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BROADWATER HEIGHTS BLK 1 LT 4
Broadwater Heights Block 1 Lot 4 #050-081-18 Development Serviczz Department Building Safety Division On -Site Water A Wastewater Program "y4� er 4700 Sragaw Street �. r P.C. SOX 196650 MarkBogich Anchoroge. RSC 99519-6650 Mayor cn�cmint av;/pri �T (907)343.7904 Pump Installation Log Well Drilling Permit Number: SNV_ Date of Issue: Parcel Identification Number: Legal Description Property Owner Name & Address: 'T.a j I7aoiS ttoakz �rt)at8L,) jv-r L4 131 Pump Installation Date:-' 3/8 Casing: 9SO feet Pump Intake Depth Below Topo�f -Well Pump Manufacturer's Name: + Jac}<Q_ 1• i`— Pump blodek 1 W 0311-$ Sa 1 Pump Size 1 by Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion? 14yes ❑ No Method of Disinfection: Comments: Pump Installer Name: S-l-e� k-ECt�d>u-i £ 1�1�K ��WinJc ¢rde„ Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. / Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: `5V%QcZZ7 PID Number: 060-00/-M Name: G,EiPAI� �rl3STFR 1 &V . Wastewater System: ❑ New ❑ U rade Y �o Y Address: ,i-L � 6-5+ C 179.9/ !P G ABSORPTION FIELD Phone: n ('/ No. of Bed r ms: � Deep Trench ❑Shallow Trench []Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from iginal grade: ra' ' GPD/Sq. Ft. Lot: Block: / 7� Subdivision: U,QQ�D Depth to pipe bottom f ompriginal grade: y Ft. Gravel d th eneath pipe Ft. Township: -� Range: � Section_ Fill added above original grad: 3 .S Gravel I gth: �0 ' Ft. 073 WELL: El New ❑ Upgrade Gravel width: �/ Num ero�ines: Distance between lines: x TTN Ft. Ft. Ft Classification (Private, A,B,C): Total Dept Cased To: Total absorption area: ,f Pipe material: Ft. Ft. 3 �j � f SQ. Ft. p4l Driller: Date Drilled: Static Water Level: In taller: �s D9e I stalled: y - ,2 Cf Ft. it alWL'Sa.7 Yield: Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Veptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Publlc/Private Manufactu er: �i;H Capacity in gallons: 1000 From Tank Field Station Tank Sewer Lines /�! Welh jQp.� ��� Material: T T � Number of Cptnp artments: �+� water fvh,. - Ivor- LIFT STATION Lot 1/1 10 0 * Al Size in gallons: Manufacturer: Line Foundation (U ,j- 1 �fI j "Pump on" level at: "Pum evel at: High water alarm at: Curtain/ 4_ Pump Make Electrical Inspections performed by: DrainIVAC BENCH MARK Remarks: '7 R nN C-H FN o ro Location and Des iption: Vr,OE Joo _S 6,4.4A4 J"to ra r916 e 0 O/VC2 JF Com Assumed Elevation: 10b (� wtf1v41A tZCQv �5r'�4 4T a• A(IR�Donllfc.'1 T c H �r,:pQJs7!{�c r 4I ► �- 77 X 04 S Nf� i carvnv ��T� E �( ��Nu CNa DIvtA,�4.2 V,44--Vf) duly TO s;,(,iV Pw-5 . :%�t9+tl I f t Dates: 1s '-9" Inspections performed by: S & CENfilMEE.RING 17034 Eagle River Loop Road Na 204 2nd E12"' ERT C. COWAN 4Eagle �o,�l River, Alaska 99577 CE -8801 k .•.�=`r�AW Department of Health and Human Services approval ,f Reviewed and approved by: _ � *-q Date: /G 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW960277_ PAGE 2 OF 3 Municipality o -F Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.0, Box 196650 ® Anchorage, Alaska 99519-6650 ® Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 1, BROADWATER HEIGHTS P.I.D. NO. 050-081-18 RAINWATER CIRCLE /\ k � n1_� 4,' \ f ` OF -c e NC / 100' ViELL RADIUS \\\ EXISTING 1000 GAL: \ SEPTIC TANK \------------------- STI ST2 103.4 FINAL GRADE NEW 99 3'1 1000 GAL SEPTIC 99•I TANK MTI = 0�.� RELOCATED \\ TRENCH LAST 20' FCO \ \ RELOCATED T1 srz\\` _ TH2' LOT LINE. WAIVER REQUES 01 D8L2 DBL7 \ V�r \ -----------------� ��? 10' UTILITY EASEMENT \ 100. 41, RADIUS MT CO r01 = 107.5' SCALE 1" C01 = 99.0' s MMT C. COWAN w� `pity SCE -43801 Z� , OF E N PAGE 3 OF 3 _ A B FCO 9.0' 30.5' ST 1 49.0' 55.0' ST2 54.5' 60.5' DBL1 58.0' 64.0' DBL2 59.0' 65.0' C01 101 .0' 108.5' MT1 98.0' 106.5' RAINWATER CIRCLE /\ k � n1_� 4,' \ f ` OF -c e NC / 100' ViELL RADIUS \\\ EXISTING 1000 GAL: \ SEPTIC TANK \------------------- STI ST2 103.4 FINAL GRADE NEW 99 3'1 1000 GAL SEPTIC 99•I TANK MTI = 0�.� RELOCATED \\ TRENCH LAST 20' FCO \ \ RELOCATED T1 srz\\` _ TH2' LOT LINE. WAIVER REQUES 01 D8L2 DBL7 \ V�r \ -----------------� ��? 10' UTILITY EASEMENT \ 100. 41, RADIUS MT CO r01 = 107.5' SCALE 1" C01 = 99.0' s MMT C. COWAN w� `pity SCE -43801 Z� , OF E N PAGE 3 OF 3 PERMIT NO. SW960277 PAGE 3 OF 3 Municipality o -F Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,❑, Box 196650 • Anchorage, Alaska 99519-6650 ♦ Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 1, BROADWATER HEIGHTS P.I.D. NO. 050-081-18 Municipality of Anchorage K DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: GER&D Uik,BS7V� DAT LEGAL DESCRIPTION: t6l 1, Sat oLk /, �;acwt,/MfxQ Township, Range, Section: 1 2V,, FSLL 3 mr-axCS 4 DrKs-; D 5 6 o 8 9 10- 12 0 12 13 d e 14 lox 15 •�0 16 _ 00'ffo Mt 0 F 17 18- 19- 20- COMMENTS 81920COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ��/ L O DEPTH? P E Depth to Water After Monitoring? Bate: SITE PLAN PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN --- AN GO FT PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GU 72-008 (Rev. 4/85) �U TIFY THAT T llS TE T WAS PERFORMED IN ON THIS DATE. DATE: Depth to Water PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN --- AN GO FT PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GU 72-008 (Rev. 4/85) �U TIFY THAT T llS TE T WAS PERFORMED IN ON THIS DATE. DATE: STATEMENT OF NON -OBJECTION FOR ENCROACHMENT WITHIN UTILITY EASEMENT Matanuska Electric Association, Inc. (MEA) has no objection with the location of a LEACHFIELD TRENCH within the utility easement along the EAST boundary of the following property; LOT 4, BLOCK 1, BROADWATER HEIGHTS SUBDIVISION, ACCORDING TO PLAT #70-322, ANCHORAGE RECORDING DISTRICT, THIRD JUDICIAL DISTRICT, STATE OF ALASKA T14N, R2W, SEC 1 This non -objection is conditioned by the stipulation that MEA will be held harmless from any and all damages to the encroachment that may result from the existing and future use of said easement. Matanuska Electric Association, Inc. By: ROBERT YLVISAKER General Manager or his Representative SEPTEMBER 12, 1997 Date MEA ACKNOWLEDGMENT STATE OF ALASKA ) ) SS. THIRD JUDICIAL DISTRICT ) The foregoing agreement was acknowledged before me this 12TH day of SEPTEMBER. 1997, by ROBERT YLVISAKER. Notary Public for the State of Alaska My commission expires:9/9/2001 HAROVAFORMSINONOBJ2. DOT --------------------- NOTARY POBLIC PATRICIA A. MCROBERTS S'FATF OF /',IAMIK F} IVI micipal� of Anchoirap Department of Health and Human Services 825 "L" Street Rick Mystran, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 October 10, 1997 Robert C. Cowan, P.E. S & S Engineering 17034 Eaglie River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 4 Block 1 Broadwater Heights Subdivision Waiver Request #WR970060, PID 4050-081-18, SW960277 Dear Mr. Cowan: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 2 feet from the leachfield to the east property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. S'rely, Daniel J. Roth Civil Engineer On-site Services ljw #7 Webster MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR970060 PID# 050-081-18 HA# Permit # SW96027.7 Date Received: September 23, 1997 Legal Description: Lot 4 Block 1 Broadwater Heights Subdivision .Engineer: Robert C. Cowan, P.E. , S & S Engineering 17034 EAgle River Loop Road, Suite -2204, Eagle River, Alaska 99577 Applicant: Gerald Webster Waiver Requested Lot line waiver of trench to the east property line of 2 feet. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions; 3. Other: Waiver is Granted: X/ Waiver is NOT Granted List Conditions or Reasons for above -jeE tA�(IwEE✓_r 141-�9CREa L Fff,& P OF Yt4X77P/C47-/vw Date: LO - /a -- 97 By: 6N Name of Reviewer Rec #: 03235/3425 Amount: $ 115.00 Date Paid: 9-23-97 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN S &S� ;ineeninq MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION SER 23 1997 RE C E I V E DROBERT C. COWAN, PE. ROBERTA. SH FER, P.E. September 18, 1997 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 4; Block 1; Broadwater Heights CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Request you grant a waiver for the horizontal separation distance between the septic trench and the east property line at two (2) feet. We do not anticipate any adverse effect on the adjacent properties due to this being a large utility easement (see letter of non -objection attached). If you require additional information, please contact us. Sincerely, -Wwzz�' Robert C. Cowan, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Municipality of Anchorage � Department of Health and Human Services 825 "L" Street Rick Mystrom, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 September 8, 1997 Gerald P Webster 12110 Rainwater Circle Eagle River, Alaska 99577 7911 Subject: Lot 4 Block 1 Broadwater Heights Subdivision Permit #SW960277, PID 4050-081-18 The subject permit, issued September 4, 1996 by this office for a single family well and/or on-site wastewater system, has expired as of September 4, 1997. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sin erely, J mes Cross, P.E. Program Manager On-site Services enc: Copy of Permit cc: S & S Engineering p-/ PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE c DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960277 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WEBSTER GERALD P OWNER ADDRESS:12110 RAINWATER CIR EAGLE RIVER, AK 99577 PARCEL ID:05008118 LEGAL DESCRIPTION: BROADWATER HEIGHTS BLK 1 LT 4 LOT SIZE: 21263 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 9/04/96 EXPIRATION DATE: 9/04/97 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE FIRST 6 FEET OF THE EXISTING TRENCH TO BE ABANDONED MUST BE EXCAVATED THROUGH THE SEPTIC ROCK AND REFILLED WITH A SOIL BARRIER. RECEIVED BY: DATE: - / ISSUED BY: �z� / DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL. SYSTEM DESIGN s&S� ,ineeRinq July 17, 1996 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage RECEIVED DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street JUL 26 1996 P.O. Box 196650 Anchorage, Alaska 99519-6650 Municipality of Anchorage Dept. Health & Human Services REFERENCE: Lot 4 Block 1 Broadwater Heights Subdivision Dear Dan, Request you issue appr:�val to relocate approximately 15 feet of the leachfield on the referenced property in order to maintain a 100 foot horizontal separation distance between the well serving Lot 5 Blk 1 and the above mentioned leachfield. Ina letter from October 30, 1995, you stated the issuance of a waiver was not possible without the completion of several conditions. With these conditions we have decided to reconstruct the system on Lot 4 Block 1 and permanently abandon the temporarily abandoned well on Lot 5 Blk 1 (see attached site plan). During the reconstruction of the system we also propose to have a flow diverter installed to reconnect the original leachfield that was abandoned in 1985. We do not anticipate any adverse effects on neighboring wells, septic systems, or drainage patterns by the reconstruction of the septic system. If we may be of further service, please contact us. Sincerely, -V"/Z 4�1.' Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1„ = 50' SCALE SITE PLAN UPGRADE I r0 O --I 1 v d0 fGs D m O. z D Z r / O IP I � O I � V) m cv r C M A O f q O l0 Zrrn I o !) t —Z 0 1p�dmm r i O ! ! m ^D cnCn m = n TCO r r o Z O- r''I O I / Cn l7 Z O rTi X --I cn I /Y O Z n j (n C Q CIO Z rrt I r'l O -� 47 C 7 /' I /' U m n O Q n U Z d �/i I �/ / -I ZO G) cn n D m a Z U) ---I O 0-9 -H rri A oto /').' Q n i� R7 "� to rri co "g i X41 0 'jt, < y -M> D^ Z .Gi HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN S&S1 aineeRinq ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 4, Block 1, Broadwater Heights S/D July 10, 1996 GENERAL: ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 1. The scope of this project includes the relocation of the southE4r,s- portion (approximately 15 feet) of the existing leachfr-et4 trench to be moved outside of the neighboring well radius to serve the three bedroom residence located on the referenced property. The existing southe sr portion of the leachfield is to be abandoned completely. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. PTIC TANK 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 to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 4, Block 1, Broadwater Heights S/D July 10, 1996 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 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 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. 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 excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 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. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 4, Block 1, Broadwater Heights S/D July 10, 1996 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 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. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 4, Block 1, Broadwater Heights SID July 10, 1996 INSPECTIONS: Typically there will be a minimum of 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 silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of 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. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 4, Block 1, Broadwater Heights S/D July 10, 1996 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, •techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ❑ NEW v C_ 1 _ L4S,. F,�PGRADE MAI LING ADDRESS ? C-) , X 9 q c-) 5 L" I — elsl n LEGAL DESCRIPTION Q' LOCATION NO. OF BEDROOMS 3 Well�� Absorption area Dwelling PERMIT NO. U DISTANCE TO: ?, �S _ 15 5 1 'W P'5r73 a z Manufacturer Material No. of compartmentsZ w Liq. capacity in gallons I �L7 IF HOMEMADE: Inside length Width Liquid depth _ Y DISTANCE TO: Well Dwelling PERMIT NO. JOz = Z N Manufacturer Material Liquid capacity in gallons = DISTANCE TO: Well I+ 1(p Founda r� I Nearestllotipe PERW�O. Osc%� J W No. of line Length of pr h Jine ��ff Total Jell lines Trench wid�b Distance bow en lines H �� inches FTop of tile to finish grade ^_ Material beneath tile Q Total effective absorp ' n area `T 1 JO inches Lp ola Length Width Depth PERMIT NO. w C7 a F- Type of crib Crib diameter Crib depth Total effective absorption area w° LU DISTANCE TO: Well Building foundation Nearest lot line J Clas Depth Driller Distance to lot line PERMIT NO. J W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS G t SOIL TEST RATING INSTALLER F'v ,mss REMARKS .r u 05/-F3L_(-- OF tji s t.... s Or �A •QST iM��a��y. ,t.Y: (Vf p 4 7 Aw rYOiln`�.'�•aM APPROVED�' DATE LEGAL SRS 196X ra.1�7�air. DIVER„ A%aSKA. pQM(• ���/S_,,,/ 1 V) PH. 60+217�_l 7/ 72-013 (Rev. 3/78) _.__, _-'..""` `" """ - 1 `„ ������1 F:::-" lr-N R 1 1"', "Y" �F:--" ��C�', �-i 0'.3 F�, el C3 [-.*,*:'. ~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �^�� ���4 - 825 L STREET, ANCHORAGE, AK 99501 264-4720 PERMIT NO: 850573 APPLICANT: SOUTH FORK CONST. ADDRESS: % S&S ENGINEERING EAGLE RIVER, AK 99577 CONTACT PHONE: 694-2979 ' LEGAL DESCRIP: SUBDIVISION: BROADWATER SECTION: 1 TOWNSHIP: 14N LOT SIZE: 18864 (GQ.FT. OR ACRES) MAX BEDROOMS: 3 F�, 1'1 :1 J C6—ef r 4 1 ZD LOT: 4 BLOCK: 1 RANGE: 2W Listed below are the options available -to ' you in designing your septic system. Choosethe option _... ..... ________�__ that best {its your site. J-URUE: U4C:� F -A n E=-: 13 ..... ... K*J~ 0 FZ f-11h][K^J DEPTH TO PIPE BOTTOM (FT.) 4.0 4.5 4.0 GRAVEL DEPT. (FT.) 8.0 0.5 3.5 TOTAL DEPTH (FT.) 12.0 5.0 7.5 GRAVEL WIDTH (FT.) 2.5 22.0 5.0 GRAVEL LENGTH (FT.) 43.0 44.0 73.0 GRAVEL VOLUME (CU.YDS.) 33.9 35.9 54.1 TANK SIZE (GALS) 1,000.0 ** 1,000.0 ** 1,000.0 ** SOIL RATING (SQ.FT./BR) 225 213 225 ** TANK MUST HAVE AT I. -EAST TWO COMPARTMENTS _________________________________________ I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. ' 2. I will install the system in accordance with all MOA codes and regulations, ` and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE.aPPROVED WI,THOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL/WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED DATE: ^ APPLICANT U K CONST. ISSUED BY DATE: 1007 7-�----------��------�----~--- ----- --------------- MW JAW e or Municipality of Anchorage{` ru DEPARTMENT OF HEALTH & HUMAN SERVICES` 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — A. RobertPERCOLATION TEST 0 ` �,o too. 1 as -r -E It 44 •• rfo IT\rj 4w PERFORMED FOR: �nOT►a �K_. c_--�►.��° DATE PER FORME9%%dk�`�' ' LEGAL DESCRIPTION: L- 4- B Township, Range, Section I P I� SLOPE SITE PLAN 1 -/ / 2 - "//,/ 3 M �.r• 4- 5 5 6 ,o v 7 v d 8 p b b 9 0 a 10 11 12 a 4 13- 14 3 14 'O U 15 a .s 16 17 18 19 20 COMMENTS CA 1M WAS GROUND WATER ENCOUNTERED? a7 S IF YES, AT WHAT L DEPTH? p E \?� Depth to Water After Monitoring? Date: Reading Date Gross Time Net Time Depth to Water Net Drop ip-� P ----s 3 1/4 --- 4 n o ter/ sg V 6� '7 , �» 1. •{ t'LAPg ° PERCOLATION RATE2� (minutes/inch) PERC HOLE DIAMETER �° TEST RUN BETWEEN_ FT AND FT PERFORMED BY:7 $Hts -sup^ � '004571 tiixym CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCEWITH AL"T,A• ff NICIPAL GUIDELIS I EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE' fle� T and Environmental Prote On Fourth Floor gest 825 1, Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAC.-,E DISPOSAL SYSTE-M NAMF MAI[ INN LOCA I ION ZA_ VK'i LLGAI, 1'1',CW1_J IONtJr -_ 104,7-s SEPTIC TANK: DISTANCE. C) NUMBER of 11JR1 k ti,- 7 M 44( -5, F HOM W1, LL Mm."uf IN`,IDE LEI`\J(.]1H___ I N) 11) L W I () I I i LIQUH) DI -PTH I IOU10 CA PAC I I- Y/'�' '" 0 A I L 0 f',15. TILE. DRAIN FII-A.D: TO -1 AI_ 1-1 T1 I f-OUNI)ATION NLAR[ �,',T LCIJ 1,1N1 0V 1, INf. DI')1AN('I_ I ROM Wi-L-1 # of Lines 1. _.., - - D 1', 1 A N C 1- 1 & L. lVi L I, N I I 11 LS T ','L N C I I V,'I I) I I I IN. DIAL LF r I. -C I P/F ABSORPI ION ARLA SO. E I. L [ N(,.', F I 1 OF E, AC I I I - I r j L D1 P I I 1 01 f 1LAt T, D1, P-1 1 1: TOP Ot TILL: To F lr,JIsl I G,�tA[)[ _MAIf R IA L H[,Nt:AiH TI(A "MOW III.. - SEEPAGE DIAME-ITR OR WIDTH LENG, I I i_:�/x DLPTH Log Crib Rings Crib Size: DIAW-11 11 H I)ISTANCE I*ROM: WELL__. '10TAL_ EFTECTIV[ ION ARE A (WALJ_ AREA) BUILDING FOUNDATION NL ARE.L)T LOF L.INL F1 Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: # of Bedrooms: Installer: Remarks: January 3, 1978 Mc Leod Construction Post Office Box 795 Eagle River, Alaska 99577 Subjects Lot 4 Block 1 Broadwater Heights Subdivision Permit # 770993 A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well leg should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerelyg Health and Environmental Protection Sewer and Water Section LNB/l j h THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �-t �EE14KA-7-1-1= -1112 ��F�"-11 I= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ���I I �r- ����1 7 ���� �I _2_' EE= �C-1 (El �F."I [.--. I-...��� --------- �" 9=4 ftl. t=p I="K_1=1 104 -1- (A F:"-],*- I ILI P-4 --------- H PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1' EITHER H CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2, H CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF H MHINTENHNCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION. .... .......... ..... ____________________________.......... .......... ........ ... ___ 0- 14 Ill ��������I C.. I i r - 4 "_=". ��9 z- E, ���K.. _. I I H: �f � .......... .... ........ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ��F-1 twl 1 "7 ��1 FT EE E5 �IE.-* twl E--'.* f;,, _-:�: A_. I CERTIFY THAT* 0 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. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE JHAN ] BEDROOMS. SIGNED ^�"� ________ HPPLICHNT MCL�OD CONST -- r) r� ISSUED B __DHTE ��_- ��_����~� Y].0 �������I F="F=l I.. X -1- 9' (�_*u� f:1 V-4 f�:# f�-*i! f:�fl C. -i LEE DEPARTMENT Or HEALTH AND ENVIRONMENTAL r`qTECTION ' �~<[}IoM- 825 'L STREET, ANCHORAGE, HK. . 99 264-4720 » / �l _�1 �EF ������ I�������� ����' PERMIT NO. ( 770993 ) APPLICANT MCLEOD CONST P.O.BOX 795 E.R. 99577 694-9715 LOCATION SKYLINE DRIVE LEGAL L 4 B 1 BROADWATER HTS SUB LOT SIZE 27000 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �-t �EE14KA-7-1-1= -1112 ��F�"-11 I= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ���I I �r- ����1 7 ���� �I _2_' EE= �C-1 (El �F."I [.--. I-...��� --------- �" 9=4 ftl. t=p I="K_1=1 104 -1- (A F:"-],*- I ILI P-4 --------- H PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1' EITHER H CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2, H CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF H MHINTENHNCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION. .... .......... ..... ____________________________.......... .......... ........ ... ___ 0- 14 Ill ��������I C.. I i r - 4 "_=". ��9 z- E, ���K.. _. I I H: �f � .......... .... ........ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ��F-1 twl 1 "7 ��1 FT EE E5 �IE.-* twl E--'.* f;,, _-:�: A_. I CERTIFY THAT* 0 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. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE JHAN ] BEDROOMS. SIGNED ^�"� ________ HPPLICHNT MCL�OD CONST -- r) r� ISSUED B __DHTE ��_- ��_����~� Y].0 0 & E GEG . cCHNI CAL & DEVEL PMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Er Foundations Land Developmerit Performed for: Name: -46", oo✓sT CCA�r1«Ai 7e1. No. 9 9� �4 '- Mai 1 i ngJAddress: "�'� Legal Description: ©1 I r J0 e K �1, Broa (•UCS, Depth (feet) 0 1 2 3 Soil Characteristics 6 `e:='e!7C` 7 8 9 10 11 12 13 'Mvsz- 1LL- 15 16 Ground Water Encountered: Yes No If yes, what depth°„_ Proposed Installation: Seepage Pit Drain Field_ Comments: Alcr 1'0 -,Ce A -MV 11V 7-14.1.. 8,e5; e4Z,,JS T , 1—E' 1-14 7-4- c/ Date: �° Performed by: - T— 11 ti -430, 4,i-rAn IRourrm A. AX.ASEKA 00 3414-771-11- 15. iNC.H WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 300 Feet - ,)[Rif -!.ED AT THE RATE OF $20*00 PER FOOT. IROPERTY OWNER - Stallian Blurs. i44-7� 277-3485 .00AT(01',! OF WELL SITE (1-(N VA *b t--3 j' )MILLER, Diving—WQ Sm ,!ELL LOG: - -with a 304 clav bgse, Womb signs of a clean wet gravel at 18tRAS Bedrock, A sedimenta rock. A granular rock s4o--%d:qg some signs of water* 63-2871 Sodimentary rock, wet granular rock producing 1.5 GRI 2160 gals of water available per 24 hour ,.ine frame, Sedimentary rock from 295 to 300 feet. ,50 feat of: water stand in casing. Pump should be installed ten fe4t off bottom. r. Qh&rgo Zor 250 feet of drillings $5000.00 V (70STINCLODES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING..:, .,:', WRITE CHECK PAYABLE TO RAMPART DRILLINGWORKS FOR THE SUM OF $50*0000 THANK YOU VERY MUCH. J:A BERNIE CLAUS OF RAMPART DRILLING WORKS 1'.1ATE-�Ilt"Itho SERVICE CHARGE OF 1 V2% PER MONTH WILL E3KSjSPS0ONk-AST, QD-- kC !� • Municipality of Anchorage "`GE On -Site Water and Wastewater Program n (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I. D. O 50- O 8 I - i $ Expiration Date: 1. GENERAL INFORMATION Complete legal description S Location (site address) /Z/IO t=,lC k Current Property owner(s) Mailing address Real Estate Agent Day phone �(ncX��LSo Dayphone eU�4-14?'O 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well - Individual P1 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by Date: lo / COSA to be released to the engineer, unless otherWse requested by the engineer. COSA Fee $ `"Wlb Date of Payment 1011b ckgOz Receipt Number COSA# ®SCIaI�Ibq Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, :based on procedures outlined In the Certificate of Onsite 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 Address Phone 6z-?c)2oP Engineer's Printed Name S7-fe/e 4:FcJ C Da 6. D SIGNATURE V _ System #1 Approved for �J bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: .11)- /s-- I L Theunicip it of A horage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12.doc If more than 1 septic system is on the lot: COSA Checklist Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: goo �-��' GT/S 161 Parcel ID: D.50 —0 8 f —/,R' A. WELL DATA Well type ?,__ If A, B, or C provide PWSID # Date completed /,P,4t/% 7 Sanitary seal (Y/N) Total depth 2 W ft. Cased to _Lft. Date of test Static water level Well production FROM WELL LOG /0 i. /_ .S g.p.m. WATER SAMPLE RESULTS: Coliform U oolonies/100 mL Nitrate 6. 8 S mg/L Arsenic:.(3_?7Zug/L date of sample:�Zy�/Z B. SEPTICIHOLDING TANK DATA Tank Type/Material 5-7 c e— Tank size 1060 gal. 'Number of Compartments Foundation cleanout (Y/N) Depression over tankk((Y/N) LV Date of pumping 0 / Z Pumper Well Log (Y/N) Wires properly protected (YM) Casing height (above ground) /r1� in. AT INSPECTION / oZ /2 /3 g.p.m. Other bacteria Q colonies/100 mL Collected by.i2 Date installed Cleanouts (YM) ti High water alarm (Y/N) C. ABSORPTION FIELD DATA / Date installed 2 % % . .Soil rating (g.p.d./fe or ft2/bdrm) � System type %Qnc. Length _ ft. Width 3 ft. Gravel below pipe & s ft. Total depth [3 ft. Eff. absorption area 54a ft2 Monitoring tube Depression over field -A/— Date of adequacy test., eWIZ. Results (Pass/Fail) P For.? bedrooms Fluid depth in absorption field before tesVO in. Water added gal. New depth/4F' in, Elapsed Time�0 min. Final fluid depth. /0 in. Absorption rate >= z I -To g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ' If yes; give date D. LIFT STATION Date installed Size in gallons Manhole/Access) "Pump on" level at _ in. p off level at _ in. High we alarm level at Datum Cycles tested eets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tankAift station on lot Absorption field on lot /06 ` e. Public sewer main rf Sewer /septic service line 2 S Animal containment areas 1410 i' On adjacent lots /0O 1 f in. On adjacent lots / o o `fi Public sewer manholefcleanout Holding tank .✓��a i Manure/animal excrete storage areas spa o ¢' SEPTIC/HOLDING TANK ON LOT TO: 1 Building foundation S� -t Property line -410 -JI, Absorption field S fi � r Water main ^n� Water service line lQ Surface water / n T- i Wells on adjacent lots /06 ?` ABSORPTION FIELD ON LOT TO: Property line 2 Building foundation 6 Water main Water Service line/0 �� Surface water /(fid Driveway, parking/vehicle storage Curtain drainyii/Wells on adjacent lots /0 o 1 F. COMMENTS 7V Gd'f Lrne C^Jc.vfr G. ENGINEER'S CERTIFICATION _ OFy I certify that t have determined through field inspections and.•• review of Municipal records that the above systems are in 1Wev 4•i conformance with MOA COSA guidelines in effect on this date. r Engineer's Printed Name• °���,;,,,. Date Slav/eeii W. Eng . COSA brown sheet 9-1-12.doc �e Municipality of Anchorage Development Services Department Building Safety Division s, �T 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING o� Parcel I.D. _ 050—d,1;8-18 HAA# Jq oA%S� 1. GENERAL INFORMATION Expiration Date: — ', Z} 4 Complete legal description BROADWATER HEIGHTS SUBDIVISION: LOT 4, BLOCK 1. Location (site address or directions) 12110 RAINWATER CIRCLE * EAGLE RIVER, AK. 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MELISSA WOLF Day phone N/A 12110 RAINWATER CIRCLE * EAGLE RIVER, AK. 99577 Day phone VALESA UNNEAN w/ REMAX Day phone 257-0425 16600 CENTERFIELD DRIVE * EAGLE RIVER, AK. ' 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 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 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 seat 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, _SUrrE 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 & 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 test 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 Phone 337-6179 Date 13 O¢ . Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: tl<<<l tv q( rii'f i .. ; ``� QPM•' • � low,y� „ON-SITE ; • VVA1 Cry r11VU ; m' : WASTEWATER PKIDURAM Attachments: L/ ���Jj ••.•,••.•••��\ HAA Checklist Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other BY: It/ Original Certificate Date: — 14— 0 if (Rev. 12/01) 1r. 4 . .. .. .. ... . .... of a A. O4�•. —7953 4 .......... a ess:' `ceoQ P,or�s$�o�°`Q��o Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: tl<<<l tv q( rii'f i .. ; ``� QPM•' • � low,y� „ON-SITE ; • VVA1 Cry r11VU ; m' : WASTEWATER PKIDURAM Attachments: L/ ���Jj ••.•,••.•••��\ HAA Checklist Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other BY: It/ Original Certificate Date: — 14— 0 if (Rev. 12/01) Municipality of Anchorage Development Services Department Building Safety Division I K 5 < <T On-Site Water & Wastewater Program ,' 14760 South Bragaw St. ! P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us � (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Le al Description: BROADWATER HEIGHTS050-018-18 , g S �, LST 4, BLOCK 1. i Parcel ID: . A. WELL DATA �. r p Well typ i PRIVATE If A, B, or C{ provide PWSID# N/A ' Well ILog (Y/N) YES Date'co ,pleted 10/11/1977. Sanitary seal (Y/N) YES Wires properly. protected (Y/N) YES Total depth 300 ft, Cased to t' 18 'ft. Casing height (above ground) 18 in. FROM WELLLOG AT INSPECTION Date off test 10/11/1977, i 4/22%2004 Static water level 150 ft. 1 130 r ; Well production 1.5 g.p.m. 0.9 I m. I WATER +SAMPLE RESULTS: Coliform �' 0 ! colonies/100 mL ! t Nitrate' 0.752 mg./L. Other'bacteria 0 colonies/100 ml. Arsenic: w/,6mg./L. Date`of sample: _4/22%2004 1Collectedkby: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA; k Tank-Ty e/Material STEEL YP Date installed 8/2/1997 I{ d, 1000 , Ta� �k i C n s ze 2 , gal. Number of Com artment., YES .. I 9 P Cleanouts (Y/N) Foundation cleanout (YIN) YES , Depression - over tank (Y/N) NO High w Iter alarm (Y/N) N/A Date of pimping 10/30/2003 Plmper JR'S PUMPING C. ABSORPTION FIELD DATA I ' i BELOW EXISTING GRADE h ^ g Date installed 8/2/1997 Soil rating p.d./ r ft2/bdrm) 0 8 F System type ''TRENCH Length (' 43 ft: Width 3 ft l' -Gravel below pipe_ 8/5 ft. Total depth '12.6 ft. •Eff. `absorption area 568 :ft2 Monitoring tube **YES Depression over field NO Date of `adequacy test • 4/23/2004.,! 23 2004 Results (Pass/Fall) PASS (i 1 For 3 bedrooms Fluid depth in absorption field before test ! 46 in. Water added' !!!gal. `i ! New depth 56 in. Elapsed Time:120 min. Final fluid depth 52 in Absorption rate >_ 450+ g p d Any, rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN 'i I r if yes, give date — **IN PORTION 1 OF TRENCH w/ 5 FEET OF. EFFECTIVE. ***SEPTIC SYSTEM' SIZED FOR 3 BEDROOMS. j 1***HOUSE VACANT FOR''45 DAYS.' PRESOAKED WITH 892 GALLONS `,ON 4/22/04. I i 1 D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump Manhole/Ac High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A arnes 95 Sewer /septic service line 125'+ On adjacent lots 100'+ On adjacent lots 100'+ .Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property 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 LOTTO: Property line *2' Building foundation 10'+ Water main - N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *LOT LINE WAIVER GRANTED WITH ISSUANCE OF INSPECTION REPORT **WELL ON LOT 5, BLOCK 1, BROADWATER HEIGHTS WAS ABANDONED 5/04 G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in - conformance with MOA HAA guidelines in effect on this date. Engineer's Printed N me JEFFREY A. GARNESS Date �o O HAA Fee $ Waiver Fee $ Date of Payment Receipt Number (Rev. 12/01) . o��F �' - 4 9 0 f • J e �O arnes 95 9� `QUO Ox,\"frofessio� o0 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 # 040185 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 1, Lot 4 of Broadwater Heights subdivision, the well's productivity was determined to be 0.9 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 2 -bedroom residence is 0.2 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. M Pumping PO Box 773415 Eagle .River, AK 99577 (907) 694-64541x_ Billing Information _ S & S Englneering^ 17034 Eagle River Loop Rd #2 Eagle River, AK 99577 (907)694-2979 e Number. 011761 Order Date: 30.Oc1-2003 Service Date: 30 -Oct -2003 100 am Technician. Caleb Job Description: 10009 + 500 H2O drop P.O. Number. Terms: Net 30 Salesrep: Nikole Job Type: Repeat Map Book: Map Grid: 86 - - Iob Site n_ormatlon _ J Cross Streets: W Skyline Dr -Y Mlkey Job Comments: Meet w/ Mikey 2pm 12110 Rainwater Circe Pumped 10008 + 5008 H2O drop Eagle River, AK 99577 (907) 529.2979 Tax Percent! 0Service Type Type Qty Price Each x 2 Men Tax Septic Service Under 2k 1 $95.00 No No Water Drop 1 $95.00 No No Additional Location Comments: On comer of Rainwater Circle w/ it's, dark brown-kinda ugly Tank pipe behind shed - cut ground level w/ steel cap Diagram: •>Leach * ❑ Shed Tank �� �dr.:r,;;`•,a = .; Fence Rainwater Extension Actual $95.00 $95.00 Gallons Planned: 1000 Gallons Actual: Hose Length: 2 Double Tank: ❑ Pump System: ❑ �� Baffles Inlet: ❑ _ Baffles Outlet: ❑ NonTaxable Total Taxable Total ' Tax Total Grand Total Estimated Charges: $190.00 $0.00 $0.00 $190.00 Actual Charges: Customer agrees to the terms and conditions printed on the back. THIS IS A BINDING AGREEMENT. Signature and Title of Customer Representative Date Accepted by ]Rs Pumping Date Accepted For your added convenience we accept Visa and Master Card payments over the phone. After 30 Days 1.5% WILL BE CHARGED! 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.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-081-18 1. GENERAL INFORMATION , SA ILTt HAA # 0 4 d 0 L/9 Expiration Date: _;,,— 19 ^ 0' Complete legal description Lot 4; Block 1; Broadwater Heights Subdivision Location (site address or directions) 12110 Rainwater Cir. Eagle River, AK 99577 Current Property owner(s) Alfred Land Day phone 696-4987 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address, same Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑✓ Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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. Municipality of Anchorage -� Development Services Department Building Safety Division ` SA 6TT 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: Lor 4 - �L� � A�'�2�, A�vJ�47�'�t� Parcel ID: t15a A. WELL DATA I+ 7-s S71 C.) Well type L If A, B, or C provide PWSID # Well Log (Y/N) Date completed P 0 ! /' Sanitary seal (Y/N) `� Wires properly protected (Y/N) 1 Total depth �i�op fL Cased to ft Giz Casing height (above ground) �n FROM WELL LOG AT INSPECTION Date of test r �" 101-30 03 Static water level ' ft r' ft. Well production 9•p -m- f g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Arseni Nitrate 4mg./i. Other bacteria colonies/100 ml. Date of sample: I ► I03 Collected by: 5,4 9 CNr,/ NE U�1 G B. SEPTIC/HOLDING TANK DATA Tank Type/Material t L Date installed Tank size J 000 gal. Number of Compartments Cleanodts (Y/N) Foundation cleanout (Y/N) y Depression over tank (Y/N) High water alarm (Y/N) Date of pumping t o Pumper � 2 I a C. ABSORPTION FIELD DATA Date installed _012J±:? Soil rating d./ftz ftz/bdrm) Q • 8 System type Length -r(b ,3 ft. Width 3 ft. Gravel below pipe ft. Total depth 2 ft. Eff. absorptioA areaIae Monitoring tube y Depression over field Date of adequacy test f 013c> 03 Results (Pass/Fail) /.1- 5 For 3 bedrooms Fluid depth in absorption field before test D in. - Water added�al. New depth in. Elapsed Time: 6 L/Jmin. Final fluid depth u in. Absorpticn rate > g•c•d• Any rejuvenation treatment (past 12 mo.) (Y/N & type) if es. gree date N N z O 0 fAL 0b ;0:0 (MEAS) rn c N 00°31' 18"W 44.94' NORTH 45.00 (R) N 02 ' / Co / P' / 10 C / Cao I, N, Cao o` /' C / C meati JI '' m z .0,D, / / QZ rn tip 0 V /in0 O O ' �g / ® k ' 33 FT. SECTIO LINE EASEMENT -------------------------=------------ 1\}. P PWR. LINE P v b T v ; 1 ■1 M m O m n c0v•v z 'a ON O O c"; E O t7 In O v a 4 Q: o ro c m� CL a m fp O n= , W .n. m n m O N E ' O G ._.n B O T7 a O N m o OCD n a 10 a a m s O D O O C 0 O p p: H a N � C m � O u O N 0 A 0 CD CL n m>> m n m N Q N lb 0 i m N S u M _r m oN =r ��0O n 0 O. O _= O o. m a O. O O 0 a m m o n CL S. O N om ; . N D'"o m X C7 D_ �z n � m m X r p m D as C r -1 9 P; CD 8 tri Cg W 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. # 050-081-18 HAA # Qc�OO 1. GENERAL INFORMATION Complete legal description Lot 4; Block 1; Broadwater Heights Location (site address or directions) 12110 Rainwater Circle Eaqle River, AK Property owner Gerald Webster Day phone 694-1365 Mailing address, 12110 Rainwater Circle Eagle River, AK 99577 Lending agency Day phone ,Mailing -address Agent` Hal' Jackson/ Fortune Proi2erties Day phone 696-7653 Address Unless otherwise requested, HAA will be held for pickup. - 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: 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 MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S& S ENGINEERING 6 g q_ a c, 7 f Name of Firm _ 17034 gayly River 1 cap lead Na. 204 Phone Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. By: Date a � d -7 4 OF ALAS �I J7 MJ��Fi. • -i 'i RO l C. ; Aga.! C C - ' 4$F J l2_t�FES���N�� Disapproved. approval for bedrooms, with the following stipulations. Additional Comments Date 3 - 17 - CAUTION Tt; .-:unicipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority A�-.::°.gyral Certificates based only upon the representations given in paragraph 5 above by an independent prc; ssional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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 N21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICESaR �2 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343RECEIVED 74� C `1 D Health Authority Approval Checklist C V Legal Description: L,+ 1 611210 1DWAT6e HIS Parcel I.D.: 02570 —00 A. WELL DATA Well type 1'� �t yA'C>w If A, B, or C, attach ADEC letter. ADEC water system number Log presentf(Y I) Date completed l t fi Total depth 3L Cased to 143' To Bri:07ftx Casing height (above ground) I Z'� Sanitary seal ( I) �ji�,rj Wires properly protected @N) 1196 FROM WELL LOG Date of test 1C21 11 Static water level 150 Well production WATER SAMPLE RESULTS: 1.5 g.p.m. AT INSPECTION c2 . 4- g.p.m. Coliform © Nitrate 1,7 Other bacteria Date of sample: 2-124> /9'5 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size 102_ Number of Compartments Cleanouts ON) Foundation cleanoutON) 'Depression(Y N00 High water alarm (Ye AA_ Date of Pumping , Pumper N bW ?A N K -105-moi i.c.60 s-1 7W -r, P"5 'Ft C. ABSORPTION, FIELD DATA ' '"S REtoC-A-rip 70 "6� T- loo' w&i, 56°6 AV0fj Date installed sS3 2 `� Soil rating (g.p.d./ft2 or ft2/bdrm) C?. System type _r>FW(-4 Length ' 'YO ' Width 3 Gravel thickness below pipe a Total depth 17, / Effective absorption area SFId iiz Monitoring Tube present &nl) 5 Depression over field (Y' 1� U Date of adequacy test Z Results (Pass ail) 'PASS For Mj "& bedrooms Fluid depth in absorption field before test (in.); 3 Z " Immediately after gal. water added (in.): of Fluid depth 39 (ins) Minutes later: 7-8 + m, -Y\ Absorption rate = *5b It g.p.d. Peroxide treatment (past 12 months) (Y/N) AWE �s&wJ If yes, give date I 72-026 (Rev. 3/96)* D. LIFT STATI Date installed ��_14 Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* * SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot too) )' On adjacent lots "Pump off" level at* X06, -IV Absorption field on lot 100 - On adjacent lots IC70 Public sewer main -45 Public sewer manhole/cleanout .14 Sewer /septic service line ZS' Lift station 1 t EO SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 14 Foundation 5 Property line 5 Absorption field Water main/service line IDS } Surface water/drainage Wells on adjacent lots 1))0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Z a v#e. g Building foundation 10 Water main/service line n ► ?" Surface water too 11 Driveway, parking/vehicle storage area � Curtain drain 0 0 1,3,t- K iA o -w n. Wells on adjacent lots 1 co 1 F. ENGINEER'S CERTIFICATION i certify that I have determined thru field inspections and review of Municipal in conformance with OA A uideli es in effect on, this date. Signature Engineer's Name 406*_"Lr- Date -7 0) i HAA Fee $ Soo, ac Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ AV C;1 4(,f Date of Payment Receipt Number KVCtKI 4. a.-W.YY CE - 8801 El are MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO.1/R984036 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot _440 Block A of P$0ADWATEA Hf/6/{TS Subdivision, the well's productivity was determined to be A gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a J,; bedroom residence is % 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. S&51 p yeepu"G IIEALIN AuN lorotr APPROVALS SEWER& WATER MAIN EXIENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND nEPOnTS WELLINSPECTION & PLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECI IANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL MIEM DESIGN ' ROBERrC. COWAN, OE. ROBERTA, SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 WELL FLOW TEST DATA FAX(907)694-1211 CLIENT: hmguy tua6f&i - DATE: a3 Oj�j LEGAL DESCRIPTION: LT 91 �R,oApw*rm p#s WELL DEPTH:_ CASING DEPTH: Lsffo 'RmRtocti< DATE DRILLING COMPLETED: ArT I l 11, � QTT DRILLER: PA-a,- MISC. DATA: CASING HEIGHT: IZ"T SANITARY SEAL: L is WIRES IN CONDUIT; 40f5 GRADING O.K.: —Lim BACTERIA AND NITRATE SAMPLES COLLECTED (date): TEST DATA CLOCK TIME METER READING (GAL) PUMPING RATE (GPM) DEPTH TO WATER (FT) - REMARKS i I ; 5 3554-5 swl 12:43 3155 P 44 3S5 5S) 2 ; 24_ 355(od ) . S3 ESULTS: WELL CURRENTLY PRODUCES . 4 GPM WITH Al) K_ DRAWDOWN TESTED BY: _ ,Ih?_ ; A-1 FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR. 17034 NOR III EAGLE RIVER LOOP 0 SUITE ?.04 • EAGLE RIVER, ALASKA 99577 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 invest!qation 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 & t ENGINEERING Phone 17034 Eagle River Loop Roel No. 204 Address7' , Engineer's signature Date 6. ROBERT C. COWA14 i ti CE .8801 - _ •rr�'�� DHHS SIGNATURE ,. Approved for bedrooms. raga '�nOFt�S�`��`'r Disapproved. Conditional approval for ' bedrooms;`with the following stipulations: ,Additional Comments gy.,, Date `25 - Z; CAUTION ..The tuui�iniaipality of Anchorage Department of Health and Human Services'(DHHS) issues Health Authority , ' Approval Certific�t'os,based only upon the representations given in paragraph 5 above by an independent professional englheer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes .and * 'it `ending institutions in orderto 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 12.= (RW. 1/91) Book MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �a r I���IL-1 f2g:opm�JkV,9, OParcel I.D. A. Well Data Well type Fk\IkI - If A, B, or C, attach ADEC letter. ADEC water system number �'IA. Log present 6�N) Date completed 1� -1 \ -'1� Driller I�—i�MPF R -T Total depth `'mat Cased to ivac IL Casing height 1721 Sanitary sealON) Date of test Static water level Well flow Pump levell Wires properly protected,(VN) FROM WELL LOG la- 11--n 1 Sb' 1.5- 9 -p.m 2-9 � SEPARATION DISTANCES FROM WELL TO: AT INSPECTION 1 t�-qS cn Septic/hekkag tank on lot I oo kk ; On adjacent lots 1 da\ �_ Absorption field on lot V n a ; On adjacent lots \ d `aI 4 - Public sewer main �� �- Public sewer manhole/cleanout �" 1 Sewer service line 25 Petroleum tank ZS t WATER SAMPLE RESULTS: Coliform Nitrate 0.,2_1', `Other bacteria Date of sample: 1 - 11 - q S Collected by: �9 SLrt�-Q-c��, B. SEPTIC/KGLqMM TANK DATA Date installed 9 - IS- 85 Tank size lc)on Compartments Z Cleanouts (9N) -- Foundation cleanout&N) 4 Depression (Y,t6pl, �I High water alarm (Y4P 1 Alarm tested (Y/N) a Date of pumping 12- Iii -9'-t Pumper L9_Ssfaot. SEPARATION DISTANCES FROM SEPTIC/HetDi%G TANK TO: Well(s) on lot On adjacent lots l e d To property line 1 btu Absorption field Surface water/drainage kDo (- Foundation S1 , S Water main/service line 1 a t 72-026 (393)' 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) SEPARATION D on lot FROM LIFT STATION TO: D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump eat Surface water Date installed t,5 -SS Soil rating (GPD/Ft) '225 �I$r� System type Length L� �, Width $ ` Gravel thickness Total depth I z' Total absorption area Lor6� k Cleanout present CYN) Depression over field (YQt} A Date of adequacy test _l2 - IS -9 4 Results/fail) for 3 Bedrooms Water level in absorption field before test 13 2 After test iZ Peroxide treatment (past 12 months) (Y&) If yes, give date �I x SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot IL -o i�- To building foundation la 41 On adjacent lots l two l�- Property line l o To existing or abandoned system on lot 10 1 �- On adjacent lots 3o s Cutbank '�� Water main/service line /014- -� SIN 7. of Surface water ! on � JL -Driveway, parking/vehicle storage area 5�Srfr-_ra 0 �pac_ Curtain drain J/, E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effeg�c,tdate of this inspection. FNS Signature a., .«« _,. >:;.; .::;,, Engineer's Name 80,96 .4 i- C.3 w q., ... ROCERT C. COWAN a �¢��• C� - 8801 Date 1 I %;� �,,, HAA Fee $ Waiver Fee $ Date of Payment ���192� Date of Payment Receipt Number �/ Receipt Number. 72-026 (3/93)' Back E MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date f— Z � `8Co 1. GENERAL INFORMATION (a) Legal Description (include lot, block, sybdivision, section, township, range) 1 Location (address or directions) (b) Applicant Name C-vWXCZ- 83 7'H Telephone: Home 041 ' 3576 Business _ Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder C' -, Buyer ❑ ; Other ❑ (explain); (d) Lending Institution (AlUI77eD r *"15. RG05k-t Telephone Address �(� /GA -k. (e) Real Estate Company and Agent Address ,_ Telephone (f) Mail the HAA to the following address: S & S ENGINEERING SR 6 196X EAGLE RIVER, AK 99577 2. TYPE OF RESIDENCE Single -Family CSI Multi -Family v Other Number of Bedrooms ago W7 ,. 3. WATER SUPPLY Individual Well 10' Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite L@' 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. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDIN_ INSPECTIONS, TESTS, FILE SEARCH, DA..r AND INFORMATION 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 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 Telephone 06y�f-Z�79 Address SR B 196X Date AK 99577 0Ife 6 •. la a .a, Robed A. Shefor •'• Pio. 1457.E �• ti '' 4 Fi g5 mv 6. DHEP APPROVAL �} Approved for �` bedrooms by Date Approved p"` Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) /fl (D 3IEA TH CHECKLIST ORITY FEBRUARY APPROVAL 4HAA) 190 i3o 264-4720 �/ Legal Description: Lew -7` 6uc 1 M110310ad TVIN;VgNQMAN3 ��R�Wdl t~ iZ V H1ld3H d0 '1,430 A. WELL DATA iMW60H7NV 10 ul1vdi.)ii,4r-1ry Well Classification -%-,F + If A, B, C, D.E.C. Approved (Y/N) � Well Log Present 61N) Date Completed /C>" // ` 77'x' Yield Total Depth Z�S� Cased to ZDepth of Grouting Static Water Level �'_-yPump Set At L!��- Casing Height Above Ground ?- Sanitary Seal on Casing &N) — Electrical Wiring in Conduit O/N) Depression Around Wellhead (YO Separation Distances from Well: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line '�� To Nearest Public Sewer Cleanout/Manhole �� To Nearest Sewer Service Line on Lot Water Sample Collected by Date Water Sample Test Results Commentsyvg`CA . Y,& -LL zdj�?Z SN©Y�ciT� iNr3C-t. 7-0 C4 C a /___-"tCCts.S ON 0.!r 6?r_4 B. SEPTIC/HOLDING TANK DATA Date Installed-, cl `r 8 ` Size '(C>0-C:>No. of Compartments 2 " Standpipes ) Air -tight Caps (LN) Foundation Cleanout (CON) Depression over Tank (YQ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) Kra- ; for Holding Tank High -Water Alarm (Y/N)�Temporary Holding Tank Permit (Y/N) N �' Separation Distances from Septic/Holding Tank: To Water -Supply Well / S 5 * To Building Foundation SI To Property Line �+ To Disposal Field 9* To Water Main/Service Line !G~�+ To Stream, Pond, Lake, or Major Drainage Course NA Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �ZS� Type of System Designl��RlLfy' Date Installed —/S r Length of Field �3 Width of Field 3 Depth of Field �Z Gravel Bed Thickness $� Square Feet of Absorption Area 8& 41 Standpipes Present (§/N) Depression over Field (Y& Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well % To Property Line �b To Building Foundation To Existing or Abandoned System on Lot Y0/4' ; On Adjoining Lots .S�4 To Water Main/Service Line �� To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course 141A To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments Pumping Cycles during Adequacy Test. Meets MOA *" Check Permitted Bedroom Rating Against HAA Request " I certify t verified, or conformed to all MOA an HAA guidelines in effect on the date of this inspection. ��I LKING 3� Signed Date Com an MOA No. y6'� RE RIVER, AK 99577 Receipt No. 6001- Ovo L 4 • j. Date of Payment Z MUNICIPAVTY Of ANCHORAGE �j D O DEPT. OF HEALTH & �• . . ; I • o Amount: $ _ ANVIRONKNTAL PROTECTION c+' Robe" A. newQ : t OCT 1 X N � s� ti No. 1457-11 �w Page 2 Of 2 �� y'� •• ••.+'•a ,... C'��� RECEIVED 0FEF0V 40 72-026 (11/84) THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 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 YA L ❑Septic Tank or ❑ Holding Tank Size: 1000 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURE J.".. TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS OL—APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE (J BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) i 1 '1