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Home My WebLink AboutBROADWATER HEIGHTS TR A LT 3A Municipality of Anchorage Page f of --~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~/x~ c~ ~ 0'~,~"~ PID Number: 0~'(~ -- l ~ ~ iName: ~ [~ p~ ;~ Wastewater System: ~New ~ Upgrade ~*d~.** I ~ 15'~;Z"[~a3e~&. ~'~. I qq577 ABSORPTION FIELD ~,o.: ~'-~54 I"~°'*~r°~:~ ~ Deep Trench ~Sh~llowTrench ~Bed ~Mound ~Other LEGAL DESCRIPTION so,,~,,,: O.~GPD/Sq. Ft. TotalDepthfromoriginalgrade:~ Lot: ~.~ C;GC~:'~~[O~/~Subdiv~i°n; ~ Depthtopipebo,omfromor,ginalgrade:~. Ft. Graveldepth beneath pipe ~ Ft. WELL: D New ~ Upgrad Grave~width: ~' Ft. ~ ~ : Ft. ~. ~ ~. TANK Yield: ~p Set et: C~sing Height Above Ground:l ~ ~EPARATION DISTANCES ~s,,tic, ~ ,o~i,, ~ s.r.~.P. From Tan~ Field Station Tank Sewer Lines ~ ~ ~ ~e,~ J00'~ tO0' ~ ~ .~.a,:F;./~/~~ SuHaCewater/~'+ I~"f LIFT STATION Line Cu~ain Drain ~0~ ~iV~ -- ~ IElectrical Inspecti°ns ped°rmed by: Remarks: BENCH MARK Location and Description: ' ~ ~ ~ i~ ~ Inspections pe,ormed by: 1~"4 ~,~ "~.. ~... "-e~J ~- D- 9~ : ~ ~..~.~?'-~/'~"~-~ Department of Health and Human Se~ices approval ,, ~. ...... Reviewed and approved by: Date: 72~)13 (Rev. 9/91) MOA 25 PERMIT NO. SW990259 PAGE 2 O? 3 un~clp, cdlt oF Anchor'cee DEPARTMENT OF HEAF_TH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O. Box 196650 IAnchorage, ALaska 99519-6650·TeLephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3A, TRACT A, BROADWATER HEIGHTS P.I.D. NO. 050--151--79 LOT S LOT ~,~v~ I I ~o'× ss' ~ I I I UI~ILITY EASEMENT I)BLI & I)BL2 4A DV ROBERT C. COWAN CE-8801 PERMIT NO. SW990259 PAGE 3 0F 3 _ iVlunicip, atifl;y .o.P Amchor'oQe DEPARTM~-NT OF HEALTH AND HUIV[AN SERVICES ENVIRONMENTAL SERVICES DIVISION P,B, Box 196650 eAncho~'cge, Alaska 99519-6650eTe[ephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3A, TRACT A, BROADWATER HEIGHTS P.I.D. NO. 050--131--79 105.5'~ j~~ /FINAL GRADE VERIFIED ~ TANK ' CO1 MT2 CO2 MT1 CO1 = 100.?' AL GRADE III '~col - 96.5' ICO2 = 96.5' MT2 = 92.4'~' '~MT1 = 92.2' · NO WATER FOUND 85.7' B.0.H. A B FCO 14.5' 9.5' ST1 28.0' 33.5' DV 35.0' 41.0' DBL1 37.0' 43.5' DBL2 38.0' 45.5' C01 32.5' *65.0' MT1 35.5' *67.5' C02 97.0' '124.0' MT2 95.5' '123.0' * USES POINT "C" GRE ,., R ANCHORAGE AREA BOR., ,',GH Department of Environmental Quality 3330 C Street Anchorage, Alaska gg503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME_ ~(,~-,.-~---~-.~¢(( I,_~ ~ SEPTIC TANK: DISTANCE FROM WELL jl2./t..,,-cp., INSIDE LENGTH MAN U FACTU R E Pr.~~ MATE RIAL INSIDE WIDTH LIQUID DEPTH _ COMPARTMENTS LIQUID C A P A C I TY/¢/-'"~¢"¢'/G A L LO N $. TILE DRAIN FIELD: DISTANCE FROM WELL ,FOUNDATION NUMBER OF LINES / DISv~/ANCE BETWEEN LINES ABSORPTION AREA 3 2'..,~__, ,~',i SQ. FT. DEPTH: TOP OF TILE TO FINISH GRADE ~ / WELL: BUILDING FOUNDATION__ CONSTRUCTION NEAREST LOT LINE TRENCH WIDTH LENGTH OF EACH LINE '~/' DEPTH OF FILTER MATERIAL BENEATH TILE_ TOTAL LENGTH OF LINES TOTAL EFFECTIVE / IN. ABOVE TILE / / IN. DEPTH DISTANCE FROM: NEAREST LOT LINE_ NEAREST SEPTIC SEEPAGE SEWER' LINE__, TANK__, SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: ,/ DIAGRAM OF SYSTEM APPROVED __ Form EQ-032 PERMIT NO. DEPARTMENT OF HEALTH FIND ENVIRONMENTAL PROTECTION 2510 E. TUDOR RD.., ANCHORFIGE, 8K. 9950? 276-222t Or-I--SITE SEL-~ER F'EF~.f-1 IT ( 7622g ) AF'PL I CANT LOCFI'f' I ON LEGFIL. DUNCAN MCCLOUD STILLWFITER ~ L~ TR FI 8ROADWRTER HGTS P 0 BOX 795 - E, R. LOT SIZE 694-97i5 ~t00D SL';!UARF.. FF=ET TYPE OF SOIL FIBSORBTION SYSTEM IS' TRENCH rlH,.,,IMUM NUMBER OF BEDROOMS SOIL RRTING (SC-! FT/BR)=t~""=..., "['HE REQUIRED SIZE OF THE SOIL FIBSORPTION SYSTEM IS' [:.E:F'TH= 1~3 L EI",IG TH = ";~2 GRR'-..'EL [:. E F' T F.t ::: (; THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINF'IEL,[~. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND FIND THE 80TTOM OF THE EXCFIVFITION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES, THE GRFIVEL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETWEEN 'THE OUTFRLL. PIPE AND THE BOTTOM OF THE EXCAVFITION (IN FEET).- F.~:EC-':!U I REC, SEPT I m~ TRI'-.It,--:. S I ZE= t~3pllE1 ,DFtL. L.,:~-.~:S.:j; BR_.KFILLING OF RNY SYSTEM WITHOUT FINAL INSPECTION AND FIPPROVRL B'¢ THIS [~EF'FIRTMENT WILL 8E SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL RND FINY ON-SITE SEWRGE iDISPOSRL ~'"- -,~ =,TEH 1OO FEET FOR FI PR IVFITE WELL OR 2.00 FEET FOR FI PUBLIC WELL _FECIFICHTIONS FIND CONSTRUCTION DIFIGRAMS ARE RVRILFIBLE TO INSURE PROPER I NSTRLLRT I ON. F"DZF,i..'I",I I T ",,,,"RLI E:, FOR ONE "-r'ERI~L' Fl~-".Cml",l I :S,; '=E"iL~E: I CERTIFY THRT ±: I 8M FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND HELL. S RS; SET FORTH BY THE MUNICIPFILITY OF ANCHORFIGE. 2: I WILL INSTALL THE SYSTEM IN FICCORDRNCE WITH THE CODES. ~: I UNDERSTAND THFIT THE ON-SITE SEWER SYSTEM MFIY REQUIRE ENLFIRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THFIN Z BEDROOMS. FIPPLICFINT 'DUNCAN MCCLOUD -- =,=.UED E'Y ~-~ / ' ~- ...... DATE 0 Et E GEO'. ZCHNICAL ~' DEVELL PMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 S0IL LOG 688-2280 Soils ~t Foundations Land Development Perfomed for: Name:. ~ .~~ Hatltng Address: Legal Description: ~ ~ Depth (feet) Sotl Characteristics 10 .... ..~ 11~ 12 13 15 16 Ground Water Encountered: Yes ': No v~x If yes, what depth_.___._ Proposed Installation: Seepage Pi*,___.___ Drain Fie~d.._.___~ Comments:__~~~'~>~ -~<z~x, .'~' ~-. ~' \~ MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ~ On-Site Services Section - ' P.O. Box 196650 -Anchorage. Alaska 99519-6650 CERTIFICATE Of HEALTH AUTHORITY ' : ~'"' ' ' '-: % '?:" ::':~PPRO~'AL-,~. FOR a SINGLE FAMILY DWE~'LING ' !- GENERAL INFORMATION ' :~ ' '; L . , ';~,~::;-;::~.~:;~':~ ~f: . .. Complete legal description ~ ~) :....: .. . .. ':.:.. : . ., .. ,,~.~.........~.. -,~,.~ _ __-,-,~:~ _ . . ., : ~'~ /.,~ .~~'. ,..~.. : - , ~ . -- · .... .Ma n~,address,--~--~/,~/~~-~-~ ~ ~,~ _ __ _ . ~.~,~-"%~:;:,:'~.':, .'-'-'~%~":--: . r. .'.:'. :' ._ '*'T~Baina'~aCk~:'"Y'"*~.~.~, ~_~.. '.: "- ' .... Day~_ _dhon- ' ' Agent · ."'_'- _' . . -' .:,_ Day phone _ _ _ Address ' "' - unless otherwise reque,,sted, HAA will be held for pickup.: 3. TYPE OF WATER SUPPLY: - Individual well X ~" Corn.,munity well'~i~ ~ '~.; :'i~ ' Public water NOTE: If community well system, provide written confirmation from State ADEC attest- . -ing to the legality and status Of s~ste~nl . _ _i.~ · 4. 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) Fronl MOAtt21 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 fbrther 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 wastewate[ disposal system is in complian(~e w th all Municipal and State codes, ordinances, and, regulations ir effect on the date of this inspection. · ' {'~SENGINEERING '' ~ ~1'-';LO/ 7r--J Name of Firm Address Engineer's signature Eagle RIver~ Alaska DHHS SIGNATURE ~/' Approved' for Disapproved. Conditional approval for bedrooms. Phone bedrooms, with the following'Stipulations: By: The Mur~icipality 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 tl~eir lending institutions in order to satisfy certain fede.ral and state requirements. Employees of DH HS 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. RECEIVED Municipality of Anchorage AUG 1 7 DEPARTMENT OF HEALTH & HUMAN SERVICES MUNICm^U~'O~ Env ronmental Services Division ~NVI~ON~4~NTN. SE~VKI~I~t 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Health Authority Approval Checklist Legal Description: Z~- ~,~/ ~'~'"~)-~-J7~ ~- Parcel I.D.: A. WELL DATA Well type 7-~ / ~',~-~'- IfA, B, or C, attach ADEC letter. ADEC water system number Log present Date oomp,eted Cased to '~--~) /''~ Casing height (above ground) FROM WELL LOG Total depth Sanitary seal<~ Date of test "~/'~/'~ ~ Static water level ~-/'/~/K Well production / Wires properly protected~ AT INSPECt'ION g.p.m. WATER SAMPLE RESULTS: Coliform ~ Date of sample: ~:Z/~ ~Z/~ B. SEPTIC/HOLDING TANK DATA Nitrate ,~ ~' Other bacteria // Collected by: ~'~/~ ~/~-//~/(=Yc-/~//V~- Date installed ~/~/~ Tanksize /~'?~'.)~"NumberofCompadments ~-* Cleanouts(~ Foundation c eanout;~)./~ '~b(-'//~'~ Depression (~F',/~ //L,'/~) High water alarm (Y/N) ,'~//,/'/,'Z~r C. ABSOFiPTION FIELD DATA" ~ '~ Date installed ., Soil rating (g.p.d./fF or fF/bdrm) (~,, ~ System type Gravel thickness below pipe 4 / Total depth Effective absorption area ~"'~) '~ Monitoring Tubepresent~7~ Depressionoverfie,d d Date of adequacy test /V~"'7-~U Results (Pass/Fail) For ~.~ bedrooms Fluid depth in absorption field before t (in.): Fluid depth (ins) ~ A~sorption'rate = ' _g.p.d. Peroxide treatment~onths) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION / Date installed ~//,~- ~llons Manhole/Access (Y/N) ~~/.~rd~on" level at* High wtae~ *Datum Cycl,,~s~e d "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELLON LOT TO: Septic/holding tank on let Absorption field on lot /~)(~)/' Public sewer main ,/¢' Sewer/septic service line ,~ ~-/-/-- On adjacent lots On adjacent lots Public sewer manhole/cleanout /¥/"~- / Lift station "~ f/'/~- / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation /(~ ~/- Property line /4¢2 /'-/-' Absorption field Water main/service line ~-I~'-F Surface water/drainage //~'~(~¢' Wells on adjacent lots /00 ¢ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /,'//~ // "~-Building foundation Surface water /00 Curtain drain /'[,/g~/V(- ,,~/t,/~/,4/,AJ' ENGINEER'S CERTIFICATION Water main/service line /~:~ 'Cz- Driveway, parking/vehicle storage area. ~-' Wells on adjacent lots /<¢~ '//- in conformance with MOA HAA gjines in effect on Signature ~./J/. /--,"z,,,/'-'----'~ Engineer's Name //~a~"'*T C. Date ~/1~ /~ ~ I certify that I have determined thru field inspections and review of Municipal rec, this date. HAA Fee $ :~ t:.~-~ ,/CZ} Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ ,//.~ ZT~) Date of Payment ~//7 /~ -. Receipt Number -~--/~-- (?77¢ Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us S & S Engineering ATTN: Robert Cowan, PE 17034 Eagle River Loop Rd, #204 Eagle River, AK 99577-0000 August 18, 1999 Subject: Waiver Request for BROADWATER HEIGHTS TR ALT 3A Waiver # WR990056 Lot Line Request for Parcel ID 050-131-79 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is 1.5 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Donna C. Mears Civil Engineer I On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section WR# 99005 Date Received: Legal Description: Engineer: .5 ~ Wa'iver Review Worksheet Permit # Waiver Requested: Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Name of Reviewer Rec %: ' ~ ~ 11~ ~7 ;$6/777 Amount: $ Date Paid: ROBERT C. COWAN, P.E. August17,1999 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 3A, Tract A, Broadwater Heights Request you issue a Health Authority Approval on the referenced property and grant a waiver for the separation distance between the west property line and the leachfield at 1l/2 feet. We do not anticipate any adverse effect on the adjacent properties. lfyou require additional information, please contact us. Sincerely, Robe~t C. Cowan, P.E. RCC/skh SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE W~TEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577 " '~T~mm~, CT&E EnvirnnmentaI Services ,nc. T-3i~ P.~2/03 F'OT6 993753001 LoI 3A: Tr A; Broadwat~r Lot 3A: TI' A: Broadwa~er Drinlcing Wa~er Client PO~ Printed Date/Time 07/29/99 Collected Date/Time 07/27/99 14;40 Received Date/T/me 07/27/99 16;00 Technical Director: Slephen C. Ede To~a~ Coliform 1 cB co~/1Oo ~L 3,60 0,500 mg/L EPA AtLowabLe Prep AnaLysis 07/2?/99 RMV max 07127/~907/27/99 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.# _~_~(~ 1. GENERAL INFORMATION Complete legal description Broadwater He±ghts, T.ot 3A Tract A Location (site address or directions) 18241 St±l[water Dr±ye, Eagle R±ver Property owner Mailing address Lending agency Mailing address. Agent Address Bruce & Kathleen Mackey Day phone 694-4784 ]8241 Sti]]water Drive. Eagle River.;',AK 99577 N/A Day phone. N/A Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well × Community well Public water ~ NOTE: 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: x 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. Name of Firm Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature ~ Date Approved for '~¢~-~"~' ~) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type /P~-! V/~-E~ If A, B, or C, attach ADEC letter. Log present (Y/N) Total depth /00 / Sanitary seal (Y/N) ADEC water system number /'///~ Date completed 0'~/'~ Driller Cased to ~ ~,~',,~ ~ Casing height ~ / Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG /'("'7 g.p.m. AT INSPECTIOJ~UNICIPALITY OF ANCHORAGE D ~/~ '2 / ~/IRONMENTAL SERVICES DIVISION g/. Z~' ,~t 2 7 199;5 R CmEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / t Absorption field on lot Public sewer main Public sewer service line /V/'~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /VOA/¢ WATER SAMPLE RESULTS: Coliform ~ Nitrate ~,. Date of sample: ~ '7/~,/~/~ Collected by: Other bacteria B. SEPTIC/~ TANK DATA Date installed D6,/OZ-/"]~ Tank size / Cleanouts (Y/N) /V'~..~ Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping /'~/~-'~/~ "~ Compartments /V Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/H~L-OIN~ TANK TO: Well(s) on lot / i 3 ~ On adjacent lots 7~/~ / Foundation To property line ~,7" Absorption field .5~ / Water real. service line Surface water/drainage /'///~' 72-026 (Rev. 3/01) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ,~\ ~ ~ Meets MOA electrica~ SEPAR~ANCE FROM LIFT STATION TO: Well o~ lot On adjacent lots .Manufacturer j "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length ,.~ / ~ Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating /~ z~/_Z~,~_ System type /~'~:/'/C~ Gravel thickness ~ / Total depth //~ Cleanouts present (Y/N) Y~-~ Date of adequacy test (~'7//?,-/~ P for -,~ bedrooms /V/,4 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~;3. [ / On adjacent lots '/' ID~) Property line ~ ;-:~ / To building foundation ~' 5- / To existing or abandoned system on lot On adjacent lots r 3> ~ Cutbank ./V/,4 Water mah~/service line ¢' '7~ Surface water /'//~ Driveway, parking/vehicle storage area ~" Curtain drain E. ENGINEER'S CERTIFICATION Signature Engineer's Name Date 7/,,3- I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on. the date of this inspection. . '~ ,~ , '~f., HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 : .' SUt,I 04 ' ~ S:J3 0~: 0? (,tORTHI N 3330 IND P~O, Box 773294 E4gle Rive= AK 99577 Attn: Louis Butera YOU= S~pie ID: cOmmentm: Lab : A123~'34 BPA 353.3 Nit= Repo%ted By: Susan C. T Mic=obiology Supervisor TESTIHG, AHCHORAGE P. 2/1 ]BTHERN TESTING LABORATORIES, INC. ISTRIAL AVI~NU~ iFAIRBANKS, ALASKA 99701 (907) BANK8 0TREET 'ANCHORAGE, ALAS~ 99503 (907) ~eport D~tet ' Date Arrived:' Date S~pledt 08~7/93 Collected ~23734 coadwate= 3A/TA H ~te-N Units mg/l * Definitions * B = Below Regulatozy!Hi~. H = Above E = Estimated Value D ~ Lost to Dilution MOL - Method Deteotion Limit Dam ' 2.4 0.$ 06/02/9~ 9EPARTHE 825 OF HEALTH AN]] ENVtRONMEN _ PROTECTION L Street, Anchorage, Alaska 99501 279-2511, ext. 224 or 225 Date Received: May.27, 1977 #1: Time ~ 0'.~, ~}q #2: Time ~3: Time Date /~-7-U~ ~h~ Date Date Insp ~~ Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Security Pacific Mortgage Corporati~ Mailing Address: 1011 East Tudor Road Suite 190 Phone: 276-1933 ® Property Owner: Duncan Mc Leod Phone: Mailing Address: % Hylen Company, Jorgen Bogdanoff 278-9591. . e Legal DescriPtion: Lot 3 Tra6t A Broadwater Heights Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: 2 Number of Bedrooms: Be Well System: Permit # Construction Individual Well (~ Community/Public System ( ) Depth of Well Well Log on File Bacterial Analysis 6. Sewage Disposal System: On-site System (xk Public Utility ( ) Permit # InstAlled 1976 Installer Septic Tank Size Manufacturer Absorption Area Soils Rate Material Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: Duncan McLeod VA FHA CONV xx Mailing Address: unknown Name of Buyer: Lazsr S. Mangan Day Phone: unknown Mailing Address: property 4. Name of Lending Institution: Mailing Address: 1011 East Tudor Rd Suite 190 Phone: Anchorage Alaska 99507 5. Name of Realtor or Agent: Hylen Co. - Jorgen Bogdanoff Mailing Address: 4060 Bo Street Suite 105 Phone: Anchorage ~LLas~a 6. Legal Description: Lot 3 Tract A Broadwater Heights Day Phone: unknown Security Pacific Mortgage Corp 276 1933 278 9591 Location: NHN Skyline Drive Eagle River Alaska 7, Type of Facility to be Inspected: 8. Water Supply Type of Supply: sfr No. Bdrms. Public Utility rlndividual xx 2 If Individual, number of dwellings presently served If Individual, depth of well unknown Sewage Disposal System Type of System: Public Utility unknown Individual (on-site). xx If Individual, date of installation 1976 72-O03(3/76) Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 3 Tract A Broad~a~er Heights Subdivision comments: Affadavit Attached: ( )// Approved: _ Disapproved: Department Worksheet: Letter Attached' ( ) Date: Date: