HomeMy WebLinkAboutBROADWATER HEIGHTS BLK 3 LT 20Onsite File
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Municipality of Anchorage
Community Development Department Page 1 of 2
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage,AK 99519-6650• http://www.muni.org/onsite•(907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSC181012 PID Number: 050-081-72 ❑ New ✓❑ Upgrade
Name:
JOHN & HEATHER DELONEY ABSORPTION FIELD
Address ❑ Deep Trench ❑ Shallow Trench [' Bed ❑ Mound
12225 BROADWATER DRIVE El Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
4 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
BROADWATER HTS 3 20 Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Lift Station Tank Line Ft' Ft.
Well 123.7 N/A N/A N/A N/A TANK ❑p Septic 0 S.T.E.P. ❑Holding 0 Other
Manufacturer Capacity
Anchorage Tank 1,000GaI.
Surface Water 100+ N/A N/A N/A
Material Number of compartments
Lot Line 56.4 N/A N/A N/A Steel 2
NA
Foundation 8.8 N/A N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain 50+ N/A N/A N/A Gal.
Remarks Pump on level at Pump off level at High water alarm at
TANK REPLACE ONLY
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank td 3034
Installer drainfiel
FLINESTONE ENTERPRISES Drainfield CO/MT
Inspector Pannone Engineering Services LLC BENCH MARK (Assumed elevation) 100ft
Inspection ' 5/17/18 a Location and description
dates: 2'
3'd - - 4°i
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
pp
. ..4.6-Z- A,.,gSl�
Conditional Approval: Date /'Ay�P. .• `,' �l1+�
ir; 49 • \ /\ .•.*
~ ''Steven.V..0annOm'e*if
li CE 814
Approve i (".,j;------45a4 Date 7-2)--fe gotg s2 -(#7,-,
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Inspection Report_1-1-12.doc
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REMOVED EXISTING 1000. 1 I 111 1 0 y / N
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`-EXISTING DRAIN FIELD 1 ,`' ,,`: i� BDR .- ---r. _ /
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/ 770 ' I i 1 I �`< < ,
/ / 7l5 780 ; t‘ Sr • f 1 1 / , /
/ 1 `, 1 ` `` '1 C. / �� �r/' i I1 // /' \/\ /
% / INSTALLED NEW 1000. SEPTIC {�/ ��\; DECKk� ' _j I // `\ /
/ TANK W/ DCO BEFORE AND AFTER 7 \ ' j �� 825 / / \ —.A---
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797.4 TANK 1797.2
PROFILE SCALE: NTS
NOTES: PANNONE ENG SVC, LLCDote
RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 05/29/18
PHONE (907) 272-8218 FAX (907) 272-8211 Scale
1"=50'
P.I.D. NO
Broadwater Hts BLK 3 LOT 20 050-081-72
John & Heather Delaney •• PERMIT NO.
DRAWN ACP •12225 Broadwater Drive `E 8149 �.' OSC181012
Eagle River, Alaska .' , �` Sheet
''S\' 2 OF 2
5//to/,a
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP171376
Work Type: SepticTank Upgrade
Tax Code Number: 05008172000
Site Legal Address: BROADWATER HEIGHTS BLK .3 LT 20 G:0253
Site Mailing Address: 12225 BROADWATER DR, Eagle River
Owner: DELONEY JOHN HUNTER &
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
nr
J
Department
1/5/2018
1/5/2019
27700
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
I
1Special Provisions: The double cleanout shall be moved or replaced so that it is not more than 10 feet
{ downstream the new tank.
II
lo moloffls' '. N. W. -I A A
64
Date: 1/9// B
Date: 5
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 I.D. 050-081-72
Property owner(s) JOHN & HEATHER DELONEY Day phone.
Mailing address 18710 UPPER MCCRARY RD, EAGLE RIVER, AK 99577
Site address 12225 BROADWATER DR
Legal description (Sub'd., Block & Lot) BROADWATER HEIGHTS B3 L20
Legal description (Township, Range & Section)
Lot Size 27,700 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
(® all that apply)
Absorption Field
❑
Septic Tank
❑x
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
APPLICATION IS AN: TYPE OF DWELLING:
Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Upgrade FX]Duplex (D) El EllMultiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
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 agent)
Permit/Rush Fees: 03yq (�u5�)
Date of Payment: I aar 11
Receipt Number: 61 S � y
Permit No. _ OSe 1 i 13"1(o
Permit App__- : .—..:c
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
111111
I•. . - -- -
28 December 2017
Municipality of Anchorage
On-site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Attention: On-site Engineer
Reference: BROADWATER HTS B3 L20 (a.k.a. 12225 Broadwater Drive)
Septic Tank Permit Application Design Narrative
The owner of the subject property needs to replace & move the existing septic tank
(1000g steel) with a new 1000 -gallon septic tank. It was determined that the tank was
underneath a support post for a deck.
The existing septic tank satisfies all of the separation distances required in Section
15.65.050A and will be decommissioned in accordance with the code.
The proposed septic tank will be installed near the location of the existing septic tank
and will satisfy all of the separation distances required in Section 15.65.050A.
Please feel free to contact me if you have any questions.
Thanks,
Joseph Lawendowski, EIT
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
2 January 2018
Subject: BROADWATER HEIGHTS B3 L20
Septic System Upgrade
To Whom It May Concern,
We conducted an adequacy test for the above listed property on 11 December 2017. The test included the
well flow test and for the operation of the septic field. The system performed well within the standards
required by the State of Alaska and Municipality of Anchorage.
There was a deficiency noted in relation to the location of the existing septic tank as it relates to the
Municipal code. Currently the tank is located beneath one of the deck support posts on the northwest
corner of the exterior deck. Due to this, the existing tank needs to be abandoned in place (per MoA code)
and a new one will be installed outside the footprint of the deck supports.
Due to the location of the tank in relation to these posts, the risk of damage to the posts and/or deck
would be mitigated by excavating in the spring once the ground has thawed.
If you have any questions or concerns, please contact me at 907.272.8218.
Sincere ,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
AS-.T'SLJII_T ~SYSTEM 13ETAlL S/SITE PI_AN r-~_~-~-~ sw97oooa~
~-G=37,0E' VACA~T~
D ~000 G~L 1
~ / ~ANI< ~ SEWER ROCK
12225 BROADWATER
~ EAGLE RIVER~ ALASKA 99577
T ~ ~ ASBUIL?: DATE: /5/97 EAGLE RIVER, AK 99577-8736
,c,o nm 96088.DW0 ,o. ,~.: 96088 (907)696-6tli/F~ (907)696-8111
NO
FROM SIDING. /
NUMBER DELTA ~RADIUS ILENGTH /;5 ~5 7.515 30
C1 3V~3'36" l~O.O0 65.75 /
~0~: Dgg Date Scare ~gal Descri~ti~
LanMark Grid ~-BU~T ~t 20 Block 3
En~needng & Su~ing I~. NW253 971094 BROADWATER HEIGHTS
5631 Silverado Way, Suite H-201
Anchorage, Alaska 99518 Dra~ by Field Book SUBDWISION
(907) 562-6050 R.O.L. ~93
I hereby certify that the property described hereon has been surveyed
by me, or at my direction, and that the improvemen~ situated thereon ~.. ..... ,.~.~n~a
are ~thin the property lines and do not overlap or encroach on the ~..
property l~ng adjacent there,o unless other~se sho~. ~at no
improvements oa the property lying adjacent ther~o encroach on the
li~es o~ other easements an said property exeep~ as ~ho~.
It is the resposibility of the o~er or builder, prior to construction,
connections and to determine the existence of any easement, covenants, ~a/d/'. LS
or restrictions which do not appear on the recorded subdivision plat.~~~~~" ·
~sted distances prey afl over scaling.
Reproduction may cause distortion.
~J
0
0 0 0 0 0 0 0 0 0 0 0
PAGE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970002
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:ERICKSON EDWARD E & JEANNIE R
OWNER ADDRESS:12225 BROADWATER DR
EAGLE RIVER, ALASKA 99577
DATE ISSUED: 1/06/97
EXPIRATION DATE: 1/06/98
PARCEL ID:05008172
LEGAL DESCRIPTION:
BROADWATER HEIGHTS BLK
3 LT 20
LOT SIZE: 27700 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
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 (18/LAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:~. _~ ~,
/ /
DATE:
~~D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
November 21, 1996
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: New sewer/well permit - Broadwater Heights, Lot 20, Block 3
Gentlemen:
On November 14, 1996, we excavated a testhole for the subject property. The
proposed development for this lot is a 3 bedroom single family residence. The
results of this test and water monitoring are attached.
The parcel slopes from northeast to southwest with grades varying up to 22% on the
lot. Five foot contour intervals are shown on the portion of the lot affected by the
proposed and reserve drainage fields.
We propose to install a very shallow 5' wide trench with 4' of gravel. Additional fill
will be placed over the system to provide a minimum of 2' of cover when complete.
There are no public or private wells within 200' of our proposed system location
except as shown. There is neither surface water within 100' nor any curtain drains
within 50'. We do not expect that there will be any adverse effect on adjacent lots by
the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
L~ Iq ~_) Engineering
Kenneth M. Duffus, P.E.
attachments: On-Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
~~D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
January 5, 1997
Dan Roth
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
Municipality ot Anchorage
Oept, Health & Human Service8
Subject: New sewer]well permit - Broadwater Heights, Lot 20, Block 3
Dear Dan:
On December 31, 1996, we excavated two additional testholes for the subject property
in an attempt to verify bedrock. Based on the results from those testholes, which are
included, we have verified bedrock at or below 11 feet. The testholes also showed an
organic layer of varying thickness between 5 and 6 feet. In order to resolve concerns
expressed on day lighting of effluent at that interface layer we have included note 11
on the plans which requires that the contractor excavate below the organic layer and
backfill with Central Paving Products (CPP) sand or approved equal. For your
reference and records I have also included the previous soils log with modifications
indicating a soils log number that corresponds to the revised site plan.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
~I~I!~ Engineering
Kenneth . · ·
attachments:
Wastewater Absorption System Details/Site Plan
Soils Logs (3)
WASTEWATER ABSORPTION SYSTEM DETAILS
BR[~ADWATER HEIGHTS S/I), LF1T 20, BLOCK
/'
/
,/
GAL, S.'
SITE PLAN
NB WELL WITHIN 800' DF PRBPBSED SEPTIC SYSTEM, EXCEPT AS SHBWN,
ND SEPTIC SYSTEMS WITHIN 800' DF PRDPBSED WELL, EXCEPT AS SHBWN,
260,0' LBT 21
VACANT
/
307,5'
/
LUT 26
LBT 19
VA NY
Horlzon~caL conSmoL
Ven~cicaL con-tr-ol, is
per <econded pla%(73-18)
assur~netaTM
DESIGN CRITERIA
1, 3 BEDROOMS X 150 GAL,/DAY/BEDRBBM = 450 GPO
2, SOILS RATING~ 1 MIN,/INCH = APPL, RATE 1,2 GPD/SF
3, 450 GPD/1,P GPD/SF = 375 SF
4, 375 SF /5'(W)X(O,5RF) = 37,5 'L
5. HIN. DESIGN SIZE = 1 TRENCH - 37,5' LONG x 5' WIDE x 4' DEEP
6, DEPTH OF GRAVEL IS 4' BELOW PIPE PLUS 0,5' ABOVE PIPE.
7, TOTAL DEPTH OF SYSTEM IS 4,5' FROM ORIGINAL GRADE.
8. 2~ HD INSULATION REQUIRED OVER FIELD <3' BF COVER
9. a' HD INSULATIflN REQUIRED OVER TANK <4' BF COVER
10. CONTRACTOR TB VERIFY AND INSURE NAX aY. GRADE FROM HOUSE,
il. CONTRACTOR TB EXCAVATE BELOW ORGANIC LAYER AND BACKFILL W/CPP
SAND DR APPROVED EQUAL,
PREPARED FOR:
EDWARD E. ERICKSBN
12225 BRBADWATER
EAGLE RIVER, ALASKA 99577
KND ENGINEERING
20441 PTARHIGAN ~LVD
EAGLE RIVER, AK, 99577
(907)696-6111/Fax (907)696-8111
)ATE:ll-21-96/rev, 1/5/97 DRAWING
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
I ~'_..' A-",..~. ,., ,
t~"'~.' ~ ..~,.~e, I
I
~ ~'~eee~eeteeeee~o~i,e~.e ~ I
DATE PERFORMED:
Township, Range, Section:
SLOPE
SITE PLAN
10
'tl
12
13
14
15
WAS GROUND WATER
ENCOUNTERED? ,/V/4~ .
s
IF YES, AT WHAT ~ ~)
DEPTH? _ . p
E
Dale: / ///~1/~'~,
Depth to Water Alter./.
Monitoring?
16
17
18
19
2O
Gross Net Depth to Net
Reading Date Time Time Water Drop
O //~q' 2... ', o / "-' ~" ""
I 2;~2- /,~/¼ z/,zS'" I, ZS"
2, ,2.:a3 ,, ~ ;z S,, i,,
3 ,~:o~ " ~,2.-:~" I"
2..'o? " '.'¢, /
¢, ,~',o,E, " /,,,~-" /"
PERCOLATION RATE / (m,nutes/~nch) PERC HOLE DIAMETER
TEST RUN BETWEEN 3 FTAND /'// ,FT
//
PERFORMED BY ---~/'~"/~. -~-~4' /~.~./"//')C/~ ~"~Y~.~ CERIIEY T.AI' THIS,TEST WAS PERFORMED IN
77-008 IRev 4/B51
PERFORMED FOR:
Municipalily of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
,,,
DATE PERFORMED:
LEGAl
5
6
7
8
9
10
'11
12
13
14
15
16
17
18
19
2O
SITE PLAN
DESCRIPTION:
(FEET)
O 0
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT 0
DEPTH? p
E
Depth to Waler Allet
Monitoring? Dale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
_ "--...
PERCOLAIIONRAIE __ (m,nuIes/~nch) PERC HOLE DIAMETER __
1ESI RUN BETWEEN ~ Fl AND '""--' F'T
CERIlFY 1HAl THISTES1 WAS PERFORMED IN
ACCORDANCE Will-! ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC1 ON TI-US DAlE DAlE ____)-~-~
PERFORMED FOR:
LEGAL DESCRIPTION:
(FEET)
!
2
3
4
5
6
7
8
9
10
'11
12
13
14
15
16
17
18
19
2O
Municipalily o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
/
Deplh Io Water Aller |
Monitoring? Dale: _~/~ ..
Gross Net Depth to Net
Reading Date
Time Time Water Drop
--.....
PERCOLATION RAIE
__. Im,nutes/,nch) PERC HOLE DIAMETER
008(F~ev ,hSF~
•
• Gf $`
• Municipality of Anchorage °"
On-Site Water and Wastewater Program
(907) 343-7904 s A F (TV
Certificate of On-Site Systems Approval
Parcel I.D. 050-081-72 Expiration Date: �,2C—(
1. GENERAL INFORMATION
Complete legal description Broadwater Heights Block 3 Lot 20
Location (site address) 12225 Broadwater Drive
Current Property owner(s) Gabriel & Desmarie Meachum Day phone
Mailing address 12225 Broadwater Drive Eagle River, AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: _Distance:
Received bk, 400 Date: —( la01/e)
COSA to be released to the engineer,unless otherwise requested by the eng er.
COSA Fee $ SCc:D+�7c7= PPC- Waiver Fee $
Date of Payment ( —1 (^1 Date of Payment
Receipt Number g Receipt Number
COSA# OSC t g10 2_ 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.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and 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 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 are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 7/3/2018
9F AL%
i
6. DSD SIGNATURE 1.. " . TO
System#1 Approved for C/ bedrooms �•'.S+ri R. •annorie.• j
CE-8149 .•
t �l � �
System#2 Approved for bedrooms sik • r
Disapproved kxOFESSIOk
Conditional approval for bedrooms, with the following stipulations:
OF A/
Q�� �1e,�/c)
01`1"Sr -
"VCR ND•
.01T PROGR
•z06,
Gc
By: �—�� Original Certificate Date: 7'-2 -IF
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet{
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Broadwater Heights Block 3 Lot 20 Parcel ID:050-081-72
A. WELL DATA
Well type Private/Private If A, B, or C provide PWSID# Well Log (Y/N) WY
Date completed 1/23/97&2/18/97 Sanitary seal (Y/N) Y/Y Wires properly protected (Y/N) WY
Total depth 410/610 ft. Cased to 21.5/30.5 ft. Casing height(above ground) 18+/18+in.
FROM WELL LOG AT INSPECTION
Date of test 1/1997 & 2/1997 12/11/2017
Static water level 168/205 ft41 .6 ft
Well production 6/0.45 gpm 4.5 g p m
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 7.09 mg/L
Arsenic ND ug/L Date of sample: 12/11/2017 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 5/17/2018
Tank size 1000gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A
Date of pumping NEW Pumper N/A
C. ABSORPTION FIELD DATA
Date installed 1/11/1997 Soil rating (g.p.d./ft2 or ftZ/bdrm) 1.2 GPD/SF System type 5 Wide Trench
Length 44 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 7.5 ft. Eff. absorption area 440 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 12/11/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in.
Elapsed Time: 90 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
N
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION .,rte OF 44. l
kk
1 certify that / have determined through field inspections and 0/rg .Agro? .y ��
review of Municipal records that the above systems are in *; /\ •.*
conformance with MOA COSA guidelines in effect on this date. / ":.mg '�• _ 1•/`� P
Steven Pannone '� U /
Engineer's Printed Name i•••Sleveri It'Pannone:
Date 7/3/2018 #11:,•,. CE-8149 1
COSA canary sheet_2-6-15.doc
Municipality of Anchorage •
• r Development Services Department
Building Safety Division
5AK E.'f t
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC 181012
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 20 of
Broadwater Heights subdivision. This inspection revealed a nitrate
concentration of 7.09 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
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ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-082('
SCALE:
HEREBY CERTIFY THAT I HAVE SURVEYED THE ,' yr.� , e0..r,v.a%1:),,,
FOLLOWING DESCRIBED PROPERTY: __ -4`. .,
� OF A( 04
d�ocO. . ,�. lV�G.S/lsicl/dLGTza zee; DATE. -- .. .• S to
AND THAT NO ENCROACHMENTS' EXIST EXCEPT AS io/% �A ..'.
or INDICATED. IT IS THE RESPONSIBILITY OF THE - . 4`� H
OWNER TO DETERMINE TH•'-: EXISTENCE OF ANY GRID: y' "'"' .•'•d
EASEMENTS, COVENANTS., OR RESTRICTIONS -'vim �'' I �,p, _
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- • Duane Merk we.
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' ,,� y7 #.31•;., •.. LS- 1 .��. s
ANY DATA HEREON BE USED FOR CONSTRUCTION tq'Zsr� •-•.` ','$
OF FENCE LINES, OR FOR ESTABLISHING BOUND- ^
DRAWN: �N sxxa• ••
ARY LINES. �iYf ��,..,'�
0 1
1
Parcel I.D. 050-081-72
ovj C� b 6 7 8 g
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vt
Municipality of Anchorage
On -Site Water and Wastewater Program (907) 343-7904
Certificate of On -Site Systems Approvals8� 9 "
Expiration Date: ��� .Z / - / P
1. GENERAL INFORMATION
Complete legal description Broadwater Heights Block 3 Lot 20
Location (site address) 12225 Broadwater Drive
Current Property owner(s) John & Heather Deloney Day phone
Mailing address
Real Estate Agent
18710 Upper McCrary Rd. Eagle River, AK 99577
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
E
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: Distance:
Received b 4a an&& Date:
COSA to be released to the engineer, unless otherwise requested bthL4ngineer.
COSA Fee $ U Waiver Fee $
Date of Payment�((II Date of Payment
Receipt Number b (0-1 "lq� Receipt Number
COSA# o5CM O`Z 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and 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 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 are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 1/10/2018
of ak,s��
i 49
6. DSD SIGNATURE • • • • •%
System #1 Approved for bedrooms %¢ Steven R.•F�oriri
CE -8149
System #2 Approved for bedrooms}�s .
Disapproved ����OFE5510N�
Conditional approval for bedrooms, with the following stipulations:
-A-, Gwt L
tpryy1 iO{p VSD eo (� v�
By:
J
::z
i 7-! --I S
RLS,
o WASTEWA
Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
COSA blue sheet f ., c
r�
X Nitrate Adviso .
Arsenic Advisory"
Other
If more than 1 septic system is on the lot:
COSA Checklist # 1 of
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: Broadwater Heights Block 3 Lot 20
A. WELL DATA
Parcel ID: 050-081-72
Well type Private Ml cl A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed -'F2: 2_1151qq Sanitary seal (Y/N) Wires properly protected (Y/N) _
Total depth Z�tD ft. Cased to 2-1 Gft. Casing height (above ground) 1�#
FROM WELL LOG AT INSPECTION 4-1
Date of test a� 2- q� 12/11/2017
Nov
Static water level Q '2-D5 ft. 41.6 ft
Well production 0.4 g.p.m.
01
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 7.09 mg/L
Arsenic ND ug/L Date of sample: 12/11/2017
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping
Pumper
4.5
Collected by: PES
9 -
p.m -
Date installed 1 /10/1997
Cleanouts (Y/N) Y
High water alarm (Y/N) N/A
C. ABSORPTION FIELD DATA -
Date installed 1/11/1997 Soil rating (g.p.d./ft2 orft2/bdrm) 1.2 GPD/SF System type 5 Wide Trench
Length 44 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 7.5 ft. Eff. absorption area 440 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 12/11/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 ' in. Water added 450 gal. New depth 0 in.
Elapsed Time: 90 min. Final fluid depth 0 in. Absorption rate >= 450+ 9-p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons _
in. "Pump off' level at
Cycles tested
in
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer /septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ 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 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that / have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven Pannone
Date 1/10/2018
COSA canary sheet_2-6-15.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 10 +
S�everi �. • �anriorie
CE -8149
ral
Pannone Engineering Services ac
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve@panermak.com
January 19,2018
Municipality of Anchorage
Development Services Department
On-Site Water&Wastewater Program
4700 Elmore Rd.
P. O. Box 196650
Anchorage,Alaska 99519
Subject: Broadwater Hts B3 L20
Conditional COSA Request
Ladies and Gentlemen:
I am writing to request a conditional COSA be issued for this property to accommodate its sale closing tomorrow. A
permit was issued to construct an upgraded septic tank, however due to time constraints and winter weather the tank
cannot be installed before the sale. 1.5 times the highest bid for the installation of the system($6,825)has been placed
into escrow.
1. COSA.The Owner is in the process of selling this property. The existing system was located and inspected by
Gayness Engineering Grpup(see attached letter). The system was tested for operation and was found that it could
accept the required 150 gallons per bedroom per day(450 gpd). The intent is to install an upgraded septic tank by July
30,2018. This system will not affect the health or welfare of anyone on this lot or the surrounding lots.
If you have any questions or concerns,please contact me at 272-8218.
Sincerely,
.••*E OF. 47 .44.
•
•
• • ':
.411, Steven R.Pannone :
if
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Day phone
Lending agency
Mailing address
Day phone
Agent
Day phone
Address
e
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
.X
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I 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.
: KND Engineering
Name of Firm ,," _' ~ ~,mlgan s/vd.
Address ua~ie River, AK g9577-87~
Engineer's signature ~.
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms,
with the following stipulations:
By:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA¢/'Z1
':r~ ~rCMI:NI'AL SERVICES DIVISION
I 0V 0 4 ]99}'
Municipality of Anchorage (~~
DEPARTMENT OF HEALTH & HUMAN SERVICE~ECEIVE D
Environmental Services Division
825 L Street, RoOm 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: ~a~/'~'a~/~'' ~//~J' ,~/,~' 5; /_~/Z~:~ Parcel I.D.:
A. WELL DATA
If A, B, or C, attach ADEC letter. AD.EC water system number
~o ~.{/ ~ I J~- ~ s, 77
Log present (Y/N) (/3 o 7~ ~ Date completed ~/ ~ ~ /~. ~7
Total depth~/ ~/~' ~ ~/~ / ~/ ' ~/'~'
Cased to~ - ~.~ ' Casing height (above ground~
Sanita~ seal (Y/N) ~ ~~ Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Wellproduction '/ ~ ~' Z/~ ~
WATER SAMPLE RESULTS:
g.p.m.
/
B. SEPTIC/HOLDING TANK DATA
Date installed ~-ID- ~ 7
Foundation cleanout (Y/N) ~/
Date of Pumping /t/At
Nitrate ~//~/D./,~/ ~,~ '~ ~./~,/Other bacteria =~z//. / ~,,~. ~
Collected by: -J~ ~,~ A ~c'//~
Tank size
Number of Compartments ~-- Cleanouts (Y/N) "/
Depression (Y/N) /V/ High water alarm (Y/N) /t//
Pumper
C. ABSORPTION FIELD DATA
Date installed /-//-~ 7
Length Z/y*' Width
Effective absorption area
Soilrating (g.p.d./fForff=/bdrm) /, ~- Systemtype
Gravel thickness below pipe Total depth
Monitoring Tube present (Y/N) Y Depression over field
Date of adequacy test ---- Results (Pass~ For ,..--"~edrooms
Fluid depth in absorption field before Immediately after ed (in.):
Fluid depth (ins~ later'. Abs~=_ g.p.d.
Peroxide treatment~past 12 months) (Y/N) _,~yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*/
Cycles tested
Size in gallons
"Pump on" level at* /Pump off" level at*
*Datum
E. SEPARATION DISTANCES
Absorption field on lot
Pub;it sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~ ! + Property line ?~) ~ Absorption field
!
Water main/service line JD -h led ~
Surface water/drainage
+
Wells on adjacent lots /DO' ~-/-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
I
Property line j~) ~-
Surface water } ~) ~)
Curtain drain / DO
Building foundation 1~ 14-
Water main/service line
¢..~
Driveway, parking/vehicle storage area
~ Wells on adjacent lots j~) C)
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review
in conformance with MOA HAA guidelines in effect on this date.
Signature ~'1-- ~-'"/'~
Engineer's Name
Date
HAA Fee $ ~ D~
Date of Payment' ././! ~ ./~/~"~ 7
Receipt Number
72-026 (Rev. 3/96)*
record_~W
of
unicipai a , ,stems are
~ Kenne~h~s
Waiver Fee $
Date of Payment
Receipt Number
,.,.] ,.,.] ..] ~] ~ ~ ~ ~ ~] ~ ~ ~
0 0 0 0 0 0 0 0 0 0 0 0