HomeMy WebLinkAboutBROADWATER HEIGHTS BLK 1 LT 1Broadwater
Heights
Block 1
Lot 1
#050-081-21
GAAB-HD-I GR TER ANCHORAGE AREA BOROV `i
OLI-ARTMENT OF ENVIRONMENTAL QUALI`,
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686_
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ZV �lCt/ �}►1 G� Yl_�__--
MAILING
ADDRESS. <!
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PHONE
LOCATION ' ' LG'`�' Lad
LEGAL DESCRIPTION G- �
�f� � A11_G?(tC'(1i'Yf
CFPTIC- TAKIV.
c i NUMBER OF
DISTANCE FROM WELL MATERIAL Q3, �' COMPARTMENTS
LIQUID CAPACITY l U620 GALLONS. INSIDE LENGTH �ef`llC G INSIDE&WI T Z DEEPTHD_(
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS__ OUTSIDE DIAMETER OR WIDTH � _, LENGTH DEPTH
LINING MATERIAL' t' J7 e_ V �� Y°! ��' !` DISTANCE FROM WELL ���C�V��f BUILDING FOUNDATION}
a -
NEAREST LOT LINE 2. -- TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) Z. � SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
FOU
ANCE BETWEEN LIN
SQ. FT. LENGTH OF EACH LINE
, NEAREST LOT LINE
ENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOT
DEPTH: TOP OF TILE TOFINISH GRADE , DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
� `
WELL: ,�4 el/e-6,- -'21L-/ -0 Z_ DISTANCE FROM WATER
TYPE DEPTH BUILDING FOUNDATION_-- SAMPLE NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE SEWER LINE , TANK SYSTEM_ CESSPOOL , SOURCES
DISTANCES:
L,
DATE �- `� / r. L— APPROVED
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G.A.A.B.
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NOTE THIS PF F -.s; ;=. s , 't V; LIO
s'f I`4S€ IT'C •ION! ;tit HC)LrR NOTICE REQUIRED. BACKFILLING OF ANY s!(EifrM VV!T"0 )T I^ 1t At- ey -THU.
€')l `�A'?TMVNT AUTt4QRITY WILL 131E SUBJECT TO PROSECUTION,
5Ecr'4,,F AV?I a SIzr.
UNI.MUN4 DISTANCES, REQUIREMENTS
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SEPTIC TANK .. 0__.ft_!__,�-___, SEEPAGE PIT
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;RAIN FIE' .D
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i`?C;N rN"IU AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP U
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ICJN 5 FE.ET INTO UNDISTURBED SOIL,
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6'
U!•"-. M F.TFF7 CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE, pr*
"FC:.CS WITH AIRTIGHT REMOVABLE CAPS- II nr r
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HEALTH AUTHORITY
LICENSED OLSIGNEIi P `
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THAT I.AM FAMILIAR `A'ITH iNi' REQUIREMENTS OF `.;if -r° -PF 1: AT,,
IS IN :iCCbt?f li^:NCC 4i'ETf-i 5.Af[7
Performed for 0,12 l� �t 5'c z r Date P+ rrforaac9—a
Lagal description -0 Lot / Alock,,,,,,4,,,— subdivision
s ion
This form reports soils log.
Depth Soil Characteristics
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Was Pmmd Tatar encountered S
r
If yrs, at what depth E
lkoposed lVatallatiasa
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Municipality of Anchorage�`��
Y`
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program '
4700 Bragaw Street
P.O. Box 196650
Anchorage. AK 99519-6650
www.muni.org/onshe
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. b5L> —cl i - 24 COSA># lycnj`�j
1. GENERAL INFORMATION Expiration Date: (o — 2,
Complete legal description BROADWATER HEIGHTS SUBDIVISION- LOT 1 BLOCK 1
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
12321 WEST SKYLINE DRrVE • EAGLE RNER AK 99577
BILL do
SUE
PUTNAM
Dayphone_(508) 360-1225
0
Individual On-site
0
12321
WEST
SKYLINE
DRIVE * EAGLE RNER AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
Day phone
Day phone
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
0
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 On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 . ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory lost
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
_Z— Approved for _�:? bedrooms.
Phone 337-6179
Date I' 4 --
..
J f y 0Aor.ness
p, E-7 53 ; dG
Ire ''�•tu?/��t''' 6°gid
Disapproved.
Conditional approval for bedrooms, with the flowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
IRr 11R %
ON-SITE
WASTEWATER
y--F'R66RAM-'
o
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
1 lV t� Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water b Wastewater Program
4700 Bragaw Street
P.O. Box 19WW
Anchorage. AK 99519.66W
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: BROADWATER HEIGHTS S/D• LOT 1 BLOCK 1 Parcel ID: 0_5_0 - O g i - a
A. WELL DATA 'CASED TO BEDROCK
Web" PRWM If A, B, or C provide PWSID# N/A
Well Log YES
Date completed 8/17/1972 Sanitary seal (Y/N) YES
Wires property Protected (Y/N) YES
Total depth 325 ft. Cased to ' 16 ft.
Casing height (above ground) 12+ In.
FROM WELL LOG
AT INSPECTION
N Date of test 8/17/1972
2/16/2006
�I Static water level 200 ft.
58 ft.
Well production 1 g_p.m.
�
0.36 g.p.m.
WATER SAMPLE RESULTS:
i
Coliform 0 colonies/100 ml. Nitrate 0.702 mgJL.
Other bacteria 2 colonies/100 mt.
41 Arsenic: <5.0 ug,/L, Date of sample: 2/16/2006 Collected by: GEG. Ltd.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material CONCRETE
Date installed 6/23/1972
Tank size 1000 gal. Number of Compartments 1
Cieanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
High water alarm (Y/N) N/A
Date of pumping 2/22/2006 Pumper
JR'S PUMPING
C. ABSORPTION FIELD DATA
i
Data installed 6/23/1972 Soil rating (g.p.d./ft'orlj!E�D 85
System type SEEPAGE PIT
Length 37 ft. Width 10 ft.
Gravel below pipe 3 ft.
Total depth 07 ft. Eff. absorption area 282 ft' Monitoringtube YES Depression over field NO
i' Date of adequacy test 2/17/2006 Results (Pass/Fail) PASS For 3 bedrooms
Fluid d In absorption field before test DRY
� rP � in. Water added 500 gat, New depth 43 in.
a
Elapsed Time: 1 B3 min. Final fluid depth DRY in.
Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE
KNOWN If yes, give date -
PRE-SOAKED WITH 1000 GALLONS OF WATER ON 2/16/2006.
SEEPAGE PIT PIPE EXTENDS 4.75 BELOW TOP OF CRIB.
D. LIFT STATION
Date installed
"Pump on" level at _in.
size
Size in gallons
High water alarm level at in.
Cydes tested
Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankllHt station on lot 50'+
On adjacent lots 100'+
*80'
Absorption field on lot
On adjacent lots 100'+
N/A
Public sewer manhole/deanout N/A
Public sewer main
Sewer /septic service line 25'+
Holding tank N/A
Animal containment areas 50'+
Manurelanimal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Properly line
5'+ Absorption field 5'+
Water main N/A Water service line
10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line
10'+ urface water 100'+ Driveway, parkingtvehicl storage 10'+
H►�aC kwr.w 3M 100'+
Curtain drain ells on adjacent lots
F. COMMENTS
■WR920050
G. ENGINEER'S CERTIFICATION
i certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in et7ed on this
date.
Engineers Printed Name JEFFREY A. GARNESS
f ray Gorness.:
C�jE-7$53
�e� •J�44 O�; �C
Date
COSA Fee S 43D UD
Date of Payment 3' j S I ot,
Receipt Number 3 LC 1 g 2 -
(n.v. 11105)
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 # 060081
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block 1, Lot 1 of Broadwater Heights
subdivision, the well's productivity was determined to be 0.36 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.
SCS ReLN
1060791001
Client Name
Gamess Engineering Group, Ltd.
Project Name/#
Broadwater Heights SD Lt 1 B I
Client Sample ID
Broadwater I Icights SD Lt I B 1
Matrix
Drinking Water
All DateVrimes are Alaska Standard Time
Printed Daternme
02232006 1521
Collected Date/Time
02/162006 9:10
Receired Datelrime
02/162006 9:10
Technical Director I
Stephen C. Ede
Sample Remarks:
9222B - Due to turbidity the sample was analyzed in two 50ml aliquots.
Paramner Results PQL Units meow Container
Prep Analysis
Container lD Limits Date Date Ind
Nitrate -N 0.702 0.100
mg/L EPA 353.2 B (<= 10) 02/16/06 JC
Metals by ICP/MS
Arsenic ND
5.00 uP/L EP200.8
Microbiology Laboratory
Total Coliform <2 OB. No Coli col/100mL Sh120 9222D
C (<=10) 0220/06 0222/06 SCL
A (<=I) 02/16/06 TLF
JRs Pumping
PO Box 773415
Eag a River, AK 99577 Number; 19262 Order Num 19262
(907) 694-6454, Date: 03 -Mar -2006 Serviced 23 -Feb -2006
P.O. Number: Manifest
Job Description: 1000g
Gamess Engineering Group
3701 E Tudor Road
Suite 101
Anchorage, AK 99507
Caleb
12321 West Skyline Drive
Eagle River, AK 99577.
antity ServlceType Amount x2 Me Tax'
Extension
1 Septic Service 15K $130.00 No No /
$130.00
RECEIVED
MAR 10 Na � F� ,�F^ Ll , Q�
Taxable Amount Tax Rate Tax Description Subtotal NonTaxed:
$ $130.00
0.00
Subtotal Taxable: $0.00
Subtotal Tax: $0.00
Payment Terms: Net 30 Less Payment: $0.00
Please Pay: $130.00
Last Sery Unknown
6/F Us - Tank still has 2/3rds solids
REC: Repump due to amount of solids
For your added convenience we accept; American Express, Dicover, visa and Master Card payments over the phone.
After 30 Days accounts will be turned over to collections. $25.00 For NSF Checks Returned.
From: Please detach here and return the bottom portion with your payment
Gamess Engineering Group
3701 E Tudor Road
Suite 101 Invoice No. Date Amount Due
Anchorage, AK 09507 19262 03 -Mar -2006 $130.00
To:
JRs Pumping
PO Box 773415
Eagle River, AK 99577
(907)694-6454,
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. # O SO — n 8 r - a I N HAA #
1. GENERAL INFORMATION
Complete legal description Lot 1; Block 1; Broadwater Heights
Location (site address or directions) 12321 W. Skyline Drive
Ea le River, AK
Property owner _ Nancv Magnuson Day phone 277-1923 (w)
Mailing address P.O. Box 770504 Eagle River, AK 99577
Lending agency
Mailing address.
Agent _
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3 ti
3. TYPE OF WATER SUPPLY:
Day phone
Day phone
Individual well XXX
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 XXX
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 MOAM21
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 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 & S ENGINEERING Phone 6 ct -1 - ;L `j l
17034 Eagle Kiver LOOP Koad No.
Address Eagle River, Alaska 99577
Engineer's signature
6. DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
Date
/ob6l 6?6
O
ROBERT C. COWAN `t
`C3,••, CE - 8503
bedrooms, with the following stipulations:
Additional Comments 7TI-Cl�FV ��g/_25� /"=L.4_ .4i- S ys
By: �`-� t' ~ Date
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-M (Rev. 1/91) Stack MOA #21
Municipality of Anchorage MUNICIPALITY Oc
• � E arvcr�o�,
DEPARTMENT OF HEALTH & HUMAN SERftftM NTAsERVlces DIVI
Environmental Services Division "r
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34 -41-94996
Health Authority Approval Checklist RECEIVED
Legal Description: 1-0 I L K 1 QRo-40'e rf 4 1+7--5 Parcel I.D.: (9 S 0 - 0 $ ( - X I
A. WELL DATA
Well type P R "V 4 7- If A, B, or C, attach ADEC letter. AD EC water system number
Log present (9N) Date completed F r / 1-7 / 7 ;t -"
Total An th 3 �1 a
f Cased to U, T ° 130C C h ht b d , #
V —
Sanitary seal Qy� 'N) Y" S
FROM WELL LOG
-7-1
Date of test
Static water level
Well production
9-00
WATER SAMPLE RESULTS:
Coliform b
Date of sample: /o i it 19
B. TIC HOLDING TANK DATA
Date installed 6 /,)- 3 7 : - Tank size
asing eig (a ove group )
Wires properly protected
AT INSPECTION
1b3`
3 5
g.p.m. O . g.p.m.
Nitrate 0.1 Other bacteria �
Collected by: S & S ENGINEERING
-17034 Eagle River LOOP KCad No. 204
Eagle River, Alaska 99577
J o a o Number of Compartments _ I Cleanouts &N) Y D S
Foundation cleanout (10N) YC5 Depression (Y/& No High water alarm (Y/(&) "0
Date of Pumping 10 h6 I q L Pumper Sh"I f Aa Y o u m/OfAS
C. ABSORPTION FIELD DATA
S hwrrc-j
Date installed 6 r/ 3 �' Soil rating (g.p.d./ft2 0 ftz/bdr System type A + r
Length 3-7 + Width 10( Av(-• Gravel thickness below pipe Total depth 6
Effective absorption area Monitoring Tube present &N) Depression over field (Ya
Date of adequacy test 10 Ib t q1 Results (Pass/Fail) PA- S s For 3 bedrooms
Fluid depth in absorption field before test (in.); a S Immediately afteri a3gal. water added (in.): 1
Fluid depth 3 g (ins) Minutes later: 33 Absorption rate = y S- 4) f g.p.d.
Peroxide treatment (past 12 months) (Y/N) NG.-vf, K^`° w#,� If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at"
SEPARATION DISTANCES FROM WELL ON LOT TO:
holding tank on lot 6 3
Absorption field on lot _V C 161R a a p030)
"Pump off" level at*
On adjacent lots 70o r -/-
On adjacent lots / 0o r 4 -
Public
Public sewer main 1�/ ��) Public sewer manhole/cleanout
r
Sewer /septic service line 30 f Lift station
SEPARATION DISTANCES FROMITPE C HOLDING TANK ON LOT TO:
Foundation Property line S 4- Absorption field
Water main/service line 3o Surface water/drainage / o u {f
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line /o } Building foundation �U t
Surface water
Curtain drain
/V t) V& K. Owta
F. ENGINEER'S CERTIFICATION
Water main/service line
Driveway, parking/vehicle storage area
r
—Wells on adjacent lots y c
1 certify that / have determined thru field inspections and review of Municipal records
in conformance with MO H guid h sin effect on this date.
10
Signature io
Engineer's Name �I 0,6 C cc
• t oc✓j9�
r)
Date /0 //6
`% 6
HAA Fee $ . r;,0. r d Waiver Fee $
Date of Payment ZT�� < ,� Date of Payment
Receipt Number,.?:,2 �// Receipt Number
72-026 (Rev. 3/96)*
r;.
/¢
too r+
r
'30
-�
ao '4
OF
ROBERT C. COWAN t
CE_ 8801
,•�4.
v
MUNICIPALITY OF ANCHORAGE
M E M O R A N D U M
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL NO.114
During a recent Health Authority Approval on-site inspection
and test of the potable water supply well on Lot _/I
Block _� of AWw4rUL 1414.ge S Subdivision, the well's
productivity was determined to be 0.15 gallons per minute.
The minimum well productivity required by this Department
(AMC 15.55) for a _yg bedroom residence is Q,.�/ 2 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.
fir
S&S1
arneeRrnG
ROBERT C. COWAN, P.E.
ROBERT A. SHAFER, P.E.
-------------
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
WELL FLOW TEST DATA
DATE: d / q �
c,wl
CLIENT: N � ^` �i 4 IVuSC1%�
�Fd wA rq•� N � S
HEALTH AUTHORITY
LEGAL DESCRIPTION: �-� /3 L l<
,G'Ra
J Gj
APPROVALS"
CASING DEPTH:
WELL DEPTH: -3 "X �.� n nwA/tn
* DRILLER: A
DATE DRILLING COMPLETED: K I -7 11."
SEWER &WATER
1 r
SANITARY SEAL: I"
MAIN EXTENSIONS
MISS_ CASING HEIGHT:
`l� S
GRADING O.K.: Y
WIRES IN CONDUIT:
/ 1� /�
COLLECTED (date):�T
BACTERIA AND NITRATE SAMPLES
SEWER&WATER
INSPECTION
TEST DATA:
METER PUMPING
DEPTH TO
CLOCK READING RATE
WATER
(FT)
TIME (GAL) (GPM)
swl
ENGINEERING STUDIES
ANDREPORTS
r
/
jS �C
3 L 0 SS '4
M ✓,'� OFF �--
WELLINSPECTION
_
7
�' J
& FLOW TEST
1 1l U.
�' %,,,N ,-
S
7
SITE PLANS
h ; O
J is ��
--
0 / ,,,N
y'
3 •3 3
ROAD DESIGN
cl
,t L l Io :� S S I S' �T•
J
SOIL TEST
PERCOLATION
TEST
WELL CURRENTLY PRODUCES
�� GPM WITH A 7� _DRAWDOWN
RESULTS:
STRUCTURAL&
Co
TESTED BY:
MECHANICAL
VARIATIONS CAN OCCUR.
INSPECTIONS
RATE NOT GUARANTEED --SUBSEQUENT
FLOW
ONSITE
WASTEWATER
DISPOSAL SYST EM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
CT&E Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
Parameter
Nitrate -N
Total Coliform
CT&E Environmental Services Inc.
Laboratory Division
Laboratory Analysis Report
965548001
S & S Engineering
L1 B1 Broadwater Heights
L1 B1 Broadwater Heights
Drinking Water
0
Client PO#
Printed Date/Time 10/21/96 12:30
Collected Date/Time 10/11/96 14:35
Received Date/Time 10/11/96 17:35
Technical Director: Stephen C. Ede
Released By
C fk�
Allowable Prep Analysis
Results PQL Units Method Limits Date Date Init
0.100 U 0.100 mg/L SM18 4500-NO3F 10 max 10/17/96 EMB
0 0 col/100mL SM18 92228 10/12/96 TMW
200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561-5301
3180 Peger Road, Fairbanks, AK 99709-5471 — Tel: (907) 474-8656 Fax: (907) 474-9685
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
wMUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES M} i
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. # �� - C%Y i - q 1 - HAA # 0 Q °i
1. GENERAL INFORMATION
Complete legal description Broadwater Heights, Block 1, Lot 1
Location (site address or directions) 12321 W. Skyline Drive
Property owner Don Cameron Day phone 694-9435
Mailing address Same
Lending agency
Mailing address
Agent Ray Heberer/RE/MAX
Address
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
Day phone
Day phone 694-4200
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 921
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 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
Phone
S & S ENGINEERING
Address 17034 Eagle River Loop Road No. 2W
Eagle River, Alaska 99577 Iq in
Engineer's signature
6. DHHS SIGNATURE
M
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date - I - Z
bedrooms, with the following stipulations:
1l1TIr
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 #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Parcel I.D.
A. WELL DATA
Well type 'r"1 441 If A, B, or C, attach ADEC letter. ADEC water system number
Log present 0�1\I)1x_ `I Date completed 8- 0'72 Driller"' -A.4 L Q'lL�irl 1-4
Total depth �4 Cased to I ' 'f- 'b6937-264-- Casing height ,_Z ry-4--
Sanitary seal (D/N)
Date of test
Static water level
Well flow
Pump level
Wires properly protectedX?YN)
FROM WELL LOG
moo r
9.p -m.
AT INSPECTION MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
1 1992
�- 3 2•�
�EIVED
SEPARATION DISTANCES FROM WELL TO: � �,ff;f,'
Septic/holding tank on lot �D� Wim' ; On adjacent lots I�
Absorption field on lot ; On adjacent lots Jr -
Public sewer main # Public sewer manhole/cleanout
1
Sewer service line `.— Petroleum tank t,�D Y� �W.--►
WATER SAMPLE RESULTS:
Coliform
Nitrate Other bacteria
Date of sample: 8� ��'`�Z Collected by: S 46V
B. SEPTIC/HOLDING TANK DATA
Date installed �'' 1 Z' Tank size t Compartments
Cleanouts&115N) Foundation cleanout MN) Depression (Y/Sp
High water alarm (Y/N) Alarm tested (Y/N)
Date of pumping Pumper 1�`s t--��
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
� � 1
Well(s) on lot( On adjacent lots Foundation
To property line 0X Absorption field Water main/service line 1 �
zit S �' �P
Surface water/drainage � A cM
-ptT2:,14 -�-y
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 (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" level at
Cycles tested
Surface water _
Date installed 407'Z- Soil rating ox!�i/�
Length Width LL2' _ Gravelthickness
2 82. -0'
System type -err
Total depth
Total absorption area Cleanouts present (Y/N)
Depression over field (Y/5P tj Date of adequacy test
Resultsfail) for
Peroxide treatment (past 12 months) (Y/fid 7 1-�r� h�->..�� If yes, give date
SEPARATION DISTANCE FR'QM ABSORPTION FIELD TO:
Well on lot 8a 4 V-60 7c n adjacent lots r� -� Property line I
To building foundation �%� To existing or abandoned system on lot
On adjacent lots �� Cutbank Water main/service line
Surface water '125 r,,b<E. Driveway, parking/vehicle storage area
WA -rt-"5 TIME ,
Curtain drain �►�+�w-a�-1
E. ENGINEER'S CERTIFICATION
bedrooms
1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
S & S ENGINEERING
Signature 17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577
Engineer's Name
Date — 1-1 Z—
'
HAA Fee $1170.
Date of Payment -` 11 1q2_
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Date of Payment�---
Receipt Number
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL NO. I-�A t �L 515-5
During a recent Health Authority Approval on-site inspection and
tes of the pota le water supply well on Lot �_ Block
of \A/A � ''t Subdivision, the well's productivity
was determined to be <2• 36 gallons per minute. The minimum well
productivity required by this department (AMC 15.55) for
a 9 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
noncritical water uses such as washing cars and watering lawns
and gardens may be required.
This advisory must be attached to all copies o the subject
Health Authority Approval.
/A C
f91;;2 _
Municipality of Anchorage,
Department of Health and Human Services h5
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
September 10, 1992
Roger Shafer, P. E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 1 Block 1 Broadwater Heights S/D
Waiver Request #WR920050, PID #050-081-21, HA920555
Dear Mr. Shafer:
Your request for waiver(s) of the required 100 foot horizontal
separation of a septic system to a private well has been approved.
The appzdved separation distance(s) are: private well to the
seepage pit of 80 feet.
This waiver approval applies to the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
Sincerely,
Robert W. Robinson
Civil Engineer
On-site Services
ljm:#6
Concur:
7 (J �
J'Jh Smi , P.E.
ram,' anager
On-site Services
r.
WR# WR920050
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
PIN 050-081-21 HA#ha920555 Permit #
Date Received: Sept 1, 1992
Legal Description: Lot 1 Block 1 Broadwater Heights Subdivision
Engineer: Roger Shafer, P. E., S & S Engineering
17034 Eagle River Loop Road, Suite 204 Eagle River 99577
Applicant: Don Cameron
Waiver Requested: Private well to the seepage pit - 80 feet
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability /
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Points:
0
r•71
Waiver is Granted: Waiver is NOT Granted:
List Conditions or Reasons for above:
Rec #: 24004/3748
Amount: $ 590.00
Date Paid: Sept 1, 1992
i
��l -7 /✓Acs, / 1C`./� _
Q�L o? a/��� J °
T
X1-13--
ROBERT SHAFER, P.E.
ROGER SHAFER. P.E.
CIVIL ENGINEERS
A A � �; Septembe4 1, 1992 (907) 694-2979
FAX 694-1211
FACf RIVER. PS�P
MUNICIPALITY OF ANCHORAGE
HEALTH AUTHORITY
py� nco4ag ENVIRONMENTAL SERVICES DIVISION
c
APPROVALS p Munic ati a Ahe
DEPARTMENT OF HEALTH AND HUMAN SERVICES SEP G j D92
825 L St4eet
P.U. Box 196650 j�
SEWER &WATER Ancho4age, Ata6ka 99519-6650 RECEIVED
MAIN EXTENSIONS
S.ince4ety,
STRUCTURAL&
MECHANICAL
INSPECTIONS
ROGER J. SHAFF , P. F.
RTS/gm
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
REFERENCE: Lot 1; B.?ock 1; B4aadwatea Heights Subdivision;
12321 west Skyt i.ne Dn i.ve
SEWER & WATER
INSPECTION
Request you issue the attached Heatth Autha4.ity Appaavat and gunt a
wa.ive4 ban the haaizontat sepa4ation distance between the pni.vate weft
and seepage pit tocated on the 4e6eaenced p4opeaty at app4ox.cmatety 80
bt•.
ENGINEERING STUDIES
AND REPORTS
The aseptic system 4e4ving this p4ope4ty was .inztatted on Tune 23, 1972.
The wete was dtiUed .in August, 1972. At that time the %equti4ed
sepa4ation distance between a weft and a aseptic tank was 50 bt.
Howeve,%, the %equ.iaed distance between a weU and seepage pit was 100
WELL INSPECTION
b't•
& FLOW TEST
The weU and aseptic systems we4e tested on Feb4uaty 11, 1992 and bound
to be bunctioning adequately boa a Heatth Autho,%ity Appaavat.
SITE PLANS
Fa4 the bottow.ing 4easons we beet the wa.ivea may be g4anted:
1. The weft is con6.ide4abty deep with a static wate4 Levet ob 209
bt•.
ROAD DESIGN
2. This enti.4e mountainside is unde4taid with bedeck. The
bedaock undoubtedly 6ottow4 the topog4aphy. The topogaaphy is
such that att 6ubsu46ace d4a,inage baam the seepage pit woutd
be di4ected away boom the wet,.
SOIL TEST
3. A4te4 20 yea4s ab opeaation the n.it4ate tevets .in the weft ane
undetectabte. This shows the weU .is Stitt unabbected by
.septic ebbtuent.
PERCOLATION
TEST
16 you have any questions a4 aequ.i4e add.itionat .inba4mation ban you4
4ev,iew, ptease contact ups.
S.ince4ety,
STRUCTURAL&
MECHANICAL
INSPECTIONS
ROGER J. SHAFF , P. F.
RTS/gm
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
D
m
c P, = 50'
ro - ------ SCALE
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e
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
ANALYSIS RESULTS for INVOICE # 57045
Chemlab Ref.# 92.4196 Sample # 5 Matrix: WATER
Client Sample ID Li B1 BROADWATER HTS. Client Name :S & 3 ENGINEERING
PWSID UA Client Acct :SNSENGP
Collected AUG 13 92 4 13:00 hrs. BP04 POi :NONE RECEIVED
Received AUG 14 92 4 14:00 hrs. Req#
Preserved with AS REQUIRED Ordered By :R. SHAFER
Analysis Completed AUG 17 92 Send Reports to:
Laboratory Supervisor STEPHEN C. EDE 1)S & S ENGINEERING
Released By 2)
4
.................................................................................................:ti................................
Parameter Results Units Method Allowable Limits
------------------------------------------------------------------------------------------------------------------------------------
NITRATE-N ND(0.10) 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
1.®.011SGS Member of the SGS Group (Soci6t4 Gdnorale de Surveillance)
TPS 2 - \ 1 - ci 2--
t-2-"
—
Flow is not Guaranteed
Subsequent Variations
Can Occur.
tz',
L..7
—
1
--1 Of,
!.e pwv JS -
l 2 . ? c�A•r. _
2
e A -L, A( • Lo 4A -L-
43 Hij�
2-2
L P �1
S & S ENGINEERING
-
17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577
Flow is not Guaranteed
Subsequent Variations
Can Occur.
Manch 18, 1992
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
Dan Camenan
12321 west Skyeine Dt.ive
Eagte Riven, Ataska 99577
SEWER &WATER
REFERENCE: Lot 1; • Btock 1; • Broadwater Heights Subdivision;
MAIN EXTENSIONS
Dean Mn. Cameton,
At you& request a 6tow test was per6otmed on the wet setving the
SEWER&WATER
negenenced property on Febtuany 11, 1992. The static water .levet was
INSPECTION
measured .in the wet at 209 6t. beeow the top as the easing. A meter
was connected to the water system and the 6tow turned on butt. Ajtet
appnoximateey 50 minutes the wate7 .levee was drawn down to the pump
(appnoximatety 342' ) . At that time the pump was shut obb and the waxen
ENGINEERING STUDIES
AND REPORTS
tevee in the wept Was attowed to neeoven bat appnox-cmateey 20 minutes.
The pump waa then .turned back on. The waxen tevee was drawn down to
the pump again white the quantity ob water was metered. This type ob
neeoveny test was repeated 4 times at dibberent time .intenvat.6 with
consistant nesutts. From this test we have conctuded the we.?te to
WELL INSPECTION
& FLOW TEST
produce appnoximate.ey 23 ga tons pet hours. This 6tow nate is not
guaranteed to nema.in constant, subsequent vatiations can occurs.
Duking the 6tow test an adequacy test was perbonmed on the septic
system serving the property. water was added to the system white waters
SITE PLANS
.levet measurements were taken bnom the seepage pit. From the data
cottec ted we have detenm.ined the system to be bunctioning adequately
bon a 3 bedroom house. However, the system .is not guaranteed against
subsequent baitune.
ROAD DESIGN
Dun.ing out site visit we observed the seepage pit to be toeated
appnoximatety 55 it. btom a drainage ditch punning along the south
ptopenty tine. This distance .is less than the 100 bt. separation
SOIL TEST
tequtined by todays' standards. However, we have consulted with Dan
Bo-Ptles ob the Mun.ie i.pat Hearth Department on this matters. Mn. Bones
has .inbotmed us that since the sepatati.on distance %equ.ited between a
septic teaehb.ield and a drainage ditch when the septic system was
PERCOLATION
.instatted (June, 1972) was only 50 bt., the existing sepanati.on
TEST
distance ob 55 bt. is "gnandbathe ed." Thenebone, a Health Ce4ti6 icate
can be obtained at this time.
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
Page Two
Lot 1; Btoch 1; Bnoadwaten He.ighta Subdivi6ion;
Manch 18, 1992
Ti you have any questi.ona on .ig we may be o6 Sunthen 6env.ice, pteaae contact
U'6.
S.incen22y,
1
ROGER J. SHAFER, P.E.
RJS/gm
i4 AfiCROAAGE q Cq �•
P 6
U
GREATER ANCHORAGE AREA BOR a�
OUGH
Department of Environmental Quality
�GgnPE01A OO 3330 "C" Street, Anchorage, Alaska. 99503 274-4561
Date Received May 14, 1976
,l
PERCOLATION TEST Time of Inspection 1:3 p.m.
, ,��t, -
Date of Inspection 5-1 `76
x
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
115 FOR
1. Approval requested by:
Mailing Address:
2. Property Owner: Albright - Skyway Realty
Phone:
Phone: 274-8561
Mailing Address:
3. Legal Description: Lot 1 Block 1 Broadwater Subdivision
4. Location:
5. Type of facility to be inspected No. of bedrooms
6. Well Data:
A. Type
C. Construction
7. Sewage Disposal System:
B. Depth
D. Bacterial Analysis
A. Installed B. Installer
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
8. Distances:
2. Manufacturer
2. Material
A. Well to: Septic tank , Absorption area Sewer Lines ,
Nearest -lot line Other contamination
B. Foundation to septic tank , Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74) Page 1 of two pages
Page
2 of two pages
- Re
st for
Approval of Individual 'er & Water F,acilit,fes
Legal
Description
Lot
1 Block
1 Broadwater Subdivision
Comments
Approved
'4,41qapproved Date 6 2- �
Approval,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
V
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74)
Date
�qj 1
0