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BROADWATER HEIGHTS BLK 2 LT 7
Broadwater Heights Block Lot 7 #050-081-30 Municipality of Anchorage ~ Development Services Department Building Safely Division On-Site Water and Wastewater Program. 4700 S, Bragaw St. P.O. Box 196650 Anchorage, AK 995'1g-6650 Page of vc,vw, cl.anchorage.ak.u$ (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ST*OI~O01~' PID Number: """'~ ..~ ~.-- t=~.' t~,p~_l..~,..,t5 Wastewater System: [] New [~"Upgrade *~"" )~-og--"/ ~/SV-"/L/FE O0~lv'~- ABSORPTION FIELD LEGAL DESCRIPTION ~ O- Z. F,. ~0~,. Well: ~ New I-1 Upgrade ...,o V ~.~, .,.~s.,., ~,. ~ TANK SEPARATION DISTANCES D septic [] Holding r-] S.T.E.P. ~/'Other: T.~,~,~To Septic Absorption Lift Holding PobliC/P~vat~ ~4,~,u~:~ =- Tank Field Station Tank Sewer Li,~e 6 lC t-yt J... ~.~ /5 I"""'"'""" "'~"' ~ *~STIN b T~N~ BENCHMARK ,nspectionspefformedby: ~S~.¢~J~"/ Dates: 1" ~/~/0~ ' ~" -'r~'l"~°~ ,,-- " Development Se~ices Depadment Approval SI'ANDA£fl TRENCH NT$ FDLJ~TIZ~I~£~ITUT--~ ITO88EN SPURKI..AND P.E. 2O3 IV 15171. AI/ENUE ANClt. AK. 99501 pOX) 2Z9-391~ PE£NIT # SVO3flf165 I~ROADFATER ItEIGETS LOT ? BLOCK I 12027 IV. SKYUNE I JE..'T HARRIS PID # 050-081-30 SEPTIC SI'STEW DESIGN DATE: APRIL 22, 2003 SHEET: 1/$ GRID: 253 ~VH0£073.~I0 I'OBBEN SPURKLANO P.E. 203 i~ 15171. AVENU£ ,4NCH. ,4K. 99501 279-$916 LOT ? BLOCK ,8 BROADWATER I~glGItTS $/D JEFF HARRIS 12027 WEST SKYUN£ DRIVE SEPTIC SYSTEV AS BULLY BATE: APRIL 22, 2003 SHEET.. 2/3 GRID: 253 PERMIT # SVf13Of165 PID # 050-081-20 FRC. H : ]~RI~-'K'S ELECTRIC Y FF~: NO. : 77~-~:933 HaW. ID1 2~X~3 07:0TFtl P2 l l 4~$ ,4vtdn Street Anchorag6 AK 99516 State Contracwr License #28624 MOA Contract~ License #1976 4-29-03 To who it may concern: Brick's Electric hnq performed all wiring necessary for the Bio-Cycle s~tic system at the following location: Jeff& Marsha Harris 12027 W. Skyl/ne Dr. Eagle River, AK 99577 Lot 7 Blk 2 Broadwater All work performed aa per curren~ National Electrical Code Sincerely, William Brickwell- Owner Phone: 907.345-2925 ~' Fwc: 907-~70-2935 *Ceil: 440..9351 Municipality of Anchorage Development Services Department Building Safely Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 WR#: 030017 PID~: 050.081~3~ Date Received: 33-03 Legal Description: ~rgp~p~r Hel.hts Engineer: Tobben Sourkland 203 W 15m t/203 Applicant: Jeff Harris Waiver Review Worksheet HA#: 030053 Permit: 030065 Block 2 Lot 7 Waiver Requested: :) f~ aeearatlon ab$orotlon field to ~)rooertv line Criteda: Geology A, Water Table B, Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: Total: Waiver is Granted: L.~ Waiver is not Granted: List Conditions or Reasons for above: Rec#: 3-303 Amount: $~0 Date Paid: 4/24/2003 MUNICIPALITY OF ANCHORAGE Deve/oprnent Services Department On-Site Water & Wasfewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Apr 03, 2003 Expiration Date: Apr 02, 2004 Permit Number: SW030065 :Legal Description: BROADWATER HEIGHTS BLK 2 LT 7 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: JEFF HARRIS Owner Address: 12027 W SKYLINE DR EAGLE RIVER, AK 99577-7910 Parcel ID: 050-081-30 Site Address: 012027 SKYLINE DR W Lot Size: 23237 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. Date: 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 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parco! I.D. Permit Number SW_..~.~..¢.¢_~ Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Day phone Zip Code Lega! description (Section. Township & Range) _o, Size THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Number of Bedrooms Well Only [] Water Storage [] [] [] Jacuzzi' ~ [] Water Softening Unit L.~ I certify that the above information is correct. I further certify that this application is being mace fcr ~ Single Family Dwelling and is in accordance with applicable Municipal Codes. (S~.cnature of property o~ Permit Fees: (.q~¢ 0°'~'~ Waiver Fees: Dare of Payment: ~[bJO 5 Date of Payment: Receipt Number: '"~. ~ ~. Receipt Number: trey 12,'00) T. PUP r Lf qD P.E. 203 W ISth. Avenue, Suite 203 ANCIIORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 7, BLOCK 2, BROADWATER HEIGHTS S/D 12024 W. SKYLINE DRIVE Municipality of Anchorage Development Services Deparunent Building Safety Division On Site Water and waste Water Program 4700 South Bragaw Street Anchorage, Alaska 99519-650 February24,2003 We are submitting an application for the upgrade of the septic system for this lot. The existing system failed an adequacy inspection and require replacement. This submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic ofthe septic system, (sheet 3/3). Soil logs and percolation tests ofapplieable test holes are also enclosed. The septic system design is based on the following: Bedrock at 12 feet. Use Standard Trench with BioCyele Soil Rating. From Testhole 02/20/03. 7.0 miWin '~3 gal per sq.fl/day No. of Bedrooms 3 Required Area: 3 x 150/3 '~150 aq.tL Rock Depth 2.5 feet Minlmum Trench Length: 150/5- 30 R SYSTEM CONFIGURATION BIOCYCLE STANDARD TRENCII TOTAL LENGTH 30 FT TOTAL WIDTtl 2 FI' TOTAL DEPTtl 6 FT ROCK DEPTtl 2.5 FT COVER 3.5 FT The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface ronoffwill not result from this installation. STAN~A£D T£ENCH ~ I tITS FZTU~TJZTN~E~DUT-~ MIN WAX TOBBEN SPURKLAND P.E. 203 V[ ISTtL AVENUE ANCtt. AK. 99501 PE£MII' # SVO$OOXX 12027 Pl. SKYUNE DRIVE JEff HARRIS SEPTIC SYSTEI~ DESIGN DATE: FEB. 27, 2003 SHEET: I/$ aRID: 253 PID # 050-081-30 BVHO£07S..310 8 \ \ \ \ \ \ \ \ \ \ \ \ % \ \ , 3 \ \ \ ~ 2 \ · 49~h SCALE' 1' = 50 FT. 1 TOBBER SPURKLAND P.E. 203 I~ lSttt. AVERUE ARCH. AK. 99501 SEPTIC SYSTEM DESIGN DATE: ItB. 10, £005 SHEET: 2/$ GRID: 255 PE£RIT # SVOSOOXX PID # 050-081-30 BVHO2072.BVG Perfcmned Fcr: LeGal De$crip[ion: 1. 2- 4- 5- 6- 7. Municipality of Anchorage Development Services Department Euilding Safety DivisJcn On-Site Water and Waetewater Pro, tarn 4700 South Brag~w eL P.O. Ecx lS66~-0 Anchorage AK 99519-6650 www ci enchomce eI<.us (g07) 343-7g04 Soils Log - Percolation Test Oate.P~r[~m~ed~ I I Site Plan g. 10- 11- 12. 13- 14- 15- 16- 17- 1B- 19- 20- CO,M.M -- HTS tO z ?1/ 3 I Iii I '.. Iii ~ t I ~. vrsr SKr. U_NE 8 SCALD I' = lO0 FT. 3 TOSSEN 5PURKLAND ~£ 205 W 15TN. AVENUE ANCN, A~ 9950l ]LOT BLOCK 2.- BROADFATER HE/GETS $/D JEFF HARRIS 12027 WEST SKYLINE DRIVE I I I I SITE PI. AN DAIE: FEB. I0, 200S SHEET: I/I GRID: 253 PERMIT # PID # 050-081-30 BVHO2OTLBVG ! MUNICIPALITY OF ANCHORAGE f DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS [~ ~ IF HOME.DE: ~O ~ Well Dwelling PERMIT NO. DISTANCE TO: O Z ~ Manufacturer Material Liquid ca~clty in ~ WeU Building f~n~tion Nearest lot line ~ DISTANCE TO: ~ DISTANCE TO: Building foundation Se~r line Septic tank Absorption area(si OTHER SOl L TEST RATING REMARKS (Rev. 3178) . . f4LIt'4 I C If~":IL I T'.r' OF Fil'-.IL-:-I-~RF! f~E · : DEPARTMENT U~- HERLTH RN[:, ENVIRONi'qENTRL r-:-~OTECTION E:25 'L' STREET, ANCHOR. AGE.. Rt<. _'9~501 ~64-4720 I,~IELL RI'-I-r':' O1'-,I--5 T TE 5EI-.IEF.' F, EI~.I-~I T T PERHIT N0. ~ ?S, 024~ ) RPF'LICRNT DUNCAN MCLEOD PO BOX 795 EAGLE RVR LEGAL L? B2 ~ S,/D LOT SIZE 694 9715 0 SQURRE FEET TYPE OF SOIL RBSORBTIOH SYSTEf'I IS: DRAINFIELD NUMBER OF BEDROOMS SOIL RATING THE REO. UIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:'EPTH-- 7 L E !'-.I t] T H = 5----':: G RFt'..-' E L [:'EPTtH = 2 THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETHEEN THE SURFACE OF THE GROUND RND THE BOTTOM OF THE EXCFIVRTION (IN FEET>. THE TREI"4OH i-I I E, TI4 I 5 5. t'Z~Elt':Z_~ FEET THE GRAVEL DEPTH IS THE ItlNII'iUM DEPTH OF GRAVEL BETI4EEN THE OUTFRLL PIPE AND THE BOTTOft OF THE EXCAVATION (IN FEET>. F:EO. LI I F-:ED SEPT I ~--- TRI'-,iI-< 5 I ZE--- -'! E~ E-~C~ 6ALLOt'45 PERHIT APPLICANT HRS THE RESPOHSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTRLLRTION INSPECTIONS OF RN'¢ HELLS ADJACENT TO THIS PROPERTY AND THE NUHE',ER OF RESIDEHCES THAT THE HELL HILL SERVE. TI40 < 2 > I l'45PECT I 01'45 RRE REQ;J I RE[:' BRCKFILLING OF RNY SYSTEM HITHOUT FINAL INSPECTION AND RPF'ROVRL BY THIS [',EPRRTI'IENT HILL BE SUB)ECT TO PROSECUTIOH. MINIMUN DISTANCE BETI. IEEN R HELL AND RNY ON-SITE SEHRGE DISPOSRL SYSTEM IS t80 FEET FOR R PRIVATE HELL; OR i50 TO 200 FEET FROI'I R PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL. HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPRRT[.1ENT HITHIH ~0 DRYS OF THE HELL COMF'LETION. OTHER REQUIREMENTS MAY RPPLY. SPECIFICRTIONS AND CONSTRUCTION DIRGRRMS ARE R'¢RILR~LE TO INSURE PROPER INSTRLLRTION. F'ERI"I I T E,"d-.P I RE5 DECEMBER _'2-::L,. 29?"8 I CERTIFY THRT ±: I RM FRHILIRR HITH THE REOUIREMENTS FOR ON-SITE SEHERS RN[:, HELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I HILL INSTALL THE SYSTEM IN ACCORDANCE HITH THE CODES. _?,: I UNDERSTRNb THAT THE ON-SITE SEI.IER SYSTEM MAY RE.qUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO,, INCLUDE MORE THAN 3, BEDROOMS. RPF'LI CANT DUHCRN MCLEOD 08'EGEO,~-~.CHNICAL 8' DEVEI,~::~PMENT CO. · ~ox 90. Davis St., Eagle River. Alaska 99577 694-2774 or 688.2280 Russell Oyster &94,2T/4 SOXL LOG Soils ~ Foundations Parroted for: Legal Description: Eazt Ellis Land Development Oepth (feet) 0 2 3 .5 ~6 7 ,Soll ~haractertsttc~ 8 9 lo 11 12 /~z r,. F 15 16 Ground Water Encountered: Yes ~ No Proposed Installation: Seepage Pit Corr~ents: P~'~g~z' ~ ~ ~'~ ~-/< /7 /: Performed by: .-.'~.//::/t"'("' ~ ~., -~/~(':, If yes, what depth Drain Field Date: / / Anchorage Well / Pump Service 6901 Ta~l~ Drive * A~c~ra~, Lot 7 Block 2 Broadwater Estates Dan Jewel Builders 1685 Blue Spruce Lane Eagle River, AK 0-19 feet Brown clay and gravel 19-42 feet Bedrock, some water 42-171 feet areenstone 171-242 feet Decomposed bedrock, some water at 172 feet Casing depth - 19 feet Static level - 13 feet from top Production - ~45 GPM Storage in well - 358. gallons ± · Domestic and Industrial Pump Sales and ,Service · Water Well Service, Water Treatment and Conditioning · Anchorage Well / Pump Service Dan Jewel Builders 1685 Blue Spruce Lane Eagle River, AK 0-19 feet 19-a2 feet ~2-171 feet 171-242 feet Brown clay and gravel Bedrock, some water Greenstone Decomposed bedrock, some water at 172 Casing depth - 19 feet Static level - 13 fee~ from top Production - .45 GPM Storage in well - 352 gallons fee~ ~ · Do~est,c oral I~:~strrc~ ~Jfl'C) S~tes and Service · Wat~ Wel Se~tce. Wore, Treeff~e~l o~ Con~tsoN,'~ MUNICIPALITY Development Services Department'` On -Site Water & Wastewater Section -- Parcel I.D. 050 081 30 t Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: _Z / - 2 Complete legal description Broadwater Heights Block 2 Lot 7 Location (site address) 12027 W Skyline Current property owner(s) Mark lig Mailing address Real estate agent 2. TYPE OF DWELLING: Fx-1 Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well FX -1 Private Septic E71 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: N O N E Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ (D Waiver Fee $ Date of Payment 6L' ) 90 21 Date of Payment Receipt Number. 0 7yd & d Receipt Number COSA # O S C)-11359 Waiver # 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 C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 6/15/21 P� �F A��sl,� 49 TH '.* r 6. DSD SIGNATURE ••• •••••• I .. . .•. G System #1 Approved for bedrooms /� ' ' ' ' ' ' ' ' CHARLES G BALZARI91 System #2 Approved for bedrooms.•. CE -13854 dw Disapproved ,�\%pROFE5S10NP���' Conditional approval for bedrooms, with the following stipulations: llll((f(tt((� J� ON-SITE o WAST`"v'�R Z_ z� �- o J� PRO'Gf;AM z, - Original Original Certificate Date: r —? The Municipality of Anchorage Development Services Division -(DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: BROADWATER HTS B2 L7 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/8185 Total depth 632 ft Cased to 21 ft ❑ Sanitary seal is functioning correctly OR Wires are properly protected Casing height (above ground) +18 in. Date of flow test for COSA 6/15/21 Static water level at beginning of test 48 ft. Comments B. TANK DATA Age of tank(s) 18 years Tank type/material OIOCYCLE FIBERGLASS Measured operating fluid level in septic tank NA ❑ Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA TRENCH Which system tested (date installed) 2003 IN ALL standpipes present per record drawing Total measured depth from grade 6.4 ft (max) Measured depth to pipe invert from grade NA ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 050 081 30 Structure served by this system 1 Well production at time of test •48+ gpm Water storage tank volume 300 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Cdliform bacteria is Negative Nitrate 0.708 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L F01Arsenic less than MRL (ND) Collected by C&M Engineering Date of Sample 6/29/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station 18 years Lift station material GKIGLA. Comments: UNDER BIOCYCLE MAINTENENCE CONTRACT Adequacy test date 6/16/21 Results ❑f✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) NA If yes, enter date NA E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft M Yes if No Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' F,71 Yes if No Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' 21 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Q Yes if No Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 177� Yes if No ft F71 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ft ft ft ft ft ®✓ Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ✓Q Yes if No. Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' ✓❑ Yes if No. Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ®✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 3 ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS WELL PERFORMANCE IS LIMITED BY THE PUMP. THE WELL LEVEL STABILIZED AT 367' UNDER CONTINUOUS PUMPING AT 0.48 GPM. BETTER FLOW MAY BE ACHEIVED WITH A LARGER PUMP. NOTE THAT THE JET PUMP OUTPACES THE WELL PUMP UNDER SUSTAINED PUMPING. IT IS POSSIBLE TO RUN THE TANK DRY BEFORE THE WELL. G. ENGINEER'S CERTIFICATION l 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. 6/28/21 COSA Checklist yellow sheet OF Al... . cS� : 49 TM '• HARLES G BALZARINI Fc CE -13854 �F�pROFESSI4NP -. ft ft ft ft 0 Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Well at Broadwater Heights B2 L7 Dear Reviewer, The well at the above referenced property has been temporarily decommissioned in accordance with procedures required by the department: ® We verified the pump and wiring had been removed. The water was sampled for Bacteria, Nitrates, and Arsenic. Coliform Bacteria was negative. Nitrates and Arsenic levels were below the MRL. Y The well cap was removed and a steel plate was welded on. When the well is recommissioned, we suggest that the water be chlorinated, flushed and resampled. Earth should also be removed from around the casing and graded to drain to ensure the minimum 12" stickup is maintained. Please do not hesitate to contact me at 907-854-5558 or by email cgbalzarini(o-)gmail.com with any questions or concerns. Sincerely, ®®O� Charles Balzarini, PE .�� 7/28/21 C HARLES G BALZARIUI GE -13854 AM' "PROFESSQO -� cyc� E "A] , aska 2nd Quarter Inspection Report 2021 Homeowner Info Customer Name: Mark 119 Address: 12027 W. Skyline Dr. Anchorage AK 99503 Email: crbioak@gmail.com (907) 274-0314 Tank #: 151 Install Date: April 2003 Initial Inspection: Area Eagle River Alarms Tested: Air 0 High Water 0 Battery Tested: Yes R No R N/A (Please make sure alarm is on "normal", not "mute") Does system have a septic tank ? No � Yes R (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor? Yes 171 Repaired ❑ Yes 51-1 Repaired R Strong R MildFJ None 0 Inlet plumbing in working order? Yes 0 Replaced EJ Are all aerators functioning? Yes IV, I Replaced EJ r Clarification return system operating? Yes 0 Adjusted ❑ pH Reading: (pH of " is ideal) 7.7 Pump float operating? Yes 0 Replaced R Filter cleaned? Yes ❑ N/A [71 Comments: Inspected By: Chris System Inspection Dissolved Oxygen PPM (2-5 is ideal) 3.6 Alarm float functioning? Yes 0 Replaced ❑ Solids pillow normal? YesFY71 Requires Pumping 0 Any buildup of solids? Yes R No 0 Any buildup of solids? Yes [:] No 0 Turbidity of discharge (in FTU) (Under 35 FTU is considered compliant.) 5.87 Any buildup of solids? Yes 0 No R Discharge line condition: Good 1V Replaced F-1 Date: 05/24/21 Has emailing or mailing of form been requested? Yes 7No (contact office to request...) Municipality of Anchorage R Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage; AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC211354 During a recent COSA on-site inspection and test of the potable water supply well on Block 2, Lot 7 of Broaswater Heights subdivision, the well's productivity was determined to be .48 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. -MUNICIPALITY (.)F ANCHORAGE ADVANCED WA2STFAVATER TRPATINIENTSY,'�TEM MAINTIFNANCE AND REPAIR AGRF , � 171 N I FINIT T! fl',S, MAINTENNANCF AND REPAIR ACjRED%4i7NT, herein the "AGRJ-:TME-N'1`" made aild elt.red inioas of thisDay of of 201 , by and between herein The -OWNER,- and the Nfunic' ipality of Anchoragc. hercin the -MUNWIPALFF- in accordance with Anchorage Munici al le 1) -A% 11C) 15.65365. In consideration of the mtnw I covvnants contained herein. the past es Lo this Ag-rcernent agiree as follwvs,: 1. Advanced Wastewater Tre. t m-ept Svstenis, The MUllicip-Ul- ity, grants permissiop to the 0,,N-)c.r to utilize and operate an AdvanVed Waste�N-ater Treatment System (Awwrs), (iescribcd,,is BIO( -'Y(*Ll--; located at ttegal description) BROADWATER I I FIGI ITS BLOCK 2 LOT 7 Nliaintenance, Rejairs and AlterAtion.s. 2 (Ovoier is required to, rcajd, understand -.,nd initial each wction ,l 7- , 'Throuo-,out -.he term ofthis Agme�ment,, the Owner shall enterinto a senice agnxment wilh,;tn AW1&7Sv:,r-vice and maintenwice Provider approved by the Municipality ordie manufacturer's repreen-attive. The AWWTS shall be maintained in a satisfaciory condition cqipable of perf6n-nin,,,,1, as prMlocing trca4�d septic effluent in With lhccquipment�s approval for operation in the Municipality, It shall be the respmqibility of the Ovvner during the term ofth , is Agreement to pay for all repair(s), main-teminco, adii4stmcntf s'), replacement costs, and inspection cosL,�. -FI11b snclu&s an annual maintenance fie fjypically S400 to Sf)00) Owner agrt!es Lhat only maintenance and repair personnel approved by the Municipality 07 The nl..Umf*acturcr`s, representative will ire:jpeiii and -,n,� 'Sa �ike an;y-nt,-ce�, T. -N maintenance, repairs or peTnit.tcd alterations to the, vsteni, Owner acknowledges that re-gailar i muntenance of an AW MTS reduces the fx)tentlal tail urs of thea system.� ich could include sewi,.,ge backup and costly repairs or drainfic.1d replacement. Owncr acknowledges tlixt the N=T tmicipalily may request records of maintenAnci�y ;,irld I repairs i-0111 Idle ITI.31,1111-;WtUTCT`s, 17C.Presentative or mainlenance provider. Owner acknowledges that the fine loo fidling to maintain and repair an A%VI&,TS may be in accordance with AMC 14-60.0.30. Owner agrees to --.ant the Municip; i]itis rca-sonable access to test arid I ri-spect the. AtVWTS- `t pie N,4unicipalily will, oive at least 24-houT T,)cIjICC. Owner aa rees that any sale or trl nsf j 3 I i�r of title of die pro rte= will ftot occur Without a nevv, Cenificatc of Oji Site; Systems Approvgal. I Owner agrees that the AWA7.S installation and mahntenance requireinwnLas, provided by the AW"W-F."S vcndi)-nIin;sIalIcr and apprageed by 'the Miunicipality arc the ver hi guidelines: for the mid repair -of th,., Owrter's AWWTS. Owner to maintain remote nionijorm4z cif the AV,`%V-T'S as reqLii%-,-d by the AW'WTS approval. Term. The t�r-,Tl A-,recniicnt shall begin i,)n ifw date ,,I -approval y= the Niunicipality to oner-ate the installcd s,,,stclrn. or upon trap -fifer oftifle, and shall Continue while the AW,A,7S- is operat onal or until tithe is jr-amer fd- r --d 4. Non giver. 'l ie failure of the NxItmicipality at any time to, enforce a prs,)visif-irj ")f this Acireeinentsball in no way constitute a waive r or j1he 7,..T-c,,visio-ns, nor in anv Nav affect the validity of the Agreement or any part hereof- or 'die right of the Manicipality thereafter to enforce every provision hCTCof, Amendment This Agnx-inent shall only be amended 1)), atahori7ed rtpre%,sentatives, of thew 0,omcr and Nlumicipality- Any attem-ol loarrrcrtdthis agreenient by either an unautlx,,rizj2d represen�a.live cir unauthorized -mean,.; shall be void. 6. Juris4icflon: Choke of Law. Any civil action arising from this Agreement shall be brought in the- Superior Court for tine 'laird JudEcial district oftlic, Shaer. of Alaska at Anchoraze, The tavvs of the State ol'Alaska shall govern, the rights and obligations of the parties wider this Agrceii era, Severability. Anypram i, siotis of this Agreement decreed itivalid by a- court. ofc;onipctcnj juri,,,dicliun shall not invalidate the remaining provi-sions ofthe Agreement - I of I OWNER: By: Date: 57-jC*H,<_(print ilame) STATE OF ALASK,4\ TFHR.D JUDICIAL DISTRICT -nie foregoing instrument was ackno'Mcdt&d before me this r.T day of 20 by N UBL-ic FO ASKA My C Imissioll expires: --1 ell NOTARY FUBLIIY-' A, -f 2-1—rtcm- i SV7E OF AL,6,SK'A INIUNICIPALITY- ()�l ,nWrc) _.-___.(pr;nt name) Da`,2:7-2 �- 21 Tifl.c-. 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. @5o- 09i-3© 1. GENERAL INFORMATION Complete legal description LOcation (site address) Current Property owner(s) Mailing address COSA # (::)SC i / I; Expiration Date: //~- ~ -,//' Day phone Lending agency Day phone Mailing address Real Estate Agent Mailing Address ~ .~. Unle~s.othem,ise_ requested; COSA will be held by DSD for pickup. NUMBER OF BEDROoMs: ~' TYPE OF WATER SUPPLY: Individual Well Individual Water Storage [] Community Class Well [] Public Water System [] Day phone 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. 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 ~-\%!c,~ ~-n~,~-:'i'~ Address '2.o,3 ~,¢, i.g~k ,~v~ .~. '~o'~ , ~,~ ~l~,cr-c~¢; ,,~t,,q Engineer's Printed Name L~,~(, Sp~¢J~t~,~.,& DSD SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X (Rev 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 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 Legal Description: A. WELL DATA Well type -~, Date completed 4-~ - g5 Totaldepth (~$~, ft. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST ?- Lo+ ~- Parcel ID: O,~0 "' If A, B, or C provide PWSID #~ Well Log (Y/N) Sanitary seal (Y/N) ¥ Wires properly protected (Y/N) Cased to '7_1 .x ft. Casing height iabove ground) + I ?_ in. FROM WELL LOG AT INSPECTION Date of test q/~,/0.?:> F'i / ?-c),, . Static water level ~AO ft. q 3 ~. ft. Well production I, 7_ g.p.m. O, 3 3 g.p.m. WATER SAMPLE RESULTS: Coliform #'~' colonies/100mL Nitrate 0,~ mg/L Arsenic: JV'~) ug/L date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~ ~.~c[~_ / ~ ~)~., ~/~ 55 / / Tank size [(0~) ~gal. ' Number of Compartments Collected by: L .4 Foundation cleanout (Y/N) ¥ Depression over tank (Y/N) /V' Date of pumping '"' Pumper ~in Jc~.(~ ,~qreeo~t.{ I Date installed '~/'3/o ~ Cleanouts (Y/N) High water alarm (Y/N) Y I System type ~p GraVel below pipe '2, ,~3 ft. ¥ Depression over field /V/ 'For ~ bedrooms New depth Iq,$ in. Absorption rate >= /-/50 g.p.d. If yes, give date "'-- Water added 3.~ gal. Date installed tilt/lo3 ~ I Length 30 Total depth (~,3 ft. ABSORPTION FIELD DATA Sell rating ~or ft2/bdrm) .~ f. Width ~-- ft. Eft. absorption area 150 ft2 Monitoring tube . Date of adequacy test ~,/~/~.ml Results (Pass/Fail)' Fluid depth in absorption field before test / in. Elapsed Time: 3(~O min. Final fluid depth ~ Any rejuvenation treatment (past 12 mo.) (Y/N & type) in. LIFT STATION Date installed "Pump on" level at ~-7.. Datum 1~o~ in. E. SEPARATION DISTANCES Size in gallons ! (~00 "Pump off' level at 15 in. Cycles tested Manhole/Access (Y/N) "/ High water alarm level at /-/,-% Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Abso~:ption field on lot Public sewer main /v'/~ Sewer/septic service line Animal containment areas ! On adjacent lots On adjacent lots . Public sewer manhole/cleanout Holding. tank /V/~, Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots Property line 5 ~ + Absorption field Water service line lO~4 Surface water 100 I 0et Jr SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line lO ~+ I Water Service line I 0 + Curtain drain ..50'~ (/,/, o,~ COMMENTS " Building foundation Jo~+ ..... Water main Surface water lDO ~ ~/~/, 0~. 'Driveway, parking/vehicle storage Wells on adjacent lots 100' + lO !+ COSA Fee $ Date of Payment Receipt Number (Rev. 4/10) I ce~i~ that I have determined through field inspections and review of Municipal recede that the above systems are in ~nf~man~ with MOA COSA guidelines in effect on this date. , Engineers Printed Name L ~ ~ O -- Waiver Fee $ ~'~ ~ -- Il Date of Payment ~ ~ ~ ~ Receipt Number 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. 030~gl-~0 . ..I I , '; GENE'PAL INFORMATION '- Complete legal descnpbo0~ ~O ~ ~ I ~ ~ Lo~On.(s~tea~dre~ord~rect~ons) ~%O~ ~ ~IM ~ ~. Cu~ent ~ope~,~er(s); ~ ~ > ~ ~ A ~t 5 ,, Day phone HAA # ~.~~.~,~-~ Expiration Date: Mailing'address Day phone Lending agency Mailing address Real Estate Agent '~ ~ ~P-O 'Z-'Z. ~ ~-r tL~ Day phone ' ' Mailing Address ~b~ E-O 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 . Well Public Water System TYPE OF WASTEWATER DISPOSAL: [~' Individual On-site ~] Individual Holding t~nk ~r~ Community On-site [] Public Sewer [] The Municipality of Anchorage Deve!opment Services Department (DSD) Issues Certificates of Health Authority. Approval (HAP,) 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 seC'ed by a single-family on-site wastewater disposal and/or water supply system. DSD aIso issues HAAs upon request to homeowners. Certificates of Health Authority Approval ere 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 pedod of up to one year with valid water samples.) Certificates are valid for one year for properties sewed 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 eng near s wor . 4. STATEMENT OF INSPECTION BY ENGINEER Se As certified by my seal affixed hereto and as of the valldation 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 tiles 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. "~"'...~>'Pi)tq..ll~.t~/~rl,..t L~ Phone. ~7~'-~,~ Address, . ~.t~ ~5, ~ ~.~..~. I ~ Z.~ ...% Eng!nee~s 'Prin'tedDsD SIGNATURE' ' Name . I c ¢//~ ¢~ ~p ~ ,- ~,.[~t ~¢J~. '~ 4~. ~~.~??~.~~, ~1~"~'~'~ ~ '~"~1~"~ ~t~_%_ ¢s~.~._~_.~j.......~,q.e.~"~'~D~at ~~ ..~.,:. ~.~..~,,,~ , · /Approved for '~ bedrooms. Disapproved. "'~"~"'-- .... ; , ' Conditional approval for bedrooms, with the following stipulatioris: Additional Comments, Attachments: HAA Checklist Septic System Adviser,/ We!l Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:_ 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 A. WELL DATA " Date completed /~"~' Total depth 'A '~Z...ff. If A, B, or C provide PWSID # Sanrm.,y seal (Y/N) Well Log (Y/N) ~ Wires property protected (Y/N) ~ Casing height (above ground). I ?-. t' in. FROM WELL LOG Date of test /'//-' ~ - st~: water ~el .,~,~ 0 ~L Wall production /, ~" g.p.m. AT INSPECTION / ~ g.p.m. WATER SAMPLE RESULTS: Coliform .._~lOnies/100 mi. Arsenic: ~' rng./I. Date of sample: ~ll/~,.,~ B. SEP'rlC/NOLDING TANK DATA Tank Type/Material ~'~ i O~ "'//~- L ~-~ Tank size _~_/e~2 gal. Number of Compartments Foundation deanout (Y/N) 7~__ Depression over tank (y/N) Date of pumping Ir'4//l~. Pumper Other bacteria 1,4 )~ colonies/lO0 mi. Collacted by: '/_']'~O ~.', ¥. I ,,,~67 I Date installed ,~.~,] il I O~ Cleanoute (Y/N) '7/ Higl~ water alarm (Y/N) '~/ C. ABSORPTION FIELD OATA Dateinstelted J'//~/~'~ Sallreang (g.p.d./fl2~.a'~drm,~ ,,"~ ; '~ Total del:~tl /r~ ft. Eft. absorption area l~"t~ ~ Monitoring tube . Date of adequacy test ~'I/A Results (Pass/Fail) "~ Fluid depth in absorption field before test ~in. Water added__ Elapsed Time: ~/min. Final fluid depth V/in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) I,/ ~ Depm~ion ~er field For ~ N~de~ ~in. ~on ram >= ~- ~ g.p.d. / If yes, g~e dam. D. UFT STATION Date installed tl/~l/; '5 Size in gallons 'Pump on" level at ~,~ in. 'Pump o~ level at E. SEPARATION DISTANCES Manhole/Access (Y/N), y High water alarm level at //~ in, Meets alan~ & circuit requirements?, y SEPARATION DISTANCES FROM WELL ON LOT TO: '~ptic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic se~ice line · * On adjacent lots On adjacent lots Public sewer manhola/cleanout Holding tank SEPARATION DISTAN, CES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation L.J[ 0 Property line ~-- ~' Absorption field Water main H//~r Water sewi~,,e line ' ~ ~' ~ Surface water Wells on adjacent Io~s' ' /~ .4 ,.. loc -I,. 5 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Probert7 line Water Service Curtain drain Building foundation ~q-~ Water main J"~/~/3~ Surface water /~ / ~) Driveway. partdnghmhicie storage Wells on adjacent lots ~ ~ '{' : F. COMMENTS review of Muni~pe/ ~s that ~e Da~ of Pwmen, ~//~/~ % Da~ ~ P~ent ~//~ c/ R~im Numar Receipt Number (Rev. 12/01) F~l : Ouic~split ~ $ & M InduStries PHOD~ ~0. : ~7 ~gG 0G47 ~. ~ L~O0~ OD:iO~M P~ ASBU{LT b"~6~Al~D & AgBOOIAT~ ~4]~ SURSrETII~ HEREBY CERTIFY .THAT I HAVE SURVEY£D THE · , ~A~, / / 5~." "'.~-'~ INDICA~. IT IS THE RE~S{B{LI~ OF THE WHI~ ~ NOT ~EAR ~ THE RE~ ~1- ~ ~ LIN~ OR ~R E~LISHINe ~- ARY LINES. AS~UILT N~R~EY CERTIFY TNAT I HAVE SURVEYED THE FOLLOWIN~ DESCR'BED PROPERTY, INDICA~D. IT IS THE R~S~S~BILITY OF THE ~'N~ ~ D~ER~INE T~ ~ISTEN~ OF ANY GRID' WHICH ~ NOT ~EAR ~ ~E RE~ kqY DAT& H~[Ot~ BE USED FOR CONS~U~ION ' FENCE LIN~, OR FOR E~LISHING ~N~- DRAWN= AEY LIN[S. 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 ON-SITE SEWEPJVVELL SUBMITTAL COMMENT SHEET To: Tobben Spurkland Legal description: Broadwater Hel,qhts Block 2 Lot 7 The attached paperwork has been reviewed and is belng returned for the following reasons: [] Original signature or stamp missing on [] Calculation error in design. [] Additional soils information needed. Test hole depth on sheet 3 of Inspection Report [] Water monitoring results inadequate. [] Discrepancy in information submitted. [] Topographic information missing or inadequate. [] Incomplete; missing AsbuiltSurvey [] Incomplete; missing E ectr ca/Report [] Additional adequacy test information needed, [] Water sample unacceptable. [] Measured/proposed distances/dimensions missing. Locations of all soils, percolation and water monitoring tests not shown. Proposed system too deep for soils information submitted, [] Welllog required. [] Omission in narrative. [] Insufficient fill over tank or field, c [] Other. t. WelIIs not propedysealed, i ~ i (~'~ 2. Is DL Enterprises approved ? 3, Letter statinq lot line watver will not Impact ne qhboring lot. Name of reviewer: Jeff Date: 4-24-03 Please supply the necessary information and re-submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK . ~~'~ ~"- ~ DATE RECEIVED · INSPECTi TIME TIME DATE ~ DATE DATE INSPECTOR INSPECTOR INSPECTOR DEPI. OF HgALTH & MUNICIPALITY OF ANCHORAGE E~IgO~ENTAL P~OTE~ION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~ION ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES ,. MAILING ADDRESS STREET LOCATION 6. TYPE OF RESIDEI~CE ~'SING LE FAMILY [] MULTIPLE FAMILY 7. WATER SUPf~LY ~' INDIVIDUAL* [] COMMUNITY I-'1 PUBLIC UTILITY NUMBER OF~BEDROOMS A~CH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPO~,AL SYSTEM .E~'~"I N DI V I D UA L/O N.SIT E** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. - . THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [~]'~'"SINGLE FAMILY f--I ONE I-'1 THREE [-I FIVE I-'1 OTHER [] MULTIPLE FAMILY [~'~TWo [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [~INDIVlDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER I'-~INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~"~//7 ~ Connection Verified INSTALLER [~}5"~'ptic Tank or [] Holding Tank Size:/.~.~"O If Tank ishomemade SOILS RATING give dimensions: / ~- 5~- ~ T;FE DP 7¢"K'/~o., ~/ · MA.U.ACTURER TOTA'A,SORPTIDNAREA MATER,AL , 4. DISTANCES ~eptic/Hold,ng Tank IAbsorption Area Sewer Line I Nearest Lot Line I I WELLTO: Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR~-X.-~ BEDROOMS [] CONDITIONAL APPROVAl. ~letter must accompany certificate} [] D~SAPPI~OVED 72-010 (Rev. 6/79)