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BROADWATER HEIGHTS BLK 3 LT 7
Broadwater Heights Lot 7 Block 3 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141000 Tax Code Number: 05013166000 Work Type: Septic Upgrade Permit Effective Dates: January 03, 2014 to January 03, 2015 Design Engineer: ANDERSON ENGINEERING Subdivision: BROADWATER HEIGHTS Site Legal Address: BROADWATER HEIGHTS BLK 3 LT 7 G:0253 Owner/Address: HENREID DEREK T & DEBRA F 11944 SKYLINE DRIVE EAGLE RIVER AK 995775096 Site Mailing Address: 11944W SKYLINE DR, Eagle River This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 36984 Total Bedrooms: 3 N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: PRIOR TO CONSTRUCTION: Additional soils testing shall be completed to verify the permitted design. If design revisions are required, an approved change order shall be aquired prior to construction. Soil test results shall be submitted with the final inspection report. Received Issued By: Date:,'='��a Date: t Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 htto://www.mu ni.om/Onsite Development Services Division On -Site Water and Wastewater Program Ment S, �o F Y n H ry Department **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP141003 COSA#: Permit#:OSPI41000 PID#: 060-131-66 Legal Description: Broadwater Heights, Block 3. Lot 7 Engineer: Anderson Engineering Applicant: Derek & Debra Henreid Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the 25% or greater slope has been approved. The approved separation distance is 29.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ................................................... 0........................... Waiver is Granted: x Waiver is not Gr ted: Date: Approved N /Name of Reviewer .............................................1................................ Rec#: 00443G Amount: $216.00 Date Paid: 1/3/2014 **** VARIANCEIWAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel LID, D. 050-131-66 Property owner(s) Derek and Debra Henreid Day phone Mailing address 11944 Skyline Drive Eagle River, AK 99577 Site address Same Legal description (Sub'd., Block & Lot) Broadwater Heights, Block 3, Lot 7 Legal description (Township, Range & Section) 36,984 Three (3) Lot Size Sq. Ft. Number of Bedrooms APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade ❑ Renewal ❑ TYPE OF DWELLING: Single Family (SF) ❑ (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) 1 THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized Permit/Rush Fees: - 54A -V l -y0 +� Date of Payment: Receipt Number: 005(1 Permit No. 05p/q/000 Permit App_9-1-12.doc Fees: Date of Payment: Receipt Number: OU L 'Y-> C" Waiver No. C)-Ol q =3 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX January 1, 2014 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 7, Block 3, Broadwater Heights Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption bed on Lot 7, Block 3, Broadwater Heights Subdivision has failed and must be replaced before a Certificate of On Site System Approval can be issued for the property. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the three-bedroom home on. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic system. The existing septic tank will be decommissioned in accordance with Municipal Code. The existing absorption bed will be left intact and connected with a flow diverter valve for possible future use. Also identified on the plans are the locations of the existing well on this and adjacent lots and adjacent septic systems. No conflicts exist between the proposed septic system and the wells on this or adjacent lots. Protective radii are shown to the adjacent wells. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole placed on the lot in the past indicated Well Graded Gravel (GW). No groundwater was encountered but bedrock was located at 10' below the surface. The percolation rate in the soil is expected to be less than 5 minutes per inch. We have designed the new trenches with an application rate of 1.2 gallons per day per square foot. We are proposing to place 2-27' long by 5' wide absorption trenches with a 2' effective depth. The total depth of the system will be 4' below the existing ground surface. A flow splitter valve will be placed to insure even flow to each trench. A test hole will be placed prior to construction to verify the suitability of the accepting soils in the proposed area. A change order will be requested if conditions found vary from those anticipated. Lot 7, Block 3, Broadwater Heights January 1, 2014 Page Two The ground surface on the lot slopes from the northeast to the southwest in the area of the absorption trenches. The trenches will be placed parallel to the contours of the slope as shown on the attached drawings. A minimum of 100' will be maintained between all components of the septic system and the proposed well and from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Since Michael E. Anderson, P.E. Attachments MICHAEL E ANDERSON N0. CE -4381 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX January 2, 2014 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 7, Block 3, Broadwater Heights Subdivision Absorption Trench to Slope Waiver Dear Onsite Services Engineer: Lot 7, Block 3, Broadwater Heights Subdivision has limited area for construction of a septic system due to a steep slopes and the presence of bedrock. The The existing failed absorption bed was placed at the flattest area of the lot. We have located an acceptable area but the lower absorption trench is only 29' from a break in grade greater than 25%. We are therefore applying for a waiver allowing placement of the absorption trench at this location. The soil anticipated in the test holes is clean well graded sand (SM/SW) which is very good for the absorption of septic effluent. No migration of effluent is expected to occur to the slope. The attached cross section describes the conditions at the site. We hereby request a waiver be issued allowing the new absorption trench system to be placed as shown. Sincerely, .fi,1' jCE Ian, Michael E. Anderson, P.E. Attachment 15 BROADWATER \HEIGHTS SUBDIVISION LOT 7, BLOCK3 5A36,984 SF �\ \ Existing \ Well Parking/Driveway \ 1 1 ABedroom 01 , %1 l Existing N I Well O ® 1 _p Existing 18' x 28' cS Absorption Bed. I� 1 Connect with Flow 1 Diverter Valve I N 1 W \ N NOTE:\\ Place Tesit Hole Prior to Constructign to Verify Soil Conditions.) I i 1 i / / LEGEND: / TH — Test Hole CO — Clean Out MT — Monitor Tube FSV — Flow Splitter SV — Septic Vent FDV — Flow Diverter Valve Valve 1,000 Gallon Septic Tank FDV ' 2-27' Long x 5' FSV Wide x 2' Effective \ Depth Absorption �q MT Trenches. Total \ 7rop. CO Depth 4'. \ rH Sm MT / CO 80 60 NOTE: /,4 ^'w Decommission Existing Septic Tank 9, 59 in Accordance With Municipal Code. S�`b5 Place New 1,000 Gallon Septic 758 Q Tank. >54 mj 8 ., VACANT J•P��'OF A..i .• 49th _.. I I I I I i SITE PLAN SCALE 1" = 40' MICHAEL E. ANDERSON 'J LOT 7, BLOCK 3, BROADWATER HEIGHTS SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home 5' Wide Trench System Perc. Rate: <5 Min./Inch 1,000 Gallon Septic Tank Application Rate: 1.2 GPD/SF 2' Drainfield Rock 3 Bedrooms * 150 GPD/Bedroom = 450 SF Absorption Area 450 SF/1.2 GPD/SF/5 SF (Width) *.70 (Red. Factor)= 52.5 LF Trench Length THEREFORE: Construct 2-27' Long x 5' Wide x 2' Effective Depth Absorption Trenches Flow Line Elevation in Trenches to be 2' Below Original Ground Surface. Total Depth to be 4' Below Existing Ground, Provide 3' Cover Over Absorption Trenches and 4' Cover Over Septic Tank. Place Flow Diverter Valve and Tie in Existing Absorption Bed. 1'6" 6 1 1 ,0 11% 5' Geotextile Fabric 4" Perforated PVC (Holes Down) Drainfield Rock TYPICAL 5' WIDE TRENCH SECTION (NO SCALE) 14 NOTE: Grade Area Over Trench to Drain Away. t Minimum 6' Separation From Bedrock. �•,•••: Minimum 4' Separation From Groundwater. Pl Minimum 100' Separation From Private Wells in the Area. , m' Minimum 100' Separation From Surface Water or Streams. 001 , MICHAEL E. ANDERSON No. CE4381 •,...• 111 m N � f o 03 - � : v. 6,11 �w w• I � 00 � N I a / ¢ N LO /�: iw u N �''/ mo'.: / �S1 N :� Io ;w \: �YI 111 ¢ Z • ��'., N � v e Ln rrrr.���� O z Ln 0 Vn Lr) > 0 Ln m cn z U LLJ � Ln C) 0 � w�w =mcn O Q LLJ LLJ N ~ a Q o W 0 0 cn m In O N O In O In c0 Co L LC) In O0 r r r r r r m N � I � � N I a o � �S1 N N PERFORMED F Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST <5 0 Ti= L LEGAL DESCRIPTION:/Li D6VrrUV-111"I I cli pp 1ie All C -H7-5 i eeclsie-� 2 C> r.9 3 4 y a ,W e 7 P` tl (y .J 9 :.D on aanen •eii n•• .nR+� "I"rt A, Shuier �w No. 1457-E DATE PERFORMED:/ 0 Township, Rance, Section: <S ( • T- 14 AJ ft? I tN•• S N SLOPE W� WAS GROUND WATER Q 10 - 'ReV ENCOUNTERED? 11 IF YES, AT WHAT �^ 12 DEPTH? 13 Depth to Water Atter Monitoring? —� Date: 14- 15- is - 17 4151617 18- 19 iL L 0 Reading Data Gross Time Net Time Depth to Water Net Drop 20 ^� PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER T�ST RLP BETWEEN TAT AND T_FT� COMMENTS PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN :r.,; IVERa / g ACCORDANCE' WITH ALL AIWOMMINICIPAL GUIDELI EFFECT ON THIS GATE. DATE: l� 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE 72-013 / w 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 P;d:UEW ED UPGRADE MAILING ADDRESS jcy lye �h/ ,C>r. '�_ 4, LEGAL DESCRIPTION p G 2? 7< 7 R Ik -3 L� r'o a T1 41 1v X7 ! 4v .I'' r LOCATION NO. OF BEDROOMS ...--- Well Absorption area Dwelling PERMIT NO. U DISTANCE TO: /V • 7'1 `. /vv 7' / Alo7' i •� .� v 417 _Y a zQ Manufacturer �T-re.� Material No. of compartments W I.- r v! Liq. cacity in gallons 7Qt) .. IF HOMEMADE: Inside length —� Width Liquid depth Y DISTANCE TO: Well Dwelling PERMIT NO. JAZ = Z FQ- Manufacturer Material Liquid capacity in gallons J = DISTANCE TO: Well /Uv 7'- Foundation Nearest lot lIine i PERMIT NO. 7� " LL Z No. of lines Length of each line Total length of lines -Tri width Distance between lines W Al 4 � / �.._ i es 6 i HTop tile to finish Material beneath tile Total of grade / effective abs rption area D l++.hs� Gu ✓fir inches�r(� Length Width Depth PERMIT NO. W 0 Q F Type of crib Crib diameter Crib depth Total effective absorption area aFL W W Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 400SOI L TEST RATING 5— 0/,Lf INSTALLER REMARKS J -4 ii �{ i L+�f /h >4 le,e /✓9Y /n e C f r /Y _I % lee, c,4 I h7 ej b G1 ai 1 M r -4tF Wt LTi ® ��, t f"1 E+0Wr�&H �O loui CE-6736 ,' •�'�< �/ A Ali, 0o { `h APPROVED DATE LEGAL fv l/ yam /Ps- 72-013 (Rev. 3/78) PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: ' 1: Fo"011 L.. 1: J- C3 FO ��VA �'_] FZ 14 C3 E: � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 I "T -'EE E3 E" hJ EE FT 84 ���� M '.1 -1-* 850679 10/16/85 ^ DEAN CONSTRUCTION SR BOX 9352 WILD MTN. DRIVE EAGLE RIVER, AK 99577 6954-9117 LEGAL DESCRIP: SUBDIVISION: BROADWATER HTG, LOT: 7 BLOCK: 3 SECTION: 1 TOWNSHIP: 14N RANGE: 1W ' LOT SIZE: 1A (SQ.FT. OR ACRES) MAX BEDROOMS: 3 Listed below are the options available to you in designing your septic system. Choose the option that best [its your site. _..... .... .... ... ** F-CEz IL 11 ` DEPTH TO PIPE BOTTOM (FT.) 3"5 GRAVEL DEPTH (FT.) 0.5 ~ TOTAL DEPTH (FT.) � 4.0 GRAVEL WIDTH (FT.) 14.0 GRAVEL LENGTH (FT.) 28.0 GRAVEL VOLUME (CU.YDS.) 14.6 TANK SIZE (GALS) 1,000.04*� SOIL RATING (SQ.FT./BR) 85~`^ DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS " I certify that: I. I am familiar with the requirem�lts for on-site sewers and wells as t , )se forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I hill 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 anyenlargement 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 WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED DATE: t -or . .... . _..... .... ��_�������_ APPLICANT ISSUED BY DATE: -���- :ZZ OF A or 49 e Municipality of Anchorage noA� o�.. •• • DEPARTMENT OF HEALTH & HUMAN SERVICES „R , r. 825 825 "L" Street, A Anchorage, Alaska 99502-0650 g BaFrsrP A. .'.rtts«iAir ^ �� SOILS LOG - PERCOLATION TEST "� "gyp 1r -t: •`fiCp__' yH low PERFORMED FOR: ����• r/ `� O / '-- `� DATE PERFORMED: LEGAL DESCRIPTION: 8j?t)PtD IA{ PTownship, Range, Section: 1 I q A) • 2 �E CH SLOPE ITE PLAN (FEPI�F) ¢ << D.( --It < 1 rig eec -V/ G -ry s -a H C �, y 2 C> Ir` q cc r0 t 3 ,0` 6 f IV 4 v a N J . 6 7 d (y .J 8 v t 9 y e. 10WAS GROUND WATER J ✓• V C', ENCOUNTERED? ,v -" f 11 s IF YES, AT WHAT L 12 DEPTH?—� O P Depth to Water After _ 13 Monitoring? - Date: 14 15- 16 17 18- 19 Pt �,����.■■■■ ■■■■■■■■■■ Reading Date Gross Net Depth to Net Time Time Water Drop 20 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER T ST Rf BETWEEN FT AND �� FT COMMENTS �e Sem a C cam/ s -i b lM k/GKC� U' —A" ac, &i314e JC22 ! 9te alOY2 2� PERFORMED BY -.CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE' WITH ALL 10WONICIPAL GUIDELI EFFECT ON THIS DATE. DATE: _� /Z.,ZgLf- 72-008 (Rev. 4/85) Reading Date Gross Net Depth to Net Time Time Water Drop 20 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER T ST Rf BETWEEN FT AND �� FT COMMENTS �e Sem a C cam/ s -i b lM k/GKC� U' —A" ac, &i314e JC22 ! 9te alOY2 2� PERFORMED BY -.CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE' WITH ALL 10WONICIPAL GUIDELI EFFECT ON THIS DATE. DATE: _� /Z.,ZgLf- 72-008 (Rev. 4/85) wurEn WELL RECORD STATE OF ALASKA DEPARTMENT 0FNATURAL e[SOVRE8 Division of Gov|ogixu| a Geophysical Surveys omx"n po,=n No. uooxrmw or WELL (r/vo*^ no~nmm o/m", /,, m o,/oJ A.D. L. No. Borough Subdivision Lot Block -LbJ 1/4qtrs. Section No. Township NCD � Range Meridian 17-11 DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL.' J Street Address and Area of Well Location 2. WELL LOG Feet Bel ow Surface Material Type Top Bottom 4. WELL DEPTH: (final) 5. DATE OF COMPLETION t 6. Coble tool Rotary Driven Dug Auger C] Jetted E] Bored E3 Other: 7. USE: Domestic Public Supply [] Industry irrigation [3 Recharge E] commerical Test Well [] Other; 4 8. CASING: R Threaded C3 Welded diam. in. to ft. Depth Weight diam. in. to ft. Depth Stickup ft. 9. FINISH OF WELL: Mk Type: Dlametert Slot/Mesh Size: Length Set between ft. and ft. Backfilling Grove[ pack 10, STATIC WATER LEVEL:_ ft. E] Above or 0 Below land surface Date Equipment used : 11 . PUMPING LEVEL below land surface and YIELD hrs. pumping UNICIPALITY OF ANCHORAGE 12. GROUTING Well Grouted: Yes Q No DEPT. OF HEALTH & Material: Neat Cement Other: 13, Pump: (if available) HP JUL I R 1988 Length of Drop Pipe ft. capacity 9 -P.M. [3 Subm. Jet E] Centrifical Other FCF LVFD 14. REMARKS: 16. WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; Registered Business Name Contract License Number Signed Authorized Representatli? Form 02-WWR (11/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer u GE BL ar • Municipality of Anchorage ° On -Site Water and Wastewater Program, (907) 343-790411 . t y FFR 6 2014: Certificate of On -Site Systems Approval' Parcel I.D. 050-131-66 Expiration Date: �s %J t 1. GENERAL INFORMATION Complete legal description Broadwater Heights, Block 3, Lot 7 Location (site address) 11944 W. Skyline Drive Eagle River, AK 99577 Current Property owner(s) Derek & Debra Henreid Day phone Mailing address 11944 W. Skyline Drive Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: F-1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well El Community ❑ Public �Y ��ater SyJtem ❑ Public Sewer ❑ WaiverNariance request for: Distance: l jReceived by: � , 1� Date: 2 Zt I i i COSA to be released to the engine r, unless otherwise requested by the engineer. COSA Fee $ fa(o-"' Date of Payment � jf2 ./bpi Receipt Number Qga,� COSA# 01501(11 ? 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. Name of Firm Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms 522-7773 Date 2/5/2014 bedrooms, with the following Original Certificate TER AND Y, -)2`F% P/0N.t!. I r 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 f Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r - , - If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Broadwater Heights, Block 3, Lot 7 Parcel ID: 050-131-66 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 5/b/b5 Total depth 450' ft Date of test Sanitary seal (Y/N) Y Cased to 23 ft. FROM WELL LOG 5/6/85 Static water level 60 Well production 2 WATER SAMPLE RESULTS: a g.p.m. Coliform 0 colonies/100 mL Nitrate 8.4'4 mg/L Arsenic N/D ug/L Date of sample: 12/12/13 B. SEPTIC/HOLDING TANK DATA Wires properly protected (Y/N) Y Casing height (above ground) >12 in. AT INSPECTION 12/16/13 39.8 ft. 4.1 9 - p.m - Collected by: Anderson Engrg. Tank Type/Material Septic/Steel Date installed 10/16/85 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Dateofpumping 1/31/14 Pumper Royal Flush 7 C. ABSORPTION FIELD DATA Date installed 10/16/85 Soil rating (g.p.d./ft2 or ft2/bdrm) 85 SF/BDRM System type Bed Length 27 ft. Width 18 ft. Gravel below pipe .5 ft. Total depth 4.3 ft. Eff. absorption area 486 ft2 Monitoring tube Y Depression over field N Date of adequacy test 1 /5/14 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 1 in. Water added 500 gal. New depth 6 in. Elapsed Time: 1,440 min. Final fluid depth 1.5 in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off level at Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Manhole/Access (YIN) in. High water alarm level at _ Meets alarm & circuit requirements? Septic tank/lift station on lot >100, On adjacent lots >100, Absorption field on lot >100, On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 5 Holding tank N/A Animal containment areas Manure/animal excrete storage areas >100, SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 2/5/2014 COSA brown sheet 10-10-12.doc Absorption field >5' Surface water >100, Water main N/A Driveway, parking/vehicle storage ®+ .....ALS®eb �I — m .`f oAUCNAEt E. ANDER.."ON x_10 i ��. • CE -4381 in. Municipality of Anchorage Community Development Department Development Services Division s 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 4 141028 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 7 of Broadwater Heights subdivision. This inspection revealed a_ nitrate -concentration of 8.44 milligrams per liter (mg/L) was reported -far, 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. Lot 16 1-54,16 IS 105-p0 N7 10' Utility Ea�en-est 1} } 1 Gzt } Story Flame h } }II Lot 15 0 } c} rn own 11 ( 03 3 } W } Lot 14 N 1 1} 1 1 Found bent Il a" rebar, 1 SCALE: 1 "= 40' LC -T I rebar 8392G \ ound J' rebar Lot 5A S�O0 ound } Iron Pipe Well of Grave/dnve"Y ood ret. wall ood )35 fenced f m f 0.1 01 \ 0 Ilk, o ao2 TNaO ` torage �q O ae � w yti irl -10 0 3 a� 100 N as 1 e" ood ret. wall ;A, 2 o � sBAi N � s,7 � ehed 30 1x060 1 ound' rebar s71°585g„� Lot 8 1 OF. A44 I/ �P49th5s',�I 00 *' +ry'j�� * 00 00 .... nd Walctko.' ON ” 3255 — S 1 1 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. FB 13-8A, pg 4748 AS -BUILT AND CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property; LOT 7, BLOCK 3 BROADWATER HEIGHTS SUBDIVISION Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 15th day of January ,2014. FRED WALATKA 8 ASSOCIATES Engineers and Surveyors BE 1 (907-248-1666) _0 61" Municipality of Anchorage o Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci. anchorage. alk. us (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-131-66 HAA# O O 0 4 % 3 Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 7, Block 3, Broadwater Heights Location (site address or directions) 11944 West Skyline Drive Current Property owner(s) zoran & Michelle Yankovich Day phone 278-8878 Mailing address 11 944 West Skyline Drive Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: Three (3 ) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well )C� Individual On-site x® Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) 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. DHHS 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. 72-025 (Rev. 01:00)' 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 the Health Authority Approval application show 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 9/19/00 v CY[. ENOINEER'S' +: a . STAMP 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. c Conditional approval for bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report j Well Flow Advisory Other By: 0 Original Certificate Date: G% 02 cc Expiration Date: 5 025 (Rev. 01.00)' �?_ -�)_ 7-0 Reissue Date: Municipality of Anchorage \'� • Department of Health and Human Services Division of Environmental Services�' o / C On -Site Services Section 825 '1" Street Room V G DA P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us SEP 1 9 2000 (907) 343-4744 MU PALITYpFgNCHpRAGE HEALTH AUTHORITY APPROVAL CHE( j y EN7ALSERVICES DIVISION Legal Description: Lot 7, Block 3, Broadwater Heights Parcel I.D.: 050-131- A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Date completed 5/6/85 Sanitary seal Y Total depth 450 It Cased to 23 ft Bedrock FROM WELL LOG Date of test 5/6/85 Static water level 60 ft Well production 2 g.p.m WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml Nitrate • 5 mg/I Date of sample: 9/12/00 Collected by: MEA B. SEPTIC/HOLDING TANK DATA 1niC-all Wires properly protected Y Casing height (above ground) 10 in. AT INSPECTION 9/18/00 22 ft 5.09 9 -p.m Other bacteria 0 colonies/100 ml Tank Type/Material Steel Date installed 10/16/85 Tank size 1 , 000 gal Number of Compartments 2 Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm N Inside Foundation Date of pumping 9/18/00 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 10/16/85 Soil rating (g.p.d./ft2 or ft2/bdrm) 85 SFSystemtype Bed Length _2--L—ft Width 48 ft Gravel below pipe . 5 ft Total depth 4 - 5 ft Effective absorption area 486 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10 / 18 / 00 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in Water added 500 gal. New depth 6 in. Elapsed Time: 60 min Final fluid depth 0 in Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date N/A 72-026 (Rev. 01/00)' D. LIFT STATION - N/A Date installed "Pump on" level at Size in gallons in "Pump off" level at in Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access High water alarm level at in Meets alarm & circuit requirements_ Septic tank/lift station on lot > 10 0' On adjacent lots >100' Absorption field on lot > 100' On adjacent lots > 10 0, Public sewer main N/A Public sewer manhole/cleanout Sewer /septic service line >25' Holding tank N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >51 Absorption field >5' Water main N/A Water service line > 10 1 Surface water > 10 0 Drainage > 100' Wells on adjacent lots 1100, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line > 1 0 ' Building foundation > 1 0 , Water main _ N/8 Water Service line >10' Surface water >100' Driveway, parking/vehicle storage ' > 20' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 9/19/00 N HAA Fee $ <&> ` bF?) Waiver Fee $ Date of Payment 2 /20je)z Date of Payment Receipt Number 6 Zg/ ( Receipt Number. 72-026 (Rev. 01/00)' vrit� i rP' � tffitgi' EER -... I : 09-19-00 09:17 FROM -CTE ENVIRONMENTAL 5615301 T-340 P.02/03 F-830 CT&E Environmental Services Inc. CT&E Ref.# 1005491001 Client PON Client Name Anderson Engineering - Printed Date/Time 09/18/2000 15:32 Project Name/# Broadwater Heights Lot 7 Blk 3 Collected Date/Time 09/12/2000 12:30 Client Sample ID Broadwater Heights Lot 7 Blk 3 Received Date/Time 09/12/2000 15:00 Matrix Drinking Water Technical Director Stephen C. Ede Ordered By - Release PWSID - 0 •.��/ Sample Remarks: - EP300 Nitrate: LCS was outside acceptance criteria (89.2%). All outer QC met criteria. Sample value may be bias low. Allowable Prep Analysis Parameter liesalis PQL Units Method Limits Dale Date Imt Waters Department - - - - Nitrate -N 4.11 0.500 mg/L EPA 300.0.. 10 max 09/12/00 SCL Microbiology Laboratory Total Coliform 0 col/100mL SM18 9222B - 09/12/00 KAP. , Received Time Sep -19. 8:19AM MUNICIPALITY OF ANCHORAGE • ..� Department of Health & Human Services 1 DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # - 1 )1 Ln HAA # to L2 (I'-, Ll 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 7; B.r?ock 3; Bnoadwata He.ightA Location (address or directions) 11944 Wat S(iytine D i,ve (b) Property owner Cant & Janet QizoteZZ Telephone: (home) Business 694-5797 Mailing Address P 0 Box 770210 Eag_.P R.ive)L, AFz 99577 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ®.?Cif hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family EXX Number of bedrooms 3u 3. WATER SUPPLY Individual Well C�Cx Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site IXx Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 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 " Telephone =, 7 Address Date sliver Loop Road No. 204 6. DHHS APPROVAL Approved for _Z_._ bedrooms by04 Date �9 Approved ^ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. 7/88) Back Page 2 of 2 G� so MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) i 3® CHECKLIST -FEBRUARY 1984 343-4744 •;t`' `�� Legal Description: �V A. WELL DATA Well ClassificationIf A, B, C, D.E.C. Approved (Y/N) Well Log Present67N) _ Date Completed �2, 857 Yield Z - <�? Total Depths Cased o D tti of Grouting - Z9 Static Water Level Pump Set At Casing Height Above Ground 4_ Sanitary Seal on Casing(TVN) Electrical Wiring in Conduittg/N) Depression Around Wellhead (Y/t SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot % Gt-L ; On Adjoining Lots /-4- � � f To Nearest Edge of Absorption Field o Lot �" ; On Adjoining Lots To Nearest Public Sewer Line N ) To Nearest Public Sewer Cleanout/Manhole N To Nearest Sewer Service Line on Lot Zai /'- Water Sample Collected by CA4; ��� Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 1`A15 Size No. of Compartments Z Stand pipeq!%i?N) y Air-tight_`Caps45 /N) y Foundation Cleanout4WN) Depression over Tank (Y f t"' TA Date Last PumpedPumping/Maintenance Contact on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) 14A Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well ( c;2 t To Building Foundation To Property Line o 'k" To Disposal Field t To Water Main/Service Line k c::>> ,�_ To Stream, Pond, ;ake or Major Drainage Course t--� Comments 72-026 (Rev. 7/88) Front Page 1 of 2 c=> I C. ABSORPTION FIELD DATA --�.�� Soils Rating in Absorption St r to Type of System Design 127 1 Date Installed k I i�)s Length of Field Width of Field I Depth of Field ail It;, M Gravel Bed Thickness O+257 Square Feet of Absortion Area "q�A� .� Statndpipes Present *?N) IJ Depression over Field (YOP r_J Date of Last Adequacy Test Results of Last Adequacy Test a J ILS tom. SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well I C:�� To Property Line �— To Building Foundation al % To Existing or Abandoned System on Lot ; On Adjoining Lots' t To Water Main/Service Line `� � To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course t Qr_> I + 1 To Driveway,,Parking Area, or Vehicle Storage Area 8� _�_ Commen G- D. LIF STATION Date Ins d Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) **Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent (Y/N) umping Cycles during Adequacy Test. 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 17034 Eagle: River Loop Road No, 204 Company Ea g 1a ,ey; Alaslra 99577 Date G MOA No, C Receipt No. C21z0 ` Date of Payment Amount: $ 0 � r o No, 145 74� Receipt No.�' Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 Seal LAGORATOR12/ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET - ANCHORAGE, ALASKA 99518 - TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 29846 Date Report Printed: NOV 7 90 a 12:53 Client Sample ID:L7 B3 BROADWATER HTS PWSID :UA Collected NOV 1 90 1 21:10 hrs. Received NOV 2 90 B 16:10 hrs. Preserved With :AS REQUIRED Client Name S & S ENGINEERING Client Acct : SNSENGP P.OJ NONE RECEIVED Req I Ordered By : R. SHAFER �NDEOFNpF Analysis Completed :NOV 7 90 Send Reports to: Laboratory Supexvi ox :STEPHEN C. EDE 1)S & S ENGINEERING Released By : C U--- 2) ................................................................................................................................. Special Instruct: Chemlab Ref #: 904638 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits --------------------------------------------------------------------------------------------------------------- NITRATE-N 2.2 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY RJS. .............................................................................................................. 1 Testa Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than 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. # DSD - /3/ - l (:� 1. GENERAL INFORMATION H A A # hA A ' LL L LI Complete legal description L,f % Location (site address or directions) S;e6l f-, Lz- Property owner al i2 �� ya Dy s 55 Day phone 5G - 9810 Mailing address //95/� ��%�,�e icy �c���_%" �,� �J_% 7 J Lending agency Day phone Mailing address Agent �.�i'o% Be���.��'�u�� Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 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 x 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) From MOA N21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm KND Engineering Phone 4L1441 r-larmigan Blvd. Address Eagle River, AK 99577 -R7 -v Engineer's signature Date is 6. DHHS SIGNATURE X Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments By: 4UTICl ®'irk 1�� � " 0 a • �o asa.a. u.aa...• •. ..5 Kenney ii M. Duf C_- _r 711 // aid✓ bedrooms, with the following stipulations: Date l --2g The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their tending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72.025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division In r 825"L" Street, Room 502 0 Anchorage, Alaska 99501 • (907) 343-4-Wr_ C E I V E JUN 191996 Health Authority Approval Checklist Municipality of Anchorage Dept. Health &Hunan Services Legal Description: $�,�' �ye,56, v��ey Parcel I.D.: 050— A. SU^ A. WELL DATA Well type 101-11'-a /c, If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) l Date completed Total depth Cased to 89. 2 3 � Casing height (above ground) Sanitary seal (Y/N) Y Wires properly protected (Y/N) FROM WELL LOG AT INSPE%CTION Date of test Static water level Well production `l. g.p.m. - 1.17 g.p.m WATER SAMPLE RESULTS: Coliform QS Nitrate Q, 7 Other bacteria Date of sample: IP17Collected by: AND E1jGIRJEE1?1A16 B. SEPTIC/HOLDING TANK DATA Date installed /o I b& I LbS Tank size 1000 Number of Compartments z Cleanouts (YIN)_ Foundation cleanout (Y/N) Y fo�Wu_ Depression (Y/N) High water alarm (Y/N) A14 Date of Pumping Pumper 1.5 C. ABSORPTION FIELD DATA Date installed /0 Soil rating (g.p.d./ft` or ft2/bdrm) System type i�tD Length %� Width ` Gravel thickness below pipe Lo Total depth S6 Effective absorption area Monitoring Tube present(Y/N) Y Depression over field (Y/N) 4 _ Date of adequacy test ! 7A Results (Pass/Fail) p4:� S For 2 bedrooms Fluid depth in absorption field before test (in.); Immediately after 756 gal. water added (in.): r Fluid depth (ins,) Minutes later: 7(e Absorption rate = z156) f g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date D. LIFT STATION. Date installed Manhole/Access (YM) _ High water alarm level'at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /DDS f ; On adjacent lots "Pump off' level at* Absorption Absorption field on lot 160 f ; On adjacent lots /OD 11 - Public sewer main 44 Public sewer manhole/cleanout 4114 Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /D I _h Property line /D / 'tAbsorption field S Water main/service line Z5 /* Surface water/drainage /DD't f Wells on adjacent lots /DD ' -�- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation /0 Water main/service line 25 f Surface water /!SO +- Driveway, parking/vehicle storage area $D Curtain drainS L� 4- Wells on adjacent lots 1QQ 'f" Property line A) f F. ENGINEER'S CERTIFICATION 1 certify that 1 have determined thru field inspections and review ofNlunicipal records. hof o,4%4�4s are in conformance with 110A HAA guidelines in effect on this date. • Q. 6.•••••••4g s �, •'•. • • Signature % * ;' qJH •'!.*+,/ .. . .44609• goo sea:$ 4 00 Engineer's Name/`j / /� / in% ; Kenne�h M. Duffu ty�go Date G l CJ� %irk ,• CE 7116 •; _� fo,Fop f�, f�l•P���`,: HAA Fee $ 3 , elz / Waiver Fee $ _ Date of Payment zz,C� Date of Payment Receipt Number 6,r ' Receipt Number Rev. 8/95 OSS: haa.wk.doc MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services t DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 015"o /3 / & b HAA # 1-4-4- 9 9 0 399 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LUT 7• BLOCK 3• BROADWATER HEIGHTS Location (address or directions) 11944 Glut Skytine Nive (b) Property owner. Cana_ & Janet Disatet.? Telephone: (home) Business 694-5797 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent TACK WHTTF COMPANV ATTN- 1 cAj0,00 ,4ojt Telephone 194- (e) Mail the HAA to the following address: (or check here XX if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle Rmwer 1 oop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family XX 3. WATER SUPPLY Number of bedrooms 3_ Individual Well SIX Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site XX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 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 Telephone -69`x, Z�Z%tel Address Date 17034 Eagle River Loop Road No. 204 �O /'v �g g r 1 l_ 00477 � ! OF •• ••t % • No. 14074 alllA.s e♦ ar ��••4'fi,'1:•'�►°moi 6. DHHS APPRO'rrAL Approved for � bedrooms b <'� ^�/ �-�Date pr y-� Approved �,� Disapproved Conditional Terms of Conditional Approval Note: The well for this property meets existing State and Municipal Codes. There are nitrates present, however, it is suggested that periodic testing be performed to insure the wells continued suitability. Nitrate concentration is 5.6 mg/1. EPA maximum concentration is 10.0 mg/1. CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. 7/88) Back Page 2 of 2 G� CaC�p�,P Sip A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 44 Legal Description: L 7; g1'oAJ1&26kr Well Classification INf ( 0 IA t__ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) _Date Completed Yield Qp= , Total Depth 5b Cased to �, yCDepth of Grouting Static Water Level 0-2 Pump Set At - u (� Casing Height Above Ground 7:2 t t 1" Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot j O0 1t ; On Adjoining Lots _'CSO , i To Nearest Edge of Absorption Field on Lot I co" -t ; On Adjoining Lots 100 t To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole &I A To Nearest Sewer Service Line on Lot e? S �t Water Sample Collected by S �N �„ tJ e e J r N q Date(- oZ g Water Sample Test Results. A 1,:51 ' AC or CommentA UJJ1 L, C At s e of ;AAA Q J dOc I< B. SEPTIC/HOLDING TANK DATA Date Installed �.5_ Size 1 (200 No. of Compartments Standpipes (Y/N) L4 Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) rJ Date Last Pumped Pumping/Maintenance Contact on File (Y/N) N I� ; for Holding Tank High -Water Alarm (Y/N) ^/ Temporary Holding Tank Permit (Y/N) &)!A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 0 , f To Building Foundation 5 CD t To Property Line g t To Disposal Field /0 r To Water Main/Service Line�-I- To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata— 8� Type of System Design Date Installed1 n ��� Length of Field "a Width of Field (lp� ! Depth of Field 5 Gravel Bed Thickness 5 Square Feet of Absortion Area 4 Statndpipes Present (Y/N) r— Depression over Field (Y/N) A) Date of Last Adequacy Test n) % (A Results of Last Adequacy Test �u S Ic v n WS 00 I 1rN N tn) U�G�vrn�er j 9 Q SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well f To Property Line To Building Foundation t To Existing or Abandoned System on Lot NIP ; On Adjoining Lots 3 0 -1- To Water Main/Service Line r To Cutback (if present) N 1p► To Stream, Pond, Lake, or Major Drainage Course DO 1" To Driveway, Parking Area, or Vehicle Storage Area 80 Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) **Check Permitted Bedroom Rating Against HAA Request`* "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Unu Eagle River Loop Road No 204 Date Eagle River, Alaska�B 9 MOA No. Receipt No. Cf �/� % Date of Payment Amount: $ 7 00 Receipt No. _ Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 .al A_ ° CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. r�F o Ve 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID #i 92.0040440 IABORATO HIES ANALYSIS REPORT BY SAMPLE for Work Order # 17129 Date Report Printed: OCT 4 89 @ 21:00 Client Sample ID:LOT 7 BLOCK 3 BROADWATER HEIGHTS Client Name S & S ENGR PWSID :UA Client Acct SNSENGP Collected SEP 28 69 @ 10:15 hrs. P.O.# NONE RECEIVED Received SEP 28 89 @ 16:30 hrs. Req # Preserved with :AS REQUIRED Ordered By : R.J. Analysis Completed :SEP 29 89 Send Reports to: Laboratory Supervis r :STEPHEN C. EDE 1)3 & S ENGR Released By 2) Special Instruct: Chemlab Ref #: 7777 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits --------------------------------------------------------------------------------- NITRATE-N 5.6 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE. SAMPLE COLLECTED BY R.J. Remarks: 1 Tests Performed See Special Instructions Above UA=Unavailable ND None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than MUNICIPALITY OF ANCHORAGE A • Department of Health & Human Services i DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # t1-),0 1.3/ —W/ 6 HAA # k� 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) LeglIal Description (include lot, block, subdivision, section, township, range) /^ iyZ Location (address or directions) (b) Property owner 2__2V<� Telephone: (home) �S�R Business Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and day phone number below: S&SENGINEERING 17034 Eagle River Loop Road No. 304 Eagle River, Alaska 79317 2. TYPE OF RESIDENCE Single-Familyo Number of bedrooms 15 3. WATER SUPPLY Individual Well.k- Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 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 FiNGINEEKING Address 17034 Eagle River Loop Road No. 204 Eagle River, AlaSKa Telephone 4! !F Date Note: The well for this property meets existing Statp� Municipal Codes. There are nitrates presence hOvA ,.' it is suggested that periodic testing be PG,e"�© i a insure the wells continued suitability. � e a .V concentration is 4.6 mg/ 1. EPA maximum "afb"n 10.0 mg/1.No. 14J74 Co r'.asc. 6. DHHS APPROVAL f Approved for —_ bedrooms by '4 / Date Approved Disapproved Conditional Terms of Conditional Approval_ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. 7/88) Back Page 2 of 2 MUN10PAWY OF ANCHO?AGE, ENVIRIONMENTAi_ 1(:V1a_S ~ N MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 F I VF D Legal Description: A. WELL DATA Well Classification : If A, B, C, D.E.C. Approved (Y/N) Well Log Present WYN) Date Completed I Total Depth Cased to ZiDepth of Grouting I a 13WR-OC-V– — Pump Set At ( K^ Yield 14- 4f7r'I Static Water Level 1120 0 Casing Height Above Ground LZ -�_ Sanitary Seal on Casing (ON) T Electrical Wiring in Conduit(ETYN) V Depression Around Wellhead (Yo SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 1. 0 95 ; On Adjoining Lots I �) 4 -- To Nearest Edge of Absorption Field n Lot On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 1-)5{'�' Water Sample Collected by "-24 S G %i It) ' t�A ; Date l - Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size I Q2K2 No. of Compartments 2- StandpipesolN) —Air -tight Caps &N) Foundation Cleanout<f%IN) _ Depression over Tank (Y/&? ate Last Pumped Pumping/Maintenance Contact on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well t To Building Foundation �7b To Property Line o ,-� To Disposal Field To Water Main/Service Line O t To Stream, Pond, Lake or Major Drainage Course t 4- Comment 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 8rL Type of System Design Date Installed o 0 Length of Field 2� Width of Field ���� Depth of Field q A� Gravel Bed Thickness Square Feet of Absortion Area Q�Iv� Statndpipes Present U/N) Depression over Field (YO Date of Last Adequacy Test N Results of Last Adequacy Test �`��!'r%�'1 (, �� `�, 1 � SEPARATION DISTANCE FROM ABSORPTION FIELD: i To Water -Supply Well I'(' To Property Line ILE) To Building Foundati` � To Existing or Abandoned System on f" Lot ; On Adjoining Lots _�" To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course r✓ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION n J Date stalled Size in Ga "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) . _ "Pump Off" Level at Vent(Y/N) Pumping during Adequacy Test. *`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 inspection. �"►' Signed % & S ENGINEERING Company 17034 Eagle River Loop koad No. 204 Eag a ver, Date � �� V MOA No. Receipt No. Date of Payment —AF IFJJ? Amount: $ 0170,-0-0 Receipt No AV \` • 0"_ 'N ate of thys Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 =o CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 IABORATO RIES ANALYSIS REPORT BY SAMPLE for Work Order # 10466 Date Report Printed: NOV 17 88 @ 10:48 Client Sample ID:1.7, B3 BROADWATER HTS PWSID :UA Collected NOV 14 88 @ 10:30 his. . Received NOV 14 88 @ 15:00 hrs. Preserved with :4 DEG. C Client Name S & S ENGINEERING Client Acct SNSENGP P.O.# NONE REC D Req # Ordered By Analysis Completed :NOV 16 88 Send Reports to: Laboratory Supery e r : PHEN C. EDE 1)S & S ENGINEERING Released By G C� 2) .................................................................................................................................... Special Instruct: Chemlab Ref #: 3437 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits --------------------------------------------------------------------------------------------------------------- NITRATE-N 4.6 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RYS .............................................................................................................. 1 Testa Performed ' See Special Instructions Above UA -Unavailable ND- None Detected '* See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than