Loading...
HomeMy WebLinkAboutBROADVIEW BLK 1 LT 2Broadview Block 1 Lot 2 #050-321-17 Jun 24 22 10:04p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section / Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Date of Issue: Parcel Identification Number: 050 321 17 Legal Description Block Lot Property Owner Name & Address: KELLY RICHARD S BROADVIEW 1 2 12301 MOUNTAIN ASH DRIVE EAGLE RIVER, AK 99577 Pump Installation Date: 06 - 16 - 2022 Pump Intake Depth Below Top of Well Casing: Pump Manufacturer's Name: MYERS Pump Model: 100M311 -8M17 Pump size: 1.00 ! Pitless Adapter Burial Depth: 5 I Pitless Adapter Manufacturer's Name: I Pitless Adapter Installer: 300 feet feet MARTINSON Well Disinfected Upon Completion? (Yes ❑ No Method of Disinfection: PELLETS I Comments: Pump Installer Name: _ ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET Company: ANCHORAGE, AK 99518 907-243-0740 Mailing Address: — City: State: Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. SUBMf``.r, nl. an Municipality of Anchorage &0 41116 On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ONSITE WASTEWATER INSPECTION REPORT Permit Number: OSP121332 PID Number: 017-142-08 Dwelling: M Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New N Upgrade Name: Richard Kelly ABSORPTION FIELD El Deep Trench El Shallow Trench El Bed El Mound Address 12301 Mountain Ash Dr., Eagle River, AK 0 Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original gradeGravel Ft. depth beneath pipe Ft. Subdivision Block Lot Broadview Block 1 Lot 2 Fill added above original gradeGravel Ft. length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines I FL SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches I From Tank Field Tank Line Fe Ft. Well >100' TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGETANK Capacity 1000 Gal. Surface water >100' Material Number of compartments Lot Line >5' STEEL 2 NA Foundation >5' LIFT STATION Manufacturer Capacity Curtain Drain >50' JGaI_Remarks EXISTING SEPTIC TANK Pump on level at Pump off level at I High water alarm ABANDONED PER UPC REQUIREMENTS in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Trainfield n to Installer DEAN CONSTRUCTION deld Dminfield CO/MT Inspector LARS SPURKLAND BENCHMARK (Assumed elevation)100 ft Inspde torn t" 10/24/12 a Location and description 2" e 4"' GARAGE SLAB COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engine.`er's Stamp OF 1115 Conditional Approval: Date ��'4 S A` - •',9 f/ %.49- G / � / SFUPKLAND /t 115 0 i �I�AFGpizlluZp�,„� Approved l Date/2 AOFE S0 Sig LO, 4Ln D - a .1FE -iW-7NG TES A 8 S I. c. a C 21.5' 20.0' ST. r- 0. D 2&5' 25.0: DBL. co. E 29.0, 27.0 DSL C.O. F 29.5' 27.5' INSTALLED 100 GALLON STEEL SEPTIC L 0 CONNECT 70 DRAIN HELD ABANDONED WK EX 84ALOONED EX11WNG F nn' SEPTIC r W p SEPTIC rANK PER MW — CODEWOUR Mrfi OW REOVIREQTNTS NOTE., THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER 25 0 25 59 75 100 125 150 DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE SCALE., I' = 50 FL APPROXIMATE. DOUBLE CLEAAVUTS CLN0 EXIST BRAIWIELB 1000 GALLON SEPTIC TAW BENCH MARK GARAGE SLAB ASSUMED ELEVATION IM FEET FawA4Tlav CLEANOUT SPURKLANV ENGINEERING I I BROMUN'BU I LT 2 I I RECORD DRAWING203 W 15TH. AVENUE DATE DEC.M&M/tV Ey qwj.I V21M I AVE KbfAU( L- MEN. AK- SHk&P tll 6W OAW I PERMIT # SSP 121332 PID # 050-321-17 BRVABVlEVBlL2,BV6 I On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP121332 Tax Code Number: 05032117000 Work Type: Septic Upgrade Permit Effective Dates: October 05, 2012 to October 05, 2013 Design Engineer: SPURKLAND ENGINEERING Subdivision: BROADVIEW Site Legal Address: BROADVIEW BLK 1 LT 2 G:0254 Owner/Address: KELLY RICHARD S 12301 MOUNTAIN ASH DRIVE EAGLE RIVER AK 995777917 Site Mailing Address: 12301 MOUNTAIN ASH DR, Eagle River Lot Size in Sq Ft: 45140 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either. A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: f2 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-321-17 Property owner(S) RICHARD KELLY Day phone 244-6363 Mailing address 12301 MOUNTAIN ASH DR., EAGLE RIVER, AK 99577 Site address SAME Legal description (Sub'd., Block & Lot) BROAD VIEW BLOCK 1 LOT 2 'groan( ek'o Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: Il7 (® all that apply) dadaLtG Permit No. 05 P la1'33 a Absorption Field ❑ Initial ❑ Single Family (SF) Q (w/Wo ADU) Septic Tank 19Upgrade Duplex (D) ❑ Holding Tank E]Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. property owner or autnorizea agent) Permit/Rush Fees: a0c) Date of Payment: Il7 Receipt Number: dadaLtG Permit No. 05 P la1'33 a Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. spac Nand FnUoMenng Environmental Consulting and Design September 25, 2012 Municipality of Anchorage Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION Broadview Block 1 Lot 2 Ladies and Gentlemen: We are submitting an application to upgrade the septic tank for this lot. The existing septic is 31 years old and the owner would like to replace it. The submittal consists of one (1) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. S'4SprkI Larand, P.E. 203 West 15th Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gcLnet �� ROP�vti 5PTIC TANK PER MOA CODE REQUIREMENTS NOTE THIS 1S NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER 25 0 25 50 75 100 125 150 DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE SCALE, I' = 50 FT. APPROXIMATE. DOUBLE CLEAN("'"' 4 FEET COVER CUMVECT TO EXIST BRAINFIELB 1000 GALLON SEPTIC TANK FOUNDATION CLEANOUT Of SPURKLAND No. CE -11500 0 I �runncarvu trvv/rvttKIrvv I I BRDADVlEI/ BLK 1 LT 2 I I SEPTIC SYSTEM I 203 W 15TH. AVENUE ANCH. AK. 99501 RICHARD KELLY DATE. SEPT 25, 2012 (907) 279-3916 12301 MOUNTAIN ASH DR. EAGLE RIVER. AK 99577 SHEET: 1/1 GRID: NW254 PERMIT It OSP 111XXXX PID # 050-321-17 BROADVIEVBIL2.DV5 4 - MUNICIPALITY OF ANCHORAGE 0- DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE L� NEW Jonathan Bettridge 694-3800 ❑UPGRADE MAILING ADDRESS P.O. LEGAL DESCRIPTION Eagle River Lot 2 Blk 1 Broadview Subdiv. LOCATION NO. OF BEDROOMS Ea le River. Ak 99577 3 Well Absorption area Dwelling PERMIT NO. V� DISTANCE TO: 130 ft min 27 ft H Q a Manufacturer 1000 Greer tank Material No, of compartments wF gal ti Li 0� � i p city in gallons 1 IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. z< _ Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well Foundation r 35 ft Nearest lot line ri 15 ft + PERMIT NO. 810509 J LL z No. of lines Length of each line Total length of lines Trench width Distance between lines Fzw 2 65 130 48 inches 84 inches Top tile to finish Material beneath the I.- of grade T tal effective absorption area o Minimum 2.5 fee SW sand/be}owstoninches Min. 850 S.F. Length Width Depth PERMIT NO. W C7 ct F- wa Type of crib Crib diameter Crib depth Total effective absorption area U.1 DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building founda ��. Septic tank Absorption area(s) OTHER pr Co PIPE MATERIALS p PA R •• 3034 PVC ''•" see 006 SOIL TEST RATING T► NO. 2124-B INSTALLER•j July 10, 1970 Dick Wood t"•.,• ..•'.` G REMARKS �� " Built in substantial co w/approved plan. Engineer performed inspections [2]selecting SW sand, [3] two inspectionE, - duringf sand and tile field, and [4] after construction Work complete except for final landrcapirg. Turner Engineering Morris J Turner P.E 2124-E I MU ICI AUT OF F H-AL1ii AN & 4006 North Point Dr. 'i' TEC ION E* IR NME TA i ph 243-4402 R ;1 Dated 12/3/81 APPROVED DATE LEGAL 72-013 (Rev. 3/78) ANCHORAGE Department — I AN Depar+:mDepartment oy .iealth lth anndd Environmental atection 825 L Street, Anchorage, AK. 99501 264-4720 # # HANDWRITTEN PERMIT # # Q WELL AND/OR ON-SITE SEWER PERMIT ,4 1 Mailin Address : 400� N . �• Applicant: yorn ,,,rnP_12 g Location: Phone Number: Zy3—y0 Z Legal Description • LOT- 2 %i. Lk 1 bev&aV, e.w � Lot Size: Type of Soil Absorption System Is: 1W00 Trench: Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) 166 - The Required Size of Absorpti3n Stem Is: AS Sitar an DEPTH LENGTH . GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ FOOD GALLONS # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # # TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 u 1 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require en the re5idenge ig remodeled to include more that 3 bedrooms. Issued by: Date: • SWP/024 (1/81) TH 16 S-VSTPM 01 U�ST E� 0 -- 2 tq - r,rze-.b a- ru E ENG1 ZERING & DEVELOP ENT CO. Box;, Davis St., Eagle River, Alaska 99577 r' Q 694-2774 or 688-2280 0� Russell Oyster -�' Earl Ellis 694.2774 SOIL LOCI 688-2280 Performed for: Name: Tel. No. Mailing Address: Legal Description: Depth (fest) Soil Characteristics 5 6 7 8 9 PLOT PLAN 10 12— J 7Qry } 13 q �' , mnn oe ax�anyun\• � p �kc P r.. ,.ten., - +'eawww•.o�n.!'� -� 14 111rl rdl L. Oyster � TEST 15 . JFCSS��j 16 ©round Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit—.. Drain Field— Comments: ield Comments: Performed by: •' 1 AS -BUILT I hereby certify that I have surveyed the following described ropetty:10 Anchorage Recording Precinct, Alaska, and that the improvements situated =care within the property lines and do not overlap or encroach on the property lying adjacent thereto, totnoimprovements on prop- erty lying 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 Eagle River,. Alaska this --- !rE --day o€ --a C-,/- i li ROBERT C. JOHNSON ` '?r� SCALE: Re.yistered band Surveyor No. LS 1 = Box 4611, Eagle River, Alaska Phone 6944543 { ITI � In M P" pri P" PTI I am 100 F -J :1-J :%w iW 'ON U 0 CK :k -j (3 CO $,ft H -i g -3 0 0 0 0 o 0 a 0 0 0 0 o" :U P, In :0 *C+ .0 :0 C+ ;PC Ub :joa RD CD 7d j !po ::u 0 -0 IV O Tj III I" III I" P" M I" 0 0 a 0 0 0 cc> H 0 0 o -i H RECEIVED I JUN 41§96 Municipality of anchorage: Dept. Health & Human Services LVV8942 9N1111da SWt;:PIIIIM AVr a g in to t 0 X O rI > < M C: > th 04 4# :t4 iN Zf 0w C-4 ire C)•0 'A ;F' OD OD P, 0 H (D :4 FAO M LVV8942 9N1111da SWt;:PIIIIM AVr a g in to X O rI > < M C: > th 04 4# ire C)•0 'A C+ LVV8942 9N1111da SWt;:PIIIIM AVr a g X M M rI < M C: > th 04 4# MUNICIPALITY OF ANCHORAGE Development Services Department �\ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-321-17-000 Leqal description BROADVIEW BLK 1 LT 2 Expiration Date: 7/1/2025 Site address 12301 MOUNTAIN ASH DR Eagle River AK 99577 Current property owner(s) KELLY RICHARD S X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: M Original Certificate Date: 10/28/2024 his Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-321-17 Complete legal description Broadview Block 1 Lot 2 Location (site address) 12301 Mountain Ash Drive, Eagle River, AK 99577 Current property owner(s) Richard Kelly 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone (907) 244-6363 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: t❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 11 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ S ��n Date of Payment I !n 'o ! ' L COSA # V C L/ / 0/ Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 N/A N/A Benjamin Schiller, P.E. (907) 522-7773 Lot 2 Broadview Subdivision As Built 124 E 7th Avenue Anchorage, Alaska 99501 (907) 306-8104 mail@S4AK.com Land Surveying Land Development Consultants Subdivision Specialists Construction Surveying AECC#173042 S4 Group 10/24/2024 p «!nVe Municipality of Anchorage all • Development Services Department Building Safety Division On -Site Water and Wastewater Program *A9 4700 South Bragaw Street 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. 050-321-17 HAA #_ Expiration Date: % ~ D 4 1. GENERAL INFORMATION Complete legal description Lot 2 Block 1 Broadview Subdivision Location (site 6ddress or directions) _ 12301 Mountain Ash Drive, Eagle River AK 99577 Current Property owner(s) _Mark B. Shasby Day phone 786-3944 Mailing address 12301 Mountain Ash Drive, Eagle River AK 99577 Lending agency Day phone Mailing address Real Estate Agent Lynn Swanson Day phone 689-1803 Mailing Address 16635 Centerfield Drive, Eagle River AK 99577 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. . NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90' days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates 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. (Rev. 11/99) 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 Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply .and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm _Pannone En -g. Svc. Phone 272-8218 Address -P.O. Box 102954, Anch, AK 99510 �.,1 Engineer's Printed Name Steven R. Pannone. P.E. Date. 0#0 1( Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The OF reported results describe the performance of the system under the conditions encountered at the tiq� �f♦ me of ♦ Q`�.•••��,......... ♦♦♦ the test, and separation distances measured to readily identifiable features. The operational life of all i ��.'• ♦. wells and septic systems depend on the local soil condition, ground water levels that may fluctuate 49TH} �f 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 this system. All systems eventually fail and satisfactory test results i do not guarantee future performance of the system, nor do they guarantee that there are no hidden defe ................ ... „ or encroachments. PES can therefore not provide any warranty for future performance nor give any - Steven R. Ponnone�= i estimate of how long the system will continue to meet the operational requirements of the ADEC or C) 1 No. CE 8149 N, •. MOA DSD. The content of this report is for the sole benefit of the'owner listed above. Any reliance upon© ♦♦� tt&op or use of this report by any other person or party is not authorized nor will it confer any legal right ♦♦`•�.,,i whatsoever. ♦ • 6. DSD SIGNATURE ♦41, is ��.+ �• Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments a QWMITI= .� WATER AND VVASTEWER PROGRAM Attachments: HAA Checklist Septic System Advisory Well Flow Advisory JJ X Maintenance Agreements 'Supplemental Engineer's Report Other By: Iv, Z26�_ Expiration Date: (Rev. 11/99) Original Certificate Date: Reissue Date: m - N Municipality of Anchorage *A1 Development Services. Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw;Street P.O. Box 196650 Anchorage, LAK 99519-6650' www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 2 Block 1 Broadview SID Parcel LD.: 050-321-17 A. WELL DATA Well type P If A, B, or C provide PWSID # Well Log. 7 Date completed 6/15!1981,1; 7115 ft/Sanitary seal YID/ Wires properly protected Y Total depl:N 360 ft Cased to -14 ft Casing height (above ground) 12+ in. ,3(�0 FROM WELL LOG 1 IT AT INSPECTION fad Date of test 6/15/1981 5/28/2004 Static water level 350/350 ft 12/22 ft Well production .5/1.0 g.p.m .65 (g p.m WATER SAMPLE RESULTS: Coliform -2-Colonies/100 ml ` Nitrate 4.41 mg/I Other bacteria 0 colonies/100 ml Date of sample: 5/28/2004 Collected by: Laura Pannone B. SEPTIC/HOLDING TANK DATA Tank Type/Material Greer Steel Date installed12/3/1981 Tank size 1000 gal Number of Compartments 2 Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm N/A Date of pumping 9/3/2003 Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 12/3/1981 Soil rating (g.p.d./ft2 or ft2/bdrm)165 System type Mound Length SS ft Width 4 ft Gravel below pipe 1.0 -ft Total depth 4.2/4.75 It Effective absorption area 850+/- fe Monitoring tube Y Depression over field N ` Date of adequacy test 5/28/2004 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test pry inWater added470 gal. New depth11 in. Elapsed Time: 1440 min Final fluid depth Pry in Absorption rate >= 450+d. 9•P• Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date (Rev. 11/99) D: LIFT STATION Dae t - installed iz� in.gal s "Pump on" level at m"Pump ' I Y in Datum Cycles est d Manhole/Access High water alarm level at in Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 112 On adjacent lots ' 100+ Absorption field on lot 100+' On adjacent lots 100+ Public sewer main , 100+ Public sewer manholelcleanout 100+ Sewer /septic service line 80+ Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10 Property line 50+ Absorption field 15+ Water main 100+ Water service line 50+ Surface water 100+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 15+ Building foundation 39 Water main 100+ Water Service line 80+ Surface water 100+ Driveway, parking/vehicle storage 2 Curtain drain None Observed Wells on adjacent lots 100+ F. COMMENTS ter 1A 10 �1a � �n l Cor111o'-� ds l.i►� a`L� �,'S uee✓1. �.••...a�� f.Lt�11 Iia aPe, Vr G. ENGINEER'S CERTIFICATION = Gj,.•• _•• 1# AV :• ': 4 Fi ••� �/ '•1 certify that / have determined through field in and I••••, • •• ••••,,,,,,,,0 review of Municipal records that the above systems are in 0 t i conformance with MOA HAA guidelines in effect on this date. .%Steven R. Po. ion ,c �! •' AV No: CE 81 a9 : `�� P.E. Engineer's Printed Name Steven R. Pannone, �j.. {D,�,� Date � •��R�er- ESS. v� HAA Fee $ !, Date of PaymentLZ v Receipt Number �� 3 / c::!r,. (Rev. 11/99) Waiver Fee $ Date 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.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 040241 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 1, Lot 2 of Broadview subdivision, the well's productivity was determined to be 0.65 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 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 Health Authority Approval. MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Mfodm Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # G s° 3211 - 17 HAA # ��, 4S�1, C -A \ � 1. GENERAL INFORMATION Complete legal description tot 2; BJ.ocic 1; Broadview subdivision Locatiorl (site address or directions) 12301 MountGi.n Ash Eagle River, AK Property owner Dr. John Bettri.dge Day phone 694-7754 Mailing address 123-01 Mountain Ash Eagle River, AIC 99577 Lending agency Day phone Mailing address Agent Virginia Kohfield/ Remax of Eagles Piver Day phone 594-1700 Address Unless otherwise requested, HAA will be held for pickup. MUNICIPALITY OF ANCHOKA(A: 2. NUMBER OF BEDROOMS: 31 ENVIRONMENTAL SERVICES DIVISION 3. TYPE OF WATER SUPPLY: ,,I;j Nj, 4 ?9s .,�.<> Individual well <,<:�- RECE IV E Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone a y— `� 7 c% 17034 Eagle River Loop (toad No. 204 Address Eante River.—Alaska ME= Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. %REE bedrooms. Date b 3 I ,.04% OF A r� __l1 e ROBERT C. COWAN mac•, CE - 8C0 Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA a21 MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO.W60alg During a recent Health Authority Approval on-site inspection and test of the potable water supply wells on Lot a Block of RRApULEUki Subdivision, the well's productivity was determined to be C)147� gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 7-AZEF bedroom residence is 0, 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 Health Authority Approval. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES MUNICIPALITY Environmental Services Division ��R OFA 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 ONMENTAL SERV :.may JUN q. ids Health Authority Approval Checklist R EC e l i / C 1 V ED Legal Description: LwrZ 5L,� I \j i e,,J Parcel I.D.: 26 0 3 2-1 17 A. WELL DATA Well type fk,J NrT7f . If A, B, or C, attach ADEC letter. ADEC water system number Log present &I) Date completed (,o t 3 , 1$1 S - S l Total depth 3C..a� t 3 4 d Cased to l'A I r"44 t f k Easing height (above ground) 12 Sanitary seal QI) Wires properly protected (YIN) FROM WELL LOG AT INSPECTION Date of test V - t-5 � t t -I - i5 -5r k Static water level yP r� Well production 3fl loo g -p.m. WATER SAMPLE RESULTS: U V-- f3u-rl� ,,i rzws g.p.m. Coliform O Nitrate k , ov_ � thhee'rI bacteria Date of sample: Collected by: Z 17034 Eagle River Loop Road No. 304 � �'1 �. ,.JIZ�P �,°�s �!;' ' e�.., �(ts r- B. SEPTIC/HOLDING TANK DATA Date installed I Z - 3 - b l Tank size ono Number of Compartments Z Cleanouts (D1)__y_ FoundatiowoleatroutON) _ Depression (Y/& High water alarm (Y rt D fe of Ruinping N '��t. Pumper C. ��ABSORPTION FIELD IItATA =' Date. installed Soil rating (g.p.d./ft2 or ft2/bdrm)(.. S System type lj. D L Length (PS- -Width' Gravel thickness below pipe I Total depth S Ito 47-x, Effective absorption area i� omtormg Tube presentQN)_y--- Depression over field (Y4Z. iv Date of adequacy test Results email) PA -56 For 3 bedrooms Fluid depth in absorption field before test (in.); 0_ Immediately after 4/6 gal, water added (in.): 3 N Fluid depth D (ins.) Minutes later: Absorption rate 9-p.d. Peroxide treatment (past 12 months) (Y; V j. -o„ I & i4:dc) 4&yes, give date /' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level tested E. SEPARATION DISTANCES Size in gallons "Pump on" level *Datum "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot t b b ; On adjacent lots 1 nD to coy+ Absorption field on lot t 0 a ; On adjacent lots Public sewer main '� ` pr Public sewer manhole/cleanout Sewer /septic service line 'ZS Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation `S Property line 1 o Absorption field Water main service line 1p \ Surface water/drainage l c~ Wells on adjacent lots to e `+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation to Water main/service line 1 o L Dfi-f•- Surface water L w o Driveway, parking/vehicle storage area 5� S�w►,Mf��— J�� n�v Curtain drain "� P- Wells on adjacent lots Leo o Property line 10 F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review of Municipal in conformance with A104 HAA guidelines in effect on this date. Signature WZ 4Z Engineer's Name � T C - Coc✓�-� Date 6 t/3 fl g t4 HAA Fee $ 910 Date of Payment (, PA/09 Receipt Number / ?d :2 &??A Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number rds 515%MiZ'� s s are ringg eal . 10BERT C. co �4 CE -8801 --- -1QT � --- .�..:,_ ,tea s+w HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL. INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN s&s� ,ineeRing WELL FLOW TEST DATA ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 CLIENT: L",C DATE: LEGAL DESCRIPTION: l -cn- Z 16 ,v-- 1 57-* WELL DEPTH: 30-o' 1',t,o CASING DEPTH: %,4' 4 DATE DRILLING COMPLETED: t_ -j< l7 _t5 _0 % DRILLER: U, L Wt &'mfS MISC. DATA: CASING HEIGHT: \Z SANITARY SEAL: WIRES IN CONDUIT: GRADING O.K.: BACTERIA AND NITRATE SAMPLES COLLECTED (date): TEST DATA: CLOCK TIME METER READING (GAL) PUMPING RATE (GPM) DEPTH TO WATER (FT) REMARKS 1' o b o p swi ✓ l•. z.5- 1LeLpL> U.S l\`,to Falb Io.0 l2i S Z1 1 til L,. , d �•,�� 'Z�?ro 2.7 7-4 71,.r . CvS+ 149-om P PJ0AP P- ►5 RESULTS: WELL CURRENTLY PRODUCES GPM WITH A 0/,( DRAWDOWN TESTED BY: FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR. �- J t•'i3 iii._ -rV M eAr% 0 '_1s-- '4 J e_ 'rb ►s�"�y-fit-- '!tet N /vtC i 1'� by t7 17034 NORTH EAGLE RIVER LOOP • SUITE 204 0 EAGLE RIVER, ALASKA 99577 dr 40 losr- 5. LEGAL DESCRIPTION ,ee �Q'. DA i e RECEIVED INSPECTION APPOINTMENTS 6. TYPE OF RESIDENCE TIME SINGLE FAMILY TIME TI •� ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six • DATE I INDIVIDUAL* DATE DATE INSPECTOR ❑ PUBLIC UTILITY INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAgUNIcIPALITY OF ANGHORA rOt H5F'LTH « YEAR ON-SITE SYSTEM WAS INSTALLED, DEPARTMENT OF HEALTH & ENVIRONMENTAL PR�ZTR� PROTECT►Oly 825 L Street -Anchorage, Alaska 995eNVIROiv A -r4 ENVIRONMENTAL SANITATION DIVISION DEc r1 1�1 Telephone 264-4720 �( REQUEST FOR APPROVAL OF INDIVIDUAL WATER ANDSL'U F FACED.ILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERT OWNER & ONE t �t/Irs ,✓ _ MAI NG ADDRESS r O r AAKisa PROPERTY RESIDEN (If diffe ent from ab e) PHONE ow Is 2. B� I' P N E MAILING ADDRESS 3. LENDING INSTITUTION PHONE - _ i �• i �. M+ Iy,G ASS v �I Y 4. REALTOR/ GENTPHON /02C \rte MAILING ADDRESS // W d,& "A� dr 40 losr- 5. LEGAL DESCRIPTION ,ee �Q'. STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY I INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled +�7 COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM_ [X INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED, ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) i 49 THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE 71 PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area SewerLineNearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE / B�' 72-010 (Rev. 6/79) d Z Z i% Mn 6 u +U) to N W m 0°' M � � W .di w Z0 39Vd 9NIN33NI9N3 S QNa S TTZTb69L06 90:ZT 966T/ET/90 CR' CD V-4, 06/13/1996 12:06 ... 9076941211 Dr Jonathan Hettridge PO Box 1033 Eagle River,Ak 99! t'?! Dear Dr Bettridge S AND S ENGINEERING PAGE 03 Turner Engineering Morris J Turner 4006 NORTH POINT DR Anchorage,Ak 99502 PH 243-4402 ,;.76-0517 As requested I have-. poi4rmed five [5) seperate inspections of your sewer instAl-I&A4.0n. flat 5 blki Broadview Subdivj in accordance with 0i refit rements of the Municipality Depart- ment ment of Health 6 96Vira»hental Protection. Enclosed is as built for your use,-. I impressed with the work done by Mr Dick Wood on th4'`'9y Vim. Let me not- that it must yet be lanscaped with top','boil;end seeded in order to provide protection in part from the'tb�la •u► i then. While I spent more.;time:"+.han I am billing you for I hope you will enjoy your: net 'home &top the mountain. Five f51 inspection trips WM &i-iuilt , 15 hours @ $50/hr= $750. Sincerely Yours, " r'Sorris J Turner P:': 06113/1996 12:06 9076941211 S AND S ENGINEERING PAGE 05 O & E ENG 'INN & DEVELOPMENT CO. box'00, Ef016 8t., 4116914 River, Aleekst OW77 804-2774 or 688-2280 Russell oyrter Earl Ellis 624-2774 SOIL LOG _ / 688-2260 Performed for; Name; Tel. No. 40'9 9 a Mailing Addrea:, Legal Description: Aix r Depth 0442) RQIt lees Q 1 oetd.Q 4,57 AO 7 rip e'r-w 40,0 "it o 0e 9 ,doRrjarA rip K+lE" �► %cK ! Qr A- :�' fi 7 tic � 10 PLOT PLAN 12 13 tPERC. TEST �1.••.••1t. 34 ♦ it 1•'A 14 , x, t :.; n .a L. 0 ;or 1 ', ,l.,et�1�cc e_ -rx-- I D Ai, A41i ru" Is - Ground Water Encountered: Y_ If yes, what depth-.- �► t' �� Proposed Installation; Seepage PILL.-- •'rain Field � �,,o� . c�J�/� I b W -q 1 4 06/13/1996 12:06 9076941211 S AND S ENGINEERING PAGE 04 1 P. Q. Box 1033 ga.gle River. ASS 99577 December 11. 1.9 7. Turner Engineer ' .09 Morris J. Turner'', 016 1'11ar th Pint; .Dr. Anchorage, AK 95112 . Dear. Mr. Turner:.. A did not togaf'" a Copy of the as bixilt as stai•.Od in your letter. Pl kse :AA—rnish us a copy of the as built Prapared by You and as 8600' a$. .'.it is received your check will be in the ina:il promptly. Sincerely Jonathan Dettridge