HomeMy WebLinkAboutBROADWATER HEIGHTS TR D BLK 1 LT 17
Municipality of Anchorage Page t 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: D'D o~, PID Number:
Name: ~'1,~-~.., C,~./~v~',, ~ Wastewater System: ~New ~ Upgrade
Address:
~ I~ Ck~C'~ ~ ABSORPTION FIELD
J
Phone:
~ No. o~edrooms: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION so,, Rating: Total Dept~m original grade:
~' ~ GPD/Sq. Et.
Lot: ~ ~ Bloc~~o ~~Subdivisi°~;~ T~ Depth to pipe bottom~.from original grade: Ft. Gravel depth ~'beneath pipe Ft.
Township~ __ Rang~ I Section: . Fill added abov~riginal grade: Gravel length:
r~ Gravel width: Number of lines: Distance between lines;
WELL: Q New . ~ Upg~ ~' Ft. i ~ Ft.
Classification (Private, A,B,C): ~1 ~ Cased To: Total absorpti Pipe material:
Ft. Ft. SQ. Ft.
Driller:~~ Date Drilled: SlaticWater Level:Ft. Installer:~ ~,~~ Date in~l~
'~GPM ] PumpSet at: Ft. Icasing Height AbOve GrOund:Ft. TANK
t
SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P.
TO Septic Absorption Lift Holding Public/Private Manu~cturer: Capacity in gallons:
From Tank Field Station Tank S .... Lines /~ ~~
Material: Number of Compartments:
Well ' ~
Surface
Water ~1~' +1~ ~1~ LIFT STATION
Lot ~3' ~¢' ~' Sizeingall°ns: IManufacturer:
Line
Foundation ~, ¢,[, .. __ "Pump on" level at: ~evel at: [ High water alarm at:
CurtainDrain ~1¢l ~t~l ~' ~~ IElectrical InspectiOns perfOrmed by:
Remarks:~ ,~S~~ ~ ~~ BENCH MARK
Location and Description:
Assumed Elevation:
Department of Health and Human Services approval
Reviewed and approved by: ~]o~ ~~ Date: t%
72-013 (Rev. 9/91) MOA 25
Permit No. ~%o1~ Page ~- of
Municipality of Anchorage
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
Legal Description: /- ~' 51 ~-o=&~,-~-~- F~,-~ ~ PID No.: O5o~.~ t'54-
72-0t3 A (1/93)*
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930133
DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC.
OWNER NAME:CLAUS BERNARD D & MARGARET L
OWNER ADDRESS:P.O. BOX774042
EAGLE RIVER, AK 99577
DATE ISSUED: 6/01/93
EXPIRATION DATE: 6/01/94
PARCEL ID:05013134
LEGAL DESCRIPTION: BROADWATER HEIGHTS TR
1 LT 17
D BLK
LOT SIZE: 35528 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK 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 (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
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:
THE MAXIMUM DEPTH OF/~HE ~ENCH MUST NOT EXCEED 8.0 FEET.
RECEIVED BY:/~'-//~;~7~/~ ,~ DATE:
SITE PLAN-WASTEWATERABSORPTION SYSTEM
SITE P~.N DETAILS
PROPOSED WASTEWATERABSORPTION SYSTEM
LOT 17 BLOCK i BROADWATER HEIGHTS SUBDIVISION
PREPARED FOR: MR. MIKE QUINN
PO 774042
EAGLE RIVER, AK, 99577
SCALE: 1" = 100'
DRAWN BY CAL
CONSTRUCTING ENGINEERS 346-2000
9601 BUDDY WERNER DR 694-9098
ANCHORAGE, AK, 99516 5-24-93
DRAWING # 93-S1-05-7
ABSORPTION SYSTEM DESIGN DETAILS--TRENCH
CONSTRUCTION NOTES:
1. 2" HD INSULATION REQUIRED OVER ALL PORTIONS OF
ABSORPTION SYSTEM WHICH DOES NOT HAVE MINIMUM 4'
GROUND COVER.
2. CONTRACTOR MAY IMPORT COVER TO MEET MINIMUM 4'
GROUND COVER OVER SYSTEM.
3. SEPTIC TANK REQUIRES 2" INSULATION.
SCOPE OF PROJECT: New proposed absorption field is designed for a four (4)
bedroom system. Lot is to be served by public water.
ABSORPTION AREA CALCULATIONS:
Minimum Required: 4 Bedrooms x 150g~d/bedroom = 600 gpd capacity
Soils rating, proposed addition, 0.8 g~d/sf (trench design)
Minimum sizing: 600 gpd - 0.8 gpd/sf = 750 sf absorption area
Use trench design, with shallow ground cover, added insulation:
750 sf - (2)(6'D) = 62.5' minimum trench length
IMPACT ON ADJACENT LOTS: There are two well casings from previous owners on
this lot. They will each be properly abandoned prior to use of this proposed
septic system. There are no other private wells within 100' of this proposed
absorption system. The proposed absorption system has no adverse impact upon
any adjacent lots as shown on attached site diagram.
T~ENCH DESIGN DETAILS
PROPOSED WASTEWATERABSORPTION SYSTEM
LOT 17 BLOCK I BROADWATER HEIGHTS SUBDIVISION
PREPARED FOR:MR. MIKE QUINN
PO 774042
EAGLE RIVER, AK, 99577
NOT TO SCALE
DRAWN BY CAL
CONSTRUCTING ENGINEERS3G6-2000
9601 BUDDY WEANER DR 69&-9098
ANCHORAGE, AK, 99516
5-24-93
DRAWING # 93-S2-05-7
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATE PERFORMED:
Township, Range, Section: ~'i~l(/~. 5 ~ Tl4t',J
8
9
10
11
12
13
14
15
16
17
18
19
2O
;LOPE
WAS GROUND WATER
ENCOUNTERED?
s
IF YES, AT WHAT ~,~ L
DEPTH? ~-~.~ pO
E
Depth to Waler Alter ~l¢-'""-
Monitorino? /kJ ~ Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
¢~ ~/',~./~ - _ z.. _
4 z,~,~ 3,,.... ~7/[~,, Vw'
_~ 7..~'-. ,.. .5. , , ~, ~ " ~; / 8 "
PERCOLATION RATE
TEST RUN BETWEEN
COMMENTS
~:~$Z~ (m~nutes/mch) PERC HOLE DIAMETER ~:~
FT AND FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE.
72-008 (Rev. 4z85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE: ~'(z+/~
December 1~ 1977
~76913
Clifford Carroll
Box 1367
Eagle River, Alaska
99577
SubJect~ Permit Expiration
Dear ~. Carroll:
A permit issued by this department for well and/or on-site
sewer installation on Lot 17 Block 1 Tract D Broadwater
Heights Subdivision has expired since the issue date exceeds
one (1) year.
In the event you still plan to install the well and/or on-
site sewer system, a new permit is required. The original
soil test may be used to obtain a current permit.
If the well has been drilled, a well log should be sent
to this department to document the installation date.
If you have any questions regarding the above matter, please
do not hesitate to contact this office immediately at 264-
4720.
Sincerely,
Les N. Buchholz, R.S.
Sanitarian
I~m/ljh
F'E:F;?,I"I ]: "t'* NO.
L...E'GRI ....
L..OT ~5:1:
THE :5.;'r E;TI!.:.ff'I ]i P']--~Cn:i:E~R[)FINC:E 14 Z TH THE CODEE;.
O 8' E GEO', 'CHNICAL ~ DEVEL ~MENT CO.
Russell Oyster
694-2774
Soils E~ Foundations
Performed for:
Name: ~
Matltng Address:
Legal Description:
Depth (feet)
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Earl Ellis
SOZL LOG 688-2280
Land Development
Soll Char~cte,rlstlc;
3
i5
i6
Ground Water Encountered: Yes~ No~
Proposed Installation: Seepage Pit
Comments: ~-'~ ~ '~'- ~J~"-~,~
If yes, what depth
Drain Field 'v"/
Performed by:
MUNICWAUTY OF ANCHORAGE
iI�
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. 050-131-34 Expiration Date: !
1. GENERAL INFORMATION
Complete legal description BROADWATER HEIGHTS TRACT D BLOCK 1, LOT 17
Location (site address) 11607 BIRCH HILLS DRIVE, EAGLE RIVER, AK 99577
Current property owner(s)
Mailing address
Real estate agent
NDA & JAMES STROTHER Day phone
11607 BIRCH HILLS DRIVE, EAGLE RIVER, AK 99577 k
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
®
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ L' I Q• 5 a
Date:
Coy 1 1) — Waiver Fee $
Date of Payment
Receipt Number_ ?O
COSA#
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/17/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to �sil1
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q: • • • • •,9 ��(
for current or future occupants or guarantee that no unseen encroachments, deficiencies or /JJ
discrepancies exist can be given by First Water Consulting & FW / * • Tl -I .....•:*
,• •r
6. DSD SIGNATURE Curtis Huffman /
System #1 Approved forbedrooms ��+cs••• CE 128991
TF97/17/2020�� r
System #2 Approved for bedrooms II�F�PROFESS1o�P��
Disapproved
Conditional approval for bedrooms, with the following stipulations:
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 X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arseni'Cc Advisory
I
40ther t ^ Aqe7
Legal Description: BROADWATER HEIGHTS TRACT D BLOCK 1 LOT 17 Parcel ID: 050-131-34
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA — PUBLIC WATER
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth _ft
Cased to _ft
❑ Sanitary seal is functioning correctly.
❑ Wires are properly protected
Casing height (above ground) _in.
Date of flow test for COSA
Static water level at beginning of test _ft.
Comments
B. TANK DATA
Age of tank(s) 27 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 49"
® Standpipes/foundation cleanout per record drawing
Date of pumping 7/14/2020
D. ABSORPTION FIELD DATA
Well production at time of test _gpm
Water storage tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ❑ N
❑ Coliform bacteria is Negative
Nitrate _mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by_
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _years
Lift station material
Comments:
Which system tested (date installed) 6/1993
Adequacy test date 7/14/20
® ALL standpipes present per record drawing
Results M Pass For 4 bedrooms
Total measured depth from grade 10.8 ft (max)
Fluid depth prior to test 14 in
Measured depth to pipe.,invert from grade 5 ft (min)
Water added 600 gal
❑ N/A — pressurized field
New depth 22 in
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 5.8' INTO THE WED
Elapsed time 270 min
® Code -required soil cover over field
Final fluid depth 13 in
❑ System presoaked
Absorption rate 600 gpd.
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons
If yes, enter date
Comments/Deficiencies: f
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well) NA PUBLIC WATER
Septic Tank/Lift Station on Lot > 100'
® Yes if No ft
Wells on Adjacent Lots:
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Surface Water > 100'
® Yes
Animal Containment > 50' ® Yes
if No
Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No 5'+ ft Surface Water > 100'
ft
ft
ft
ft
ft
® Yes if No ft
Property Line > 5'
® Yes if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes if No ft
Private Wells > 100' ® Yes if No _
Water Main > 10'
® Yes if No ft
Community Wells > 200' ® Yes if No
Water Service Line > 10'
® 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'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
Or
At
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os®°``°:�
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Curtis Huffman
CE 128991
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MUNICIPALITY.OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section`Y
www.muni.org/onsite
Septic 'Tank Advisory
Certificate of On -Site Systems Approval #OSC 201353
Subdivision: Broadwater Heights Tract D Block 1 lot 17
907-343-7904
Fax: 343-7997
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 27 years old. Typical replacement costs range from $8,000 to $11,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
0201,10M
�� � �Mad�ng Address P O Box 196650 *Anchorage, Alaska 99519 6650 * www m � �� ��i
un org
Municipality of Anchorage °P�GEY e�� z
On-Site Water and Wastewater Program
(907) 343-7904 A E T . :.
?
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-131-34 Expiration Date: akkq 2S, ,)b 1 a
1. GENERAL INFORMATION
Complete legal description BROADWATER HEIGHTS TRACT D BLOCK 1, LOT 17
Location (site address) 11607 BIRCH HILLS DRIVE, EAGLE RIVER,AK 99577
Current Property owner(s) LARRY&CYNTHIA ASTRUP Day phone
Mailing address 11607 BIRCH HILLS 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
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ❑ Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class Well ❑ Public Sewer ❑
Public Water System
WaiverNariance request for: Distance:
Received by: Date: yz./i7
COSA to be released to t ineer,unless otherwise requested by the engineer.
COSA Fee $ �j�'�a " Waiver Fee $
Date of Payment $ [((a hl Date of Payment
Receipt Number 0142-11t, Receipt Number
COSA# OSCAI V6-1 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 ARCTERRA CONSULTING,INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 8/112017
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineers Comments: This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ��\
encroachments,deficiencies or discrepancies exist. — OF 4I 14,
Aw
6. DSD SIGNATURE
;: 4: 9Lu-*"} y*
,/ System #1 Approved for "1 bedrooms. 4 ,r/
KENNETH . . Dl rr c f
System #2 Approved for bedrooms. ( ��r� 7116
1
Disapproved. ipEs,oti'`
1k'IL
Conditional approval for bedrooms, with the following stipulations:
ON-SITE
WAT E R AA N D
WASTEWATER
PROGRAM c-
By: 'RgtfittS, CivJ Tim Fc0uc+►ci Original Certificate Date: 5/2-E2 O 1 7
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 10.10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: BROADWATER HEIGHTS TRACT D BLOCK 1 LOT 17 Parcel ID: 050-131-34
A. WELL DATA — PUBLIC WATER
Well type If A. B, or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (Y/N)Y Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic: ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC J STEEL Date installed 6/1993
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y
* aCStru.ri7 6'*rjioE —'3
Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 7/28/17 Pumper JRS
C. ABSORPTION FIELD DATA
Date installed 611993 _ Soil rating ..p.d./.2 .r ft2/bdrm) 0.8 _ System type DEEP TRENCH
Length 64 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth 10.8 ft. (Measured 7/28/17) Eff. absorption area 768 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7128117Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 13 in. Water added 635 gal. New depth 22 in.
Elapsed Time: 1380 min. Final fluid depth 12 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"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 - PUBLIC WATER
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot _ On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank _
Animal containment areas Manure/animal excrete storage areas
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 200'+_
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'+(NONE KNOWN) Wells on adjacent lots 200'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COS.A guidelines in effect on this date.
Air � OF A
, L1
Engineer's Printed Name KENNETH M.DUFFUS ��`Z�
Date 8/1/2017 r * t 9 TI 1
10' ir�.liC.�,
-P KENNETH M. 1)141F.4,:7, /
COSA canary sheet_2-6-15.doc 1i,Tri16 �
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va.! PE ANI"
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m Lot 18
.'Utility Easement
i30 Wood ten. N87°48'30"E 234.65 N
O �—'—__ ° Lot 12
co O ,.... ..-----77-77-,,,,,, ^' 36.0110 reenhouse \ to
NCO ,..7,1-..;;,•-•:,7?.'•'.._.,.., „ , . . ....
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0 I :. . F °F o Gravel _ ` O
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I r` m I �oimi=]
20 Lot 17
_ o. Ram
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I I o �, I N o deck
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Et W2.0 0 , 24-o f. •tic vents
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I o I 33' BLM Reservation
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I 10' Utility Easement
N89°49'50"W 298.00
30 Lot 4
Birch Hill Terrace Addn. No. 1 REVISED 8-24-17 Added Septic ventst,
AS-BUILT NO CORNERS SET THIS DATE
Note:This property is served by a public water system �N\
��' • , , ,OF AL 1 I hereby certify that I have performed a Mortgagee's inspection
!`. q k, of the following described property: LOT 17. BLOCK 1.
�Q.:. SLI BROADWATER HEIGHTS. TRACT D SLtBDIVISION
/ 49Offth ') • 1�•*1/ Anchorage Recording District,Alaska,and that the
/ •• / improvements situated thereon are within the property lines
/ •• / and do not overlap or encroach on the property tying
/ «•�► • / adjacent thereto,that no improvements on the property lying
/ Fred Wa I o t k a :15 f adjacent thereto encroach on the premises in question and
s •• 3255 - S •• that there are no roadways,transmission lines or other
•• yJ visible easements on said property except as indicated
I1 its;• • o hereon.
SCALE: 1"= 40' MI
1'� gsia��•�r3Dated at Anchorage,Alaska
EASEMENTS OF RECORD,OTHER THAN %%%%,%. % this 7th day of &must ,2017.
THOSE SHOWN ON THE RECORDED FRED A&ASSOCIATES
BE
PLAT ARE NOT SHOWN HEREON. FB 17-4. pg 66 (907-248-1666) Engineers ers and and Surveyors
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SER~/ICES
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
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address.
Agent
Address
Day phone
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water
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
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Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L ~-6! ~,-o~,~..~,~ IA--~ ¢,~)~1-~-~ Parcel I.D.
A. Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing heigh
Wires properly protected (Y/N
FROM WELL LOG AT IN,~
MUNICIPALI[Y OF ANCHORAGE
F. NVIRONMENTAL SERVICES DIVISION
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL ~,O:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE
Coliform
Date of sample:
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Nitrate
B. SEPTIC/HOLDING TANK DATA
Date installed (0-3~
Tank size
Collected by:
Other bacteria
Cleanouts (Y/N) '7'
High water alarm (Y/N)
Date of pumping ~-v~
Compartments '7__
Foundation cleanout (Y/N) Y' Depression (Y/N)
m Alarm tested (Y/N) '--
~ 1~', Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
g.~r~ C E IV E D
Foundation
Water main/service line
Well(s) on lot N ~ On adjacent lots
To property line ~'~' Absorption field
Surface water/drainage
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level ~ y~'~cles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FR~M"~I~ STATION TO:
Well on lot ~ On adjacent lots
Manufacturer
Manhole/Access
~mp off" Level at
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length G
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF)
Width Gravel thickness
-7(;'~ .~-~ Cleanout present (Y/N) '¢
e~,-.~ ~'~ S'r~r~ Results (pass/fail)
O, ~, 3~:~/5-,C System type -r'lz~"~ ¢ ~
d~, Total depth ~'
Depression over field (Y/N)
-- for ~
After test N ~'
If yes, give date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
On adjacent lots ~oo' Property line
To existing or abandoned system on lot
Cutbank -~¢~,' -t,. -~-~¢ o¢ c,~,~,~. Water main/service line
Driveway, parking/vehicle storage area -F 50'
Curtain drain .+
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date I ~-7.,'~ -
HAA Fee $ _'~')0 d~"~
Waiver Fee $
Date of Payment
Receipt Number
Date of Payment
Receipt Number
72-026 (3/93) Back