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BROADWATER HEIGHTS BLK 3 LT 4A
Onsite File Broadwater Heights Block 3 Lot 4A #050-081-35 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201505 PID Number: 050-081-35 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JOYA CHUNG-BIN FAMILY TRUST ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 12044 SWEETWATER CIRCLE, EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot BROADWATER HEIGHTS 3 4A Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ -- GREER 1000 Gal. Material Number of compartments Lot Line 10'+ __ NA HDPE 2 Foundation *6'+ __ LIFT STATION Manufacturer Capacity Remarks *PER PERMITTED DESIGN. Gal. Alarm location Electrical installed by Installer JRS PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034. Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection ection ls[6/29/21 2na 6/30/2021 Location and description 3rd 4'" BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL -�� Conditional Approval: Date i j*: 49 7H .......... % • • • • • • • • • •�• Septic System r Curtis Approved - Huffman �� �'F���.• 128991 Date �, CE �lPROFESSIto/7/2o2N. dW O Note: this approval does not include well permit requirements. i -j PID: 050-081-35 PERMIT: OSP201505 A—C=12,4' B—C=15,4' A—D=15.8' B—D=18,4' A—E=19,3' B—E=17,4' SOIL BEARING SEPTIC SECTION PRISM SCALE, NTS BROADWATER HEIGHTS BLOCK 3, LOT 4A PREPARED FOR: JOYA CHUNG—BIN FAMILY TRUST 12044 SWEETWATER CIRCLE EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK@gmail.com �)UFFUK i StKV1ULti: AdW °F�s C ,t 9TH DATE: 10/7/2021 rtis Huffman 04 SURVEY: HOLT CE 128991 DRAWN: FWCS X eow 10/7/2021 SCALE: 1" = 30'1 phbFBSS1014 y AV MUNICIPALITY OF ANCHORAGE Onsite Water & Wastewater Program ¢ Po Bax 196650 4700 Elmore Road a t R Anchorage, Alaska 99519-6650 Phone: (967) 343-7904 Fax: (907) 343-7997 „ n httpllwww.muni.orglonsite � 9'rMOT P'g e;)artnzent On -Site Wastewater Disposal System Permit Permit Number: 0SP201505 Effective Date: 1212212020 Work Type: 5epticTank Upgrade Expiration Date: 1 212 212 0 2 1 Tax Code Number: 05008135000 Site Legal Address: 13ROADWATFR HEIGHTS BILK 3 LT 4A G:0253 Site Mailing Address: 12044 SWEETWATER CIR, Eagle River Owner: CHUNG-BIN JOYA FAMILY TRUST Lot Size in 5q Ft: 22825 Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2, All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.85 and the State of Alaska Wastewater Disposal Regulations (18AAC72)l and Drinking Water Regulations (18AAC80) 1 The wastewater code requires intNctJon8 during the installation. The engineer shall notify the Development Services Department per AMC 15.55. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either. a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: If septic tank cannot be installed outside the sail beating prism of the foundation or at least 5 ft from the drainfcid, a waiver will be required to close out the permit. Received 8y: Date, 12J22/2020 Issued By: j Date: -1�0oxo 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com December 17, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: BROADWATER HEIGHTS BLOCK 3, LOT 4A The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The existing tank is within 4% of the foundation and has been for over 30 years without any known issues. Every attempt will be made to install the tank as far as possible from the foundation and maintain elevations to the existing field. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201505, Rebecca Carroll, 12/22/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201505, Rebecca Carroll, 12/22/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201505, Rebecca Carroll, 12/22/20 /- 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 I [~EW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS ]Well. , Absorption:r / Dwelling, / PERMIT~ ~ ~ Manufacturer Matorial ~o. of compartments Liq. gapac~ty in gallons Inside length Width Liquid depth / OD'~ IF HOMEMADE: .~_ ~ DISTANCE TO: Well W/t Dwelling PERMIT NO. ~ -- ~ Manufacturer Material Liquid capacity in gallons Welt Foundation ~ Nearest lot line~ I PERMI = DISTANCE TO: ~ /~'~ I t ' ~ ~ No. of lines/ Length of~ ~ne Total le~ i~f Trench.~i~ g S Distance~between ~ ~tines Total effective~ '~,~--abs°rpt~-- area ~ Top of tile to finish grade ~ ~ Material beneath tile ~ inches Length Width D~pth PERMIT NO, N Typeofcrib Crib diameter ' ' ~depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth , Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation Sewer li~e Sept]0 tsnk AbsorptJofl OTHER ~ ~' PIPE MATERIALS S OILTESTRATING'*,'__¢ ¢/~.. INSTALLER ~ 1 REMARKS Rev. 3/78) PERHIT NO. RPF'LICRNT LOCATION LEGAL RUDY MUELLER L4BB3 BRORDWBTER HTS SR BOX 2~8~-R 99587 LOT SIZE 694-5i±0 SQUARE FEET TYPE OF SOIL aBSORPTION SYSTEM IS: 'TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL. RATING (SQ FT,.."BR)= :1.25 THE REQUIRE[:, SIZE OF THE SOIL aBSORPTION S'T'STEM IS: [:,EF"TFt= ± "-Z'~ L E 1'-,t,.3 T H =- 47 G R I--~'-.." E L [:,EF'TH= 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF a TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFRCE OF THE GROUND aND THE BOTTOM OF THE EXCaVaTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVE[_ DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OLITFRLL F'IPE aND THE BOTTOM OF THE EXCaVaTION (IN FEET). PERMIT aPPLICaNT HFtS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DI...IRING 'THE I NS'TRLLRTION INSPECTIONS OF aNY WELLS aDJaCENT TO THIS PROF'ERT'¢ aND THE NUMBER OF RESIDENCES THaT THE WELL WILL SERVE. -F ~---) ,3 ( 2 ) I I'-,I S F' E E: T I C, I"-,i $ R F-: E fi.: Em;., Li I F.: E [:. BRCKFILLtNG OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPF.:OVRL BY THIS [:,EPRRTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTANCE BETWEEN R WELL RND RN"r' ON-SITE SEWRGE DISPOSAL SYSTEM IS ±00 FEET FOR R PRIVATE WELL OR :1.50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE T'¢F'E OF PUBLIC WELL MINIMUM DISTANCE FROM R PRIVATE WELL TO a PRIVATE SEWEF.: LINE IS 25 FEET aND TO a COMMLtNITY SEWER LINE IS 75 FEET. WELL LOGS aRE REQUIRED aND MUST BE RETURNED TO THE DEPARTMENT WITHIN 3:0 [:,RYS OF THE WELL COMPLETION. OTHER REQLliREHENTS MaY aPPLY. SF'EF:IFICRTIONS aND CONSTRUCTION DIaGRaMS aRE R',,,'RIL. aBLE TO INSURE PROPER INSTRLLRTION. F' E F< i".1 I T E >:: F' I F~: E :5 [:, E ,]: E I'-1 E: E F-: __~,:: ± ... ± LTM- :5: ~: I CERTIFY THRT :1: I RM FRMILIRR WITH 'THE REQUIREMENTS FOR ON-SITE SEWERS aND WELLS RS SET FORTH BY THE MUNICIPRLIT'¢ OF aNCHORaGE. 2: I WILL INSTFtLL THE S'~'STEI"I IN RE:E:ORDRNCE WITH THE CODES. 3:: I UNDERSTAND THaT THE ON-SITE SEWER SYSTEM MaY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMO[:,ELED TO INCLU[:,E MORE THaN 2: BEDROOMS. HF F L I iSSUE[:' V4. 0 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION:_ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O DATE PERFORMED: SLOPE SITE PLAN SOILS LOG PERCOLATION TEST WAS GROUND WATER ~i~J0 I~ ENCOU NTERE D? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS ¢ ~-~ ~/~ ITEST RUN BETWEEN FTAND /T 72-008 (6/79) ?.= M'- DRILLING, Inc. M pTn 'Rl. v'A 'i mon. _ 19'In!`'1.:+..«.:..+:...,_14n:::.. DRILLING. LOG Well Owner z r yeller �' `.'-� `' txc� i c�ri' t7se of We»' 1 ^ane-si- Location (address of:' Township, Range, Section, if known; :or distance main road' - Kot+ 4A,tix'Oa&atpar, kle:t:�lts' Size of casing 6' 'Depth of Hole '04 feet Cased to 19 • 84 feet Static water levelL 30 ft above below land" surface. Finish of well check one o en end Screen ' ( J` ' Perforated ( ) Describe screen 'or perforation iGTl Well pumping test at ` gallons aper �hjo'r) (minute) for" hours with , of drawdown static level = , .from �n�~ '! i I'S3 N. r x vx t Ly Date of comnpletio-- r ae ��a,., .3• s WELL LOG. Depth in feet from a r } ground surface Gimme `details ofsformations penetrated, size of material, color and: hardness, a.F,._......, 5 � y TO 12boulders TO 304 lored: small vrater seeps i5 y S TO � a 7- TO L TO - TO TO —TO- OTOTO -TO- -TO— .. ' —TO- O TO -TO iIAVWA ctrt'sfiedt . •tfirNte -Nri �. 8 14 dt —TO- O3—CONTRACTOR 3—CONTRACTOR z 0 a�'OWoc 042JW~ Qry4l LuyV�22 20w�SC� I Q OZ x 0 S -,o _ �O � NOU LU W m' ¢ W O `Z ! QTLO W Z t -- CC CE x CI LLI �uIW q 4t 1-•.. Cn � � fj� N err LLwwzq �..ZCp it - C>w,=iqO N �pY O C�> 4 q}j W <. J�pQ- 13 V zoo azLESQ x z� - o¢z5 0 2 U m LL U 23 W W W D O roti'- ow 3 W O Oz F. W � Zw�q Quo woo qow �zv�� Oma woh-�w0 vim X Z Z � w�OC'JW OO¢ o�z=�apnm �pz: 28 z Vii- mp 04 �p ''.wzoa-o��mi zwwwxwog 0 om>zNo O U m0 s O ?LL�wziyjaR S -,o _ � Q z� - o¢z5 0 2 U m LL U 23 W W W D O roti'- ow 3 W O Oz F. W � Zw�q Quo woo qow �zv�� Oma woh-�w0 vim X Z Z � w�OC'JW OO¢ o�z=�apnm �pz: 28 z Vii- mp 04 �p ''.wzoa-o��mi zwwwxwog 0 om>zNo O U m0 s O ?LL�wziyjaR MUMICIPALITY OF ANCHORAGE o�'-� Development Services Department T Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-081-35 1. GENERAL INFORMATION Expiration Date: rZ- I _ Z Complete legal description BROADWATER HEIGHTS BLOCK 3, LOT 4A Location (site address) 12044 SWEETWATER CIRCLE, EAGLE RIVER, AK 99577 Current property owner(s) JOYA CHUNG-BIN FAMILY TRUST... Day phone Mailing address Real estate agent 4850 E DESERT COVE AVE. UNITE 32, SCOTTSDALE AZ 85254 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 4. TYPE OF WATER SUPPLY: Date of Payment TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Waiver # Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA # Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/07/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & Fks 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for 3 bedrooms bedrooms i g�P TH 49 • �.. Curtis Huffman.' r� sll F�*40/07/2Q24' �.����r 1,PROFESSI� � bedrooms, with the following 1ip�� �r�i(s1 OF(Anr/����i ON-SITE '- WATER -AND `.m WAST�_VVATERPROGKAM z^ 1 J l 1 J� 1)))))111 Original Certificate Date: h) 7Z 'Z� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: BROADWATER HEIGHTS BLOCK 3 LOT 4A Parcel ID: 050-081-35 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/23/1983 Total depth 304 ft Structure served by this system _ Well production at time of test 1.52+ qpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ® No Cased to 19 ft (INTO BEDROCK) ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 10.6 mg/L ElNitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by: &SULLIVAN Date of flow test for COSA 12/10/2020 Static water level at beginning of test 31 ft. Date of Sample 12/18/20 & 3/1/21 Comments SEE ATTACHED SULLIVAN DOCS - WELL MITIGATION WELL FLOW & NITRATE SAMPLE IT IS ASSUMED & HOPED THAT NITRATE LEVELS MAY CONTINUE TO DROP WITH ONGOING USE B. TANK DATA Age of tank(s) NEW years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 5/21/1983 ® ALL standpipes present per record drawing Total measured depth from grade 11.4 ft (max) Measured depth to pipe invert from grade *7.3 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 12/10/2020 Results 2 Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time <1 min depth 0 in Code -required soil cover over field Final fluid d— ❑ System presoaked Absorption rate 450+ and-- (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date F_WC Comments/Deficiencies:. *SUMP INVERT VISIBLE AT 7.3' FROM GRADE. « �_ E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *6+ ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells >' 100 _ ®Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *PER PERMITTED DESIGN (TANK TO FOUNDATION) G. ENGINEER'S CERTIFICATION l certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Aw �+ 7H . .. .... ..........� Curtis Huffman CE 128991 ���k ,0 ROFESStONA�� � Municipality of Anchorage ® Development Services Department :x Building Safety Division K q e T On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC201706 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 4A of Broadwater Heights subdivision. This inspection revealed a nitrate concentration of 10.6 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a mljor component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. m T ti N>h >+HA q� Q�: y x ,aj Q _j: v � � A q�.1R 11 LL O M 2 x rn 2 cn O 5 ti kz H G�1O 1 f s�iu N 1 -ten- crw�l�� O _1v v n -- 11a �` o� o � CT��h-lid ry LU� ?'CD W�1-J T ti j N Qc� z ti W O K W W W W O O `L WO m L tiza� o � ?wj`� c9ZO O Ov¢i QO � W X Z T � 2tiF=x o�I'D w Vi � ti W 4 Q Q �nzooz�z� o�a,o>h�w Wz�o`�"tiai zwww�To� o3aw���o x QmjoowZID z j ZiL wa wZi-rw.,wtio> U z W 4 02 4¢ Q�: y p. �I Q _j: v � � a j N Qc� z ti W O K W W W W O O `L WO m L tiza� o � ?wj`� c9ZO O Ov¢i QO � W X Z T � 2tiF=x o�I'D w Vi � ti W 4 Q Q �nzooz�z� o�a,o>h�w Wz�o`�"tiai zwww�To� o3aw���o x QmjoowZID z j ZiL wa wZi-rw.,wtio> U z W 4 02 4¢ MUMC�PAU7Y (OF (' Development Services Department ' On -Site Water & Wastewater Section Parcel I.D. 050-081-35 C,D bb wD A L.._ Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: l — Z —2— Complete legal description BROADWATER HEIGHTS BLOCK 3, LOT 4A Location (site address) 12044 SWEETWATER CIRCLE, EAGLE RIVER, AK 99577 Current property owner(s) JOYA CHUNG-BIN FAMILY TRUST... Day phone Mailing address Real estate agent 4850 E DESERT COVE AVE. UNITE 32, SCOTTSDALE, AZ 85254 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Private Well Private Septic Water Storage ❑ Community Well ❑ Public Water System ❑ Day phone TYPE OF WASTEWATER DISPOSAL: Private Septic Holding Tank ❑ Community ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 630 COVID Date of Payment 1 '2 - Receipt Receipt Number. 141 i Z COSA # OSC201706 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 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 12/30/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the Family being served by the system and maintenance. The operational life of all well and septic systems are subject to OF Ad these various and dynamic characteristics and are outside the control of the evaluator of the "`� well and septic system. Therefore, any estimate of how long a system will function satisfactory ,;.e OJ • .. !�,9 �) for current or future occupants or guarantee that no unseen encroachments, deficiencies or f�J discrepancies exist can be given by First Water Consulting & FWGS . *' lli •�* rr .... ...... 6. DSD SIGNATURE Curtis Huffman System #1 Approved for bedrooms %}�`c,'P . CE 128991 ..�����,�� �I�FgFO ROOSSIO�P% System #2 Approved for bedrooms �� Disapproved Conditional approval for with the following stipulations: By: �" Original Certificate Date: '7 �Z 21 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory /�' Well Flow Advisory 0ther � dmv`i 6 Legal Description: BROADWATER HEIGHTS BLOCK 3 LOT 4A Parcel ID: 050-081-35 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/23/1983 Total depth 304 ft Cased to 19 ft (INTO BEDROCK) ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 12/10/2020 Well production at time of test 1.52+ gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ No ® Coliform bacteria is Negative Nitrate 10.6 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by: NES & SULLIVAN Static water level at beginning of test 3'1 ft. Date of Sample 12/18/20 & 3/1/21 Comments SEE ATTACHED SULLIVAN DOCS - WELL MITIGATION WELL FLOW & NITRATE SAMPLE IT IS ASSUMED & HOPED THAT NITRATE LEVELS MAY CONTINUE TO DROP WITH ONGOING USE. B. TANK DATA Age of tank(s) 37 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 47" ® Standpipes/foundation cleanout per record drawing Date of pumping 12/09/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/21/1983 ® ALL standpipes present per record drawing Total measured depth from grade 11.4 ft (max) Measured depth to pipe invert from grade *7_3 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: NEW TANK TO BE INSTALLED 2021 Adequacy test date 12/10/2020 Results M Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time <1 min ® Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons FWCS Comments/Deficiencies-.. *SUMP INVERT VISIBLE AT 7.3' FROM GRADE. 4 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 4 ft Surface Water > 100' ft ft ft ft ft ® Yes if No _ _ ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ®Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS CONDITIONAL COSA — NEW TANK TO BE INSTALLED IN SPRING / SUMMER 2021. G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. tl� .• TH .. .. ... I. .. .. .... ..........� Curtis Huffman Ij�Fc •. CE 128991 1 �s�F • 1;/30/20gU • ��� $���, pROfESS10N��.a I1 ft Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC 201706 Subdivision: Broadwater Heights Block 3 lot 4A Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 37 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. Ma�lmg Address�p O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org � s Municipality ®f Anchorage AV Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC201706 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 4A of Broadwater Heights subdivision. This inspection revealed a nitrate concentration of 10.6 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. FIst Water N S U L T I N G ;; 1 1 i N C 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com March 1, 2021 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: CONDITIONAL COSA LEGAL: BROADWATER HEIGHTS BLOCK 3, LOT 4A PHYSICAL: 12044 SWEETWATER CIRCLE, EAGLE RIVER, AK 99577 The pending permitted 3 -bedroom septic tank upgrade has been impeded due to winter conditions and other factors. We are therefore requesting a Conditional COSA at this time and will proceed with the upgrade once conditions allow. The system has been working for the occupants and granting of this Conditional COSA will not impact any of the neighboring properties or pose a public health risk. Attached are 2 bids and escrow letter from title for the pending installation. Please contact us if you have any questions. Sincerely, OW46 LZI^- Curtis Huffinan, P.E. P.O. Box 670269 Chugiak, AK 99567 P: (907) 688-2759 F: (907) 688-2259 TO: Brent Western 12044 Sweetwater Circle Eagle River, AK 99577 Camera Inspection Report Pitless: 15' Casing: 21' Static: 30' First Aquifer: 39' Date: 1-5-21 Saw discoloration at pitless with evidence of leaking in due to water drips on pitless. At bottom of casing saw discoloration on rocks with seeping wetness. P.O. Box 670269 Chugiak, AK 99567 P: (907) 688-2759 F: (907) 688-2259 TO: Debbie Mumma 12044 Sweetwater Circle Eagle River, AK 99577 Flow Test Report Resting Static: 30' Max Drawdown: 271' Well Yield: 2.6 GPM Date: 2-12-21 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 GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name'~k)~ ~,~.~ ~-"L-- Telephone: Home t.,d¢~-~'~ ~ Business Applicant Address ~,, /~::>, '[::z~,'::"/-'~'~'7--~"~ "' ~~--,c~'''~-'~,'''/~/'~--- ~>l/~-"--- Applicant is (check one): Lending Institution []; Owner/builder ~ Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) (f) Address Telephone .Meifthe HAA to the following address: S & S ENGINEERING Ea~lo River, Alaska f9577 2. TYPE OF RESIDENCE . ~ Single-Family/',','~ Multi-Family [] ':':NL~-rnb~i; Of Bedrooms Other </"/'/tll WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written cor~firmation 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) "~JOM s,Jeeuil.~ue iBuoisse,toJd eqi u! SUO!SS!LUO JO S JO J JO JO,t elq!suodseJ ].ou s! e6BJoqouv Jo HuIBd!o!unlAI eq..L 'penes! s! @:mo!,t!:rJeo B eJojeq Bmp eZ/{IBUB JO suou.::)edsu! l. onpuoo leu op Cl=IHC] ,to seeHoldLU=l 'slueuJeJ!nbeJ elBls pub IBJepe,t u!B::peo H,ts!lBs Ol. Jap.Jo u! suo!ini!lsu! 8u!puel Jieqi pub SeLUOq ,tO sJesBqoJnd el XSe:lJnOO B sB s!ql seep cl':IH(] eqJ. 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Hu.l LUOJ,t pUB Sel!,t el~B.Joqou¥ ,to HUled!o!unlAI aLII LUOJ,t pau!Blqo uo!].BuJJo,tu! eql uo pesBq :].BLI1/{,t!Je^ Jeqpn,t I 'u!eJeLI pelBo!pu! e.mlon..lls ,to adH1 pub suJooJpeq ,to .leqLunu eqi. elBnbapB pub IBUOl].oun,t 'ejes si U..lelSXS IBsods!p J@IBMelSBM Jo/puB Xlddns JeiBM ellS-UO eql 1BH1 SMeLls IBAOJddV HipoLIinv q].lBeH s!q~, ,to uo!lBe!lse^u! ,~uJ mql X,t!JeA I 'MOleq UMOqS el. Bp Uo!mpflBA eql ,to se pub oleJeq pext,t,tB IBeS HuJ Hq pe!,t!:Peo sV NOIJ. VlNblOJNI aNY YJ.¥Q 'HOMY3S =l'lld 'SJ.S=I.L 'SNOIJ. OidSNI ONIQIAOIJd INI::IIJ 9NI~33NION:; '9 'g ~O~./~G~' MUNICIPALITY OF ANCHORAGE (MOA) _~./~C . ,,$\o~HEALTH AUTHORITY APPROVAL (HAA) .~C~?~ ~E~C~5 ~w, CHECKLIST- FEBRUARY 1984 ~.~ ~ ~ 264-4744 ~O~ t 0 Legal Description: ~ WELL DATA ~C~ t~ Well Classification ~, ~' Well Log Present~) Total Depth ~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit(~N) Separation Distances from Well: If A, B, C, D.E.C. Approved (Y/N) Date Completed ,~d¢~'z_ ~ ~5'~ Yield Cased to Depth of Grouting ~ 7-,'""7 ' Pump Set At '~ ~ z¢¢c:~ '~ Sanitary Seal on CasingC~;~l) Depression Around Wellhead (Y~j~) To Septic/I-J~le~rg Tank on Lot I ~ / ' On Adjoining Lots TO Nearest Edge of Absorption Fieldc,~n ~_ot · On Adjoining Lots To Nearest Public Sewer Line //:~ To Nearest Public SeWer Cleanout/Manhole Water Sample Collected by ~--~'~ '~1~ ~,h..~cczr-~l ~ ;Date ~ ~.- Water Sample Test Results Comments B. SEPTIC/~NK DATA Date Installed ~' ~ ~-1 ~¢"5 Size !¢¢c::> No. of Compartments Standpipes (~/N) Air-tight Caps~)N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~//~, Separation Distances from Septic/~e~Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Foundation Cleanout ~N) Date Last Pumped I ~,~ '~ - ~:)'7 r'b/,K; ;for ~ Temporary Holding Tank Permit (Y/N) /"3/'A~ / To Building Foundation To Disposal Field To Stream, Pond, Lake, or MajOr Drainage Page I of 2 72-026 (Rev 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~:.~ -?.~t -~"~ Width of Field Square Feet of Absorption Area Depression over Field (Y~]~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ¢/'~' To Water Main/Service Line Length of Field Depth of Field Gravel Bed Thickness Standpipes Presentd~N) Date of Last Adequacy Test lc;, To Property Line To Existing or Abandoned System on · On Adjoining Lots To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments '~ LIFT STATION ~/~,< Date Install~.~ Size in Gallons ~ "Pump On" Level at ~ High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~mping Cycles dequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M O~_a~n~ HAA guidelines in effect on the date of this inspection. Signed ~ · ~ I[NGINEERING Date ~//Y/~ ~ - -- :~4 Eagle Ri.vet Leop Road No. 204 /' /_/ .., Company_l?0~ ~_:. __ -_;2-_~- ,',-_~?? MOA No. ~c'~'/~O'D--~ Receipt No. ,/~ d_J / ~)~__J/4 Date of Payment '/./',"~./'/~'"~ Amount: $ / ~ ~ ~ Page 2 of 2 72-026 fRev 8/861 Back 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 I "~ - I ~,--' ~,~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name '~LJ~ ~/V[.~b4-.~c~---_Telephone: Home (¢~'1~-.- ,~'~ ~,O Business Applicant Address ~::::~.~, '~_ ~:::;~)4 d ~ '~.'Z..~ ~, ~ ~:;;;/~L.~¢ [r~. ~ i /~"~ ~:~%~-I' (c) Applicant is (check one): Lending Institution []; Owner/builder~, Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) ~a-il the HAA to the following address: 4 TYPE OF RESIDENCE Single-Family~~' Multi-Family [] Number of Bedrooms '~ Other WATER SUPPLY Individual Well J~ 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~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA, A 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 Telephone $ 8, $ Englneerln~ Address __ Date Eagle River, A~as[-,a 99~77.' \ ~-~ ~"~ -'~.~ Approved_ ~'~ Disapproved Condi~io~nal Date 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) WELL DATA DEPt. OF HEALTH ~IUNICIPALITY OF ANCHORAGE (MO~.v ENVIRONMENTAL P~TE~TH AUTHORITY APPROVAL (HAA) ' . , CHECKLIST- FEBRUARY 19" .J~ 2 3 ~ 264-4720 RECEIVED Legal Description: Well ClaSSification Well Log Present ~N) Total Depth ~3.~c~/~ i Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~:fN) Separation Distances from Well: To Septic/~ Tank on Lot ~ '~" If A, B, C, D.E.C, Approved (Y/N) Date Completed ~r-~.-~ ~'~ Yield ~ ~, E~ J)~L Depth of Grouting Pump Set At LJ ~V.-, ~ ~4 Sanitary Seal on Casing ~N) Depression Around Wellhead (Y,~ ; On Adjoining Lots t ~.-~,.~1 .~ To Nearest Edge of Absorption Field on L~ot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ./~ ~,.J ~4_.. I ~'~ ; On Adjoining Lots 1 To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~ 4 ~-~ ~:=a,-.~I~l~ ; Date {'~,-" ~ B. SEPTIC/I=I.~;E~,IN~ TANK DATA ~ --~Z.\ - ~'~ Size ~ ~ No. of Compartments Foundation Cleanout ~N) Date Last Pumped IZ.-, -' ~--~ - ~'~' / ~d//~ for / Temporary Holding Tank Permit (Y/N) Date Installed Standpipes (~N) Air-tight Caps (~N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/bi~flf~ Tank: T© Water-SUpply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata t'Z_ _~ Date Installed ~--~-'Z,~ -~ "~ "~ Width of Field '~'~ Square Feet of Absorption Area Depression over Field (Y,~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ~ Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cut~ank (if present) To Driveway, Parking Area, or Vehicle Storage Area Comments ~ t"lr'~o~ ~-~'"~, 1'4~'1'" ~ ~-..~-'~1> ~ ~. '~,--~'1"~ ~ D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for I~lanhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes. (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S Engineering Date I'Z..,"~-'~-~' Compan~E~,~c ,~: .... ~,--,-- ??='~' MOA No, Receipt No. ~ ~ ~ Date of Payment ~ ~ - ~ ~ -~ ~ Amount: $ ~ '~ Page 2 of 2 72-026 (11/84) APPLIC FILLS OUT UPPER HAl ONLY Property Owner RUc].y and Betsy Hueller Phone Mailing Address ,~ 7378 Skyline Dr£ve, Eagle River~ Alaska Zip Code 99577 694-5110 Buyer N/A Address Zip Code Lending Institution First National ~ar~ of ~cborage Phone Address :P.O. BOX 548 Eagle River, Alaska Zip Code 99577 694-2103 Realty Co. & Agent Area Realtors, Inc./Maureen Clayton Phone Address :P.O. BOX 249 Eagle River, Alaska Zip Code 99577 694-9555 Legal Description Lot 4A Block 3 Broadwater Heights Street Location NI-]N Sweetwater C~.rcle Type of Residence [] Single Family [] Multiple Family No. of Bedrooms 3 [] Other Water Supply [] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. [] Community ~or wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal [] Individual Year Individual Installed: 1983 [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQiJEST BEFORE PROCESSING CAN BE INITIAl:ED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: "Btmic!paJJty of Anchora,qo" ...... '"'"~"~ Pr01ecti0~" ( ~PPROVED BEDROOMS ~ *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* Septic T~k Size Well to Tank 72-023 (3/82)