2:15 45 104' 3.3 150 230350
2:30 60 122' 3.3 200 230400
2:45 75 142' 3.3 250 230450
3:00 90 160' 3.3 300 230500
3:15 105 178' 3.3 350 230550
3:30 120 189' 3.3 400 230600
3:45 135 203' 3.3 450 230650
4:00 150 218' 3.3 500 230700
4:15 165 234' 3.3 550 230750
4:30 180 247' 3.3 600 230800
4:45 195 262' 3.3 650 230850
5:00 210 280' 3.3 700 230900
5:15 225 291' - 750 230950
5:30 240 291' - 750 Stop Test 230950
RECOVERY
5:45 PM 15 291' All wellprotection ~muresareadequme.
7:15 105 257'
7:45 135 248'
3/9
11:30 AM 1080 44'
Average Flow Rate: 3.3 gpm
Comments:
DURING THIS TEST, THE WATER SUPPLY WELL WAS CAPABLE OF
PRODUCING 3.3 GPM. THIS TEST DOES NOT CONSTITUTE A
WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM
WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE.
Reviewed by:
Date:
Paul Pinard i'~?
3/14/11
PINARD ENGINEERING
P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
ADEQUACY TEST
LOCATION: Tract D, Lot 5, Block 1, Broadwater Heights Subdivision
APPLICANT: Dennis Clark
11908 Broadwater Drive
Eagle River, Alaska 99577
SEPTIC TANK TYPE/SIZE: Steel/1000 Gallons, per MOA Records
ABSORPTION SYSTEM: 5 Wide Shallow Trench, per MOA Records
DAILY FLOW:
3 BEDROOMS x 150 GAL/BR = 450 Gallons
JOB NUMBER: 11-029
DATE OF TEST: 3/8/11
FIELD STAFF: PJ Pinard
NUMBER OF BEDROOMS: 3
SCUM: 0.0' SLUDGE: Minimal
NEEDS TO BE PUMPED: Yes No XX
CURRENTLY IN USE: Yes XX No
TEST DATA
Time Flow Volume Cumulative Septic Tank Septic Soil Absorption System Comments
Rate Volume Tank
PM (GPM) (GALs) (GALs) Liquid Level A Level Monitor A SAS Monitor A SAS
* Tube 1' Level Tube 2* Level
1:30 3.3 4.0' 0.0' 0.0' Start Flow - Meter 230200
1:45 3.3 50 50 4.1' 0.1' 0.0' 0.0' 0.0' 0.0' 230250
2:15 3.3 100 150 4.1' 0.0' 0.0' 0.0' 0.0' 0.0' 230350
2:45 3.3 100 250 4.1' 0.0' 0.0' 0.0' 0.0' 0.0' 230450
3:15 3.3 100 350 4.1' 0.0' 0.0' 0.0' 0.0' 0.0' 230550
3:45 3.3 100 450 4.1' 0.0' 0.0' 0.0' 0.0' 0.0' 230650
4:15 3.3 100 550 4.1' 0.0' 0.0' 0.0' 0.0' 0.0' 230750
4:45 3.3 100 650 4.1' 0.0' 0.0' 0.0' 0.0' 0.0' 230850
5:15 - 100 750 4.1' 0.0' 0.0' 0.0' 0.0' 0.0' Stop Test - 230950
RECOVERY
Date Time SAS MT1 SAS MT2
*ALL MEASUREMENTS IN FT.
TEST: PASSED XXX FAILED
COMMENTS:
System seems to be functioning satisfactorily. There was no measurable liquid in the SAS MTs
prior to or at any time during the test.
Reviewed by: Paul Pinard ~'~)
Date: 3/14/11
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 APPROVA. L
FOR A SINGLE FAMILY DWELLING
ParcelI.D. 050-131-28
1, GENERAL INFORMATION
Complete legal description
HAA#
Expiration Date:
LOt 5.' Block
Location (sits address or directions) I~IF~NI
Current Property owner(s)
Mailing address
Lending agency
Dennis Clark
2120 *C' St Apt. 1
Day phone 69/~-4888
Anchorage~ AK 99503
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
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 4 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. (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 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.
NameofFirm S & S EnRineerin~,
Address 17034 N. Eagle River Lp Ste. 204
Engineer's Printed Name Robert C. Covan
DSD SIGNATURE
~ Approved for .~
Disapproved.
Conditional approval for
bedrooms.
Phone694-297g
EaRle River, AK 99577
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: / ~,~ "' ~ '7-'
(Rev 01~02)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescfiption:LO'Y- ~ fJ&'~ I 'T,~. Z) ~',~4z)h-4x-~.'~. //'/5 ParcellD: ~7,,~O- J~/-o~ 1~
A. WELL DATA
Well type ~q/~/~¥t
Dale completed '7 ]~6",'/t-~
Total depth '~' 0 0 ft.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~ coloniesll00 mi.
Arsenic: __ mgll.
IfA, B, or C provide PWSID #
Sanitary seal ~)N)
Casedto 93 ft. 71 ~,~.
FROM WELL LOG
~O
O. ~ g.p.m.
Nitrate <0.5' mg./l.
Date of sample:
We~ Log ~N)
Wires properly protected (~N)
Casing height (above ground)
AT INSPECTION
G'o ft.
I.~'
gp.m.
in.
Other bacteria O coloniesll00 mi.
Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material ~'/:p~-tC~/ /~/ /~ P~
Tanksize }OeO gal. Number of Compartments
Foundation cleanout ~/N) Y Depression over tank (Y~
Date of pumping ~'/',~ ~'/~-~"/ Pumper
Date installed 0}/17/°.3
Cleanouts~Y~N)
High water alarm (Y~). ~' O
C. ABSORPTION FIELD DATA
Dale installedq//( 7/¢3..~ Soil rating ~or ft=/bdrm) I. ~ System type .I,~, ~o ~_ -j--,~ ¢,,,c.,~'
Length ,,.~'..~ ff. Width ,.~ ff. Gravel below pipe ~ ff.
Total depth 3 ft. Eft. absorption area~'7 ¢~ fl2 Monitoring tube ~/~-<~ Depression over field ~v~
Date of adequacy test /v,/,z~ ~ ,~/~;4../ Results (Pass/Fail) _~ For,_,,~_.bedrooms
Fluid depth in absorption field before test ~ded gal. New depth in.
Elapsed Time: m~eP~th . in. Absorption rate >= __ g.p.d.
Any rejuv~t (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Eo
Date installed. Size in gallons Manhole/Access (Y/N) _...-----
'Pump on' level at in--arm level at
Meets alarm
Datum ,..-~ Cycles tested & circuit requirements?
SEPARATION DISTANCES
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ! 0(..3 '-/'-
Absorption field on lot JOO /"[
Public sewer main ,,V/,~
Sewer/septic service line '"~-,S'- ~
On adjacent lots
On adjacent lots ,/
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main
Wells on adjacent lots /4)0 /.-./-
Property line ~ ~
Water service line
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line J 0 /-/- Building foundation JO
Water Service line /O ~/~ Suffacewater Job
Curtain drain/v~'''''~-' /~.,~,c~v~/ Wells on adjacent Pots/dc3
Absorption field
Surface water
Water main
Driveway, parking/vehicle storage
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 HAA guidelines in effect on this date.
Engineer's Printed Name ~l)~ ~'~.7"' C..
Date I ;'-,/~. 7 / 05'--
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
DEC-19-05 MOM 12:59 PM FI~gA ILP
D~o 1~ 05 O~:/~p SUDSBURY"S&SOHS
F~ I, t0, 907 777 5636
SO'7 ;:98 1~12
P, 02
I HEREBY CERTIFY .THAT I HAVE SURVEYED THE I
FOLL~ING DES~IBED PROPERTY~ ~
~,~~~~,~, .~ ~ ..;.. ,~ o~ ~,',,
INDICA~. IT IS THE RES~S!DILI~ OF ~EI , "' . ~/'~z~. '~
O~ TO D~ERMINE THE ~ISTENCE OF ANY I ~ID,
E~E~TS, COVENANT~, O~ RESTRI~IONS I
~ ~ NOT ~.~. ~ ~.~ ~,_ ~
L ~.-..
'
FENCE tlN~ O~ ~R E~MLISHIflG ~ND- .