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Home My WebLink AboutBROADWATER HEIGHTS TR H LT 2Broadwater Heights Tract H Lot 2 #050-08! -46 Municipality of Anchorage Page / 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: ,,3'V,/?,g~O,~'-'3~ PID Number: 0,-5-~ Name: ;W~E ~ ~A~/~ ~I~/~'~ Wastewater System: ~ New ~ Upgrade Address: ~ ~]~ C,~:,~-~. ABSORPTION FIELD ~ ~ Deep Trench ~ShallowTrench ~ Bed ~ Mound ~ Other I D',ock: Subdiv~ion: Depth to pipe bosom from original grade: Gravel depth beneath pipe Number of lines: Distance between lines: WELL: ~ New D Upgrade arav~lwidth: ~ Ft. t ~ Ft. Classification (Private, A,B,C): Totaz~ ~e~h: Cased To: Total absorption .rea:.~ Pipe mater, al: Date Drilled: Static Water Level: Installer: Date installed: Yield: ~ Pump Set at: Casing Height Above Ground: SEPARATION DISTANCES ~ Septic ~ Holding ~~ To ~lOC~-~ Absorption Lift Holding =ubliclPrivate Manufacturer: Fro~ Tank Field Station Tank Sewer Lines / Material'. // Number of Compa~ments: S~,.~e ' LIFT STATION Lot ~ z Sizein gallons'. Manufacturer: / ~ ~i "Pump on" level at: ~ "Pump off" level at: High water alarm at: Foundation ~o I Pump Make & Model Electricat Inspections pe~ormed by: Location and Description: Assumed Elevation: /00 Ft. E Department of Health and Human Se~ices approval ""~ ", .,"' Reviewed and approved by: ~ Date: I · ~-~ 72-013 (Rev. 9/91) MOA 25 PERMIT NO, SW980055 PAGE 2 Ot~ 5 Munic i ~l~Ji~zO~ Anchop~loe DEPARTMENT OF AND HUNFAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O, Box 196650 ~._Anchop~Oe, Al~sk~ 99519-6650e Telephone: 343-4744 ON-SITE WASTEVVATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEOAL LOT 2, TRACT H, BROADWATER HEIGHTS TR. P.I.D. NO. 050-081-46 ~' LOT 5 ~' LOT 2 A TH//1 MT2 ALT. SITE NEW PRESSURIZED DRAINFIELD / SEPTIC AREA~ LOT 1 NEW BIOCYCLE T~ WASTEWATER TREATMEN SYSTEM ~_ SCA ,f,,~ s CE 88 PERMIT NO. $W980055 PAOE DEPARTMENT OF HbALIH AND HUIVFI ENVIRONMENTAL SERVICES DI P,B, Box 196650 ~_Anchor~ge, At~sk~ 99519-6650 · TeLe ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR W LEaA~. LOT 2, TRACT H, BROADWATER HEIGHTS TR. P.I.I 3 OF 3 iN SERVICES VISION phone~, 343-4744 ELL INSPECTION REPORT NO. 050--081 --46 A B 47.0' 16.5' 56.0' 50.0' 70.0' 73.5' 100.5' 72.0' MT1 MT1 = 91.0' NO WATER FOUND 85.0' B.O.H. PRESSURE DISTRIBUTION SYSTEM' 1 LATERAL ,'-, 45' LONG 50 HOLES (1.4' O.C.) 1/4" DIA. HOLES FACED DOWNWARD 1" DIA. LATERAL 1 1/4" DIA. SOLID MANIFOLD N, T. S. by DOC Co, dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND .~~~O,~1.,~ ~ A~RESS, ,O~ ~O.X '7 70 .~ j~ /'= LEGAL DI=SCRIPTION .j~.a AO ~J~']'.~L H~,'TJ' PERMIT NUMBER ~ O ~._~r.~TDate of Issue 3 .%/~ -~?_ TAX INDENTIFICATION NUMBER 0 ~'O~.~/4 ~ ts well located at approved permit location? Method of Drilling: ~air rotaq/ Depth of well: 4 0 0 ~;~'es [~ No ~ cabie tool Casing Type Diameter .... Liner Type: Wall Thickness o O~'''0 inches · / inches, depth~// feet Casing Stickup Above Ground: ~, feet Static Water Level (from ground level): / ~'~ feet Pumping level: . ~feet after hrs. pumping gpm Recover Rate: ~ O Well Intake Opening Type: · [~1 Screened; Start feet [~ Perforations Start feet Grout Type: .~,~7'e,~V Depth: from _,~). feet Pump Intake Depth: feet Well Disinfected Upon ComPletion?. Method of Disinfection: (:~ ._/J_~ ~/~, Comments: Open End ~ Hole feet Stopped __feet Stopped Volume feet, to Brand Name BORE HOLE DATA DEPTH From To ~4-- /,2/ I~[. ! 7o RECEIVED DEC ;~ 1:1998 Mur_~icipality O~ Ancnorag. e DepL Health & Humui; Scrv'.ccs~ DrilleKs Name_ ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health 8, Human Services and/or Department of Environmental Conservation. MatSu Borouo4h; Department of Environmental Conservation, IO*d ~N~N~N~6~&~ 889 S993M ~31UM NUAIllA$ Wd ~: 60 NOW 86--~I--33~ DEC--~ 1--98 THU . P. 0 I 12 ~'$? CARCEL ELECTRIC INC. 10410 FINLEY CIR. . ANCHORAGE, AK. 99510 907,346.4030 , 907-346,~032 ~ Treed £xcavating & Con.t: Re: Bio-Cycle ~i~ing~ Dec,. 31, 1998 Carce! ELectric wl~ed the Bio-Cycle located at 12107 ~kyline D~. EagLe River, &Laeka ~9577. The Legal des~r/ption of the property ie, Lot 2 Track H Broadvater Sub, Ca;.Cel v/red th£a eyatem to the 1996 National Electrical Code. 'you have'any' questions please give me a call. The k Steve 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 WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW980035 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MCCORMICK MICHAEL W & NORMA OWNER ADDRESS:12107 SWEETWATER CIR DATE ISSUED: 3/19/98 EXPIRATION DATE: 3/19/99 PARCEL ID:05008146 LEGAL DESCRIPTION: BROADWATER HEIGHTS TR H LT 2 LOT SIZE: 21291 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROXrED 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: MUST BE FIELD VERIFIED BEFORE CONSTRUCTION. ANY DEVIATION' FROM THE ATTACHED DESIGN MUST BE APPROVED BY DHHS DURING? CONSTRUCTION. ~ RECEIVED BY: ~J- ~ DATE: ISSUED BY: DATE: March 3, 1998 ,'i ,~ '~NMENT~I SERVICES DIVI$1,.~. ROBERT C. COWAN, RE. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN ED(TENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 2, Block H, Broadwater Heights S/D eECE,tVED Request you issue a permit to drill a well and install a innovative "Biocycle" wastewater treatment septic system to serve the proposed three bedroom house on the referenced property. A test hole was excavated and a percolation test will be performed prior to construction of the proposed septic system. The approximate location of the test hole is located on the attached site plan. At the time of excavation no groundwater was encountered and after seven day groundwater monitoring, the test hole was found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/jlm Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ,1' = 60' SITE PLAN DESIGN ~-~ ~ z~ - ~' ~ 0 DESIGN DETAIL 1" = 30' SCALE >__~o m~ o3 LOC I"SCALE= 40' DETAIL ~PROFiLE (,eSOmm)6'06' (~omm)2'6' x x ', I z \- \ \ \ \ \ \ \ \ \ \ \ \ \ \ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ! -'F~ p, ~ T LEGAL DESCRIPTION: ~"~"~ ~ ownship, Range, Section: ~~~~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? DEPTH? Depth to Water After [ ,.'~'~ MonitorinD? "C;;'f--~ Date: I 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O DATE PERFOR~ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT COMMENTS S & S ENGINEERING ~_. PERFORMED BY: 17034 Eagle River Leop Road NO. 2{~)4 ACCORDANCE WITH ~aI~i~7~ela~I~II~I~JI~[~GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: :~"~ ! ~ ~--~'--'- ROBERT C. COWAN, RE. ROBERTA. SHAFER, P.E. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 2, Block H, Broadwater Heights S/D March 3, 1998 GENERAL: The scope of this project includes the installation of a innovative "Biocycle" wastewater treatment system and a five foot wide drainfield to serve the proposed three bedroom residence or the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. o The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 2, Block H, Broadwater Heights S/D March 3, 1998 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 fi. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. o Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. o Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must approved septic tank manufacturer. be constructed by a Municipally Page Three Lot 2, Block H, Broadwater Heights S/D March 3, 1998 The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: TYpe of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. o Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). ° Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). o A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. o All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the//200 sieve. o When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. ° The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Page Four Lot 2, Block H, Broadwater Heights S/D March 3, 1998 Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/OWNER Parcel I.D. 050-081-46 Certificate of On -Site Systems Approval Expiration Date: �`"�' Z, Z y Legal description BROADWATER HEIGHTS TR H LT 2 Site address 12110 W SKYLINE DR Eagle River AK Current property owner(s) CARRINGTON MORTGAGE SERIVCES X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original. Certificate Date:11 /20/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval —June 2022 MUNICIPALITY OF ANCHORAGE ti �t �4 Development Services Department �\ =�� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 05008146000 Complete legal description BROADWATER HEIGHTS TR H LT 2 Location (site address) 12110 W SKYLINE DR Current property owner(s) CARRINGTON MORTGAGE SERIVCES LLC 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 854-2200 3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete Al Fiberglass Age 25 yrs _ See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑■ AWWTS ❑ Bed ❑ Deep Trench X Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $ 55a Date of Payment COSA # 05 C _Z _�) I l. 4 1-1 Waiver Fee $ Date of Payment Waiver # COSA Application —June 2022 COSA Checklist Legal Description: BROADWATER HEIGHTS TR H LT 2 Parcel ID: 05008146000 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 813/98 Total depth 400 ft Cased to 20.3 * ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 10/31 /23 Static water level at beginning of test 49•5 ft. Comments * Seated in Bedrock B. TANK DATA * Measured operating fluid level in septic tank Date of pumping na ❑■ Required maintenance completed, if AWWTS Comments: * Blocycle D. ABSORPTION FIELD DATA Which system tested (date installed) 8/11/98 ❑■ ALL standpipes present per record drawing Total measured depth from grade 3 ft (max) Measured depth to pipe invert from grade ft (min) ■❑ N/A — pressurized field. ❑■ Per record drawings, field is insulated. ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficienci Well production at time of test 1 gpm Water storage tank volume0 gallons Well disinfected for coliform test? ❑ Yes ❑■ No 0 Coliform bacteria is Negative Nitrate mg/L ❑■ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by NRimEng Date 10/31 /23 C. LIFT STATION ❑■ Required maintenance completed Age of lift station 25 years Lift station material fbrgls Comments: Adequacy test date 10/31 /23 Results g Pass Fluid depth prior to test 0 Water added 450 gal New fluid depth 1 in Elapsed time 30 min Final fluid depth 0 in in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 Effective depth used 0 in Effective depth remaining 6 in in COSA Checklist June 2022 E. SEPARATION DISTANCES From Privatee Well on Lot to: {Please enter distances if less than required or if community well on lot} Septic Tank/Lift Station on Lot > 100' Cornmunity Sewer ManholeiCleanout > 100' WYes if No ft E Yes K No ft Neighboring Tank > 100' ❑■ Yes if No ft Private SewedSeptic Line > 25' ❑■ Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' ■❑Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 5D' Yes if No ft R Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑■ Yes if No ft CE lies K No ft ❑ N/A — Served by Oomrnunity Well (not on lot) or Public Water From SepticlHolding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ■❑ Yes if No f. Surface Water > 100' ■❑ Yes if No ft Tank to Property Line > 5' ❑■ Yes if No = ft Wells on Adjacent Lots; Field to Property Line > 10' ❑■ Yes if No ft Private Wells > 100' ■[ Yes if No ft Water Main > 10' ❑■ Yes if No ft Comrnunity Wells > 200' ❑■ Yes if No . ft Water Service Line > 10' E Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on -site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm NorthRim Engineering Engincer's Printed Name Steve Eng Pho-ne 694-70 8 Date 11/15123 Ar 49a* 0,,;,,, Steve Eng, �; CE-6256? a COSAChecklist June 2022 3705 Arctic Blvd #313 Ib0@ YCLET"Alaska Anchorage AK99503 Email: crbioak@gmail.com (907) 274-0314 3rd Quarter Inspection Report 2023 Homeowner Info Customer Name: Wayne and Barbara Elmquist Address: 12110 W. Skyline Drive Tank#: 44 Install Date: Aug. 1998 Area Eagle River Initial Inspection: Alarms Tested: Air F,� High Water Battery Tested: Yes A No ❑ N/A ❑ (Please make sure alarm is on "normal", not "mute") Does system have a septic tank ? No ❑ Yes V (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor? Yes Repaired ❑ Yes Repaired ❑ Strong ❑ Mild ❑ None [� System Inspection Inlet plumbing in working order? Solids pillow normal? Yes [VI Replaced ❑ Yes R1 Requires Pumping ❑ Aeration Chamber Are all aerators functioning? Any buildup of solids? Yes [VI Replaced ❑ Yes ❑ No [� MQQ&tion Chamber Clarification return system operating? Any buildup of solids? Yes FVJ Adjusted ❑ Yes ❑ No [� pH Reading: Dissolved Oxygen PPM Turbidity of discharge (in FTU) (pH of 6-8 is ideal) (2-5 is ideal) (Under 35 FTU is considered compliant.) 7.5 0.0 3.01 Discharge Chamber Pump float operating? Alarm float functioning? Any buildup of solids? Yes 1;4 Replaced ❑ Yes A Replaced ❑ Yes ❑ No Filter cleaned? Discharge line condition: Yes [VI N/A ❑ Good ✓ Replaced ❑ Comments: Replaced discharge pump, air blower, and aerators. Ins ected B : Chris p Y Date: 11/02/2023 Has emailing or mailing of form been requested? Yes (contact office to request...) ❑ No Mu.icipality 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) 343-7g04 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-081-46 .-- 1. GENERAL INFORMATION Complele legal descriptionLot 2; Tract H; Broadwater Heights Subdivision Location (sile address or directions) 12110 West Skyline Dr. Current Propedyowner(s) Wayne & Barbara Elm~-ist Day phone 694-9015 Mailing address .' Lending agency Day phone Mailing address Real Eslate Agent ~-rn3yn nrein~r! R-m~-~- ~'.R.Dayphone 6Q;,-;.?RO Mailing Address 16600 Centerfield Dr. Ea~le River, AK 99577 2. NUMBER OF BEDROOMS: 3 .3. TYPE OF WATER SUPPLY: Individual Well Individual Water Slorage Community Class __ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [~ Individual On-site [~ Individual Holding. tank [] ~ CommuniIy On-rote [] Public Sewer [] The Municipality of Anchorage Developmenl Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates o1' Health Authority Approval are required for the transfer of lille (except between spouses) for properties served by a single family on-site wastewaler disposal and/or water supply system. DSD also Issues HAAs upon request Io homeowners. Certificates of Health Authorily Approval are valid for 90 days from the date of Issue for propedies served by a private er Class C well and may be reissued with new water sample results less than 30 days old. (Cedificates may be reissued for a period et up to one year with valid waler samples.) Cerfific'~[es are valid for one year for propedles 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 ot the validalion date shown below, I verity Ihat my Investigation, based on procedures outlined In the Health Authorify Approval Guidelines for this application, shows Ihat Ihe on-site waler supply and/or wastewater disposal system Is(are) safe, funcfional and adequate for the number of bedrooms and lype of structure Indicated herein. I further verify tha~ based on the InformaHon obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the an-site water supply end/or wastewater disposal system Is(are) In compliance with all applicable Municipal and Slam codes, ordinances, and regulations In effect at Ihe time of Installafion. Name of Firm S & Address 17034 N. Engineer's Printed Name S En~ineerin~ Phone EaRle River Loop Ste. 204 Ea~le River, Robert C. Cowan Date DSD SIGNATURE "/' Approved for '~ Disapproved. Conditional approval for -?. bedrooms. 694-2979 bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements SUpplemental Engineer's Report Other Mnnicipality of Anchorage ,o Development Services Department : - '" Building Safety Division " ' On-Site Water & Wastewater Program 47O0 South Bragaw St. P.O, Box 196650 Anchorage, AK 99519-6650 www.ct~nchorage, ak.us (S07) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST WELL, DATA wal~ ~ Date completed ~..~1 ~ 6 If A, B, or C provide PWSID # ~ san~ary se*, (Y/N) Y' Well Log (Y/N) Wire~=propedy protected (y/N) Y Total depth ~ft. Cased to ~._, ff. Ca, sing height (above ground) ~n. FROM WELL LOG Date of test Static water level J ~[ O I ft. Well production Ow ,~ g.p.m. AT.INSPECTION ql ,. O, 0 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. B. ~-,C/~'~/HuLialtIG-TANK DATA Ntir~ate ~.~q& mg./1. Other bacteria ~ colonies/100 mi. Collected by: ~/~ ~/4~'/,',f~f.-,~,2(,,-- Tenl~ Si~'/...~"~) g~. Nu~er of Compa~e~s ~ ;~.dedon aec= W/N) ~ O.p~ss~. ove,=.k W/N) ~ '. Da~ ~ pumping ~ / ~ ~m~r ~o ~ · c V c ~ :. AeSOR~ION R~L~ OATA Da~ ins~lled ~ ~il rating (g.p.d.~ ~ ~drm) ~' ~ Len~ ~ ff~ I ' . W~ ~ Total dep~ ~-4 ". Eft. abso~fion ,, ¢¢~ M~i,ring t~e. ~ Fluid dep~ in abs~pfion fi~d ~e ~st ~ in. Wa~r add~ gal. Elaps~ Time:~ min. F~ fluid depth ~ in. ~y rejuvenati~ ~a~ent (past 12 ~.) (YIN & ~) Date installed Cleanouts (y/N) High water alarm (Y/N) )/' System type Gravel below pipe O' ~' ft. Depression over field For _.~ bedrooms New depth_./__, in. .Absorption rate >= ~'~'~ g.p.d. If yes, give date D. Ul~' b'~rATION Date installed ~/' I ] ~~ 'Pump on" level at ~,.~n. Datum//~ E. SEPARATION DISTANCES · ga ons "Pump off" level at cycles tested High water alenn level at ~f..~ in. Meets alarm & drcutt requirements? ~" SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanl~fl~-~tatlon on lot Absorption field on lot [OO Public sewer main /'~/,~'/ Sewer/septlo servloe line ~' 4-- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building fomldaflen /~'''~ Propm'ty Dine ~ I~.. Water main ! C) J' Wells on adjacent lots I ~ On adjacent lots On adjacent lots ~/00 Public sewer manhole/deanout Holding tank Absorption field Water service line / (~ ~/- Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Propertyllne 4 ~' ~ Buildtngfoundafien /O~ Watermain I0 Water Service line /~ I~ Surface water /0~ ~-' Ddveway, pa~Jng/vehiciestorage Curtain drain/~*J~ ~////,~Wells an. adjacent lets /(~/'~ ~' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field ir~pections and review of Municipal records that the above systems are In conformance with MOA HAA guidelines In effect on th~ date. EngineersPrintedName*-' ~* ~ ~.7- C . Date ~'/t ~. / 0 Z HAA Fee $ Date of Payment Receipt Number (Rev. 12~o) Waiver Fee $ Date of Payment Receipt Number WELL RECOVERY TEST DATA [toUr'lll C. COWAI I, P.E. ItOtlEIl! A. SI I^rEII, P,E. CIVIL EtlGIIIEE[IS (907) 694.2070 FAX (907) 694.1211 WELL LocA~ToH TEST DALE: ~)/~/~ / T~STED DY: ~ WELL DEPTII: / I CASIUG DEPTII: ~. 1EsT pRocEDuBE; ~!.!sc l/AI_al I) Draw water down Io pump. Casing Ilelilht: J (~'" ~" 2} Shul primp oil t5-60 thin. Sanitary Seal? V -lecord (hue Wiles Iii Conduit? ~ -lecord meier lea(lin0 Oimllno O.K.? __o ~..- 3) 3urn p,nip on. I)rawdow,. Pmnp Depth: ~ ~-- -r~cof(I lime Dale: ~~ -lecofd meier leadlno 5) Calcufalo gaLImln, recovery. I ES_T.~.ATA;. START lIME: /,.~ ..,3;,% ' STATIC WAIER LEVEL: '[RIAL II PUUP II TIME OFF I ~ oH lb oFF orr OFF 3 ON , OFF OFF 4 OFF OFF 5 ON OFF II METER II 3q3' I!E S ULT_A'.. WEI.I. CURRENTLY PRODUCES: t,' a (F- FLOW RAIE HOT GtJARAI'JIEED--SLJDSEOUEHT VAillATIOtlS CAN OCCUR. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 050-081-46 1. GENERAL INFORMATION Complete legal description Lot 2, Tract H, Broadwater Heights Location (site address or directions) ., 12107 Sweetwater Circle Property owner WaTne & Barbara Elmc~ist Day phone 694-9015 10845 Anvik Circle, Eagle River, AK 99577 Mailing address Lending agency Mailing address... Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XXX Public sewer If community wastewater system; provide written confirmation from State ADEC attesting to the legality and Status of system. 72-025 (Rev, 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING Phone 17034 Eagle River Loop Road No. 204 ~'~.1~_ I~iwr. Alaska ~9577 Date ! )-/3i / ~ ~' D~S SIGNATURE Approved for / ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The i~lu-nicil~'lity of Anch°i;age Department of Health and Human Services (DHHS) issues Health Authority Appr6~a_l certificates §~sed only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and trieii; lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct, inspections or. analyze data before a. certificate is issued. The Municipality of Anchorage. is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~ DEC ] 1998 Muni¢ipalily of Anchorage MUNICIPALITY OF DEPARTMENT OF HEALTH & HUMAN SE~~ENTALSE~WCEs DWi Environmental Se~ices Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type P,/{ ~ ¥ Health Authority Approval Checklist '7,~. ~ I~'e~,,,,~. /'/(-rS ParcelI.D.: 0~0 If A, B, or C, attach ADEC letter. ADEC water system number Log present (~/N) Total depth Sanitary seal i~'N) ¥/~ 3' Date completed Cased to 3.0. 3 Date of test Static water level FROM WELL LOG ! 0.3 Well production g.p.m. ~' ~ ~-'('.Casing height (above ground) Wires properly protected ~.)N) Y '~ J~ AT IN SPECTION g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate Dateofsample:l~-/~/~t' ,~ )~-/3o/°]~' B~ o c,~ c ~ B. $~'"T~C/HCLD:;:C T~:.'K DATA Date installed ~ ! h / ~ ~' Tank size ~ .,,~d o Foundation cleanout (~YN) "/& ~ Depression (Y/{~. Date of Pumping ~/~ - ,-' ~,~ Pumper ~ O.AG Other bacteria Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Number of Compartments z./ Cleanouts ~_.)N) ~-~4~-c¥ ~ o High water alarm {~N) ~- J~ C. ABSORPTION FIELD DATA Date installed <~/! ~//~) ~' / Length' ~ ~ Width Effective absorption area '3 ;~-,'- ~'r z. Date of adequacy test ~/A - ,~ ~-~ Soil rating ~or fF/bdrm) ! System type 'r~ ~..~.~ Gravel thickness below pipe (~, .5-- Total depth Monitoring Tube present (~N) ~)~ $ Depression over field (Y~) Results (Pass/Fail) For ~-~ Fluid depth in absorption field before test (in.); Imm~ (in.)' Fluid depth (ins) Minutes la.~ta:~--~/ Absorption rate = g.p.d. Peroxide ~Y/N) If yes, give date bedrooms 72-026 (Rev. 3/96)* LIFT STATION Date installed ~ [ Ii/ ¢1 ~' Manhole/Access {~/N) ~/,~' ~ e High water alarm level at* Size in gallons ; ~-Q o ~.~ ,~. r~ "Pump on" level at* 3 G */'t" "Pump off" level at* ! 7 ~/~t ' ff t '/~t *Datum &o r ~ .~ ,.,,, Cycles tested E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ,?,ei~th~d~ tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station ~/~ ~ ~>- +. ,,'¢c',',') -/- SEPARATION DISTANCES FROM,-.-.°'-~'r'u"", ....,, ,....-,..,, .~ n~,~-.TA ~l~(,,~,.,. ON LOTTO: Foundation '~ ~ ! 5- '-+ Property line Absorption field Water main/service line. ]o -+ Surface water/drainage /o ~) ~- Wells on adjacent lots / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ ~,~r4 udd~ng foundation Water main/service line Surface water I 0 ~ f.+-- Driveway, parking/vehicle storage area Curtain drain Wells on adjacent lots / F, ENGINEER'S CERTIFICATION ~....~'~ _ '~,~,~ I ertif that I have determined thru field inspections and review of Municipal recor&~r'~t..~ ~b~fL'~ ;tems a~e C y in conformance with MOA HAA guidelines in effect on this date. /i / / / Engineer s Name ~% ~ ~/ % _ C ~ ~ Date I% f ~ / / "t ~ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot 2 '~lh~ lq Block .~.[R of ~fOO~UO~{{ R~,~l~e Subdivision, the well's productivity was determined to be 0,2~. gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a ~l{~ bedroom residence is ~[~ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the preductien capacity ef 'the well may fluctuate. Restriction of nen-critical water uses such as washing cars and watering lawns and gardens may be required. This advisery must be attached to all cepies Of the subject Health Authority Approval. Rick Mystrom, Mayor c pamy of Anchorage Department of Health and Human Services 625 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www,ci.anchorage.ak, us January 4, 1999 Robert C. Cowan, PE S&S Engineering 17034 North Eagle River Loop Suite 204 Eagle River, AK 99577 Subject: Waiver Request for Broadwater Heights Lot 2, Tract H Waiver Request #WR980103 Parcel ID #050-081-46 Health Authority Certificate #HA980524, As-Built for Permit #SW980035 Dear Mr. Cowan: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. The approved separation distance is 4.0 feet. This waiver approval applies to the existing on-site wastewater disposal system 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. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Donna C. Mears, E.I.T. Civil Engineer On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section WR% WR980103 Date Received: Legal Description: Lot 2 Tract H Engineer: Applicant: Waiver Requested:' south property line. Waiver Review Worksheet PID% 050-081-46 . HA% HA980524 December 31, 1998 Permit ~ SW980035 Broadwater Heights Robert C. Cowan, PE, S & S Engineering 17034 Eagle River Loop Road, Suite 204~ Eagle River, Alaska 99577 Wayne & Barbara Elmquist Lot line waiver of 4 feet from the nhmnrpttnn {t~]fl tn th Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: Points: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Na~e of Reviewer Rec 9: 04415/9780 Amount: $ 115.00 Date Paid: Dec 31, 1998 ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. December 31, 1998 CIVIL ENGINEERS (907) 694-2979 . FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 2, Tract H, Broadwater Heights Request you issue a Health Authority Approval on the referenced property and grant a waiver for the horizontal separation distance between the leachfield and the south property line at 4 feet. We do not anticipate any adverse effect on the adjacent property. The property line is adjacent to a developed property. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/sh 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ~ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. cIVIL ENGINEERS HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN E~TENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN WELL FLOW TEST DATA CLIENT: (907) 694-2979 FAX (907) 694-1211 LEGAL DESCRIPTION: LoT ~ -T-/~4c'7' ,,t./ ~',,4,.3w,47¢~. WELLDEPTH: ~CO ' CASING DEPTH: ,.3o % *"' r~ DATE DRILLING COMPLETED: ~// ~ / ~ ~ DRILLER: MISC. DATA: CASING HEIGHT: ~ ~ 4-- SANITARY SEAL: WIRES IN CONDUIT: y/i. )- GRADING O.K.: BACTERIA AND NITRATE SAMPLES COLLECTED (date): [ ["~ I METER PUMPING DEPTH TO CLOCK READING RATE WATER REMARKS TIME (GAL) (GPM) (FT) I'~('1 Oo <flgYo - q I sw~ ~, ~-3 oo S-~136 7.6 '3~,3o 0o~3 S-I '~ = o.10 3~5- p~,~ 0,:¢ _ RESULTS: WELL CURRENTLY PRODUCES TESTED BY: ~ ~ ~, GPM WITH A l,~ 0 ~ DRAWDOWN FLOW RATE NOT GUARANTEED--SUBSEQUENT VARIATIONS CAN OCCUR. 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 ° EAGLE RIVER, ALASKA 99577 30 3 a� (R) N g021,50.E 167.76' 0�• ro well 5 a 2a X_X V Q° R X t CP 6 �o �S� '�, oho •a. 2 O 1.5, CANT. S F ,o 0 01. � pFCK �C, 0 ❑ SEPTIC VAULT d �2. 4' PVC SEPTIC �y STD -PIPES (TYP) 5 16� lR) Np N� o O .N .�O 10' UTILITY EASEMENT 2`5 8i29i02 ( AS BUILT 56-30 DATE FLD. BK. ,®W OF t. AV * ��' � °°•• I :t• ep gteea:*0e,g,e.,e P6%.oeeee°s a Willi&D. Fleming _ I ��°. LS-5773 Ar 00, Fes, °ee °.• p ArOfesslona� � NOTES: Easements not appearing on record subdivision plat are not shown unless description of easement is provided by client. It is the responsibility of the owner or builder, prior to construction, to verify proposed building gra Je relative to finish grade and utilities connections: and to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Elevations based on assumed datum unless otherwise indicated, and bearings and distances are record data. SnSSEngineering I7OU EAGLE RIVER LOOP ROAD ng EAGLE RIVER, ALASKA 99577 (907)694-2979 LEGAL DESCRIPTION LOT 2, TRACT H, BROADWATER HEIGHTS SUBDIVISION PLAT NO. j SCALE GRID 7 1 — 156 1 " = 30' NW 253