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HomeMy WebLinkAboutBROADWATER HEIGHTS TR D BLK 1 LT 4Broadwater Heights TR D Block Lo1- 4 #050-131 - 29  O Municipality of Anchorage ,¢~-- Development Services Department i~ Building Safety DivisionX,,~,, On-Site Water and Wastewater Program, 4700 EImore St. P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of www. ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: Sk4100017 PID Number: 050-131-29 Name:Tr'oy I)ovis WastewaterSystem: [~ New [] Upgrade Address:NHN Br'oo~dwet;er' Drive ABSORPTION FIELD Phone; 357-- 9394Number of Bedrooms: 3 [] Deep Trench ~,~ Shallow Trench [] Bed [] Mound [] Other: LEGAL DESCRIPTION So, Rating: 1,2 GPD/Ft' Total Depth from original grade: 3 Ft. S¢.&b division: ~ B,ock: 1 Lot: 4 ~r'oc~owc~-I;er' Ht;s ?¢ to ~e bottom from original grade: Gravel depth beneath pipe: 0,5 Ft. 3 Ft. Township: Range: Section: Fill added above odginal grade: Gravel Length: 3+ Ft. 44 Ft. Well: [~] New [] U pg rade Gravel width: Number of lines: Distance between lines: 5 Ft. P 10 Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: P~'ivc-I;e 300 Ft. 44Ft. 375 Ft' PVC 3034 Driller: Date Ddlled: Static Water Level: Installer: Date Installed: SuLLivo, n 4/P9/10 44Ft. Pomr'c~nin,q 4/30/10 Yield: GPM Pump Set at: Ft. Casing Height Above Ground: 1 ZooO , 3 Ft. TANK SEPARATIONDISTANCES ~]~Septic [] Holding [] S.T.E.P. [] Other: T~ To Septic Absorption Lift Holding Oublic/PrivateManufacturer: Capacity: From~ Tank Field Station Tank Sewer Line t~ n c h o ~' o~ 9 e T o~ n k 1000 ~a,. We, 100'+ 100'- NA NA 25'+ Mate~al: St::ee~ Number of Compartments:2 Lot Line ~ 0' + 3' + N A N i~ Size: Manufacturer: , Gal. , Foundation ~ 0'+ ~ 0'-~ N i~ N i~ "Pump on" level at: "Pump off" level at: in. High water alarm at: in. in. Pump Make & Model Electrical Inspections pedormed by: Curtain Drain NA NA NC NA Remarks: BENCH MARK Location and Description: Lot; Line ~/c~ive~' Bock Deck Assumed Elevation: Top 100Ft. Inspections performed by:N°r'-l;tnRim Engineer'ingoates: 1St 4/~9/10 ,~T.<¢ 2nd 4/30/10 .' .~"'~X .'" '~1~ ,'~ ~. ee Development Services Department Approval ~j-' ~' ',,~ ';~*~ 49T. T~u ~ : *. Conditional Approval Date: ~,,.~ ~'~'~;2;~"';'~/~ ~..~: .,< Reviewed and approved by: ,(',?~ Date: ~ ',..D,- / 0 RECORD DWG MEASUREMENTS ST CO1 41 29 STCD2 40 33 ZcbeL V~Lve 42 45 BCD 38 40 CD/MT1 60 68 CO/MT2 63 63 Anchor .o¢ 3 Trenches WeLL Drivewc 3 3 Grodin9 Associ~ced ~/ith Lot 3 ~: Zc~be~ 0 Z~beL ])is~rib. 2 0 -~5~~. HT/C[ ~'ADVANTEX Replacement Trench 5' Wide Trench N 01~ TH~IM EN GINEERIN G PO 8ox 770724 Eogle River, AIc~$ko 99577 New 1000 Gallon Septic e C.O.'s (Cowan,4/17/02) Anchor Easement 3ROADWATER HEIGHTS TRACT D BLOCK 1 LOT 4 RECORD DRAWING Tonk = 40' -p /3_ C 0 c C + II II F'l _o .9 0 C U c 0 0 -P d 0 c- O 0 L~ 0 ~ ~- II II +~o .~_ 0 E E i, h 0 0 > > (- d II 0 > ~ E i,i 0 i,I Y U Y U q- 0 0 Mark Begich Mayor Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: Legal Description Property Owner Name & Address: Pump Installation Date: S/~ C)/ Pump Intake Depth Below Top of Well Casing: ~<~ feet Pump Manufacturer's Name: [-~2~ Pump Model: Pump Size ~ hp Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Upon Completion? ~Yes ~ No Well Disinfected Method of Disintkction: Comments: Pump Installer Name: Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. SULLIV ATER Domestic - Commercial - Geotherrr~el Phone 90?-688-2?59 wwwosullivanwaterwells.com Well Log Permit Number: #SW 10001? Date of Issue 3/12t2olo Date Started: 3129/2010 Date Completed: 4/2912010 Property Description BROADWATER HEIGHTS TR. D Lot 4 Block 1 Property Owner Name & Address: Parcel Identification Number: Is well located at approved permit location? Section: Town: TROY DAVIS HOMES 165 E, PARKS HWY. #,204B WASILLA, AK 99654 Borehole Data: Depth Soil Type, Thickness & Water Strata From To Casing Stickup 0 3 Overburden 3 8 Bedrock Broken 8 10 Gray Bedrock 10 68 Gray Bedrock Broken 68 69 Gray Bedrock 69 92 Gray Bedrock Soft 92 97 Gray Bedrock 97 171 Gray Bedrock Soft 171 174 Gray Bedrock 174 197 White Bedrock 197 201 Gray Bedrock Fractured 201 239 Dark Gray Bedrock 239 291 Gray & White Bedrock 291 300 050-131-29 Method of Drilling ~_~ air rotary El cable tool Casing type: Wall thickness 0.2s inches Diameter $ inches Total: 44 feet Liner type: Diameter inches Depth: feet Casing stick-up above ground: 3 feet Static Water Level (from top of casing) Pumping Level: feet after hours pumping gpm Recovery Rate 1 gpm Method of Testing: lest Pump 44 feet ENo Well Intake Opening Type ',.i~ "i Open End {)~j Open Hole i i Screened Start feet Stopped feet i",? Perforations Start feet Stopped feet Grout Type: Bentonite dry granular Volume: 600 Pounds Depth 44 Start 0 feet Stopped 44 feet Pump Intake Depth: feet Pump size: HP brand name Well disinfected upon Completion? [X_] Yes i Method of disinfection CHLORINE 50 PPM Comments: Water Sample Results: Arsenic: ug/l Well Driller: .......... i Cole Sullivan Nitrates mWl Sullivan Water Wells Total Coliform Bacteria colonies/100mL :P.O. Box 670272 ........ Chugiak, AK 99567 Other bacteria: col/100mL 688-2759 No 8" SURFACE CASING DRILLED. SURFACE SEAL SET TO 44'. WELL YIELD IS AFTER HYDRO-FI:lAC. Attention: The property owner shall provide this log to DSD (onsite) and DNR within 30 days of completion. MUNICIPALITY OF ANCHORAGE Development Sen/ices Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Mar 12, 2010 Expiration Date: Mar 12, 2011 Permit Number: SW100017 Legal Description: BROADWATER HEIGHTS TR D BLK 1 LT4 Design Engineer: 0838 NORTH RIM ENGINEERING Owner Name: TROY DAVIS Owner Address: 165 E PARKS HIWAY WASlLLA, AK 99654- Parcel ID: 050-131-29 Site Address: NHN BROADWATER DR Lot Size: 18864 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail construction must be in accordance with; 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By:. Issued By:. °ate: Municipality of Anchorage P.O. Box 196650 · 4700 Elmore Road Anchoraqe, Alaska 99519-6650 · (907) 343-7904 · Fax {907) 343-7997 htt p:l/www,m unl.orq/O nslt e Development Services Department On-Site Water and Wastewater Proqram I)e )a t ] ar tmell **** VARIANCE/WAIVER REVIEW **** WR//: OSP101000 HA#: Permitfl: SW100017 PID#: 050-131-29 Legal Description: I~roaclwater Helqhts Tracl~ D Block 1 Lot 4 Engineer. North Rim En.qineerin,q Applicant: Troy Davis Your request for a waiver of the required I0 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 2.0 feet. This waiver approval applies to thc absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver Is Granted: ~( Waiver is not Granted: Date: 4/26/2010 Approved bye_ r,N,~_of Re;~iewer Rec#: 01527C Amount: ~200.00 Date Paid:4119/10 **** VARIANCE/WAIVER REVIEW **** Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.orglonsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 050- I%1- ~.cf Property owner(s)'-~/~C~V J~,,~ ~'/'-.~ Mailing address ,/~/~'~" ~J ~ ~ ~/~/ Site address ~ ¢ ~'~&¢ ~ ¢ IV ~ Legal description (Sub'd., Block & Lot) ~ Cd/%E,~ Legal description (Township, Range & Section) Lot Size ~ Sq. Ft. Number of Bedrooms Day phone Zip Code Zip Code THIS APPLICATION IS FOR ([~ all that apply): THIS APPLICATION IS AN: Absorption Field [] Initial ~J~ Septic Tank ~ Upgrade Holding Tank j'-J Renewal [] Priw [] Private Well ~ Water Storage [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorize~,,~ent) Permit/Rush Fees: Date of Payment: Receipt Number: (Rev. 11/05) Waiver Fees: MEMO Steve Eng, PE, PH P.O. Box 770724, Eagle River AK 99577 (907) 694-7028 tel northrimeng@aol.com Date: 4/20/10 Number of Pages: To: MOA On-Site Services Subject: Broadwater lleights, Tract D, Block 1, Lot 4 Septic System Re-Design During excavation of the original design, based on a test hole by others, bedrock was encountered higher than anticipated. We have changed the design to 3' effective depth 8: a total trench depth of 4'. 2 test holes at the site revealed unconsolidated material to a depth of I 0'. We are requesting a lot line waiver to 2' due to the tight fit. The lot line waiver will not affect the neighbor lot in this vicinity. The elevation and grade between lots 4 & 5 are similar. Soil Test application rote = 1.2 GPD/FT: Required Area = 450 GPD/1.2 = 375 FT: Length = 375 171':/5. x .58 reduction factor = 43.5', say 44', 2 lines (~ 22' each (3' effective) ADVANTEX SIZING-ALTERNATE SITE A Category llI System drain field will be utilized, which will allow an application rate of 6 GPD/FT: Required Area = 450 GPD/6 = 62.5 FT: say 63 FT: (5' x 13' shallow trench) Thanks-Steve DESIGN NOTES: 1. Total Depth of Trench is 4'. 2. Sewer Service Line minimum 2% slope. .3. Measure All Well Separation At Construction. 4..3' Lot Line Waiver. 5. Do Not Violate Easem ;nts. hot Lot 3 Trenches DrillE Wetl 3 BDRH 0 Drive~ 1000 Gallon Septic Tank --Double C.O.'s (Cowan.4/17/02) UT/CO Replocemen[ Trench 5' Wide Trench Anchor Eosemen~c- NORTHRIM ~'~,'~.,,~'".~..~, BRnADVATER HEIGHTS ENGINEERING Jf~,.~-~'.'*..TRACT D BLOCK ! LFIT 4 PLAN ,'o .o. , ,o , ~ . '~ ~ .~.~.. "~,~'~' ~ ' ~' LAYOUT 9o7.694.7o2e "F"" SEPTIC SYSTEM ~'~/16/~o 0 (- 0 mO) 0 Ck n 0 ~ 1g ~ OL.J ,. *- © c' L,. CD U c::~ c' 0 0 0 F%H~..~.G~JNEERING SBILS LBG - PERCBLATIBN TEST 9ate Per¢orMed: 4/7/10 Per?orMed For: Troy Davis Legal Description: Broadwater Hfs, Trac~ D Bt L4 2- 3- 4 - 5 - 6- 7 - 8 - 9- 10 - 11 12 - 13 - 14 15 - 16- 17 - 18 - 19 - 20 - 21 - DEPTH (FEET) ?":: :..": Brganic GP Sc~ndy Groover w/ Low Silt T,H, LocoFtion: See A'tto, ched Design Groundwoter? No Depth -- Woter Depth AFter Monitoring. None Dote, 4/16/10 # Da~e Gross TIMe Ne~ TIMe Depth Ne~ Drop 1 4/16 0 -- 7- __ 2 4/16 2 8 3 4/16 32 -- 8, _- 4 4/16 34 8 MJn, 9' 1' 5 4/16 64 -- 8' -- 6 4/16 66 8 Min. 9' 1' Percototion Rote 8 Min,/inch Perc Hate DioMeter Test Run Between,8' and 3' Comments: prpqnnk~d. PerFormed By Nor'"I:hRIM Fog. I~ CERTIFY THAT THIS Per'Formed in Accordance with Att State/Nunicipot Guidetines ON THIS DATE. DATE, 4/16/10 T.H, 1 TESTHBLE LOG GEBTECHNICAL 4/16/10 TEST WAS in EFFect MUNICIPALITY OF ANCHORAGE I K � Development Services Department "NZ j Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 050-131-29 1 Certificate of On -Site Systems Approval Expiration Date: 9 `q — Z Z GENERAL INFORMATION Complete legal description BROADWATER HEIGHTS TR D BLK 1 LT 4 Location (site address) 11934 BROADWATER DR, EAGLE RIVER AK Current property owner(s) WARE Day phone Mailing address Real estate agent SAME 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic (] Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 - Date of Payment Receipt Number a 31 rl a 5 COSA # _0 S G 2 1 V49 Waiver Fee $ Date of Payment Receipt Number Waiver # Distance.- Received istance: 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 6-29"22 r I-• 6. DSD SIGNATURE 49TH .. ' System #1 Approved for 3 bedrooms l':', .°..........s. �. • :. • 7� MICHAEL N. AN'DLRSCN �� System #2 Approved for bedrooms C E 469' Disapproved �� >�'�'Fp ' c•'� d Conditional approval for bedrooms, with the following stipulr��i� ITY n, �` �V N -S/ wASTr:V`,�ND m i� f'vuGM B ��, `— Original Certificate Date: C 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 COSA Checklist Legal Description: BROADWATER HEIGHTS TR D BLK 1 LT 4 Parcel ID: 050-131-29 If more than 1 septic system on tot: COSA Checklist # of Structure served by this system A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled 429110 Total depth 300 ft Cased to 44 ft ❑� Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 36 in. Date of flow test for COSA 5/27/22 Static water level at beginning of test 43 ft. Comments B. TANK DATA Age of tank(s) 2010 years Tank type/material SEPTiCSTEE Measured operating fluid level in septic tank 48" 0 Standpipes/foundation cleanout per record drawing Date of pumping 5/27/22 D. ABSORPTION FIELD DATA TESTED WEST TRENCH Which system tested (date installed) 41,30110 9 ALL standpipes present per record drawing Total measured depth from grade 6.5/6.5 ft (max) Measured depth to pipe invert from grade 3.513.5 ft (min) ❑ N/A —pressurized field ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test 1.0 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑■ No Coliform bacteria is Negative Nitrate i 7t/Zmg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by MNA Date of Sample 5/27122 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5127/22 Results [DPass For 3 bedrooms Fluid depth prior to test DRY in Water added 450+ gal New depth 8 in Elapsed time 1440 min ❑■ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 0 gallons If yes, enter date Comments/Deficiencies: WEST TRENCH WAS DRY PRIOR TO TESTING COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 21 Yes if No Community Sewer Manhole/Cleanout > 100' If absorption field is under driveway comment below (,( Yes if No ft 2 Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' F. ENGINEER'S COMMENTS Anima! Containment > 50' Yes if No ft ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' EJ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ED Yes if No ft Private Wells > 100' Q✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' ✓�] Yes if No ft 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' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *2 ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' [✓ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS * SEE LOT LINE WAIVER �;A���° G. ENGINEER'S CERTIFICATION _ �`•;> 9 ! certify that l have determined through field inspections and review -0�'• '�: of Municipal records that the above systems are in conformance with MOA COSA in this date. / 4 9 T H ° ' ' ` ' ' ' ' ' ' ' guidelines effect on Mla~F{AEL N. ANDERSON ;,`'k' , It vi'. CE -449 T p�ESS1�0-�•�.. COSA Checklist yellow sheet Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 g$¢t Anchorage, AK 99519-6650 ~ www. muni.org/onsite ~ (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 050-~31-29 Parcel I.D. COSA # O-C-~ ~=~ / Expiration Date: / ~ 1. GENERAL INFORMATION Complete legaldescription Bro~dwater Hfs Troct ]~, BLock 1,'Lot Location (site address) llqS~ ~ Broc~dwcd;er ~lr'ive Current Property owner(s) Mailing address Troy Dovi$ Day phone 165 E, Parks Hiway 99654 357-9394 Lending agency Day phone Mailing address Real Estate Agent MailinffAddr~ss Audrey Mason 622-3344 Day phone RE/MAX o¢' EagLe River Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDRooMs: 3 TYPE OF WATER' SUPPLY: Individual, Well Individual WaterStorage Community class __ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site , ,J~X 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 propedies 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 ,5. 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 ~.r. mation obtained from. the Municipality of Anchorage files and from my investigation and inspection, the o~it~ :~§ter supply and/°r'~astewater disposa system is(are) in comp lance with al applicable Municipal and St~t~! ~'~ .0r~J~a:h~&s 'and regulations in effect at the time of installation. . ' _ ' %` 'Na'~ne of Firm N.or'thRim Engineer'ing Phone 694-70~8 P,D, 3ox 7707B4 Address S%eve En9 Date 9/1/10 ~ ~.~...~ .... ' ~ ~' ?~o~ s ~{:t.'g~'' bedrooms, with the following stipulations: Engineer's Printed Name bedrooms. DSD SIGNATURE ~ Approved for Disapproved, Conditional approval for By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 11105) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore 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: A. WELL DATA Well type P Date completed ~ Total depth 301~. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Br'oadwater H-'cs Tr D, Bi L4 Parcel ID: IfA, B, or C provide PWSID 4 / ;:> 9 / 10 Sanitary seal (Y/N) Cased to 4 4'ft. FROM WELL LOG 1189/10 44 ft. 1 g.p.m. 0 colonies/100 mL Arsenic: 0.83~LO, ~'3Z 'date of sample: . 8/11/10 B, SEPTIC/HOLDING TANK DATA Tank Type/Material Anch Tank ('5-t;eet) Tank size 1000 gal. Number of.Compartments Foundation cleanout (Y/N) 7~Y Depression over tank (Y/N) / 'Date of pumping new Pumper C. ABSORPTION FIELD DATA Date installed 4/30/11~oil rating (g.p.d./ft2 or ft2/bdrm) Length 2) P x 2 ft. Width 5 Total depth 3 ft. Effl absorption area~ Date of adequacy test ne w Nitrate O.3L~ll/L O. J'g¢ 050-~3i-a9 Well Log (Y/N) Y Wires properly protected (Y/N) Y casing height (above ground) 36" in. AT INSPECTION new ft. new g.p.m. Other bacteria '0 'coloniesll00 mL Collected by: K P Date installed 4 / 3 0 / ! 0 Cleanouts (Y/N) '~ High water alarm (Y/N) N 1'2> System type Trench ft. Gravel below pipe 3 ft. 37~~ Monitoring tube Y Depression over field N Results (Pass/Fail) P ct $ $ For 3oedrooms Fluid depth in absorption field before test nct in. Water added nct gal. New depthq 0, in. Elapsed Time: nomin. Final fluid depth net in. Absorption rate >= tact g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) fqct If yes, give date D. UFT.STATION /.//4 Date installed "Pump on" level at ~ Datum in. E. SEPARATION DISTANCES Size in gallons "Pump off" level at~ Cycles tested in. ' SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot100' + 100' + Absorption field on lot *Public sewer main NA Sewer/septic service line 85' + Animal containment areas 100' + Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100' + 100' + On adjacent lots Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 10o' + Absorption field Surface water SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'. + Property line~10' + Water main NA Water service line 85' + 'Wells on adjacent lots 100' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10'+ Surface water 100' + Wells on adjacent lots 100' + Water main NA Driveway, pa. rking/vehicie storage Property line 3'+ 10' + Water Service line Curtain drain NA F. COMMENTS 5/ + 100' + 10~ + in, G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name S-I;eve En9 Date 9/1/10 COSAFee $ ~ ,.~ .-~ ~ ~ ~'"~tJc; L WaiverFee$ Date of Payment ? "--' / - / ~ Date of Payment Receipt Number. ~ 0 ~ ~ ~ ~ Receipt Number (Rev. 11/05) C) C) Z 30.00 o '30 ~FOR: TROY DAVIS IIOMES, INC. LanMark Sut'veytttb~, 9:330 Vanguard Drive, SuiLe 131 Anctlorage, Alaska 99507 (907) 562-6050 Ct?APHtC .5'CAL£: I Inch Date 8-25-10 Grid NW-253 Drawn by cef Scale 1 "=30' As-Built 2010103 Field Book 237 Legal Description Lot 4 JBlock 1 BROADWATER ESTATES SUBDIVISION I hereby certify that tile property described hereon has been surveyed by me, or aL my direction, and that Lite improvements situated thereon are within tile property lines and do not overlap or encroach on the properly lying adjacent thereto unless otherwise shown. That no improvements on the property lying adjacent ttlereto encroach on the premises itt question and that there are no roadways, transmission lines or other easemenLs on said property except as shown. IL is tile responsibility of the owner or builder, prior to construction, to verify proposed building grade relative to finish grade and utility connections and to determine the existence of any easements, covenants, or restrictions which do not appear on the .recorded subdivision plat. LisLed distances prevail over scaling. Reproduction may cause distorLion.