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Home My WebLink AboutBROADWATER HEIGHTS BLK 2 LT 2ABroadwater Heights Block 2 Lot 2A #050-081-83 GREW R ANCHORAGE AREA BOR "GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME D'4mcah MC"-e0d MAILING ADDRESS QPH�ONE /j LOCATION St�y�l>18�121UE Anw4 LEGAL DESCRIPTION Lr d &k Z (/YC04Dtt1iPrFe //5 �. SEPTIC TANK: DISTANCE ',/ NUMBER OF FROM WELL MANUFACTURER W,+LLI-AC.E MATERIAL C4"TTE COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY l000 GALLONS. SEEPAGE PIT: NUMBER OF PITS �. DIAMETER JC) OR WIDTH IS , LENGTH 4 , DEPTH �I LINING MATERIAL 06MV CRIB SIZE: DIAMETER _41LDEPTH_6�_DISTANCE FROM: WELL i TOTAL EFFECTIVE' BUILDING FOUNDATION NEAREST LOT LINE 20 ABSORPTION AREA (WALL AREA) E/� SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ILI-ED CONSTRUCTION �ND�I�°A DEPTH DISTANCE FROM: BUILDING NEAREST FOUNDATION LOT LINE NEAREST EWER INE SEPTIC TANK12/ S SYSTEM CESSPOOL APPROVED DISTANCES: OTHER SOURCES DISAPPROVED REMARKS INST/ALLED BY: ,,WALLAGE EX , PIPE MATERIAL: &L I.fKT LOT SLOPE: REMARKS: �a DATE Form No. EQ -031 DIAGRAM OF SYSTEM APPROVE G.A.A.B. W 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 SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960066 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:SIMPSON TIPP & ELMA OWNER ADDRESS:12043 W SKYLINE DR EAGLE RIVER, ALASKA 99577 PARCEL ID:05008129 LEGAL DESCRIPTION: BROADWATER HEIGHTS BLK 2 LT 8 LOT SIZE: 20019 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 5/02/96 EXPIRATION DATE: 5/02/97 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 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: ISSUED BY: DATE: 21� DATE: _17-2 - q� OCT 15 "93 15:06 907x,41251 JACO; WHITE/ER r f ��►�"•� '[•!1 '.+�/ � Irl;. � •�- �::r,� - \ -Pry I!J P.2 ` r y J, tom' ma C� ' %�\►�.S°� w L � �• J . AS -BUILT I hereby certify that I have surveyed the following described property:Z g //p. /< Z ' Anchorage Recording Precinct, Alaska, and that the improve. merits situated thereon are within the property lines and do not, overlap or encroach on the property lying adjacent thereto, that no improvements on 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 Eagle River, Alaska this _day 19 ROBERT C. JOHNSON R e?; SCALE; Registered Land Surveyor No. VOLS Box 7.4156. Ea6e River, Alaska 99577 13�131.IRG ( UN L"13D:VII)N1) ) S Ut6 COR. as h 6onittuctlon Beit RE 1 z -fab 4 G Z v 1974 "One test is worth a thousand opinions" MU Sato TUDOR ROAD. ANCHORAGE. ALASKA 99507 • TEL[►HOME 333- ANCHORAGE ANCHORAGE AREA ®OROUGH DEPT. oP jNv VoNmtNTAI WOW Performed For Klondike Concrete Date Performed 8/8/74.. Legal Description: Lot. Block 2 Subdivision Broadwater Subdivision This Form Renorts Soils Log Yes Percolation Test I)eoth Feet Soil Characteristics SM & Organics 2 3— AT A 5 —Inlet 6- 7 19- 9*_ — 9.® Well graded Sand 125 SF/BR 16' Bottom of Test Hole. Was. -G -round Water Encountered?. No If Yes, At what Depth? Readinq ( Date ( Gross Time Net Time I Depth to H2O Net Dron; Percolation Rate Minute Proposed Installation: SeepagePit Yes Drain Field Deoth of Inlet Depth To Bottom Of Pit Or Trench V MMENTS: 2 bedroom. e roc or c ay at 16'. No ground water encoun ere - Test Performed 8y A. Clopton Data Certified By: cons.truction Test Lab,: N. A. Hausam Date: 8/26/74 OCT 15 '93 15:06 907-41251 JACK WHITE/ER P.z IX K o wL , j t ten' !j6a .4r,ti •� - ` = ri ♦ . •'� — it ? � �, AS -BUILT r S �/" I hereby certify that I have surveyed the following described \ ., : property:� 3 . n' oc�C � : �.. Anchorage Recording Precinct, Alaska, and that the improve. mens situated thereon are within the property Lines «- G,".,,.,�� t, ;-3 d and do not vz. !�W: eta wy M ap or enaoach on the property lying adjacent thereto, that no irnprovements on property iymg 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 Ea;le River. Alaska this i—a y Q � o 19 rQ� oda of - . ROBERT C. JOHNSON :v SCALE: Registered Ladd Surveyor No. 180 -LS 4 ' 'lti Sox 7-t_4.56, Sade River, Alaska 995 iterfifieD drilling lwg by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND f i Y f� y /r yt')Sn rt! DEPTH OF WELL 9?v. boy `t'l3yg3 / 4fs�7 ADDRESS i2o�3 lt). sk I��es �-� Eb5le �2:t/� , Ac I y STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION`='t` =�. € 'C, -' �a i 1 ~; DRAW DOWN FT. DATE - Started Ended 53 % GALS. PER HR } PERMIT NUMBER 6W 9 (600 (� �, _ KIND OF CASING KIND OF FORMATION: From—2 Ft. to = Ft. '.) � ,G r U ` From. _ Ft. to Ft. From �x Ft. to_Ft. ? J From—Ft. to Ft. From r': Ft. to. Ft. LF �4 4 C. k O� C' 6 r� From Ft. to Ft. From ' Ft. to f 5Ft. &F4W C� 94'Ic� From Ft. to Ft From Ft. to—Ft. From Ft. to Ft From /.7 j Ft. to - " Ft. From Ft. to Ft. From�'Tj Ft. to ,,) Ft. _ 1 .�& " K �� L (., �� • [ ��r r �� hrom Ft. to Ft. -4.1's From Ft. to Ft.,) From Ft. to Ft. From Ft. to 0, Ft. tGt.:�C. � r's°t From Ft. to Ft. ', _Ft. From 0 Ft. to 2j Ft. ZI)Al,tC.. (�ey,%j Y4 om to Ft. From Ft. to Ft. .�.� From Ft. to Ft. From s_Ft. to+ Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From F4. to Ft. From Ft. to Ft. From From Ft. toF Ft. OR LLIVED From Ft. to Ft. to From Ft. to Ft. From Ft. to -9 A 3 1996 MISCL. INFORMATION: Municipality ut Anchorage Dept. Health & Human Services DRILLER'S NAME Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 050-0$1- 9 '_5 1. 1. GENERAL INFORMATION Expiration Date: -7- Complete legal description Lot 2A lid), Block 2, Broadwater Heights Location (site acdr 12043 W. Skyline Drive, Eagle River, Alaska 99577 Donald Tarver 907 551-5163 ' Knigs ovwDay phone }t I - .``12043 W. Skyline Drive, Eagle River, Alaska 99577 *-'RPS t, None (FSBO) Day phone 2 TYPE OF,DWELL,I,r 8`af' 1] ° StngtjAarnily (w/wo ADU) DupAV ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 F `1 A. 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ P1 ihliC \Nater Rvcfam Sevyer Waiver/Variance request Received by: Date: j l COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ (o r _ Waiver Fee $ Date of Payment �r H C�� Date of Payment Receipt Number COSA# ('!15—C- I A I \ 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 Pinard Engineering Phone (907) 357-3647 Address PO Box 871347 Wasilla, Alaska 99687 Engineer's Printed Name Paul E. Pinard, P.E. 6. DSD SIGNATURE ZSystem #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the Date 2/25/14 By: i i4- �% /� l TI Original Certificate Date: n / Z /� The Municipality of Anchorag 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 emors 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 ° e 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: Lot 2A (lots 2 & 8), Bk 2, Broadwater Heights Parcel ID: 050-081-29 A. WELL DATA dee C�'. , - A-5 Well type Pvt (2) If A, B, or C provide PWSID # Date completed 1-74; 2-5/96 Sanitary seal (Y/N) Y Total depth 1-7%2-400 ft Cased to 1-402-20 ft. FROM WELL LOG Date of test 5/96 Static water level 78 Well production 0.25 ft. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate rmg/L Arsenic ND ug/L Date of sample: 2/10/14 B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Concrete Tank size 1000 gal. Number of Compartments 1 Foundation cleanout (Y/N) Y Date of pumping 2/10/14 C. ABSORPTION FIELD DATA Date installed 8/4/74 Length Well Log (YIN) Y for well #2 Wires properly protected (YIN) r Casing height (above ground) 1-12;2-18 in. AT INSPECTION 2/19/14 1-6.1;2-144.2 ft 1.5 w/#1 & #2 g P m Z t""ti a"I 1. z� rnyli Y Collected by: Pinard Engineering Date installed 8/4/74 Cleanouts(Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) Pumper One Stop Services N Soil rating (g.p.d./f:2 orftz/bdrm) Unkn System type Seepage Pit 15 �° Width ft. Gravel below pipe ft. N rption area 34 8 ft2 Monitoring tube Y Depression over field — Results (Pass/Fail) Pass For 3 bedrooms —s�4� — bbe a test 42 in. Water added 450 gal. New depth 52 in. "450+ j #inal fluid depth 42 in. Absorption rate >= g.p.d_ At 12 mo.) (Y/N & type) None Known If yes, give date D. LIFT STATION Date installed NA "Pump on" level at in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line_ Size in gallons "Pump off" level at Cycles tested 100'+ 100'+ NA 25'+ Animal containment areas 50 + SEPTIC/HOLDING TANK ON LOT TO: 10'+ in. Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout NA Holding tank 100'+ Manure/animal excrete storage areas 100'+ Building foundation Property line 11)1+ Water main NA Water service line 25'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water Service line 25'+ Surface water 100'+ Curtain drain None Known Wells on adjacent lots 100'+ F. COMMENTS OK for owner to pick up COSA. G. ENGINEER'S CERTIFICATION 1 certify that 1 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 Paul E. Pinard, P.E. Date 2/25/14 COSA brown sheet 10-10-12.doc Absorption field 51+ Surface water 100'+ Water main NA Driveway, parking/vehicle storage 10'+ Z- (on `I -arks fo PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) WELL FLOW TEST WELL # 1 LOCATION: Lot 2A, Block 2, Broadwater Heights Subdivision DRILLER: Unknown DATE WELL COMPLETED: 1974 WELL DEPTH: 79' STATIC WATER LEVEL (top of casing): 0.1' JOB NUMBER: 14-029 DATE OF TEST: 313/14 FIELD STAFF PJ Pinard Time Elapsed Time (Minutes) Static Water Level Flow Rate ( m) Cumulative Gallons Pumped 10 Remarks 6:40 PM - 6.1' 4.0 - Start Test - Meter 260340 6:45 5 30.5' 4.0 20 260360 6:50 10 50.9' 4.0 40 260380 6:55 15 76.0' - 60 Stop Flow 260400 RECOVERY 7:00 PM 5 64.8' All well protection features arc adequate. 7:05 10 57.0' 7:15 20 44.7' 7:30 35 29.2' 7:45 50 16.9' 8:00 65 12.1' Recovery rate P. 1.6 gpm for this well (isolated from storage tanks & well #2) Average Flow Rate: 4.0 gpm Comments: DURING THIS TEST, THE WATER SUPPLY WELL WAS CAPABLE OF PRODUCING 4.0 GPM. THIS TEST DOES NOT CONSTITUTE A WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE. Reviewed by: Paul Pinard -i Date: 318114 PINARD ENGINEERING S P.O. Box 871347 ..n Wasilla, AK 99687 r(907) 357-ENGR (3647) l/{ I' WELL FLOW TEST WELL # 2 LOCATION: Lot 2A, Block 2, Broadwater Heights Subdivision DRILLER: Sullivan Water Wells DATE WELL COMPLETED: 5196 WELL DEPTH: 400' STATIC WATER LEVEL (top of casing): 58.8 JOB NUMBER: 14-029 DATE OF TEST: 313114 FIELD STAFF: PJ Pinard Time 3:30 PM Elapsed Time (Minutes) - Static Water Level 58.8' Flow Rate m 4.0 Cumulative Gallons Pumped - Remarks Start Test — Meter 260260 3:35 5 78.3' 4.0 20 260280 3:40 10 99.9' 4.0 40 260300 3:45 15 115.0 4:0 60 260320 3:50 20 129.5' 4.0 80 260340 3:55 25 137.4' 4.0 100 260360 4:00 30 143.2' 4.0 120 260380 4:05 35 150.5' - 140 Stop Flow 260400 RECOVERY 4:10 pM 5 149.2' All well protection features are adequate. b3Q 145 156.0' 8:00 235 141.0' Recovery on this well not determined — well was in use by homeowners during this recovery. Average Flow Rate: 4.0 gpm Comments: DURING THIS TEST, THE WATER SUPPLY WELL WAS CAPABLE OF PRODUCING 4.0 GPM. THIS TEST DOES NOT CONSTITUTE WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE. Reviewed by. Paul Pinard &C Date: 3/8114 PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 2A, Block 2, Broadwater Heights Subdivision APPLICANT: Donald Tarver 12043 W. Skyline Drive Eagle River, Alaska 99577 SEPTIC TANK TYPE/SIZE: Concrete/1000 Gallons, per MOA Records ABSORPTION SYSTEM: Seepage Pit, per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GALBR = 450 Gallons TEST DATA JOB NUMBER: 14.029 DATE OF TEST: 2119114 FIELD STAFF: PJ Pinard NUMBER OF BEDROOMS: 3 SCUM: 0.0' SLUDGE: 0.0' NEEDS TO BE PUMPED: Yes No XX CURRENTLY IN USE: Yes XX No Time Flow Rate Volume Cumulative Volume Septic Tank I Septic Tank Soil Absorption System Comments PM (GPM) (GALS) (GALS) Liquid Level A Level Monitor Tube 1* p SAS Level Monitor Tube 2* A SAS Level 2:05 4.0 - 4.8' - 3.5' - Start Flow - Meter 254640 2:35 4.0 120 120 4.8' 0.0' 4.1' 0.6' 254760 3:05 4.0 120 240 4.8' 0.0' 4.2 0.1 254880 3:35 4.0 40 280 4.8' 0.0' 4.0' -0.2' 254920 4:05 4.0 0 280 4.8' 0.0' 3.5' -0.5' 254920 4:35 4.0 60 340 4.8' 0.0' 4.1' 0.6' 254980 5:05 4.0 0 340 4.8' 0.0' 3.5' -0.6' 254980 6:05 0.3 60 400 4.8' 0.0' 3.6' 0.1' 255040 7:05 - 50 450 4.8' 0.0' 3.9' 0.3' Stop Test - 255090 MT *ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMMENTS: System appears to be operating satisfactorily. There was 3.5' of measurable liquid in the SAS MT prior to beginning the test. With the addition of 450 gallons to the system (the design daily flow), the level rose and fell over the test period of 5 hours, ending at the initial starting depth 30 minutes after stopping the test flow. Reviewed by: Paul Pinard .1 Date: 2/25/14 MUNICIPALITY OF ANCHORAGE Development Services Department �., Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-081-83 1. GENERAL INFORMATION Expiration Date: 4,/. /! —Zd_?,z— Complete legal description BROADWATER HEIGHTS BLK 2 LT 2A Location (site address) 12043 West Skyline Drive Eagle River Current property owner(s) SLATER MICHAEL P Day phone Mailing address Real estate agent 12043 West Skyline Drive Eagle River 2. TYPE OF DWELLING: F-1 Single Family ©'wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone AK 99577 AK 99577 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage 0 Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ _ Date of Payment /��Z ( Date of Payment Receipt Number 0610(4 D Receipt Number COSA # 0-5 G 22.100 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone 907.406.1058 Date a�Pr�dFES�10'� ��+1(nliC� b'ti SSTAN/P Conditional approval for bedrooms, with the following stipulations: g ON -sl -FE INA -r OG�AM 1 � Original Certificate Date: — � � ^ 2_� Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: BROADWATER HEIGHTS BLK 2 LT 2A Parcel ID: 050-081-83 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1974 water well A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 3.75 gpm Date drilled 1974 Water storage tank volume 300 gallons Total depth unk ft Well disinfected for coliform test? ❑ Yes ❑ Nc Cased to unk ft ❑ Coliform bacteria is Negative no Sanitary seal is functioning correctly Nitrate 2.73 mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12 in. Collected by Curtis Townsend Date of flow test for COSA 12/47/2421 Date of Sample ''M'2024 Static water level at beginning of test 14 ft. Comments well pump is set at 66' below grade, this well is located nearest the house B. TANK DATA A of tanks) years Tank typ /material Measured opeing fluid level in septic tank F-1Standpipes/foun t' n cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (ma Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of ective. If not, state depth into effective ❑ Code -required soil co r over field ❑ System presoa tl (Required if va nt for greater than 30 days prior to date of tes . C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Water id depth prior to test in ded gal New depth in Elapsed time min Final fluid depth I Absorption rate gpd Any rejuvenation treatment (past 12 ths) no Gall ' s introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES f 1974 water well From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Q Yes if No ft Q Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑✓ Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓❑ Yes if No ft r71 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Buildi oundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if ft Property Line > ❑Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ -... if No ft Community Weis > 200' .____ _ ❑Yes.- if ft - Water Service Line > 10' ❑ Yes if ft If septi n�is nder driveway comment below From Absorption Field on Lot to: (Please enter distances Building Foundation > 10' ❑ Yes if No ft Property Line > 10' Yes No ft Water Main > 10' Yes if No ft Water Service Line > ❑ Yes if No ft Surface Wa > 100' F-1Yesif No ft s than required) If ab tion field is under driveway comment below Wells on Adja t Lots: Private Wells > 100' ❑ Yes if No ft Community Wells > 200' s if No ft F. ENGINEER'S COMMENTS barn or fenced areas haven't contained animals since at least 2010 G. ENGINEER'S CERTIFICATION I certify that I have determined through held inspections and review of Municipal records that the above systems are in conformance witt,� MOA COSA guidelines in effect on this date. '"'�S COSA Checklist yellow sheet Legal Description: BROADWATER HEIGHTS BLK 2 LT 2A If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1996 Parcel ID: 050-081-83 Structure served by this system 1996 water well I Well production at time of test 4.3 gpm Water storage tank volume 300 gallons Total depth 400 ft Well disinfected for coliform test? ❑ Yes ❑ N Cased to 20 ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate 3.09 mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 18 in. Collected by Curtis Townsend Date of flow test for COSA 12/7 1 2021 Date of Sample 121W021 Static water level at beginning of test 14 ft. Comments this well is located farther away from the house, water storage is filled by both wells B. TANK DATA Age of tank(s) 48 years Tank type/material septic Iconcrete Measured operating fluid level in septic tank 59" ❑ Standpipes/foundation cleanout per record drawing Date of pumping 11/24/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 1974 ❑ ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 48 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance corn Age of lift station y Lift station material Comment Adequacy test date 12"'f202E Results Q✓ Pass For 3 Fluid depth prior to test 42 Water added 474 gal New depth 48 in Elapsed time 1320 min ❑ Code -required soil cover over field Final fluid depth 42 in F-1Systempresoaked Absorption rate , gpd bedrooms ff (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES 1996 water well � I From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' ft If absorption field is under driveway comment below ✓0 Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' ft Animal Containment > 50' 0 Yes if No ft Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓Q Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' [✓ Yes if No ft Surface Water > 100' 0 Yes if No ft Property Line > 5' 171 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' El Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Q Yes ._if No ft _ Community Wells > 200'✓Q lies if No - ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS barn or fenced areas haven't contained animals since at least 2016 G. ENGINEER'S CERTIFICATION I 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. COSA Checklist yellow sheet Municipality of Anchorage s • Development Services Department Building Safety Division Z On -Site Water and Wastewater Program S A F Er Y 4700 Bragaw Street P.O. Box 196650 1 r Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o50 -o81-83 COSA # Expiration Date: 1. GENERAL INFORMATION Complete legal description Broadwater Heights, Block i, Lots zA and 8 Location (site address) 12043W. Skyline Drive, Eagle River Current Property owner(s) Walter E & Michele Monteil Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems 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. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4. 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 100217, Anchorage, AK gg510 Engineer's Printed Name Steven R. Pannone, P.E. Date 11/8/2010 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. .."„'r1 The operational life of all wells and septic systems depend on the local soil condition, ground water .��OF FA levels that may fluctuate during the year, and the water usage of the family being served by the system. ��`P ,..••••""'••••., These conditions are outside the control of the evaluator of this system. All systems eventually fail and �..•''�'ry �� satisfactory test results do not guarantee future performance of the system, nor do they guarantee that;°• 49 r �� there are no hidden defects or encroachments. PES can therefore not provide any warranty for future 00•••••r •• •••••••••••...... 0 performance nor give any estimate of how long the system will continue to meet the operational o j,,,, , ,,,,,, ;;, „0 requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed , � :Steven R. Pannone; i above. Any reliance upon or use of this report by any other person or party is not authorized nor will it �1�% ':,.. No. CE 8149 ,.••'AV confer any legal right whatsoever. �� .,• 5. DSD SIGNATURE ��.•' Approved for �_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: OFkj,;'b I L Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory By: " L4 (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 3/3( /( Municipality of Anchorage *A9 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Broadwater Heights, Block 2, Lot 2A and 8 Parcel ID: o50 -o81-83 A. WELL DATA in. Well type Private If A, B, or C provide PWSID # Date completed ldi/i996 Sanitary seal (Y/N) Y_ Total depth #1-79 #2-400 ft. Cased to #1-40+ #2-20 ft. FROM WELL LOG Date of test 5596 Static water level #2-78 ft. Well production #2-0.25 g.p.m. WATER SAMPLE RESULTS: Coliform N_ etc -colonies/100 mL Nitrate 1.52 mg/L Well Log (Y/N) Y for well 2 Wires properly protected (Y/N) Y Casing height (above ground) #1-12 #2-20 AT INSPECTION 10/21/2010 #1-17 #2-264 ft. #1-1.8 #2-5-9 - 9 -P.M. awl go ffil: Arsenic: ND ug/I Date of sample: 1 2o11 Collected by: Pannone Engineering B. SEPTICIHOLDING TANK DATA Tank Type/Material Concrete Date installed 8/4L974 Tank size l000 gal Number of Compartments 1, Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 8/12/2mo Pumper IRs Pumping C. ABSORPTION FIELD DATA Date installed 8/4/ig74 Soil rating (g.p.d./ftz or ff/bdrm) Unkn System type Seepage Pit Length 18 ft. Width 15 ft. Gravel below pipe 8 ft. Total depth ft. Eff. absorption area 3&-8 fe Monitoring tube Y Depression over field N Date of adequacy test l0/21/2010 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 1pn. Water added �al. New dept �in. GLY 4A__1 Elapsed Time: 20 min. Final fluid depth 'in. Absorption rate >= 45o+ g.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 in Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot loo+ Absorption field on lot loo+ Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots loo+ On adjacent lots loo+ Public sewer main NA Public sewer manhole/cleanout NA Sewer /septic service line 25+ Holding tank loo+ Animal containment areas 50+ Manure/animal excrete storage areas loo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 10+ Absorption field 5+ Water main NA Water service line 25+ Surface water 100+ Wells on adjacent lots loo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main NA Water Service line 25+ Surface water loo+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots loo+ F. COMMENTS is Wall r mmcrnnrl Iry DCC ..n -..t G. ENGINEER'S CERTIFICATION i 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 R. Pannone, P.E. Date q/11/2011 COSA Fee $ 4 °l Date of Payment 1/q//0 , Receipt Number 05 Lt Ct 2 - (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number •..•� OF • �••...............� 95�1� 49 rH t* wA. ... uuumAm ...... ... ... ................ ........... . � %Steven R. PonnonT %°•. No. CE 8149 in. 00 AS -BUILT - Lots 2 & 8, Biock 2,. Broodwater Heights Subd. West-Rer)son aou�,evard, SQae 200 526— Fox. 26—wtlx: Ufa 1', — Dmor 7- —L-129 ' 6'72/22-24 SOPVC Stang,, rxiati%'4 +utas PCAV USON NCIiW itea cww a° i? ti14iFltgt to cf t sr.jnatn. excac t+l lrC� cii Q"Y ca-%omA vt&, ccc rngx�'$�„ q+' r��$,� j, y,ffi CES ata Act Axa 1#w r rOppew b ,ptat. 0 into' no ci d xt r��t�a n°atara � aatr�€�ti�rra car f�rr° e"stt'�t2km res s at,4 oyw P pert #inxx. 'F R t#roaar�r +�%pte xa �+w °#ta#� tawnq �swc9 lPEtai ttaac �r p,� satx,ate ame vwtka�#!« tha Pwt tansy urri9 rtx :aaczs^mt radt �a titer, "tari. r A; J'4— RENEWAL - / �, Municipality of Anchorag Development Services Departme t Building Safety Division" i On -Site Water and Wastewater Program , •, I T V 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 2A ( lots 2 Location (site address or directions) 12043 W. HAA # /t C IZ1F t A1, O S O i t Expiration Date: / oZ. � / .. 1O G 2. Broad ►ra Current Property owner(s) Tipp & Elma Simpson Day phone 694-2043 I Mailing address PO Boz 773493 Eagle River, Alaska 99577 Lending agency Day phone Mailing address I Real Estate Agent Raney Hardman - Re/Max of ElDay phone 440-7257 -Mailing Address 16600-Centerfield-Drive—Eaple-Ri-ver--Alaleka-99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: ---- --- —TYPE OF WASTEWATER DISPOSAL: --- Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of supply system. DSD also issues HAAs upon request to homeowners. 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. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this 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 Pinard Engineering Phone (907) 357-3647 Address_ PO Boz 871347 Wasilla, ALaska 99687 Engineer's Printed Name Paul E. Pinard Date Pam E. Pletaed;, S. DSD SIGNATURE P C,2 4T93 !% Approved for bedrooms. �'�� PP Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other Current water sample results By: W (/ Original Certificate Date: (Rev 01102) RENEWAL Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T.nR 2A (l n+.n 2 & A), Rl nntr 2, Rrnadwate"I Heights A. WELL DATA Well type gate (2) If A, S, or C provide PWSID A _ Well Log (Y/N) Y for well 12 Date completed 12- 5/96 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Total depth --791 . Cased to #1- 2 -ft. Casing height (above ground) 1 12 in. f #2+400 ft FROM 2- 20 in. OM WELL LOG ft AT INSPECTION # Date of test #1 -NA 02 -5/96 7/7/05 Static water level #1 -NA #2 - 78 ft, #1 -7.51,#2 -15.0 ft. Well production #1 -NA #2 -0.25 g.p.m. #1 -1.4, #2 -0.25 9 - p.m -WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 4.33 mg./1. Other bacteria 0olonies1100 ml. I Arsenic: JJU— mg./l. Date of sample: 7120/06 Collected by: Pi nerd Fn&i neeri ng B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Concrete Date installed 8/4/74 Tank size 1000 gal. Number of Compartments 1 Cleanouts (Y/N) Y ! Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (YM) N C. ABSORPTION FIELD DATA Date installed 8/4/74 Soil rating Pumper JRs Pumping (g.p.d./fe or felbdrm) IInkn System type SeepageI. Pit Length 18 ft. Width 15 ft. Gravel below pipe 8 ft. Total depth ft. Eff. absorption area 348 ft Monitoring tube Yes Depression over fiend No Date of adequacy test 7/7/05 Results (Pass/Fail) Paaa For 3 bedrooms Fluid depth in absorption field before test -,U in. Water addecfja/& gal. New depth_ Z in. Elapsed Time: JA2 min. Final fluid depth 3i in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None known If yes, give date D. LIFT STATION AA Date installed 'Pump on' level at _ in. Datum Size in gallons 'Pump ofr level at _ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 1001+ Absorption field on lot 11001+ Public sewer main NA Sewer /septic service line 251+ Manhole/Access (Y/IJ) _ High water alarm level at Meets alarm b circuit requirements? On adjacent lots 1001+ On adjacent lots 11001+ Public sewer manhole/cleanout NA Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 251+ Property line 201+ Absorption field 101+ Water main 10 r + Water service line 10' + Surface water 11001+ Wells on adjacent lots 100 r + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: in. Property line 201+ Building foundation 25' + Water main 101+ Water Service linel O r + Surface water 1001+ Driveway, parking/vehide storage 10 r Curtain drain None known Wells on adjacent lots 100 r + F. COMMENTS A 2nd ST was found on the property and van prope�ed on 8/24/05 G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and *• r review of Municipal records that the above systems are in •W -V -me • ` : e conformance with MOA HAA guidelines in effect on this date.r Engineer's Printed Name Paul E. Pinard , •e c�•4TOi ,fi. Date 8/30/06 '•.. .•'�•`�f" _ ..... - •re — HAA Fee $ 4- tD " Date of Payment $ X10, Receipt Number F5'45q (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number SGS ReEN Clieat Name Project Namt/N Client Sample ID !Matrix Sample Remarks: 1064042001 Pinard Engineering Lot2A Blk2 Broadwater Hts. Lot2A BIk2 Broadwater Hts. Drinking Water All Dates/fimes are Alaska Standard Time Printed Datdrime 08/03/2006 8:05 Collected Datefrime 07/20/2006 11:45 Received Date/fime 07/20/2006 12:37 Technical Director Stephen C. Ede Metals Department Hardness as C&CO3 Private Individual Analvai■ Aluminum Antimony Arsenic Barium Cadmium Calcium Chromium Copper Iron Lead Magnesium Manganese Phosphorus Chloride Fluoride Selenium Sodium Silicon Silver Thallium Sulfate Zinc 19.5 '5.00 mg/L �SM202340B C 1620 20.0 • Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Nitrate -N 4.33 0.100 mg/L EPA 353.2 B 07/20/06 ALR Nitrite -N ND 0.100 mg/L EPA 353.2 B 07/20/06 ALR Metals Department Hardness as C&CO3 Private Individual Analvai■ Aluminum Antimony Arsenic Barium Cadmium Calcium Chromium Copper Iron Lead Magnesium Manganese Phosphorus Chloride Fluoride Selenium Sodium Silicon Silver Thallium Sulfate Zinc 19.5 '5.00 mg/L �SM202340B C 1620 20.0 ug(L EP200.8 C ND 1.00 ug/L EP200.8 C ND 5.00 ug/L EP200.8 C 4.76 3.00 ug(L EP200.8 C ND 0.500 ug/L EP200.8 C 5670 500 ug/L EP200.8 C ND 1.00 ug/L EP200.8 C 4530 a 1.00 ug/L EP200.8 C 371 a 250 ug/L EP200.8 C 23.4 a 0.200 ug/L EP200.8 C 1300 50.0 ug/L EP200.8 C 5.42 1.00 ug/L EP200.8 C ND 200 ug/L EP200.8 C 29.5 0.100 mg/L EPA 300.0 B ND 0.100 mg/L EPA 300.0 B ND 5.00 ug/L EP200.8 C 22300 500 ug/L EP200.8 C 7860 200 ug/L EP200.8 C ND 1.00 ug/L EP200.8 C ND 1.00 ug/L EP200.8 C 25.0 0.100 mg/L EPA 300.0 B 371 5.00 ug/L EP200.8 C 07/24/06 07/31/06 MH 07/24/06 07/31/06 MH (<6) 07/24/06 07/31/06 MH (<10) 07/24/06 07/31/06 Mll (<2000) 07/24/06 07/31/06 MH (<5) 07/24/06 07/31/06 MH 07/24/06 07/31/06 MH (<100) 07/24/06 07/31/06 MH (<1300) 07/24/06 07/31/06 Mil (U00) 0724/06 07/31/06 Mil (<151 0724/06 07/31/06 MH 0724/06 07/31/06 M11 (<50) 0724/06 07/31/06 Mll 0724/06 07/31/06 MH (<250) 0720/06 07/20/06 DSH (<2) 07/20/06 07/20/06 DSII (<50) 07/24/06 07/31/06 Mil (<250000) 07/!4/06 07/31/06 i Mil 07/24/06 07/31/06 M)1 (<I00) 07/24/06 07/31/06 Mil (r2) ', 07/24/06 07/31/06 Mil (<250) 07/20/06 07120/06 DSII (<5000), 07/24/06 07/31/06 MH SCS Ref.B 1064042001 Client Name Pinard Engineering Project Name/# Lot2A Blk2 Broadwater Hts. Client Sample ID Lot2A BIk2 Broadwater Hts. Matris Drinking Water All Dates/Times are Alaska Standard Time Printed Date/fime 08/03/2006 8:05 Collected Date/time 0720/2006 11:45 Received Date/time 07202006 12:37 Technical Director Stephen C. Ede tl tl Allowable Pmp Analysis Patsmeter Results PQL Units Method Container ID Limits Date Date [nit Private Individual Analysis Total Dissolved Solids 569 a 10.0 mg/L SM20 2540C D (<500) 0720/06 KP Nickel 3.81 2.00 ug/L EP200.8 C (<I00) 0724/06 07/31/06 M11 IICO3Alkalinity 288 20.0 mg/L SM20 2320D D 0724/06 PLW CO3 Alkalinity ND 20.0 mg/L SM20 23208 D 0724/06 PLW 011 Alkalinity ND 20.0 mg/L SM20 2320D D 0724/06 PLW Conductivity 750 1.00 umhos/cm SM2025109 D 0720/06 CRY PH 6.86 0.100 pfI units EPA 150.1 D (6.5-8.5) 0720/06 CRY Alkalinity 288 20.0 mg/L SM20 2320B D 0724/06 PLW Total Coliform 0 colfl00mL SM209222B A (<I) 0720/06 TLF Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 050-081-29 HAA # 6504((C Expiration Date: — I roo ` OS 1. GENERAL INFORMATION Complete legal description Lots 2 & 8 (2A), Block 2, Broadwater Heights Location (site address or directions) 12043 W Skyline Drive Current Property owner(s) Tipp & Elma Simpson Day phone 694-2043 Mailing address Lending agency Mailing address PO Box 773493 Eagle River, Alaska 99577 Day phone Real Estate Agent Raney Hardman— Re/Max of ER Day phone 440-7257 Mailing Address 16600 Centerfield Drive Eagle River, Alaska 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY:* TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site El Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of fitle (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. 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. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this 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 Pinard Eneineerin - Phone (907) 357-3647 Address PO Box 871347 Wasillap Alaska 99687 Engineer's Printed Name Paul E. Pinard Date 9/7/05 =1 :y•wsei •� ^ 4 y'W •IEPIGt a' �;, o° Q 90 o•e a♦e 0 S. DSD SIGNATURE J-•C,;''"„-i•PT —016o•• / Pout E. Pinard a J; Approved for bedrooms. {'3 ' CE -4783 , Disapproved. 0••• Conditional approval for bedrooms, with the following stipulatio%s�'N:`' Additional Comments J ON-SITE Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: — 0'e,-_ "�'y �� ` Original Certificate Date:_ 0 /0 pi«. 01401) Municipality of Anchorage • '� Development Services Department t Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Boa 196650 Anchorage, AK 995196650 www.cl.anchomge.ek.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lote 2 & 8 (2A). Bk 2. Broadvater HteParcellD: 050-081-29 A. WELL DATA Well type Private (2 )f A, B, or C provide PWSID # _ Well Log (Y/N) Y (for well 12 ) Date completed _12 —5/96 Sanitary seal (YIN) _I Wires properly protected (Y/N) Y #1 -128 Total depth Cased tojj.�ft. Casing height (above ground) #2_.,_2&a 2-400, FROM WELL LOG 12- 201 AT INSPECTION Date of test 11 -HA #2 - 5/96 7/7/05 Static water level 11 -HA #2 = 78 ft. 11 - 7.5', #2 8.15.0' Well production #1 -HA #2 - 0.2!�,p,m, WATER SAMPLE RESULTS: Coliform 0 coionies/100 ml. Nitrate 3.28 mg./l. Other bacteria 0 colonies/100 ml. Arsenic: _ mg.11. Date of sample: V22/05 Collected by: Pinard Engineering B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Concrete Date installed 8/4/74 Tank size 1000 gal. Number of Compartments 1 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (WN) H Date of pumping 7/22/05 Pumper JRe Pusrvin C. ABSORPTION FIELD DATA Date installed 8/4/74 Sail rating (g.p.d./fe or ftzlbdrm) In -lm System type Seepage P t Length 18 ,eft. Width 15 ft. Gravel below pipe ft. Total depth I VV ft. Eft. absorption area 348 ftp Monitoring tube Depression over field RO Date of adequacy test 7/7/05 Results (Pass/Fail) Pasa For 3 bedrooms Fluid depth in absorption field before test 32 in. Water added5�4 gal. New depth42 in. Elapsed Time: 147 min. Final fluid depth 35 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None known If yes, give date D. UFT STATION HA Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at_ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access(Y/N) High water alarm level at Meets alarm ti circuit requirements? Septic tankilift station on lot 11001+ On adjacent lots Absorption held on lot 11001+ On adjacent lots Public sewer main NA 1001+ 1001+ Public sewer manhole/cleanout NA Sewer /septic service line 251+ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: NA Building foundation 251+ Property line 201+ Absorption held 1101+ Water main 10' + Water service line 101+ Surface water 100'+ Wells on adjacent lots 1001 + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 201+ Building foundation 251+ Water main 101+ Water Service line 101 + Surface water 1001+ Driveway, parkingNehide storage 101 Curtain drain None known Wells on adjacent lots 1001 + F. COMMENTS A 2nd ST was found on the property & was properly G. ENGINEER'S CERTIFICATION I certify that I have determined through held inspections and review of Municipal records that the above systems are in +� conformance with MOA HAA guidelines in eh`ect on this date. 15 " : Engineer's Printed Name _ Paul Be Pinard Date 9/7/05 HAA Fee $ Date of Payment Receipt Number 7 3iA3 /41 (Rev. 12/01) 41 in. on 8/24/05. �U-'EWiz: rre ibis l♦•�.�e.if.• Plwd E. Pk%W, Waiver Fee $ Date of Payment Receipt Number PINARD ENGINEERING P.O. 111 871347 Wasilla. AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 2A, Block 2, Broadwater Heights Subdivision APPLICANT: Tipp 6 Elma Simpson PO Box 773493 Eagle River, Alaska 99577 SEPTIC TANK TYPESIZE: Concrete/1000 gallons per MOA Records ABSORPTION SYSTEM: Seepage Pit. per MOA Records DAILY FLOW: 3 BEDROOMS x ISO GAL/BR u 450 gallons TEST DATA JOB NUMBER: 05-131 DATE OF TEST: 717105 FIELD STAFF: A.Wlen NUMBER OF BEDROOMS: 3 SCUM: 0.0' SLUDGE: Minimal NEEDS TO BE PUMPED: Yes No XX CURRENTLY IN USE: Yes XX No Time Flow Volume CumWative Septic Tank Sep ko Soil Absorption System Comments Rate (GPM) (GALS) Volume (GAL$) Liquid Level A Level Monitor A SAS Monitor A SAS PM • Tube 1' Level Tube 3' Level 2.71 - Start Flow - Meter 89261 8:03 4.0 - 4 8' - 8:16 - 52 52 4.8' 0.0' 3.3' 0.6' 89319 8:33 5.0 52 4.8' 0.0' 3.3' 0.0' 89319 8:48 5.0 75 127 4.8' 0.0' 3.3' 0.0' 89394 9:03 5.1 76 203 4.8' 0.0' 3.4' 0.1' 89470 9:18 2.5 77 280 4.8' 0.0' 3.5' 0.1' 89547 9:55 3.6 94 374 4.8' 0.0' 3.5' 0.0' 89641 10:15 3.2 72 446 4.8' 0.0' 3.5' 0.0' 89713 78 524 4.8' 0.0' 3.5' 0.0' Stop Flow 89791 10:30 *ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMMENTS: There was 2.7' or messu rabic liquid in the SAS MT prior to beginning the test. With the addition of 524 gallons to the system (more than the design daily now) the level rose to 3.51 midway through the test, lwhere it stabilized. A recovery evel had almost returned to the IMWI me uremen A second. apparently taken an hour end a half after unused Septic tank, ning the It". exxttdto that the garage, needs to be property abandoned. Reviewed by: Paul Pinard Date: 7/25105 PINARD ENGINEERING P.O. Box 871347 o Wasilla, AK 99687 (907) 357-ENGR (3647) J Vb WELL FLOW TEST WELL 0 1 LOCATION: Lot 2A, Block 2, Broadwater Heights Subdivision DRILLER: Unknown DATE WELL COMPLETED: 1974 WELL DEPTH: 80'. per owner (probed to 791. pump @ TV) SLTATIr: WATER LEVEL (too of Casing): 7.5' JOB NUMBER: 05-131 DATE OF TEST: 717105 FIELD STAFF: A. Wien Time Elapsed Time Static Water Flow Rate Cumulative Gallons Remarks 8:03 PM inutes Level 7.5' m Pum — Start Test – Meter 89267 8:16 13 7.5' 52 89319 8:33 30 5.0 89319 8:48 45 5.0 127 89394 9:03 60 76.0' 5.1 203 89470 9:18 75 76.0' 4.2 280 89547 9:33 90 76.0' 1.4 343 89610 9:48 105 76.0' 1.4 364 89631 Sto 89641 Pijmn cavitatin 9:55 112 76.0' 374 Switch to well 2 automatic switch was overridden in order to test Output of each .Well #2 is used as the backu well for this s tem. Also note that there are four 4 atmospheric storage tanks, each 80 allons in size, row in 320 allons of water. These tanks were bypassed and not utilized in the test, in order to better evaluate the well out LIT. RFCOVERY 10:15 20 GPF = 29 Gal - 1.4 GPM 10:35 40 = 22 Gal - 1.1 GPM 10:55 60= IS 21 Gal - 1.0 GPM 11:15 80 11:50 115= 26 Gal - 0.5 GPM ...... A n 1 d onm k Onwed as the head increased. Average Flow Rate: 1.4 gpm Comments: DURING THIS TEST, THIS WATER SUPPLY WELL WAS CAPABLE OF PRODUCING 5.1 GPM. THIS TEST DOES NOT CONSTITUTE A WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE. Reviewed by: Paul Pinard Date: 7/24!05 PINARD ENGINEERING P.O. Box 871347 Wasilla. AK 99687 (907) 357-ENGR (3647) WELL FLOW TEST WELL # 2 LOCATION: Lot 2A, Block 2, Broadwater Heights Subdivision DRILLER: Sullivan Water Wells DATE WELL COMPLETED: 5198 WELL DEPTH: 400' crnnr WnrFn t FVFL (too of casino): 15.0' JOB NUMBER: 05.131 DATE OF EST: X7105 FIELD STAFF: A. Wien Elapsed Time Static Water Flow Rate Cumulative Gallons Remarks Time inutes 10:00 PM — Level 15.0' 4.8 Pum — Start Test — Meter 89641 10:15 5.2 72 89713 10:30 5.2 150 89791 10:45 5.2 229 89870 11:00 5.4 307 89948 11:15 300'+ 389 StO 90030 Switched to well 2 10 PM auto switch was overridden in order to test output of each .Well #2 is used as the backUD well for this s stem. Also Note that there are 4 atmospheric storage tanks, each 80 nallons in size, ofovidin 320 allons of water. These tanks were bypassed and not utilized in this test, in order to better evaluate the ne rine it of the 2 wells. RECOVERY Average Flow Rate: 0.25 gpm Comments. DURING THIS TEST. PRODUCING 5.4 GPM. I THIS EST DOES NOT CONSTITUTE A CAPABLES WATER SUPPLY WELL WAS OF WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RAE. Reviewed by: Paul Pinard Date: 7!24105 Qom•' �4 t'� :t .,` 'tri ` .. a'•('e�n • e . rrq I it3I� a '�, \�� 7V r \+ I hereby certify that 1 have surveyed the following described property: L,2 S. $ l c -k ' /'gyp A . � te. n—T ..r F ' fY _t � �/. �. • _ � �iL��CI Anchorage Recording Precinct, Was", and that the improve merits situated thereon are within the property !Ines and do not overlap or encroach on the property lying adjacent thereto, that . * .:� "� "•., '/rtl� no improvements on property lyi%adjacent thereto encroach •. ,, � Jr.�- ,y� y d, on the premise In question and t at there m no roadways,. r;CY except ssti n tines or other visible easements on said property . g� . 'txcept as indicated hereon. ' r t U tc? �y ry {Ia•-' Dated at Eagle River, Alaska �.`P of 19�i F -.ct t :cn ,, this day .: I I .: + ROOERT C. JOHNSON '4 t SCALE: Regbtered Land Surveyor No. 860•LS Box 77-0456, Eagle River, Alaska 99577 Phone (907) 6947.543 r