HomeMy WebLinkAboutBROADVIEW BLK 2 LT 2ABroadview
Block 2
Lot 2A
#050-321-13
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: 0SP111195 PID Number: 050-321-13
Name: Eric Scholtisek
Wastewater System: ❑ New ❑ Upgrade
Address:
18615 Upper Skyline Drive Eagle River AK 99577
ABSORPTION FIELD
Phone: Number of Bedrooms
[]Deep Trench ❑ Shallow Trench O Bed ❑ Mound ❑ Other:
LEGAL DESCRIPTION
Soil Rating:
EXISTING rp�w
Total Depth from original
Block Lot: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth �-pipe:
2 2A Broadview
�.
Ft
Tovmship: Range: Section
Fill added above original grade:
a Length:
Ft.
Well: [_1 New El upgrade
Gravel Width
Number of lines:
Distance bebveen lines:
Ft.
Ft
Classification (Private, A, B, q: Total Depth: Cased to: -:•
Total absorption ar
Pipe Material
EXISTING n Ft
":- Ftp
Driller: Date -- Slatic Water Level:
In
Date Installed:
FL
Yield urop Set at: Casing Height Above Ground:
TANK
GPM Ft. F[
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
ubliclPrlvate
Manufacturer:
Capacdy:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1250 Gal.
Well
1001+
--
--
NA
251+
Ir&terial:
Numberof Compartments
Steel
2
Surface Water
1001+
--
--
NA
LIFT STATION
Lot Line
Sr+
--
--
NA
Size:
Manufacturer:
_
- Gal.
Foundation
5 r+
--
••
NA
"Pump on" level at
"Pump dP'level at
"igh water alarm at
in
Curtain Drain
NA
--
NA
Pump M _
r6cbiml Inspections performed by,
Remarks
Existing septic tank decommissioned in place per code.
BENCH MARK
Installed by PC� �o
Location and Description:
Bottom of Siding
Assumed Elevation:
100 Ft
Engineer's Stamp
by:ArcTerra Dates: 1ST&2ND
#,
Inspections performed 08/18/11
Development Services Department Approval
Xams V,
Reviewed and approved by:Date:
(1u, tzrog)SFAW
WASTEWATER SYSTEM AS -BUILT
BROADVIEW EST. S/D BLOCK 2, LOT 2A
EXISTING FIELD SEPTIC
VENTS
(tYP)
0
I
DECK TO BE o
REMOVED
AW OF AL4 '
* 9 TH�
/ KENNETH M. D
` CE -7116 ,rya
AV
SSI0 AV
PERMIT M OSP111195
PID: 050-321-13
110
.P o.
0
/GS �
CONNECTTOE STING LINE
12 0 G5z A_L. S.T....
A -C: 51.2'
B rtiF� B -C: 31.0'
A -D: 58.9'
2 z z c� B -D: 38.7'
BMG uo O — m
L
BOJ p o 99.44
^�
O O O 00
QO
GPS
PREPARED FOR:
ERIC SCHOLTISEK
18615 Upper Skyiine Dr
Eagle River, AK 99577
FIELD BOOKS
BOUNDARY: SLS
STMNQ SLS
ASBDiLT: n/a
M. FILE:
ACRD FILE 11-087
4" SOLID
ABS/PVC PIPE
2% TO TANK
95.00
D mm:
DNAm'- BMW
WEUM: KMD
DATE` rev 11 /11
MD` NW254
"No'; 11-087
SEPTIC
TAN K
95.00
Scale) 1'= 30'
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:
OSP111195
Tax Code Number:
05032113000
Work Type:
Septic Upgrade
Permit Effective Dates: August 12, 2011 to August 11, 2012
Design Engineer:
ARC TERRA CONSULTING INC
Subdivision:
BROADVIEW
Site Legal Address: BROADVIEW BLK 2 LT 2A G:0254
Owner/Address: SCHOLTISEK ERIC V & JEONG HEE
12300 MOUNTAIN ASH DRIVE EAGLE RIVER AK 995777917
- 1.9 -- l I C" /,Z `)'>
Site Mailing Address: 18615 UPPER SKYLINE DR, Eagle River Lot Size in Sq Ft: 72888
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 By
Issued By:
Municipality of Anchorage
• A-� Development Services Department
f Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-321-13
Property owner(s) Eric Scholtisek Day phone
Mailing address 18615 Upper Skyline Dr. Eagle River, AK
Site address 18615 Upper Skyline Dr. Eagle River, AK
Legal description (Sub'd., Block & Lot) Broadview Blk 2 Lot 2A
Legal description (Township, Range & Section)
Lot Size 72,888
Sq. Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field
❑
Septic Tank
0
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Zip Code 99577
ip Code 99577
Number of Bedrooms 3
THIS APPLICATION IS AN:
Initial ❑
Upgrade 0
Renewal ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property I64) or authorized agent)
Permit/Rush Fees: `,C7 Waiver Fees:
Date of Payment: Rk�,%/ Date of Payment:
Receipt Number:
(Rev. 11/05) Receipt Number:
o tFtCTERy
�9c 0 h
R NSUL7I NO 6
eR• AK. 995]]'8]3
August 5, 2011
AKcTFKYZA
CONSULTING, INC
212 E. 51" Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Septic Tank Permit - Broadview Estates Block 2 Lot 2A
The owner has requested we proceed forward to obtain a septic tank
replacement permit on the subject lot. The tank is being replaced to
accommodate an addition to the house that puts the new foundation within 5' of
the existing tank. No additional bedrooms are planned in the new construction
and the existing leachfield will not be affected.
The subject property and adjacent lots are served by private wells and the
replacement tank is not within 100' of any well. There is no surface water within
100' of the proposed tank and there are no known curtain drains within 50'. We
do not expect there to be any adverse effect on adjacent lots by the replacement
of this tank. If you have any questions, please contact me at 696-6111/FAX 868-
3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
r
Kenneth M. Duffus
Attachments: On -Site Sewer Application
Wastewater Absorption System Details/ Site Plan
Owner/ Contractor Specs
20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793
IAld
WASTEWATER SYSTEM DETAIL
BROADVIEW EST. S/D BLOCK 2, LOT 2A
287.
I'
LST
n LOT 2A ti� a1
I_ BLK 2��z2��
N �
3
o bf1511NG FlELD�—
Z Z
NO PUBLIC WELLS WITHIN 200' OF
PROPOSED SYSTEM.
NO PRIVATE WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
NO SEPTIC SYSTEMS WITHIN 200' OF
PROPOSED WELL EXCEPT AS NOTED.
SYSTEM PLAN
SCALE: 1"=100'
ANNETH.
'ACy= �I
IKEI
` CE -7116 /
t 4w
Af
1 P�ssta��y
\A
0 100'
\ \ GRAPHICS SCALE
I SCALE: 1:100
l
LOT 1A \
BLK 2 /
P
LOT
BLK 3
NOTES:
1. REMOVE EXIST. FIBERGLASS TANK, COMPACT SOIL TO 95% & INSTALL NEW
1000 GAL. SEPTIC TANK & INSULATE TANK IF LESS THAN 4' OF COVER.
CONTRACTOR MAY RE—INSTALL EXIST. TANK SUBJECT TO ENGINEERS
APPROVAL. CONTRACTOR TO VERIFY TANKS INTEGRITY.
2. RESIDENCE HAS 3 BEDROOMS — OWNER PLANS ON ADDITION THAT WILL
IMPACT TANK SETBACKS REQUIRING THE RELOCATION OF THE TANK TO THE
EXISTING SYSTEM. CONTRACTOR TO INSURE THAT ALL LINES AND CLEANOUTS
ARE BROUGHT INTO COMPLIANCE WITH EXISTING CODES (I.E. POST TANK
CLEANOUTS TO BE INSTALLED).
3. CONTRACTOR TO INSURE THAT THAT MINIMUM OF 2% SLOPE INTO SEPTIC
TANK.
4. CONTRACTOR TO VERIFY AND INSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTIC SYSTEM COMPONENTS, EASEMENTS, PROPERTY LINES, ETC.
5. INSTALL SEPTIC TANK 10' FROM EXISTING FOUNDATION, PROPOSED
FOUNDATION & FROM FIELD.
6. FLAG ALL SETBACKS (PROPERTY LINES, EASEMENTS & WELL RADII) PRIOR
TO CONSTRUCTION.
7. CONTACT ENGINEER PRIOR TO CONSTRUCTION TO COORDINATE INSPECTIONS.
PAGE 1 OF 2
PREPARED FOR:
ERIC SCHOLTISEK
18615 Upper Skyline Dr
Eagle River, AK 99577
FIELD BOOKS
COMPUTED:
BOUNDARY: SLS
DRAWN.
kmd
STAKING: SLS
CHECKED:
KMD
ASBUILT: n a
DATE:
DWG. FILE:
GRID:
NW254
ACAD FILE: 11-087
JOB No.:
11 —087
41
11
w"Od'Amme",
WASTEWATER SYSTEM DETAIL
BROADVIEW EST. S/D BLOCK 2, LOT 2A
°
EXISTING FIELD 3SEPTIC
° VENT
/`S p
11
O' ti
�p CONNECT TO EXIST INE $
X60 �G INSTALL NEW CO.
�O INSTALL EW 1000 GAL. S.T. W/2 POST
y 'Zo.MTo GO E0 N
"0-
Q 0
�p SCO
o
REMOVE EX. FIBE GLASS TANK SEE NOTES)
WELL ^4� �•5 h CO2
�0 ti �tK.
DECK TO BE
REMOVED _QQ
OF
A, 1
I* .9TH *�
./
KENNETH D US /
CE -7116 W� /
Pftns5I0'o'
4VE
/W
I IN •;
ERIC SCHOLTISEK
18615 Upper Skyline Dr
Eagle River, AK 99577
FIELD BOOKS
BOUNDARY. SLS
STAKING: SLS
ASBUILT. n /a
DWG. FILE:
ACAD FILE: 11-087
COMPUTED:
DRAW": kmd
CHECKED: KMD
DATE: reV 8111.
GRID, N W254
JOB No.: 11-087
Scale: 1"= 30'
PAGE 2 OF
�RCTERRq
AxcTERRA
CONSULTING, INC
�. 212 E. 51St Ave, Anchorage, AK. 99503
0 Office (907) 868-3791, Fax (907) 868-3793
RSL �SULT NG 6
fq AH. 99577
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS
LEGAL DESCRIPTION: Broadview Estates Block 2 Lot 2A
GENERAL:
1. The scope of this project includes the installation of a septic tank and/or
drainfield to serve a single-family residence on the referenced property as
delineated on the attached Municipality of Anchorage (MOA) permit and site
plan. Construction shall be in accordance with the approved site plan and
design drawings; MOA permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
2. ArcTerra Engineering & Surveying, Inc. (ArcTerra) assumes no responsibility of
the accuracy of the as -built survey provided by the owner or owner's
representative.
3. The owner or contractor is responsible to notify the engineer of any
discrepancies noted on the design plans or drawings prior to commencing work.
These discrepancies could be, but not limited to, possible encroachments, surface
water, varying soils, unplatted easements, types or use of dwellings on or
adjacent to property, nearby public wells, etc.
4. The contractor shall be responsible for locating any necessary underground
utilities, easements, property lines and surface water. The owner and/or
contractor shall ensure, if deemed appropriate, that a registered land surveyor
prior to construction flags all setbacks. The contractor shall be responsible for
verifying all pertinent separation distances and component layout.
5. Unless specifically agreed otherwise, the property owner shall be responsible for
final grading areas subsequently depressed from soil settling. On all leachfield
mound systems, the property owner shall be responsible for ensuring a
satisfactory vegetation growth over the mounded area.
6. The MOA Development Services Department On -Site Water & Wastewater
Program must certify contractors installing wastewater disposal systems.
Owners installing their own systems must also receive prior approval from said
MOA Department.
SEPTIC TANK/ HOLDING TANK/ LIFT STATION INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded with proper material and
compacting to prevent damaging, settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches above the
final grade.
Broadview Estates blk 2 Lot 2A
August 5, 2011
Page 2 of 4
4. Septic tanks installed with less than 4 foot of cover shall be insulated. The
contractor will ensure that the fill over the tank does not exceed the burial depth
rating.
5. 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 feet
from the tank. The second cleanout, in line, shall be to clean toward the septic
tank.
6. Final grading over the septic tank shall be such that a positive slope exists away
from the septic tank.
7. All H.D.P.E. tanks shall have a vertical length of 4 -inch perforated drainpipe
besides the tank extending to the bottom of the tank to above grade to monitor
ground water.
8. All tanks shall be anchored when there is not enough adequate soil cover to
resist buoyancy forces in high -groundwater areas.
9. All holding tanks and lift stations shall have an audible and visual alarm inside
the residence.
10. All lift stations shall be wired in compliance with the Uniform Electrical Code
and all MOA guidelines.
11. The contractor shall remove the old tank, or abandon it in compliance with the
Uniform Plumbing Code. The contractor is solely responsible for the
abandonment procedure.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. 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
excavaction become smeared, they must be raked or scratched (roughed -up)
before gravel (sewer rock) placement.
2. Once the sewer rock is installed, the distribution pipe is installed level with the
perforations facing downward. Gravel is then to be placed over the distribution
pipe to provide a minimum of 2 inches of cover over the pipe.
3. 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.
4. Monitoring tubes shall be 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.
5. Backfill over the final gravel layer must not be less than twenty-four 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.
6. All advanced technology waste water disposal systems (Advantex, Biocycle,
Intermittent Dosing Sand Filter, etc...) shall be constructed, installed, maintained
and monitored per manufacturer's specifications and MOA requirements.
20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793
Broadview Estates blk 2 Lot 2A
August 5, 2011
Page 3 of 4
MINIMUM MATERIAL SPECIFICATIONS:
1. A MOA approved septic tank manufacturer must construct any septic tank
proposed for installation.
2. The following pipe materials are MOA approved for use in septic system
installations:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder,
Fernco, or equal).
5. 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.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less
than 3% passing the #200 sieve. If deemed necessary, a sieve analysis should be
performed.
7. When sand is being used as a filter material, its gradation specification must
conform to current MOA or ADEC requirements.
INSPECTIONS:
Typically there will be three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
1. 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.
2. The second inspection must be conducted after the placement of the sewer rock,
distribution lines, standpipes, and cleanouts, but before the placement of the silt
barrier, insulation, or any 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. 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 contractor's activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and attached plans and in accordance with the attached MOA permit. All
materials, components, and construction practices shall comply with the MOA's and the
State of Alaska's latest ordinances, regulations, or policies regarding wells and septic
systems. The failure of the inspecting engineer to notice a material or construction non-
compliance does not relieve the contractor of his/her responsibility to correct such
deficiency. There will be no contractual arrangement existing between the contractor
20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793
Broadview Estates blk 2 Lot 2A
August 5, 2011
Page 4 of 4
and ArcTerra. ArcTerra shall be the owner's representative and will inspect the work as
stated above to document the contractor's activities. Final acceptance of the contractor's
work rests with the owner and the MOA.
ArcTerra 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.
ArcTerra's inspecting engineer will not be responsible for the construction means,
methods, and techniques, sequence, procedures or the safety precautions incident to this
project.
BY PROCEEDING FORWARD WITH THE INSTALLATION OF THE WATER
AND/OR WASTEWATER SYSTEM (S), THE PROPERTY OWNER, CONTRACTOR,
AND WELL DRILLER ACKNOWLEDGE HAVING READ AND ACCEPTED THESE
SPECIFICATIONS.
20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NameDISTANCES
L Z/M
TO
SEPTIC
ABSORPTION
WELL
c�
,6_%
Address
_a QC) �/I . N D 2 t �
FROM
TANK
FIELD
WELL
ADD r
/fid �
_/2
Phones))Permit
P No.
No. of Bedrooms
6 �I Y'r
8 $ e) /q s
1 3
LOT LINE
LEGAL DESCRIPTION
Lot
214
Block
Z
Subdivis
�O/a 0 !� � �
FOUNDATION
Township, Range, Section
' �' 44 A ' �C
P
AS -BUILT DIAGRAM
(Show location of well,
septic system, property
lines, foundation,
-1A /V
driveway, water bodies,
etc.)
TANKS
Lol//'
SEPTIC F^ 15 I�- HOLDING
Gq 2. 7 33't_
Manufacturer Capacity in gallons
V0 I 3 O
Material No. of Compartments
Q �
Co�0 t /
G
TYPE OF SYSTEM
❑ TRENCH x BED ❑ W. DRAIN ❑ OTHER
ST 2 3 s'
Depth to pipe bottom from Total depth from original grade
/ f n 7
( 2—/'
original grade FT FT
Fill added above original ade Gravel depth beneath pipe
O FT • ,S- FT
_
Gravel length ��LL Gravel width
FT
rST FT
Total absorption area Distance between lines
12— F6 SQ FT 6 FT
Number of, Soil rating Pipe material
%
i � SQ FT
Installer Date Installed
eek X89 -1011D 6 88
°
WELLS 7-/116—
PRIVATE ❑ OTHER (Identillv)
An—(A,
Classdica, 8,C) Total Depth sed to
FT FT
Installer Date Installed:
REMARKS:
/¢ Scale:
0C�Nr''J f ' Inspections P e
ENGINEER'S SEAL
.y.� q •,
Date ///���
*4
•��oOLfn x.57
{ G f7 TJ(vew
P.lo
s �
S & S ENGINEERING
• •� •..�„ , s�•, r C' ��,
_32034 E$���pp,gpgp5 RQQd N c ily that this/ins�pe tion was performed according to all
�, * ,•
Municipal a11�tiCdt IIfif�s I t s date:
�S': + �,
,,yie l,; t•,',: ,°
Date: L�
�f' ?' ' "= ��
�-
Health Department Approval:
x ati �
-013 (3/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name / DISTANCES
Address FROM TO SEPTIC ABSORPTION WELL
���� o TANK FIELD
_ _ �Glee� n 120-5 �iiE'_ ^
Phfe(s) / Permit N No. of Bedrooms WELL
l� T3 SC !4 3 LOT LINE /0 '4- !(� l7� zo
LEGAL DESCRIPTION
LolocG su'24 S l/
FOUNDATION iS /�- J" r¢- `00
Township, Range, Section
7 `� AS-BUILT DIAGRAM (Show location of well, septic system, property lines, foundation,
f0 dnveway, water bodies, eta)
TANKS a TW �{
xl SEPTIC ❑ HOLDING 8
Manufacturer Capacity in gallons
g_&r7-�c lZ)Od G-,J L
Material i No. of Compartments
-- G p S S � .► 33
TYPE OF SYSTEM N,
TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from Total depth from original grade
original grade / / /
2 FT ///—
er S_ 4141— FT
Fill added above original grade Gravel depth beneath pipe
4±,5- FT _ _ S /* FT
Grav_el length �/ Gravel width r
_ S3 FT _30 �' FT
Total absorption area Distance between lin Co
15,510 SQ FT �% %4 FT // �c �
Number of lines Soil rating Pipe material Is H'% 6
K K SQ FT v C
Installer Date Installed
176
WELLS
PRIVATE MUNICIPALI® (4}T,h{S�Ij tfv) 1161
ClassrfZtion (A,B.C) o $I e t Cased to
ENVIR N EN AL PRO FT TION FT/
-- -- - /o o G . D
Installer [�'a4 l�tallec¢ � ��
�! LL 0 Gt LAJ 10 15-4.S
REMARKS:RECFIVFD
/ / /tJ C l A' E
Ao F L c
Tff
IA-) PD rfl/NE'_/9 E T
v Scale: Erl+t`sb L
S .l8 Performed by. (�, OF � t�'
� / G A I2Q F Or
COS ' Date: p �±,� 1 •• •• �'
-,,* ,•.
_047/9 8
/i. to Z.
0447sia•
S & S ENGINEERING •s• a•�•w..e,e• •+�' ••
certily spe performed a Ing to all• A. �y� .�
y O' I!iw 14217 • +•,
Municipal ft&j 11N86&jlAkfAkjdate: J�ti•• �',� •
Health Department Approval: Date:P776 7
72-013 (3/85) 7 _ u NG I•
MUNlClPALITY OF AN[HORAGE
Department of Health & Human Services
825 L Street, Anchoraqe, Alaska 99501 343
DN -SITE �EWER PERMIT
Pe/`mit Number: 880185 Upgrade
Date Issued: 09/09/88 Enqineer Designed
Owner Name: LEE ZIMMER
Ownep Address: 12300 MOUNTAIN ASH DR.
EAGLE RIVER, AK 99577
Day Phone:
694-4345
Parcel Id: 050-321-13
Loi Legalx Gub ivision:
�JROADVIEW 'Lotu
2A Blo�k: 2
Section: 6
"Iownship: 14N
Range: 1W
Lot Size 3 A (sq.ft.
or acres)
�ox 0^drooms: This Permit:
3 Total
Capacity: 3
SE7|1� TANKx Minimum total
septic tank
capacity: 1,000 Each septic
�ank �ust have at least 2 compaptments.
Depth to top o� septic
�eeL requires insulation over
tank(s>.
lNSTALL PER ENGINEERS ATTACHED
DESIGN.
VAR%FY EXISTING SEPTIC
TANKS INTEG
ISSUED
FOR A SINGLE FAMILY
RESIDENCE ONLY AND
1/8B.
l CERTIFY THAT:
1. l am [ami1iar with Lhe requirements <or on-site sewers and wells as set
forth by the Municipality o{ Anchorage (MOA) and the State of Alaska.
2. Iwill install the system in accordance with all 11 C) codes and regulations,
and in compliance with Lhe design criteria o[ this permit.
�. I will adhere to all MOA and StaLe of Alaska requipements {or the set back
distances rom any existing well, wastewater disposal system
orf public
sewerage sys�em on this or any adjacent or nearby lot.
�. J understand 1..hat this permit is valid for a maximum bedrooms. I
a1so u d th t th it f th t t l system is 3 bedrooms and
a/.y enTar�v .
Sign+d, � �-=� =� "~ ' J .....
---
(Ownep> LEE ZlMMER «
Is�ued By: DATE:
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MP 011AL)
e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650 `" ._._ • a
SOILS LOG — PERCOLATION TEST Ma, 1467-6
PERFORMED FOR: Zee 11p?IIe.11— DATE PERFORMED:
LEGAL DESCRIPTION: Z24 %3 2 9x0'1 ()VjL=jX)TOWnship, Range, Section: /441'-j •
QF�PT-W SLOPE SIT PLAN
10 WAS GROUND WATER
ENCOUNTERED? eS
11 S
IF YES, AT WHAT Q L
DEPTH? o O
12 P
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13 Depth to Water After O ��
Monitoring? O Date:
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10 WAS GROUND WATER
ENCOUNTERED? eS
11 S
IF YES, AT WHAT Q L
DEPTH? o O
12 P
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13 Depth to Water After O ��
Monitoring? O Date:
14-
15-
16-
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Time
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20 Q
PERCOLATION RATE ✓ 0 (minutes/inch) PERC HOLE DIAMETER
/
TEST RUN BETWEEN FT AND 2 s2- FT
COMMENTS
PERFORMED BY: 17034 Eagle River Loop Road NO. 2 01
Eagle River, Xlas a 99,277 THAT TH)S TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE IN CT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
M U N I ::: I F=* Fl t- I -r *-e t_-, F= F4 N 1:� " C, F_* n 13 EE
DEPARTMENT C" HEALTH AND ENVIRONMENTAL ":'OTECTION
825 '1 STREET, ANCHORAGE., HK. 95 1
264-4720
PERMIT NO. ( 800540 )
APPLICANT JERRY GOTTBEHUET BX 42 CHUGIHK 694-3587
LOCATION CHUGIAK
LEGAL LOT SIZE 54560 SQUARE FEET
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND
TO H COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
��F;'-'M I -r �X F=" I FQ.* F=!F- EP, ���M E�. E: F;.�.,
I CERTIFY THAT
1: I HM 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 THE CODES.
,
SIGNED: - ----- - ---__-------
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RECEIVED
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
Parcell.D. 0,50-391-13 HAA# /iC5ng1--
r Expiration Date: - eZ. S O S
1. GENERAL INFORMATION
Complete legeltlAsdiptioif•�:'7Lots2,P;,Block 2; Broadview Subdivision
Location (sit�a4rb's's o;directlons)"';12300 Mountain Ash Dr.
Current Proparty$wjer(s) `' 'June's akepi Day phone 333-2428
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Retty Rnran f nynnmir Day phone -A51-7-A-An
Mailing Address 3111 'C' St. #1100 Anchorage, AK 995037
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
ll
Individual On-site
�yJ
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
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.
Name of Firm S & S Engineering Phone 694-2979
Address 17034 N Eggle River Lon p SrP ?04 FA01P River, AK 99577
Engineer's Printed Name Date
5. DSD SIGNATURE
Approved for 3_ bedrooms.
in K. WJhams
CE -9867
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory
Well Flow Advisory
Supplemental Engineer's Report
Other
By: �d Original Certificate Date: R ;2-.6'— 05-
.. (Fte,
2-6'-0.5-
(Rev. 01102)
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
Legal Description: LOT A% rJLeVA 2 ' Z"bV ILt 3 410 Parcel ID: D.Z;'o - 3a, I - /3
A. WELL DATA
Well type 2 tVKTr- If A. B. or C provide PWSID # =
Date completed _112p lgp
Total depth �?(i ft.
Sanitary sealQ�J)rj
t
Cased to $ �a �
ft. n JTh
FROM WELL OG
Date of test C1 I 2q
Static water level 235r ft.
Well production N• C) g.p.m.
WATER SAMPLE RESULTS:
Well Log(6N) "I Kg
Wires properly protected 9 1)�_a
atwaZasing height (above ground) 19 '%+ in.
Coliform colonies/100 ml. Nitrate 2.2:7 mg./l.
Arsenic: — mg./I. Date of sample: F411W&>
B. SEPTIC/HOLDING TANK DATA
C.
TankType/Material s me /e>7- (_
AT INSPECTION
L1316
3' q g.p.m.
Other bacteria _J_ colonies/100 ml.
Collected by: �4 J �x^[.tKdLrL`t?l�l'Jp�
Date installed «iL
Tank size tVW gal. Number of Compartments Z Cleanouts4FA) qrm
Foundation cleanout&N) —AKS, Depression over tank (Y11t) �X High water alarm (Y(D) w -%D
Date of pumping d'S Pumper fow" X1 'T � Rtk-,
ABSORPTION FIELD DATA
Date installed 1,411,63
Length 5 ft.
Total depth 2- ft. Eff. absorption area I29b fe Monitoring tube
Date of adequacy lest 3 O 5 Result ( ss/ ail)
Soil rating (g.p.d. or ft /bdr 2ib`4
Width 24' ft.
YC System type 79r -b
r
Gravel below pipe �• 5 ft.
Fluid depth in absorption field before test in.
Elapsed Time: Q min. Final fluid depth � in.
Depression over field 1.10
For �a bedrooms
Water added gal. New depth -11 in.
Absorption rate >= - y56 t' g.p.d.
Any rejuvenation treatment (past 12 mo.) (YA(b type) f__5 C) If yes, give date
D. LIFT STATION
Date installed
'Pump on" level at _in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off level at
tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot %m • �
Absorption field on lot 1 C710 f 4-
Manho6/Access (YIN)
level at in.
Meets alarm & circuit requirements?
On adjacent lots f Gb
t
On adjacent lots (d0 -�
Public sewer main )DR Public sewer manhole/cleanout
I
Sewer /septic service line '- Holding tank to 1k,
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
1 r
Building foundation S �' Property line -LV-4-Absorption field 1U -�
Water main N Yl Water service line 1+ Surface water t t+
Wells on adjacent lots 1004- '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
I '
Property line (0 r +- Building foundation I d 'f' Water main u1k
t 1 1
Water Service line 1 U 4- Surface water ICD& 't Driveway, parking/vehicle storage 1D
1
Curtain drain tixit U Wells on adjacent lots Lod 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 HAA guidelines in effect on this date. g
Engineer's Printed Name / /r d 111ltfl rlat S
*-49
Coffin K. Wlhacu
CE•93F7 •`
E�
Date
r
HAA Fee $ Waiver Fee $
Date of Payment �� Date of Payment
Receipt Number'ILI iJ Receipt Number
(Rev. 12101)
65T OF A ��000
eU!'49T—H '�d
........................... "4 SHANE A. MOLT:
�A LB -6914 ' jG
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30' X 7e' NEL, EBUT. Wes
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THE WFORMATION HEREON 18 FOR THE USE OF LENONO INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN
EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING AOOITKINAI
STRUCTURES OR FENCEUNE5
EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON.
NOTE ANY FENCEUNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY UNE
OR LOCATE STRUCTURES
ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CDNOTIONS.
o'0���
92!1
0
2 (`
,1T2
XX
�h
N
AS -BUILT SURVEY
SCALE: V- 40'
I HEREBY CERTIFY THAT 1 HAVE PERFORMED A
MORTGAGEE'S INSPECTION OF THE FOLLOWING
DESCRIBED PROPERTY.
LOT 2A. BLOCK 2. BROADVIEW SUB.
ANCHORAGE RECORDING DISTRICT. ALASKA AND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND THAT NO VISIBLE
ENCROACHMENTS EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE. ALASKA THIS _23RD
DAYOF JUNE 2005
HOLT LAND SURVEYING 8793. FB 1143.6
TEL. 315-5513
\�e
NOTE:
THE ORIGINAL PLAT FOR BROADVIEW BUB.
\
SHOWS A 1 O' UTILITY EASEMENT ON THE
WEST BIDE OF THE ORIGINAL LOT II.
PLAT 80-1911 CONTAINING LOT IIA), DOES NOT
\
SHOW SA10 EASEMENT. THERE ARE EXISTING
ELECTRICAL AND TELECOMM. FACILITIES NEAR
THE WEST LINE OF SAID LOT IIA.
THE WFORMATION HEREON 18 FOR THE USE OF LENONO INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN
EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING AOOITKINAI
STRUCTURES OR FENCEUNE5
EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON.
NOTE ANY FENCEUNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY UNE
OR LOCATE STRUCTURES
ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CDNOTIONS.
o'0���
92!1
0
2 (`
,1T2
XX
�h
N
AS -BUILT SURVEY
SCALE: V- 40'
I HEREBY CERTIFY THAT 1 HAVE PERFORMED A
MORTGAGEE'S INSPECTION OF THE FOLLOWING
DESCRIBED PROPERTY.
LOT 2A. BLOCK 2. BROADVIEW SUB.
ANCHORAGE RECORDING DISTRICT. ALASKA AND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND THAT NO VISIBLE
ENCROACHMENTS EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE. ALASKA THIS _23RD
DAYOF JUNE 2005
HOLT LAND SURVEYING 8793. FB 1143.6
TEL. 315-5513
OB -19-05 09:06AM FROM -CUE ESI, SCS ENV SERVICES
9075615301 T-752 P.02/03 F-774
SOS Fttf q
1055154001
All Datraffimes are Alaska Standard Time
Client Name
S & S Engineering
Printed Date/rima
08/18/1005 20:36
Project NameM
Lot 2A. B2. Broadview
Collected Date/time
08/122005 15:30
Client Sample (D
Lot 2A. B2, Broadview
Received Date/time
08/122005 16:33
Matrix
Drinking Water
Technical Director
Stephen C. Me
Sample Ftemarka:
Allowable Pmp Analysis
Paranetn Results PQL Units Mcd1od Comainer ID Limits Date Dace Init
Nitrate -N 2.26 0.100 mg/L EPA 353.2 B (v10) 08/12/05 AZS
Microbiology Laboratory
Total Coliform 4 OB. No Coli coV100mL SM20 9222B A (til) 08/12/05 TLP
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 3Q b HAA # �92L (
1. GENERAL INFORMATION
Complete legal description
Lot 2A; Btock 2; Broadview Subdivision
Location (site address or directions)
12300 Uppers SkyZi.ne Dfti,ve
Property owner Rick weesh Day phone 696-1199
12300 Mountain Ash Dir i.ve Eagte Riven, Ak. 99577
Mailing address
Lending agency Stewart Tito Company Day phone
Mailing address
Agent Roto Milton HERITAGE REAL ESTATE Day phone 694-4994
Issbu Eagze KLveA Road
Address Ea .fie. Raven Ata6 ka 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3 \,�
3. TYPE OF WATER SUPPLY:
Individual well XX
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 XX
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
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm s g 5 EjgGINEERING Phone
Address 17:334 Eagle River Loop Road No. 204
_lkinska 9957-7
Engineer's signature
6. DHHS SIGNATURE
'\ Approved for 7`4�C'Er--3 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
0
Date
bedrooms, with the following stipulations:
Date /0 - A —
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 k21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: --( 2) Z F'*-°P't>'lle�-1siparcel I.D. 0 50 32- / / 3
A. WELL DATA
Well type FIzt� PeD&
yp If A, B, or C, attach ADEC letter. ADEC water system number
Log present Y)N) J Date completed Driller TPI
Total depth 2` C.0 Cased to 5V t.STO Casing height I Z 4,
Sanitary seal ON)
Wires properly protected &N)
rn
FROM WELL LOG
AT INSPECTION
z
Date of test q ' Zq `�' dy
co
'��
z n
m
F
Static water level
m
Well flow
W
g.p.m. �D•a �gq co
rn0
< z
Pump level J�
�I c0
J�
rn n
v_
�t S�ie(&��-- �&.,�D „SLtS •T'OnG�+S• .� ��+�
p�•C..o.� sr, c.p�,. Pf•�k� � C7(�P'7-� a � ...1 �.tc,. v
0
roa.lnj'
SEPARATION DISTANCES FROM WELL TO:
z
Septic/holding tank on lot 1p0��
; On adjacent lots tUO 14-
+Absorption
Absorptionfield on lot hod
; On adjacent lots o o t+
�
Public sewer main
Public sewer manhole/cleanout
Sewer service line 25
Petroleum tank ZS
WATER SAMPLE RESULTS:
Coliform °J Nitrate
.1 µ� ��-• Other bacteria
Date of sample: -ZS -9 2. q 14.gZ
Collected by: S & S ENGINEERING
17034 Eagle River Loop Road No. 204
B. SEPTIC/HOLDING TANK DATA
Eagle River, Alaska 99,577
Date installed Tank size
k'° oD Compartmentsy
CleanoutsOyN) Foundation cleanout/N) Depression (YJA
High water alarm (Y& h� Alarm tested (Y/N)
Date of pumping
I 11-0 Cl -I--
Pumper T'?-, C-i;•SS Poo L
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I i7 a ' On adjacent lots look*
To property line 10 t Absorption field ) o t
Surface water/drainage
foo tt
Foundation +
Water main/service line 10 1
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes
Manufacturer
Manhole/Access (Y/N)
SEPARATI-ON-15-ISTANCE FROM LIFT STATION TO:
I on lot
D. ABSORPTION FIELD DATA
On adjacent lots
,_ ---"Pump off' level at
Cycles tested
Surface water _
Date installed 9 - Ilv , $ Soil rating 2 eq t3ty System type 10;
Length S�t Width Z4 1 Gravel thickness �� s � Total depth Z �
Total absorption area )'L9 L. 4 Cleanouts present &N)
Depression over field (YO 4 Date of adequacy test 1 -z4-9Z
Results 3s ail) for T�� L3� bedrooms
Peroxide treatment (past 12 months) (Y49) '40^1e_ KrJoyJ a If yes, give date 031A
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot lC>Q 1, On adjacent lots 1 oo %*--Property line 100 -
To building foundation To existing or abandoned system on lot 30%A -
On adjacent lots �� Cutbank '►,- Water main/service line l01
Surface water 100 Driveway, parking/vehicle storage area 0%+
Curtain drain �Ipr
E. ENGINEER'S CERTIFICATION
I certify that/ have checked, verified, or conformed to all MOA and HAA guide
S & S ENGINEERING
Signature L7034 Eagle River Loop Road No. 204
,-571a, I nmr, llaska.
Engineer's Name
Date
Gi-Z�►-92-
HAA Fee $ Z Zbq� Waiver Fee: $
Date of Payment `' 2�`Y �l z— Date of Payment
Receipt Number b�7 7 4;=> ` Receipt Number
72-026 (Rev. 3/91) Back MOA 21
9ction.
CHEMICAL & GEOLOGICAL LABORATORY
AMIL\., A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
'�•�nr 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
ANALYSIS RESULTS for INVOICE # 58406
Chemlab Ref.1 92.4984 Sample # 13 Matrix: WATER
Client Sample ID L2A B2 BROADVIEW S/D Client Name :S & S ENGINEERING
PWSID UA Client Acct :SNSENGP
Collected SEP 14 92 0 15:40 his. BPO# POt :NONE RECEIVED
Received SEP 15 92 ! 14:30 bra. Req#
Preserved with AS REQUIRED Ordered By :R. SHAFER
Analysis Completed SEP 16 92
Laboratory Supervis r STEPHEN C. EDE
Released By : C vi I
Send Reports to:
1)S & S ENGINEERING
2)
....................................................................................................................................
Parameter
Results Units
Method
Allowable Limits
------------------------------------------------------------------------------------------------------------------------------------
NITRATE-N
1.7 mg/1
EPA 353.2
10
Sample ROUTINE SAMPLE COLLECTED BY: RAY.
Remarks:
....................................................................................................................................
1 Tests Performed See Special Instructions Above UA -Unavailable
ND- None Detected " See Sample Remarks Above
NA- Not Analyzed LT -Less Than, GT -Greater Than
A040
ASGS Member of the SGS Group (Societd G4n6rale de Surveillance)
11034 Eagle River loop Road RODERT A. CHAFER
Ea01e River, Alaska 69511
CIVIL ENGINEER
** WELL FLOW TEST DATA SHEET ** 6942979
PROJECT: __FoLF- iI ► To�•� - a -Fk DATE OF TEST: 2 -
LOCATION
LOCATION OF WELL (legal Desor)ptlon):._r ZA
WELL DEPTH: 7-40, FT. CASING: `� ��. FT. SCFtEEN:-
DATE DRILLING COMPLETED: DRILLER. _ S \a k LL ► ,rkl/y S
STATIC WATER LEVELo ►
IY D of Casing): 9 Ft. DATE: _ �I - Z 4 - yZ
CLOCK
TIME
ELAPSED TIME SINCE
_ _
PUMPINGSTOPPED,
STOPPED, fdlN.
DEPTH TO
-WATEFI, FT.
DRAWDOWNI
RECOVERY
PUMPING
RATE, GPM
REMARKS
1'�
0
lswl)
0
FOLAI -
10
15
20
25
30
35
J 1L
.71L
A A yq h
40
45
50
55
1 l 1 2 l
v•,�'l
•, ►
60(1 hour)
90
12012 hours)
150
180 (3 hours)
210
t1►[.
JIt-
V yL
v��-
q-1 (� (�
3 o to r
�' -rA l; �y M P --
S�R�F-�M.. f�%PA,•��5
Ti�L�,S .J►T►1 Act c_oJ�,G �►c�
c F ?J1A
240 (4 hours)
J IL-
►S�
''tea (sIP
RECOVERY
t 0
5
0
10 .
15
20
25
30
35
Comments: �,�,� p��►� J i1✓ S 3 o ttP >a
now is not Guaranteed
Stibsequent Variations
Can Occur.
MUNICIPALITY OF ANCHORAGE
' Department of Health & Human Services i
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. #� " ��� - HAA # V_\, Lt��
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
1-04 611-r 2 !� r2o � �i E'�J S /L
Location (address or directions)
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
"/--) el -
low E 2 Telephone: (home) OP Business
Telephone
Address �---��l�t / e�N �',�- 1�WZ_2
Telephone d %- i42CO o
(e) Mail the HAA to the following address: (or check here if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
17034 Eagle River Loop Road No. 204
>gaala River, Alaska 99577
2. TYPE OF RESIDENCE
Single -Family Number of bedrooms
3. WATER SUPPLY
Individual Well Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
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suolloadsul }onpuoo jou op SHHa 10 saaAoldw3 -sluaweimbei ejuls pue Ieaapal ule;aao � Ashes o} iapio ul suopnipul
6ulpuai alayj pue sawoq to sieseyoand o; �(selinoo a se sly} saop SHHa 9141 Te SLRIV to ale}S 9141 ul p9a9lsl69a
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pue IedlolunV4 IIB qj!m eouelldwoo ul sl welsAs iesodslp aajemelsem ao/pue Alddns aa}em 9;!s-uo ay} 'uoljoadsul
pue uolje6l}sanul Aw woal pue salll 96eaoyouy jo AjlledlolunW ay} woa; paule}go uoljewiolul ay} uo paseq
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s14110 uolje6l}sanul AwIeyl /(ilaaA ,molaq unnoys alep uolIeplleA a14l;o se pue oIaaay paxl>.Je Ie9s Aw Aq pal}lja90 sy
NOIlVWaO:INI aNV V1Vo'HOaV3S 3'11d'S1S31'SN01103dSNl ONIMA08d Wdl-q ONIE133NIJN3 'S
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CH - FEBRUARY 1984
*CIPALITY OF D43-4744
ENVIRONMENTAL SERVICES DI 151 �L p
Legal Description: G 2
SES' 191988
A. WELL DATA ' � (�� V E D
Well Classification If A, B, C, D.E.C. Approve (Y N)
Well Log Presen ( N) Date Completed9 Z�l�d Yield
l
Total Depth Cased to Depth of Grouting C C o c
Static Water Level Z•�s Pump Set At u V
e.
Casing Height Above Ground Sanitary Seal on Casing(Y/ )
Electrical Wiring in Conduit ON) Depression Around Wellhead (Y N)
SEPARATION DISTANCES FROM WELL:
To Septic/H Tank on Lot "Do '� ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot �l%n �*� ; On Adjoining Lots ZOO r
To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole GLJ �
r
To Nearest Sewer Service Line on Lot
Water Sample Collected by S ° tS Date
Water Sample Test Results -re S F4 r7-:1cc y �o Q
Comments /`1 T "�r low
G/e/t/ Cers1N G "s G��.v�e��zc�
SEPTIC/HOLDING TANK DATA
Date Installed /9'76 Size VcO) No. of Compartments 2
Standpipe 6N) Air -tight Cap (Y/ ) Foundation Cleanout (Y:/ )
Depression over Tank (Ye t Date Last Pumped 1?12-,Ig S
Pumping/Maintenance Contact on File (Y/N) /`' ; for &
Holding Tank High -Water Alarm (Y/N) 4 Temporary Holding Tank Permit (Y/N1
SEPARATION DISTANCES FROM SEPTIC/ -TANK:
To Water -Supply Well �Q� � To Building Foundation
I
To Property Line `0 Ic To Disposal Field L3� W_
To Water Main/Service Line '�_2 '5- -/-
6— c
To
To Stream, Pond, Lake or Major Drainage Course
Comments %A ^J/-(-
" d til 4f-
eEFk C A 0 '�f
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Z �� Type of System Design e
Date Installed O// eg ui4l�r� Length of Field �4
�/
c l
Width of Field 2y Depth of Field Z
Square Feet of Absortion A ea
Depression over Field (YC
Results of Last Adequacy Test
22 l 6
Gravel Bed Thickness D - _�-
Statndpipes Prese t (Y N)
Date of Last Adequacy Test GJ
A(
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well `G To Property Line
c
To Building Foundation To Existing or Abandoned System on
Lot On Adjoining Lots `v o
To Water Main/Service Line 40 To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course /�,J O NJ a
To Driveway., Parking Area, or Vehicle Storage Area `ate
Comments __OL D 7',Q.casNc !-F Oc)v-1
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
M�ents
al Codes (Y/N)
C
Dimensions
Manhole/Access (Y/N)
"Pum " L-ev81
Vent (Y/N)
"'Check Permitted Bedroom Rating Against HAA Request"
Pumping Cycles during Adequacy Test.
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect
inspection:`': ,�•.�
Signed S & S ENGINEERING
17034 Eagle River Loop Ituad NO. 204
Company Eagle River, Alaska 99577
Date 8
MOA No. —�
Receipt No. O S ` ?-O(,P--2
to of this
Receipt No.`�`��gJ�
Date of Payment ` (�- Waiver Fee: $ —
Amount: $ Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
-o
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
FEDERAL TAX ID # 92.0040440
IABOFATO PIES
ANALYSIS REPORT BY SAMPLE for Work Order t 8979
Date Report Printed: SEP 6 88 @ 16:56
Client Sample ID:L2A, B2 BROADVIEW
PWSID :UA
Collected SEP 1 88 @ 12:00 his.
Received SEP 2 88 @ 14:40 his.
Preserved with :4 DEG. C
Analysis Completed :SEP 2 88
Laboratory Supervisor STEPHEN C. EDE
Released By : J G
Client Name S & S ENGINEERING
Client Acct SNSENGP
P.O.# NONE REC'D
Req #
Ordered By : R.P.
Send Reports to:
1)S & S ENGINEERING
2)
....................................................................................................................................
Special
Instruct:
Chemlab Ref @: 2473 Lab Smpl ID: 3
Parameter Tested
----------------------------------------------
NITRATE-N
Sample ROUTINE SAMPLE
Remarks: SAMPLE COLLECTED BY RP
Matrix: WATER
Result/Units
------------------------------
1.5 mg/i
Allowable
Method Limits
--------------------------------
EPA 353.2 10
..............................................................................................................
1 Tests Performed See Special Instructions Above UA -Unavailable
ND- None Detected "" See Sample Remarks Above
NA- Not Analyzed LT -Leas Than, GT -Greater Than
5. LEGAL DESCRIPTION
DATE RECEIVED
INSPECTION APPOINTMENTS
D 7— t% -
L
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTO
%.....
MUNICIPALITY OF ANCHORAGE
❑ MULTIPLE FAMILY
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTWH16WALITY OF ANCHORAGE
825 L Street - Anchorage, Alaska 99501
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
MAY 19 1981
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S I Ero S
C
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
8. SEWAGE DISPOSAL SYSTEM
PHONE
r _
17(PYEAR
® INDIVIDUAL/ON-SITE**
MAILING ADDRESS
❑ PUBLIC UTILITY
Po.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
PROPERTY RESIDENT (If different from above)
pyresRc�vab a CJ IVO e_&;-- .2 6C .2
PHONE
9
_
2. BUYER
PHONE
MAILING ADDRESS
15-56
3. LENDING INSTITUTION
PHONE �—
MAI LI GADDRESS
2
4. REALTOR/AGENT
PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
S/erAL 1) c,J
D 7— t% -
L
STREET LOCATION
8. TYPE OF RESIDENCE f
NUMBER OF,BEDROOMS
® SINGLE FAMILY
❑ One ❑ Four ❑ Other
❑ Two ❑ Five
❑ MULTIPLE FAMILY
;X Three ❑ Six
7. WATER SUPPLY
CK INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
r _
17(PYEAR
® INDIVIDUAL/ON-SITE**
2kON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
dam„"
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
❑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
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
fr, --r b c
BY
V �
72-010 (Rev. 6/79)
DAVID A. SLENKAMP
ROBERT A. SHAFER
MECHANICAL ENGINEER CIVIL ENGINEER
694-9055 694-2979
May 27, 1981 MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL p,.,OTECTION
MAY 2 9 1981
Jerry Gottbehuet RECEIVED
P.O. Box 3628
Anchorage, Alaska 99510
Dear Mr. Gottbehuet,
Reference: Lot 2A; Block 2; Broadview Subdivision
A sewer system adequacy test was performed on the system located
on the referenced property as you requested. The septic tank was
pumped and verified to have a capacity of 1000 gallons. The
absorption trench was tested by a continuous flow of water over
a period of 48 hours. The average flow for a 24 hour period was
542 gallons without any adverse effect on the system.
It can be concluded from this test that the waste water disposal
system constructed to serve the three bedroom residence located
on this property is currently functioning adequately. However this
system cannot be guaranteed against subsequent failures.
If we may be of further assistance, please do not hesitate to call.
Sincerely,
.r F
tt2 BERT A. SHA ;ER, P.E.
S/ss
J
cc: National Bank of Alaska
ATTENTION: Kathleen Claiborne
Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA