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HomeMy WebLinkAboutBROADWATER HEIGHTS BLK 3 LT 6Broadwater Heights Block 3 Lot 6 #050-081-39 • MUNICIPALITY OF ANCHORAGE 147* DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION �� 1� ENVIRONMENTAL ENGINEERING DIVISION 825 L Street -Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME � eQ / P�g2'6` / 1. NEW ❑ UPGRADE MAI LINp6DR�EiSS ` 6'1 t.G.. D E$/C,(,(,R// II PT I %�(cA LJ tbkT)C(K[Witt:rEti ti-Ts • {__,I ` pl(_/OCJ >Y LI )c.)-0, LOCAT NO. OF IRO [SEPTIC TANK DISTANCE TO: Well `O®/( Absorp on area DwellingPERMIT l NO. q , /�`� Manufacturer Gry IGS �2 Material �•Q No. of compartment 01-04.- Lig. / -city irlgallons IF HOMEMADE: Inside length Width Liquid depth D Y -u 0 c = z FQ- DIST�AN�C�E TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE GRAINFIELD TRENCH DISTANCE TO: Well `6 6 i ../...._ Foundation ` f Nearest lot line/0 e NO. 0Q-7s— No. of lin Lenj of each?a, I Total h lines Trench h Distance be w lines ,.fr Top of tile to finish grade Length ,e....,..— �!' S , Width Materia ben ath tile/ t J inches Total effec absorption area , Depth PERMIT N . / SEEPAGE PIT Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J W Class Depth Driller Distance to lot line PERMIT NO. �I L DISTANCE TO: Building foundation Sewer line Septic tank Absorption areais) OTHER PIPE TERIALS SOIL EST RA�Gz+{' 4 INSTALLER ed ^ '`{J 'coo O , t) SAR KS s/ F 144t \ 4 �V w APPROVE DATE LEGAL r t..47 5. Vkdd L- i• 5 x-c,--v" 72-0 e v. 3/78) �� U/-"&�~no/ur` ������������ �� ���������� (J ^��� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ---->Y 825 'L' STREET, ANCHORAGE' AK. 99501 264-4720 WIEAL.AL_ E;lawlaRI PERMIT NO. ( 800075 ) APPLICANT ALASKA USA LOCATION SKYLINE DRIVE E.R. LEGAL POUCH 6613 ANCHORAGE 99502 694-3161 TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 LOT SIZE 23000 SQUARE FEET SOIL RATING (SQ FT/BR)= 240 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DIT -V4== 71.2 ILlar4laTI-il= IGNEFM= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION <IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). tREDDLIIIRao. 7-Fir4K 1...01e101 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL 5ERYE. _—_ <2› FIFZIE FZIaIDUIFZIEDI BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. FlEEF!Mil- colalCMOR! I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. �x// ^- �rm 5IGNED�_ APPLICANT LASKR USA ISSUED BY_ lZ��'��/ � ���`�~~-' DATE L.1-0 �~����=(2s� ' V40 December 31, 1979 q :3C 4t4. q- ig-qe 825-9:THEET A.A.-1dOili 5 11 A N C !()RACE, I_ K A 99501 54 -1111 'SIJLIJVAN, MAYOH 14 Pin 4b. ig -RC 0-0 dousLizki.. ILeic- ie asA - Lk A_LLo P LA. nu, ii- LakiLe a IVA J. Alaska U.S.A. Federal Credit Union Pouch 6613 Anchorage, Alaska 99502 Permit #790631 Subject: Lot 6 Block 3 Broadwater Heights Subdivision 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 log should be sent to this department to document the installation date. If an engineer has inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there .are any further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Speci '1st LNB/ljw enc: Copy of Permit MFA Ci FE DEPARTMENT HEAL TH AND ENV [RONMENTH| .OTECTlON 825 ' STREE 7. ANCHORAGE, RK. 264-472@ I- FE ���E› Or4 TE F L:��M�T APPLICANT �^~,. /^/�''_ --- LOCRTlON /��' ^''^ ^ �l� ��./�� - -~- ��� LEGAL / //, ^�- `~ ���/7.;/y7��^� TYPE OF SOIL HR5ORBTlON SYSTEM I5 MAX IMUM NUMBER OF BEDROOMS /// s0lL RATING ( SO FT/BR)= PERMIT NO. ( 17��t"%,� /9/7Th CIX / LOT SIZE 7 / 7.1 (){��` SQUARE FEET ) THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 17> lr/'� �_�����iT- � �- m=�,r7 �����^`.'��L' [��P���= / THE LENGTH DIMENSION IS THE LENGTH (1N FEET) OF THE TRENCH OR DRHTNFIELD THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). 100f) PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY NELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL. WILL SERVE. --- .J(71 I: rA .11:=TI CD r -i FA EE ID Li TE. F;7FE� 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 R PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOOS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER IN57RLLHTIW F"- F7...! IF:'IF���E.) CEr.i FE: FE ::E-4 { CERTIFY THAT 1: l AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE 2: } WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 2: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 2 BEDROOMS SIGNED' APPLICANT ISSUED c' '// DHTE. YI2 0-111J�i1CIE '-ii1. .. ..,„ I --11; -11-r" 0:20E-7 ��P...::::!.y����� DEPARTMENT HEALTH AND ENVIRONMENTAL JTECTION 825 'L' STREET, ANCHORAGE, HK 99501 264-4720 g y11, -,y ” .. "11-�ir " , V-�UV r.“: PERMIT Nil ( 790631 ) APPLICANT ALASKA USA FED C U BOX 966 EAGLE RIY 69'+ ]1,F1 LOCATION SKYLINE DRIVE LEGAL 16 B] BROADWATER HEIGHTS S D 2�000 SOAHRE F,:::ET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOI| R8TING (SQ FT/BR)...,' 2�6 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS k��0—.1-T- R -f= :I_ „;;;;:::11 �1E-17.Tqf0-":'g-T"'IHA= �� �IR! FT! ",,,.-11!EE1L— -;;::::" THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH QR DRHINFIE.D_ 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 OUTFE11.1. PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET) �I.1.1.:[11)UKI 4;;;;" Fr:- Ir. �EJ-' FP' -IF I H7." �F !FT P. -,,W. �����---- ��Pr..22� ������'.:::: PERMIT HPP| ICHWT HAS THE RESPONSIBILITY TO INFORM THIS DEPHR|MEN[ DURIMS THE INSTHLLHTION INSPECTIONS OF ANY NELLS HDJHCFNT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THAT |HE WELL HILL SERYE -Y- gAir-11 .7: ;22: I> ���FP" �����-TIP-4f; ��� ���)g. ... J1 T. 11::;::..!: r:1:-.7.: BHCKFILLING OE 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 150 TO 200 FEET FROM H PGBLIC }JFLL DEPENDTo8 UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS APE HCHILHBLE TO INSURE PROPER INSTHLLHTION. S ^C:��-'11 .1: 1- ���F--T F.�r-",. r) F." r-IF1-9F,.........p, I CERTI�1 THAT i: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND NELLS Hs SET FORTH BY |HE MUNICIPALITY OF HNCHORHGE 2: I HILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]� I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MHY REQUIRE ENLARGEMENT IF THE RESIDtNCE IS REMODELED TO INCLUDE MORE THAN ] BE01O01-.11S. SIGNED._______________________-__________ APF'ICHNT H|HSKH USA FED C U ISSUED RY DATE _______ December 29, 1978 #780267 Ross Carrington Post Office Box 689 Eagle River, Alaska 99577 Subject: Lot 6 Block 3 Breadwater Heights Subdivision 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 log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Specialist LNB/ljw enc: copy of permit - r • �� ��F DEPARTMENT Ur HEALTH AND ENVIRONMENTAL /r.:QTECTION 825 'L' STREET, HNCHORHGE, HK 99501 264-4770 I,UEE 0 _A__ �):"..4; F> r 4_1_, 11:7 �����?!.��� PERMIT NO. ( 780267 ) APPLICANT ROSS CHRRINGTON LOCATION SKYLINE DR E.R. LEGAL L6 B] BROADWATER HTS S/D PO BOX 689 EHGLE RVR 99577 694 3161 TYPE OF SOIL ABSORBTION SYSIEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 LOT SIZE 23000 SQUARE FEET SOIL RATING (SQ FT/BR). 248 THE REQUIRED SI�E OF THE SOIL ABSORPTION SYSTEM IS. (3144Z7FIVEEF__ 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 BQT|OM OF THE EXCAVATION (IN FEET). 721-, :q" 11',4 :FE; PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. 17 0,1 ICJ I rA -T I WA rAl'e=„ ff—fiF. Fr, A.D! 113 E> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTIM MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NFU_ WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS OF THE WELL COMPLETIM OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTHLLHTIM ��F""IFjE �FECT.--FEMBEER: I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE 2: I WILL INSTAL...! THE SYSTEM IN ACCORDANCE WITH THE CODEa ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE !U INCLUDE MORETHAN 4 Bi-DRJUM S , 111!PPRREMO' llitkACANT ISSUFD VI2 O E GE' ECHN! CAL Et DEVE )PMENT CO. Russel/ Oyster 694-2774 Soils & Foundations Box 90, Davis St., Eagle River, Alaska 99577 694 2774 or 680 2200 SOIL LOG Performed for: Name: ,/,')/z Mailing Address: Legal Description: Z. C'r– Depth (feet) 0 2 4,4 3 5 6 1 Earl E//is 688-2280 Land Development Tel. No. 691,(- 3/‘)/ chi' c1,1-67 I Soil Characteristics_ '1174Ne • (l ,4 •..,- 7 7t1 - C a 8 t 9 10 �,. %`� f �.c_:^ t _�� rr� , - 15 16 1 L/C` t 2 7?„3" 41 �7 el c Ground Water Encountered: Yes No ' If yes, what depth__,__,. Proposed Proposed Installation: Seepage Pit Drain Field Comments: (-72--R!7 – i�Ne rr 1:A = f1 l s -,s 4/ ✓ Performed by: 41E- -3 1E L( „. :-rte Date: /(1• )WNER OF LAND (.1,•rtuirob &iuhn Fwavi '' V LHS 3�7 A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 ADDRESS _EGAL DESCRIPTION 1----67 S K 1 )ATE - Started % — Ended DEPTH OF WELL `A 01 STATIC LEVEL OF WATER FT I c !/ zott [.c„ 7645-4 DRAW�[)OWN ..SG �L) y)L4-4S5zi Gy+ x-44 7&.-s' 714-N, S• (4, GALS. PER HR °C 42,7 'ERMIT NUMBER 7 S 03 & 7. --5---- / 7 KIND OF CASING :IND OF FORMATION: 'rom a Ft to ""L Ft D v 6",e. /, u e2/5 -J From Ft to Ft =rom Ft. to / 4 Ft. S.- / `'-" a w/ 4 ,e,-, -45:4__ From Ft. to Ft. "rom Ft. to Ft. ft` t?a .c 0/4;‹S From Ft. to JFt. 'rom / 4 Ft. to / �l Ft. /417(k2 45 "J From Ft. to Ft =rom /1 Ft to / j o Ft IS -/- ' Y,<'o L /( From Ft to Ft "rom /act Ft. to / ? Ft. ,gfll /oC K "4"N` c r�'`— 5/rom Ft. to Ft. "romFt. to Ft. Q, 1 i.< 7 From Ft. to Ft. :rom / _3 •2 Ft. to o0?' -7 Ft. /.? f4 eo ' e_ So <i 4 From Ft. to Ft. :rom a 25 Ft. to 9 3 7 Ft. gE,5,eo 4 e 1-0e1S'<, L44., From Ft. to Ft. -rom Ft. to Ft. 5C ia.-yr From Ft. to Ft. =roma3 2 Ft to 62 47 O Ft. .15�Afe> G. As' 5-0 / C From Ft to Ft From Ft to Ft From Ft to Ft 'rom Ft to Ft From Ft to Ft 'rom Ft to Ft From Ft to Ft 'rom Ft. to Ft. From Ft. to Ft. •rom Ft. to Ft. From Ft. to Ft. rom Ft to Ft From Ft to Ft IISCL. INFORMATION: DGc5 it/4) Municipality of Anchorage /c.727/-freli< Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-081-39 HAA # ifRecer+ -Ftca,+-1o11/a 1. GENERAL INFORMATION Complete legal description Lot 6 Block 3 Broadwater Hts 056090 Expiration Date: 1— Z 7 - 0 6 Location (site address or directions) 12010 W. Skyline Drive, Eagle River Current Property owner(s) Michael Chambers Day phone 694-2976 Mailing address 10210 W. Skyline Drive, Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Charlie Whitlock/CB-Fortune Day phone 265-9165 Mailing Address 2525 C Street, Ste. 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. (Rev 11/99) 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eno. Svc. Phone 272-8218 Address P.O. Box 102954. Anch, AK 99510 - Engineer's Printed Name Steven R. Pannone, P.E. • • ' . '• `.Date Engineers Comments: In conducting an adequacy test, 1 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system undcr 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there arc no hidden def or encroachments. PES can therefore not provide any warranty for future performance nor give any 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. 6. DSD SIGNATURE 17 Approved for 1/. bedrooms. Disapproved. —" - Conditional approval for By: 10/10/2005 • • • Steven R. Pannone: if No.CE 8149 e ,o _•..TOI?' i \Q� bedrooms, with the following stipulations: • Additional Comments atouturritoi "ter?? J • ON-SITE • • WATER AND ; • WASTFWATFR ; PROGRAM • Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: / 0 — .2_ 7- or Expiration Date: Reissue Date: (Rev 11/99) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anehorage.ak. us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 6 Bk 3 Broadwater Heights Parcel I.D.: 050-081-39 A. WELL DATA Well type E If A, B, or C provide PWSID * _ Well Log y Date completed 61711978 Sanitary seal Y Wires properly protected 11 Total depth 240 ft Cased to 19 ft Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION 31412005 Date of test 61711978 Static water level 120 Well production 6.0 ft g.p.m WATER SAM LE RESULTS: GoldwynJO co les/100 ml Nitrate 5.66 mg/ Date of sample: 3/4/2005 Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Greer Steel 77 ft 3.0 g.p.m /1/.Vr o Other bacteria OO colonies/100 mi Laura Pannone Arsenic N/A mgll Date installed 412111980 Tank size 1250 gal Number of Compartments;: Cleanouts y Fo nda on dea"nppu�tt Depression over tank LIQ High water alarm /A /©..-1GOSuzj Date of pumping Pumper JR's Pumntna C. ABSORPTION FIELD DATA Date installed 4/21/1980 Soil rating (g.p.d./f9 or ft2/bdmt)144Q System type Deep Trench Length flit Width 1_ ft Total depth 12,9 ft Effective absorption area 1,112,t2 Gravel below pipe j_ ft Monitoring tube Y Depression over field I_ Date of adequacy test 3/4/2005 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test Q in Water added)):Q¢ gal. Elapsed Time: 4Q min Final fluid depth Q in Any rejuvenation treatment (past 12 mo.) (Y/N & type) No (Rev. 11199) New depthz in. Absorption rate >e OS+ g.p.d. If yes, give date D. UFT STATION Date installed Size in gallons 'Pump on level at _ in"Pump off level at _ in Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Manhole/Access High water alarm level at _ in Meets alarm & circuit requirements? Absorption field on lot 100+ On adjacent lots 100+ Public sewer main NIA Public sewer manhole/cleanout _NIA Sewer /septic service line 30+ Holding tank NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10' Water main 100+ Property line a Absorption field 10' Water service line 30+ Surface water 100+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 0+ Building foundation 10+ Water main 100+ Water Service line 30+ Surface water 100+ Driveway. parking/vehicle storage 0 Curtain drain None Observed Wells on adjacent lots 100+ F. COMMENTS There has been no recorded evidence of problems wlthis system due to freezing] begliuse!"the system is under the driveway. It has 3.9 feet of cover. errs Ie,Z • G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone, P.E. Date / a !l0les 544 '.‘>,....;..••••••••....(44\%:5'•• ;r4. •• :.»».».A..4 • • j n,Steven R f Ponnc^eiRis •jam^., h� 87'-1 :8. SSSSSSSSSS HAA Fee $ Date of Payment Receipt Number (Rev. 11/99) Waiver Fee $ Date of Payment Receipt Number 2-10-05i 3S58PM; SGS GS Refit :heat Name "reject Nene/ .Beat Sample ID 4atrix 1051201001 Pannone Eng. Srv. Pannone Broadwater Fits, L6,133 Drinking Water ample Remarks: 1937 5813301 • 2/ 4 All Date/Times ars Alaska Standard Time Printed Date/Time 03110/2005 9:59 CollectedDate/Time 03/032005 15:30 Received Date/Ilme 03/04/2005 16:20 Technical Director ����,,,,Stteph C. Ede Released F4%% Miele= Rerolu Tatars Department Nltrete-N tiorobi Total Col Laboratory 336 PQL WTIMethod ContainerID �um. e 113 DDate Deno a Init 0.100 mg/L EPA300.0 B (<-10) 03/0.1.'05 Xht vvi° ptrzsY (0//3/0-S' coL'IOOmL 5M2092220 A (0.1) 03/04105 DCC :0-17-05:12:08 ; SG t SOS/C'&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Collform Bacteria REAO PISTRUCRONS ON REVERSE SIM IOU COLLECTING' SAMPLE MUST BE COMPLETED BY WATER SUPPLIER Q PUEUC MUTER EYREM PDS l„FRNATE TER SYSTEM SAMPLE COLLECTION: Wit a..r. b to Yet send netts ;907 631 6301 * 2/ 2 200 W. POTTER DRIVE ANCHORAGE. ALASKA 92518 Tal: 907-582.2343 Fax: 907-EE15301 Lab ReINo. t 1056831 *{` IHML.II . note Mr.apa.N..Zwyw.. /'-r.my... SLPc S -flew iDANFOCIKIP c2rN6- 9z`6 ti ila Zr 297t%T N.a,7- f2^ SAMPLE TYPE: 0 Routh* 0 Repeat Sampta �,A (rater to lob no. p Spool Purpow float ha! ! 0 0 AM ante LewVant [6133' 122 t)Anta-W-� Ceaeaon S TY . N lX1 U [/ Transported to tab a r )(Sarre as celiac -tor Otter: em.r grim 0 Treated Water 7' Untreated Wator fbV wary TO BE COMPLETED BY LABORATORY Sart ROCIIISIrEtt Date: ID -t 1 -as Ttm.: 1 •jL • Temp: DaOvey Maticd: C. Rece;vac By. c:C ►nom num Con ontE ❑ SatN(.erar 70 Noun dxr, RaaaNa may W ruI.ble 0delburW 0 RUSH SAMPLE Phone q: Fax St BactertolooIcatt(pterMjfnIij ord• Melye4 on= /G//T/I C /730 mom: Matytly( Methods Reportad By: ratan/ Mir MMO.MUC (P/A) MMMU0 ramJ Tow Cowomr. t Cad: It b ACEC R[sULTla ANC r�JUN N 0- Gals nne: MEMBRANE BLUR REEUL Vaderedon: LBO Data/Tlma: /pp 9/O Olin Count WbMnW Coat Sant b Arent Phoned Q Fatal = Dat.Rlme S $ Sa isfactory Unsatisfactory IIC .7..aw.. O Cara ea spat....* 11'14--. tWewlnasOBAVILGroup0a9wubI000UMENTIFORMS''zpprovediCab Form 121703xls Form E FW- 0053 12/17/03 QcV� o3o3! Municipality of Anchorage Development Services Department Building Safety Division ••.On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL G( FOR A SINGLE FAMILY DWELLING Parcel I.D. ()56 aog 1- act 1. GENERAL INFORMATION I Complete legal description 1--o tL (o iSK 3 15 &» fr ,_ +145 5 • 0 HAA ft h 5DQ 9() Expiration Date: &o -16 - n ,4— Location (site address or directions) (( V i. Current Property owner(s) NlIC_k&o. CLatt e(SDayphone &T4 -R9710 Mailing address Lending agency Mailing address 6004171 Real Estate Agent f1i 4 31Q (c3} yphone C96".9133Mailing Address Unless otherwlse requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System t ao(o (0 -SKI i� Dr. Eci3kRiverN4L19Q577 Day phone Mosul &utak f Da 05(25 01 ,r .100, 46ic/,oragp�� %953 Well 0 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered the State of Alaska. properties Certificates f Health fo-sftrequiredroval are the transfer titl(ecep between spouses) on erved bya single Authority e wastewater disposal and/or supply system. DSD also Issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results Tess than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. (Rev. I1NO) 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation based on procedures outlined In the Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system Is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on- site water supply and/or wastewater disposal system Is in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Firm Pannone Enci. Svc. Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone. P.E. Engineers Comments: In conducting an adequacy tcst, 1 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 end septic systems depend on the local soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no Kidd defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the ADEC or The content of this report is for the sole benefit of the owner listed above. My reliance upon Phone 272-8218 Date or use of this report by any other person or party is not authorized nor will it confer any legal nght whatsoever. 6. DSD SIGNATURES r. Approved for L- bedrooms. Disapproved. Conditional approval for 31131os- •S• � SC ............ ti S:01 •if {z • • 'Steven R. onnone' 7Gr''s, ♦ No. CE 8149 ♦ O.''•l . ♦1. Jj Si, �:: . bedrooms, with the following stipulations: • Not.6-4bevtlejr_foY•this property meets eTisting State and Municipal Codes. There are nitrates present It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 5.56 m01. EPA maximum concentration Is 10.0 mg/l. More information on nitrates is available from the On -Site Services Program, at 343-7904. By: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other / ((/,r/0,4-4* Original Certificate Date: 3-fFo - 0 6 -- Expiration Date: Reissue Date: (n.v. UM) • • • • • ar Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.a.anchorage.ak.us (907) 343-7904 / HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: !a I 67 & 3 ((Q d(Lt`Ie r�j fl-Parcell.D.: 0 -C °' °$/-39 A. WELL DATA Well type r If A, B, or C provide PWSID # Date completed 6%7/73' Sanitary seal y Total depth 210 ft Cased to /17 ft FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: .: ft g.p.m Coliform "6).- colonies/100 ml Nitrate .55t_ mg/1 Date of sample: 3/yl0 5 Collected by. tou rck Arsenic mgill B. SEPTIC/HOLDING TANK DATA ?barite_ Tank Type/Material Greer- / e Date installed y a(/50 Tank size, /1 c2 Jo gal Number of'Compartments Cleanouts I Foundation cleanout y �/D�epressioon over tank /C High water alarm /1.) 19 Date of pumping /o/// /O y -R Pumper �! , POtt (I/ 9 C. ABSORPTION FIELD DATA Date installed y/2//0 Soil rating (g.p.d./ft2 or ft2/bdrm) l} System type Length / pft width 3 ft Gravel below pipe Total depth ___ / ft Effective absorption area Monitors tube N / c-� n9 � Depression over field Date of adequacy test a/tjf C Results (Pass/Fail) �aS5 For if bedrooms Fluid depth in absorption field before test -5-7n Water added 6t &gal. New depth 2 in. Elapsed Time: '10 min Final fluid depth`G min Absorption rate >=6CD t Any rejuvenation treatment (past 12 mo.) (Y/N & type) /(/d If yes, give date (Rev. 11/99) Well Log / Wires properly protected I Casing height (above ground) 1°2 71" in. AT INSPECTION 3/9/0 5- 7 7 77 ft 3, U g.p.m Other bacteria V — colonies/100 ml 9ft D. LIFT STATION Date installed Size a allons Manhole/Access "Pump on" level at _ In"Pump ` - el : _ in High water alarm level at _ in Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift-station on lot Inn On adjacent lots (00 1- Absorption field on lot j b Of" On adjacent lots / 00 IL Public sewer main 13PIl Sewer /septic service line 30 I Public sewer manhole/d/eanout Holding tank /Ulf+ SEPARATION DISTANCES FROM SEPTIC/HOG TANK ON LOT TO: r Building foundation /0 Water main A %+ Property line 1()± Absorption field /0 / I b 04" Water service line 1/450-f- Surface water 00 f Drainage (Q() I Wells on adjacent lots 10 0 1 -- SEPARATION SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 f Building foundation /0 f' Water main /to t• Water Service line .3 0' Su ce water 10 t Driveway, iveway. parlring/vehide storage —CS— Curtain — Curtain drain / v6f a,), C'e on adjacent lots /1061 F F. COMMENTS ,1102a OAS1324a.N .vo Recti r to £vVbANcia err- peoetants `"�Tk�`� s 1's rt t"—DvQ •• a��-✓r+ -C3 a town `-cNts sYs .,4 tt V WIZ>O--- • G. ENGINEER'S CERTIFICATION e • at and re review of Mthat I unicipal Rrecords that the abovedned through field s : a1 $ ; --$1 & ' ••i are In conformance with MOA HAA guidelines In effect on i ������ja �� this date. ` R. Pannone; t Engineer's Printed Name Steven R. Pannone. P.E. .s . Steven ✓n _ No. Date 3/13/or HAA Fee $ Date of Payment Receipt Number (Rev. 11/88) 2iw .U0 3//& os Waiver Fee $ Date of Payment Receipt Number 3 -t0 -Olt 3,SOPM1 4;S Reta :heat Name 'reject Nament ;tient Sample ID 4atrix ample Remarks: 1051201001 Pannone Eng. Srv. Pannone Broadwater Hts, L6,B3 Drinking Water ;937 611S301 „ 2i 4 All Dates/Timu are Alaska Standard Time Printed Date/Time 03/102005 9:59 Collected Date/rime 03/042005 15:30 Received Date/Time 03/04/2005 16:20 Technical Director Steph C. Ede Rcleased rcad 'ermrcta Results Tatars Dapartmant Nttrate-N fiorobiology Laboratory Total Coliform 5.56 0 PQL Unite Method Container ID Allowable Prcp Aaeiyris Limits Date Date Inst 0.100 mg/L EPA 300.0 B (<-10) 03/04/05 XM coL700mL SM200 22B A (<-1) 03/04,05 DKC • 1- • : fe -4 • 4 , >1;e: • 'r•..)rkki•eti.2.;•;\ *31' ;. r; 144 • -".• 'V I je- Vrj.,. • A it-; r : " r • , • • : •:4'11•0 . Et • ga-Ass4 Aid r .1 • • 1.4.42 -iii-•/, et:•.(,.- .;•••"•,.ifTr-.: : •• . • -1.-• • '1 • tk f 3 • .• ;,47-p,(R144,:lifd 0.5:77.4 c. I lirtb$F...;-',..PoTIVY-2Shtl /lave 7.2snrynyccl11e , 4,77.4.114a.i 1•17.1: FA-. • kr , .th 4feigCri6;cri;r;i3.t4fiT‘a 774 3e:0'46G-i.e.? :471-ild.atitZi.:S4Q4:47Q A;Mic'1:;.:5714.141:;" .imprcivEnsein,Vpituatect‘the6n.arcwithni?,the lAoperty4 line* ion& ;flo'inatzpv.e-ti eficrna ch abn ;She >proPerty,. Jyng adjacent :th?et,p,'pnt-,.np;ii.tpproyei-Pents tpn itprop ety 'ilecantedjiapnrtherettrencrbachi on ;the Prehnses.'mv, question thn•tht;ec*re..eoljO4cIvia51;-:,transrrAission:' Loos or other'vtislge easerpeplcon..talitprojaertyvexcep .:is.windidn;ect..110ebb.;.;. ., •.. . :t• Itita4A1.31ea I • 414 • 1..?• •• • 4." za. • 7,1;icalw—'4:4107;Loterftte.77 ' ' s‘t: .121,1,..itc=:•,:L;‘,Rbl§naL tit 4C.::,;17",e7110'ititeoect '14ixi'Suryeyoe'tio MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 091r.-1 OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date October 29� 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 6; Block 3; Broadwater Heights Subdivision Location (address or directions) Tsai Chambers 694-2976 (b) Applicant Name Telephone: Home Business Applicant Address 12010 West Skyline Drive, Eagle River, Alaska 99577 (c) Applicant is (check one): Lending Institution 0 ; Owner/builder qi ; Buyer ❑ ; Other 0 (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telep (f) (the HAA to the following address: S & S Engineering SRB 196X Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family 50 Multi -Family 0 Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well ® Community 0 Public 0 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 6Cl Public 0 Community 0 Holding Tank ,0 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 PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 SR B 196X Address EAGLE RIVER, AK 99577 Date 6. DHEP APPROVAL Approved for Approved bedrooms by ,,:; W..... . ,R. 11404 $0�� I�'�aiDM Date tC 1� 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) A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV7 1986 RECEIVED Legal cription: Z..07 l cxi . 3 4-A - H75. 547 Well Classification If A, B, C, D.E.C. Approved (Y/N) Date Completed A,-- ? 98 Cased tol4'8; Italetig9 Depth of Grouting Static Water Level 16` Pump Set At 0. k. Well Log Present 6/N) Total Depth ?-410 ! Yield 5 }M Casing Height Above Ground en Sanitary Seal on Casing (0/N) Electrical Wiring in Conduit &N) Depression Around Wellhead (V/ Separation Distances from Well: To Septic/Holding Tank on Lot !dCd ; On Adjoining Lots laa To Nearest Edge of Absorption Field on Lot /Co! ; On Adjoining Lots (OO 41 - To Nearest Public Sewer Line AVIA To Nearest Public Sewer Cleanout/Manhole N/ a- To Nearest Sewer Service Line on Lot /6/4 Water Sample Collected by M .0-A -- MA) PIL ; Date see. sieve, ,✓' ::1" Water Sample Test Results I4 ( c't° 7 - S 1, ?1r P-011- c. "To 2. ^' PiZdJutc l N 8yr_d 5 Comments 11t1c`c. Y�c�-7> /tea.? St�,toyvay I��c<... c7P O. S & P— . TE ' ? c IA -'J F-0 to *Pia' . 0(4. ///5/8 6 B. SEPTIC/HOLDING TANK DATA Date Installed 4!'7,!--F30 Size te-S Standpipes (ON) Air -tight Caps e/N) Depression over Tank (Y() Date Last Pumped Pumping/Maintenance Contract on File (Y/N) 14( A ; for `�— Holding Tank High -Water Alarm (Y/N) - Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well irx) r To Building Foundation To Property Line !O/� To Disposal Field S To Water Main/Service Line (v ' To Stream, Pond, Lake, or Major Drainage Course Pf /i Comments No. of Compartments Foundation Cleanout (Y(' //�S/ Page 1 of 2 72-026(11/84) '), -T C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2YI Type of System Design J( -d Uc -f Date Installed 174 -al -et), Length of Field Width of Field 3 Depth of Field Gravel Bed Thickness Square Feet of Absorption Area /(71, s 9' Standpipes Present 6/N) Depression over Field (Y/) Date of Last Adequacy Test / /— S 13 6 Results of Last Adequacy Test :Sc -7 is Pit -c z»e y Separation Distance from Absorption Field: To Water -Supply Well loop To Building Foundation Lot N/A To Water Main/Service Line /orf To Property Line /01-4 To Existing or Abandoned System on 3v (4 ; On Adjoining Lots To Cutbank (if present) /4/19 To Stream/Pond/Lake/or Major Drainage Course M/P To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) 1 "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for 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 MOAnd HAA guidelines in effect on the date of this inspection. signed S & S ENGINEERING Date /l CompanSR B 196X EAGLE RIVER, AK 99577 MOA No Receipt No. 26oi D 0 /)- Date of Payment l/77/".44 Amount: $ 6/ i`� Page 2 of 2 72-026 (11/84) 6/rt •k*****.•1 Robert A. Sheik No. 14574 *+, 1 PrOFESS' ITo r mov4R.tgr :,res Time ` Time e Date Date Date -Ali. .- J2Qr—ii Inspector Inspector Inspector Comments Conditional Approval 0_6. .' 3 -9- 5 1.- Date Sewer Installed Permit No, Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well to Tank Well Log Received APPLICANT FILLS OUT LOWER HALF ONLY Property Owner Alaska U.S.A. Federal CreditUn i Ofl Mailing Address Pouch 6613 Anchorage AK 99501 Phone Buyer Address Lending Institution Address Phone Realty Co. & Agent Address Phone Legal DescriptionLOt 6 131DCk 3 Broady/Ste? Heights Sub Street Location Type of Residence re Single Family CT Multiple Family No. Other of Bedrooms Wate[_Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June O Community 1975. For wells drilled prior to that date, give well depth (attach log if O Public Utility available.) Sewage Disposal ES Individual Year individual '_O Public Utility When Connected ❑ Holding Tank Installed: to Public Utility. NOTE THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 4„1-1-tvi c(ei"-r- ' * 7, ,,,,,.._ EXCAVATION ROBERT A. SHAFER WORK CIVIL ENGINEER 694-2979 March 9, 1982 Alaska U.S.A. Federal Credit Union ATTENTION: Fred Smith Pouch 6613 Anchorage, Alaska 99501 Dear Mr. Smith, Reference: Lot 6; Block 3; Broadwater Heights Subdivision An on-site inspection of the sewer and well was performed on March 4, 1982. All clean -outs for the septic system were visible and exceeded required horizonal distances from the well. Each clean-out had been properly sealed as required. The well casing was adequately sealed, however, the well wires required placing in conduit to meet Municipal codes. A water sample was taken and water analysis performed by Chemical and Geological Laboratories of Alaska. The results indicated a satisfactory analysis of the total coliform bacteria. A re -inspection of the well casing was performed on March 8, 1982 and the well wires had been placed in conduit as required. The grade around the well casing adequately sloped away from the well. It can be concluded that the waste water disposal system and the well currently meet Municipal codes. If we may be of further service, please do not hesitate to call. Sin e •ely, i vrvv '— ERT A. u SHA F , P.E. S/ss dc: Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA