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HomeMy WebLinkAboutSTUCKAGAIN HEIGHTS #2 BLK 2 LT 2tuckagain Heights #2 Lot 2 Block 2 #041-021-39 Municipality of Anchorage • �.e Development Services Department Building Safety Division =_. _• =�_ Onsite Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SWIG o 3 o O % sL PID Number. 041-021-39 Name: HAYDEN GREEN c/o STEVE BOLAN Wastewater System: 0 New ■ Upgrade Address: 9611 BURNING BUSH DRIVE * ANCH. 99507 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 729-3711 5 O Deep Trench ■ Shallow Trench D Bed O Mound D Other LEGAL DESCRIPTION Sol Rating: 1.2 Total Depth from orlgtrwl Wade: 7.0 MAX DPOA4. Ft FL Block: lot: Subdivision: 2 2 STUCKAGAIN HEIGHTS #2 Depth to pipe bottom from w"d. SEE fromora: Gravel depth beneath pips 3 & 4 Ft. i, Township: Range: Section: nl added above odgkwt orode: Gravel knptn: — — — SEE DWG. Ft 32 & 37rL WELL: O New p Upgrade 47ave1 widU: 5 Number of lines: 2 Dlotona between Ines: 15+ Ft rL Cloeelfkutlon PrtM*, A.B.0 : Tofal Cased To: Total obeorptlon area: PIW material. D 3034/ F-810 In. FL 640 + so. Ft. DNler: Date Drilled: Stutlo water LsM: Inskmer: AKWWC Date krtollw : 5/6-8/2003 M meld: Perp Set At Gawp Height Above Ground: TANK ,�„ M SEPARATION DISTANCES ■Septic E3 Holding CIS.T.E.P. 13 Other To Septic Tank Absorption Field Uft Station Holding Tank bac 1W sew« um« Manulactu .. ANCHORAGE TANK Gapadgr In galmc 1500 From Well 100'+ too'+ — — 25'+ Mate": STEEL Numb« of compartments: 2 Surface Water 100'+ 100'+ — — — LIFT STATION Lot Una . 5 + . '1 + — — — Size In gallons: Manulaaturer: Foundation 5'+ 10'+ — — — 'Pump on level at np d: High wat« alarm at Curtain Drain NONE KNOW Pump Mob Electrical Yrpections Wrtom»d br. Remarks: —THE EXISTING SEPTIC TANK WAS BENCH MARK l000tlon and Deecrtpt m COMPLETELY ABANDONED TOP OF GARAGE SLAB= 104.58 * WAIVER GRANTED Aesurrwd Ekwotion: 104.58 rL ENGINEER'S SEAL 64p�.s000 o OF 4 Inspections performed by: AKWWCe INC. Dates: 1st 5/6/2003 O VA. 2nd 5/7/2003 3rd 5/8/2003 OQ ff A. Corn ss: OHO c -7 oo�. Development Services Department Approval ' Reviewed and approved by: Date: �j- S -03 OpedPr•ofesskof\& (Rev. 12/01) 4OOD�D�O4 PERMR NUMBER: SW810443 AS -BUILT DRAWING f IXISRINC DRAINFlELD TO BE USED AS A RESERVE STTE� PARCEL ID NUMBER: 041-021-39 L- /-----------� - DRAINFlELDS 1 IUs I I EXISTING WELL J A 13 EXIS'pNC � 5 HODUEOOM N 1500 GALLON SEPTIC TANK — — — — — — — — — — — — — — — — — 20' UTILITY EASMENT Ile \ 5/21/200 _ �!, .. .. a DRAWN BY: ....._. _. _ .......-.. ALASKA WATER & NVASTEWATER SCALE: N.C.H. CONSULTANTS, INC. 1" = 40� 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507' PHONE (007x137.6179' FAX (907)338-32L6 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: HAYDEN GREEN c/o STEVE BOLAN (907) 729-3711 1 2 OF 3 LEGAL DESCRIPTION: STUCKAGAIN HEIGHTS SUBDIVISION #2; LOT 2, BLOCK 2 TYPE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ST1 55.47 65.985 ST2 64.86 ' 4./ DBLI 66.79 71.115 DBL2 67.93 71.515 FD 62.96 61.53 FS 65.91 161.07 C01 63.45 56.49 MT1 62.86 :•,•• E / 84.66 i •ri I•� MT2 84.14 ww CO3 88.35 71.435 GNI 90.12 \ f:• MT3 \ C05 99.33 66.575 MT4 99.39 84.82 C06 96.54 81.49 • f. EXIS'pNC � 5 HODUEOOM N 1500 GALLON SEPTIC TANK — — — — — — — — — — — — — — — — — 20' UTILITY EASMENT Ile \ 5/21/200 _ �!, .. .. a DRAWN BY: ....._. _. _ .......-.. ALASKA WATER & NVASTEWATER SCALE: N.C.H. CONSULTANTS, INC. 1" = 40� 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507' PHONE (007x137.6179' FAX (907)338-32L6 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: HAYDEN GREEN c/o STEVE BOLAN (907) 729-3711 1 2 OF 3 LEGAL DESCRIPTION: STUCKAGAIN HEIGHTS SUBDIVISION #2; LOT 2, BLOCK 2 TYPE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ST1 55.47 65.985 ST2 64.86 70.115 DBLI 66.79 71.115 DBL2 67.93 71.515 FD 62.96 61.53 FS 65.91 161.07 C01 63.45 56.49 MT1 62.86 54.525 CO2 84.66 58.085 MT2 84.14 59.395 CO3 88.35 71.435 C04 90.12 1 69.91 MT3 102.63 70.545 C05 99.33 66.575 MT4 99.39 84.82 C06 96.54 81.49 1../.. .... .. eff ey Drne s " C 795 0 I PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: I SW810443 041-021-39 Ifia.7l:env44 INSULATION TOP OF TANK A INLET - 97.41 INVERT OF BUNG J AT INLET - 96.83 FILTER FABRI INSULATION LOWER TRENCH FINAL GRADE - 100.91-101.07 F NEW 1500 GALLON SEPTIC TANK FINAL CRADE - FILTER 96.37 (AVG.) ORIGINAL GRADE - INSU / 94.47 (HIGHPOINT) 4'W:37101NGI NVERT OF PIPE 1 _91.49 BOTTOM OF TRENCH - 87.47 RELATIVE ELEVATION OF BOTTOM D' OF TEST HOLE - 81.47 (DRY) DA I ALASKA WATER & WASTEWATER SC CONSULTANTS, INC. 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99307 • PHONE (907)337-0179 • FAX (907)338.32L6 PREPARED FOR: PHONE NUMBER: PA HAYDEN GREEN (907) 333-6771 LECAL DESCRIPTION: STUCKAGAIN HEIGHTS SUBDIVISION #2; LOT 2. BLOCK 20 TYPE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE TOP OF TANK AT OUTLET - 97.41 \\—INVEFZT OF BUNG AT OUTLET - 96.60 TEST HOLE UPPER TRENCH AR CO FINAL CRADE - 99.67-100.79 /- ORIGINAL GRADE IC•,7 / _ 96.36-99.48 BOTTOM—INVERT OF PIP:a 95.50 . RELATIVE ELEVATION OF BOTTOM OF 1 • •• • i/21/2003 �� F WN BY: N.C.H. :........ Q N.T.S. E NUMBER: 2 OF 3 Q '•,J ff y dp �, C ams. 7953 pn_e,. � ..... •',tea o MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 -57-�- 03 e (;o10­'� 0 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030074 :Legal Description: STUCKAGAIN HEIGHTS #2 BLK 2 LT 2 Design Engineer: 0041 AK Water & Wastewater Consultan, Owner Name: Hayden Green c/o Steve Bolin Owner Address: 9611 BURNING BUSH ANCHORAGE , AK 99507-1246 Date Issued: Apr 11, 2003 Expiration Date: Apr 10, 2004 Parcel 10: 041-021-39 Site Address: Lot Size: 62168 SO. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: [71 Disposal Field []✓ Septic Tank [] Holding Tank Privy E] Private Well Water Storage 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 (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: Date: e Municipality of Anchorage Development Services Department *A1 Building Safety Division On -Site Water and Wastewater Program4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: WR030026 PID#: 041-021-39 HAM Date Received: 419/03 Legal Description: Stuckagain Heights 02 Block 2 Lot2 Engineer: Jeffrey A. Garness. PE Alaska Water & Wastewater Consultants. Inc. Applicant: HAyden Green Waiver Requested: 1 foot from from Proposed drainfteld to west lot One Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Permit#: Points: Waiver is Granted: V Waiver is not Granted. List Conditions or Reasons for above: Date: �� — By. _ ......................................... Rec#: 33589 Amount: $150.00 Date Paid: Q of Reviewer George P. ll'ucrch, Mayor Anchorage Alunicipa1W of Anchorage hffll� All -America City Building Safety Di«sion ' I I F 2002 4/11/2003 Jeff Garness Alaska Water Waste Water Consultants Subject:. Waiver Request for 1 R Lot Line Waiver Request #WR030026 Parcel ID #041-021-39 Dear Gamess: 11 Your request for a waiver'of the required 10 feet horizontal separation from the absorption field to property line has been.approved. The approved separation distance is 1.0 feet. This waiver approval applies to the existing 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. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904.. Sincerely, Jo dall Civl E gineer On -Site Water & Wastewater Program P.O. Box 196650 • Anchoragc, lVaska. 99519.0050 • Tcicpltonc: (907) 343-8301 • Pas: (907) 343.800 4700 South Bragaw Strcct • Anchorage, Alaslcu 99507 ht tp://tttt�c.ci.anchongc.nlc.us Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. 041-021-39 Permit Number S6'j03cnq-c-1 Property owner(s) HAYDEN GREEN c/o STEVE BOLIN Day phone 729-3711 Mailing address (1) 9611 BURNING BUSH DRIVE * ANCHORAGE. AK Mailing address (2) Zip Code 99507 Legal description (Lot, Block & Sub'd.) LOT 2. BLOCK 2: STUCKAGAIN HEIGHTS SUBDIVISION J2 Legal description (Section, Township & Range) N/A Lot Size (a�Z"1651 Acres/Sq.Ft. Number of Bedrooms 5 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. ALASKA WATER & WASTEWATER CONSULTANTS INC. Permit Fees: #400 • r Waiver Fees: 4150. Date of Payment: -� '.i ' o ei Date of Payment: '�i ' 5.O3 Receipt Number:SSg Receipt Number: 3.35$9' � Q�3o o�lo ALASKA. WATER & WASTEWATER mm � Y'■ m �� CONSULTANTS, INC. April 4, 2003 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water R, Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Septic Upgrade for Lot 2, Block 2; Stuckagain Heights Subdivision #2 To whom it may concern: The existing 5 bedroom house is served by a private well and septic system. The existing septic system consists of a 1250 gallon septic tank and a trench type drainfield. The drainfield is in a state of failure and needs to be upgraded. A test hole was excavated north of the existing drainfield. The drainfield will be designed around the 30 foot radii of this test hole. We are proposing that the existing 1250 gallon septic tank be replaced with a new 1500 gallon septic tank and a dual five -wide type drainfields be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that an application rate of 1.2 gallons/day /fl 2 should be used. 2. TRENCII DESIGN: a. Percolation Rate: <1 minutes/inch b. Proposed Application Rate: 1.2 gallons/day/112 c. Number of Bedrooms: 5 d. Design Flow: 750 gallons per day e. Minimum Absorption Area: 625R2 f. Total Depth: 7 feet (max.) g. Effective Depth: 4 h. Width: 5 feet i. Reduction Factor: 0.5 j. Minimum Length: 2 @ 32 feet loy each (64 feet total length) k Effective absorption area = 640 ft 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 4. TOPOGRAPHY: The area for the proposed drainfields is a 20% +/- slope running approximately northeast to southwest and then east to west. The trenches will be installed parallel to slope contours. 5. DRAINFIELD WAIVER: We request a 7 foot waiver from the existing drainfield to the proposed drainfield. Given the porosity of the soil the effluent from the proposed drainfield will have rapid vertical migration and very minimal horizontal migration. Also, each system will not be used simitaneously. We are proposed to use the existing drainfield as a reserve site after it rejuvenates. Based upon these factors, it is our opinion that there is minimal risk with the granting of this waiver. 6. LOT LINE WAIVER: We request a 1 foot lot line waiver from the proposed drainfield to the west lot line. We are unaware of any adverse effects with the granting of this waiver. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If yo ave any questions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. NOTE: A site plan drawing, a design drawing, a detail drawing, a soils logs, and a 7 page constniction specification letter which are all part of the design: package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwe.com STUCKAGAIN HEIGHTS S/D /2; LOT 7. BLOCK 1. 1 I 1 1 STUCKAG,Uf1 HEIGHTS S/D #2; LOT ,\BLOCK IN 11 �\ ;1 STUCKACAIN HEIGHTS S/D j2; LOT 9, BLOCK 1, CEPTIC ARS ------------ -- Y Z� /l / / \ h—�--- ------ \ / L 1 1--THII NEAR POINT S/D; LOT 1 B. �— ENISTIN 5 BEDROOM ----------H–%15L---- -� PROPOSED SEPTIC UPGRADE Imo\ (SEE DESIGN PACE 2 OF 2) SEPTIC SYSTEM \\ HILLSIDE NORTH S/D /3; ? LOT 1. BLOCK 2, 1 / , f 1 HILLSIDE NORTH S/D /3; LOT 2. BLOCK 2. HILLSIDE NORTH S/D 13; LOT 5, BLOCK 2. 64W 4/4/2003 ` 'QF // (95-28) :- \ t.......----.._..----� DRAWN BY: rL+'`�...... «A1 R % ` / 1 1 C.J.G. ALASKA R & NVASTENVATER .,, CONSULTANTS. INC. SCALE * 4 " = :....„ 6001 DERARR ROAD. SUITE 28 • ANCHORAGE. OK 9950E • PHONE (907)337-6179 • FAX (9071(9071338-371.61 100, .............:....+ 6 +� PREPARED FOR PHONE NUMBER: PACE NUMBER: i? HAYDEN GREEN c/o STEVE BOLIN 729-3711 1 OF 2 y A. arne s: l% LEGAL. DESCRIPTION: o STUCKAGAIN HEIGHTS SUBDIVISION #2; LOT 2, BLOCK 2, TYPE OF WORK: vcrofeasiono��=c-� SITE PLAN FOR SEPTIC SYSTEM UPGRADE EXISTING DRAJNnELD TO BE USED AS A RESERVE / SITE (SIZED FOR 5 BEDROOM SYSTEM) lo. 6 ZINSTALL FLOW SPLITTER INSTALL FLOW L DNERTER _/ INSTALL DOUBLE CLEANOUTS NOTE: THE CONTRACTOR S A VE THE 100 FOOT WELL RADIUS AND THE WEST LOT LINE FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. — — — — — — — — — — — LAqk FOUNDATION CLEANOUT — — — — — — — — — — — — — — — EXISTING 1250 GALLON SEPTIC TANK TO BE REPLACED WITH A 20' UTILITY EAsmEmT NEW 1500 GALLON SEPTIC TANK. 4/4/2003 1 FYI WN ErY* -------- - ---- . ... ... F C.J.G. ALASKA « 'AT E R & NA 'A S T ENA 'AT E4 R SCALE. CONSULTANTS, INC." 40 PROPOSED DRAINFIELDS. EXCAVATE TWO ....... ...... TRENCHES THAT ARE 7 FEET DEEP MAXIMUM BY 5 FEET WIDE BY 32 FEET LONG EACH (64 FEET TOTAL LENGTH). ADD 4 FEET OF PAGE NUMBER: CLEAN. WASHED SEWER DRAJNROCK. 2 OF 2 ... f ... ..... ...... . EXISTI No am s., 795 BED m STUCKAGAIN HEIGHTS SUBDIVISION#2: LOT 2, BLOCK 2, Aounoo SE LAqk FOUNDATION CLEANOUT — — — — — — — — — — — — — — — EXISTING 1250 GALLON SEPTIC TANK TO BE REPLACED WITH A 20' UTILITY EAsmEmT NEW 1500 GALLON SEPTIC TANK. 4/4/2003 1 FYI WN ErY* -------- - ---- . ... ... F C.J.G. ALASKA « 'AT E R & NA 'A S T ENA 'AT E4 R SCALE. CONSULTANTS, INC." 40 . ....... ...... 6901 DEBARK ROAD. SUITE 28 • ANCHCRAGF. AK 99501. - PHONE (907)337-6179 - FAX (907)338-3246 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: HAYDEN GREEN c/o STEVE BOLAN 729-3711 2 OF 2 ... f ... ..... ...... . e *p c am s., 795 LEGAL DESCRIPTION: STUCKAGAIN HEIGHTS SUBDIVISION#2: LOT 2, BLOCK 2, DO TYPE OF WORK: DESIGN OF SEPTIC SYSTEM UPGRADE p sl t'%o\ AILA..SKA WATER N& WASTE'17ATER -�---� CONSULTANTS, INC. 6901 DEBARR ROAD. SWE 28 • ANCHORAGE. AK. 99504 • PHONE: (907)M-1-61 79 • AK: (907)338-3246 • MUM 0kgge.p SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: STUCKAGAIN HEIGHTS SUBDMSION #2 ; LOT 2, BLOCK 2, PERFORMED FOR: HAYDEN GREEN DATE: 3/25/2003 DEPTH (feet ORGANICS ITEST HOLE 1 1 2—:0-* W -9 ..-g.-. **•,• .s toe. "o Do` 4 •:.••- ..•..,. .00 Do ;.• 55 .• •g .•.• :I:::� „e: SP lgo•$% 7-1. 6,400, loll •.. go•o•,o 8— g; o•o• .00. 0600 g; ggsg „, o,.' 9 •:.•.• •1:?96:'-11 ': L`:': 10 OQQ O°O° 11 O 9°00°0 p0O°p 0° OOpo SW 12- 13-0 2 13 n 14- 15- 16- 17 4151617 18 DEPTH TO DATE GROUNDWATER DRY 3/25/2003 D" y VAY H hhcc,� -* .......... pm® 7953 �'ia'frofesswd"' 26 f � I /t f � T„i, i ------�� SITE PLAN 1"=100, DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 3/25/2003 1 3:51 — 6" — ulllllll 3:52 u�lll�ll 0" 6- iiia. 3:52 — 6" — HBO 3:53 • Em 6" 5 111111111 — 6" — 6 3:54 <1 0" 31il;tll 7 3:54 �a.� • — 8 3:55 <1 DEPTH TO DATE GROUNDWATER DRY 3/25/2003 D" y VAY H hhcc,� -* .......... pm® 7953 �'ia'frofesswd"' 26 f � I /t f � T„i, i ------�� SITE PLAN 1"=100, DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 3/25/2003 1 3:51 — 6" — 2 3:52 <1 0" 6- 3 3:52 — 6" — 4 3:53 <1 0" 6" 5 3:53 — 6" — 6 3:54 <1 0" 6" 7 3:54 — 6" — 8 3:55 <1 O' 6- 9 3:55 — 6" — 10 3:56 <1 0" 6- "11 I 1 3:56 — 6" — 12 3:57 <1 0" 6" 19� PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.0 FT. AND 6.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ❑ NO SOILS LOGGED BY: MATT FISHER PERCOLATION TEST PERFORMED BY: MATT FISHER COMMENTS: PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS W S PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 4"1x4 -/O? s MUNICIPALITY OF ANCHORAGE J ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW 11 '-@.✓ uC deH lYl 333_07/ ❑UPGRADE MAILING ADD ESS - 4 E, D �" LEGAL DESCRIPTION a LOCATIONnV NO. OF BEDROOMS U DISTANCE TO: Well m (f Ab rpi�I area U Dwelling rd i �' /II PERMIT NO. /) V� y H e w I-- Manufacturer t n /v C. t- � Material - c C L No. of compartments e2. Liq. capacity in gallons / IF HOMEMADE: Inside length Width Liquid depth - L' JO'Z DL5TANCE TO: Well Dwelling PERMIT N 0 z G 2 Manufacturer Material < uid capacity in gallons DISTANCE TO: Well/O Foundation Nearest) line PERMIz1,9 '13 2 ,W / U UJ No. of lines L n th of ea line Q Total length f 'nes Trench wi i inches Distance, between lines 22 /.� 15 ot1i ac F T p of tile to finish grade Material beneath e SL'?rU Total ff dive absorpt n r a l. Le th Width De h PERMIT O. w C7 Q H T of crib Crib diameter Crib depth Total effective absorptioafiea w °- w Well Buildingjodhication Nearest lot li DISTANCE TO: - Class Depth Driller Distance to lot line PERMIT NO. �v W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER ITa PIPE MATERIALS SOIL TEST RATING /jId A)_ / --- ,L INSTALLER GV C Cl -D r� RE ARKS NE' L t 5n,0 Z31 771 Acer- w 1+S i ✓ /=oa Fixs'r iNSPre>iar✓ 5o LJ /f5 E AeovI z), G✓/'T/l I' !V C aI� �ECE/PT of fi/�/D txT �"f" G-�c� vc"L/✓r A L NEW 50/13 }-ES'T G✓/' 'Lj JESTED vE' olrr✓b'' DrEP - it A G! TylErlc f�S o __ ' �✓ �%/file /✓ � t% YlViFM Z' ler el!f ;ve APPROVED DATE LEGAL � ay C- e/ - 72-013 (Rev. 3/78) 1 r471r t F TYPE OF _OIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 -OIL RATING !:SCS FT/BR7-= 220 THE REQUIRED "IEE OF THE `OIL ABSORPTION SYSTEM IS: 1.171 L d ® ' 9—y E3E3 C3 F_ € A %? E0Lr C_a F-- F " F FA ..— 15 THE LENGTH DIMENSION IS THE LENGTH r:IN FEET? OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO 'SET WIDTH FOR TRENCHES. THE GRAVEL. DEPTH I`_-' THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET) }%== E= a_ s €_� � ��_' Fes' C= d = EE 6=" -6' I e� �" 6=B �"•"9 �--": � = 1 "�. E<'== � -` `w aE� a_`a !=-� L_ Lr ®= ®E"-�'-_ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -- ----- 1- 14 ED we -• g I- r4 "_" F" EE ED "IF J_ ED rA cy FA FT E FZ EZ Col Rw1 I FT° E7 10 ------ BACKFILLING ---B=1CK:FIL.LING OF ANY SYSTEM WITHOUT FINAL_ INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. OlIP4IMUll DISTANCE BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 Fr -ET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DI_TANC:E FROM A PRIVATE WELL TO A PRIVATE NEWER LINE IS 2 5 FEET AND TO A COMMUNITY 'SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON --SITE: SEWERS AND WELL'S AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. —: I WILL INSTALL. THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON --SITE _,EWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I` REMODEL. -ED TO INCLUDE MORE THAN 4 BEDROOM'_;. SIGNED: ---------------------- --_.-.----_---------.-- APPLICANT HAYDEN GREEN �� - " t a- s uno .11 k—. A v_ 01 @-._ A tl _r 99 C r- n -4 t rn • e n2- r-® � DEPARTMENT OF HEALTH AND ENVIG:ONMENTAL PROTECTION 025 `I STREET, ANCHORAGE, AK:. =''_� 11 'i 264-4720 -1-IF2-- E4EnL_L_ F404C.fi a_aS 1-- " °E�14U_r" I--°E:FZr-11 7- PERMIT- NO. :: 810144 APPLICANT HAYDEN GREEN 7466 E. 20TH AVE LOCATION BURNING BUSH LEGAL LOT 2 BLK 2 S TUCKAGAIN HTE. LOT SIZE 43r^,�1 Si'Lll f E JPUU TYPE OF _OIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 -OIL RATING !:SCS FT/BR7-= 220 THE REQUIRED "IEE OF THE `OIL ABSORPTION SYSTEM IS: 1.171 L d ® ' 9—y E3E3 C3 F_ € A %? E0Lr C_a F-- F " F FA ..— 15 THE LENGTH DIMENSION IS THE LENGTH r:IN FEET? OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO 'SET WIDTH FOR TRENCHES. THE GRAVEL. DEPTH I`_-' THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET) }%== E= a_ s €_� � ��_' Fes' C= d = EE 6=" -6' I e� �" 6=B �"•"9 �--": � = 1 "�. E<'== � -` `w aE� a_`a !=-� L_ Lr ®= ®E"-�'-_ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -- ----- 1- 14 ED we -• g I- r4 "_" F" EE ED "IF J_ ED rA cy FA FT E FZ EZ Col Rw1 I FT° E7 10 ------ BACKFILLING ---B=1CK:FIL.LING OF ANY SYSTEM WITHOUT FINAL_ INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. OlIP4IMUll DISTANCE BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 Fr -ET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DI_TANC:E FROM A PRIVATE WELL TO A PRIVATE NEWER LINE IS 2 5 FEET AND TO A COMMUNITY 'SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON --SITE: SEWERS AND WELL'S AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. —: I WILL INSTALL. THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON --SITE _,EWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I` REMODEL. -ED TO INCLUDE MORE THAN 4 BEDROOM'_;. SIGNED: ---------------------- --_.-.----_---------.-- APPLICANT HAYDEN GREEN �� - x 1 -"`ss` fit' !^�3� #8'➢iC. -i �M DEA, AAftt 1 hl5tXrH fTffP EUVIROt4AfFzS6 _ ARt3T �TEs1t8 264-4720 PERMIT M. f G�L944.'% g F APPLIemr HAYDEN Ask 74" VE 24TH AAMC rte? -677L ; a i r"RTION LN_IRNIts OySti LC13AL LOT 2 BLie' 2 S rLICKFR3R fN € rS. LOT 11M 4 69 '3"NJRw i T°{PE t SOIL A6543r#PT ION Scr`STEM IS, TqSlz,%2H 14AY ff•VJN NJI48ER Olc SEDRI-XV4S = 4 SOIL RAr INQ 4 aQ FF/&9)= 229 � iTHE REREQUIRED+cIRED SIZE �z s T's¢-.';klrLTRaSiL TION SYSTEM ■IS: �y ras 3»=t- i l""IJLCD- rW LET -10TH DVIE i 15 THE Le)GTH < IN F'EET3 OV TW—F MMH 17R ORRIWICLO. TFC DEPTH OF R TF4 14 OR PIT tS T%C OtSrANIX £CTl tl4 Tt�.-- --:UJRFill� OF TW- AO-IftlD MJD T'rfZ- 00rf;7ff sj; TTS e;,0,33VnFI*N (IN FFET3. Tf<RE Ili PAR SET W11PTH FOR TAI�NGHE5. T't< 19VEL DEPTH IS TW- PTINIM#Ut £ 'Tti OF l t?`s L c TTr#ETHE i�JTFr#_L PIPE t%NQ TW. 0])M11 3X- rrFJ--4iVt4r f -l?f ( f N FEET). PF zm £ r Apr- . v -fid T l#Fr- TFC RES -PONS I S IL I TY TO INFORM n4 t5 Cbty t" TP 011RIM I _ Ild Ti it4?N Li •F'FCTiam OF l3NY #DLLs t'3ojnc-�Jr To mrs F'A't;FERry Atli} rw fPJf li CR OF RE's I 3 THAT TW WELL WILL SERVZ jai=a^ T +t sai�T�i i 3 E•ftQi ILLI2N OF Allff 'aesTEV WITl+3UT F'ItIF1L I{Fy..PE'F l'Ir3N fi#%'O APPRCWf-. eky THE; ISE-PART'tiENT WILL E SUBJECT TO PROSECLTIO?t M ul ll<lum D I S TF'INCE € E n-JESH 9 WGUL € NO m4y (7N-15 f r < -Seti13E DISPOSHL SIT STEH €' i IA{£ Fgcr F*)R A PRIVATE WV -L OR i,59 To 809 FEET FROM A f•`U LfC WELL (C C+IW t7F t'td£L IC WE - f i IET JIi IFISTF A X ;°R011 N PRI` ATE I4.L TO A PRIVATE 0, LINE IS � FeEr AND TO Ataa3tgl#t#NfTY • LI? -F- IS 75 FEEL I• �L L+ � RRE REQUIRED SHO AMT BE RETURNEO TO rf-JE 0CPARtPWJlT WITHIN 30 D+Te OF THE 100-L r]T# R REi3fJ£REhtE#9T3 AIRY APPLY.CIFI{:t�Tt� Ia' AMj'OIVaTRI TIs3N OIFi+3RRfia IRVRELSO-E TO INSURE PROPER "r_;rnLj-Arx,3N- € = T IFY TTit'IT I i s tiff F1311 IL IFIR 01 TH Tim RSOASV41airi I= tR. ON --'s 1 TE 40*3`5, )*M i L 5 f6- '-E f ByTt� t lI}Ilx IG £f � t T'Y' 3�r fV-#, [ sa3di_ C05TPLA- TW `4eSTOf IN WITH THE L:O s. 3 : i s FT{t ci? Ti3IdD T3sil; 3T #"W 0N --'S t Ts ' ". s7re'1 PLRY REQU f RtE fUI &nR, t3T If; Tr 3loEa'�P- IS RF-ty 0-yz0 TO Ima-UvE flplw TTm 4 SECCRIX3WS, I 3 t SOILS LOG _,s.--- MUNICIPALITY OF ANCHORAGE' -4-.-- w MUNICIPALITY OF ANCHORAGE DEPT. OF H...-�ITi ENVIRONMENTAL PFO?CTt9N PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720AUG r/ 'orf SOILS LOG - PERCOLATION TEST l RECEIVED PERFORMED FOR: `r �J 0/,-'s G'�t`"'^ DATE PERFORMED: LEGAL DESCRIPTION: "+ � � � /)� z of Ga 1 SLOPE SITE PLAN 1 2 m V 3 4 6�) 7 �v u 1� 10- 12 0 12 is 13 14 15- 16- 17- 18- 19- 20- COMMENTS 51617181920COMMENTS PERFORMED BY 72-008 (6/79) 6-'`i7 ie j a -r S P WAS GROUND WATER S ENCOUNTERED? L let 4(p P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) F1W6E A .,�N `fir- �• CERTIFIED BY:•�;_-. � ! DATE6 -JJ D r ll� (. LT SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 11\q1%• \-F0.4 LNUS e:K /j�f /7'12rrl�_+-� LEGAL DESCRIPTION:p 4. i6 t! 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 ___1-8 19 20 IFNTS Jee?T_P F;)-ao J�Jl/r/" Ca xVA DATE PERFORMED: --• 7'.R._ S'I SLOPE r SITE ?LAN asy.rytq grilS Lq tS GROUND WATER COUNTERED? YES, AT WHAT PTH? t� S O P E Reading Date Gross Time Net Time Depth to Water Net Drop -� .131 3 / of lH 3 11 =S 1 a'9 .07 10 / to '3., 7c� l CJ RCOLATION RATE ,(minutes/inch) TEST RUN BETWEEN a— FT AND Rye FT PERFORMED BY: n� //\AX4. CERTIFIED BY: 72-008 (6/79) r UI-• 1- 0 l - s0 4 j u s Y�� .moi �_L--Lfi•_� .�4�l�s�,/i TO de S.R. - 2 Bm 4"I'll') CHUGV.!, ALA -R'4? 99567 mrd TERMS: DATE CUSTOMEfl ORDER NO. SALESPERSON VIA QUANTITY ;GTI DESCRIPTION ,—wer coolk VOCk PRICE AMOUNT p a Elm WO 8w m � N � y E3 c ti e v o$ z �5 m c s�w6S 62£ 3„SI $OAS 19111— — —66'012-- I� m -I ° a rN bw / N Q °O 0 ey W QoRN m m $ �oa \ S'c- m C ocD a o �. C ¢aav Cy � maoo6' boa a' m a n — ,ca., p a Elm I ,y i I7 I� WO 8w m � N � y E3 c � 0 3 o$ z �5 m c s�w6S 62£ 3„SI $OAS 19111— — —66'012-- I� m -I ° a rN bw / N Q °O 0 ey I ,y i I7 I� �2S K'yg52 ` s 00 a� yN m� awl N. a $ I Z ��, 62Os2�iy e° � y c c � 0 3 wM68�ry$$ � m c s�w6S 62£ 3„SI $OAS 19111— — —66'012-- I� m -I ° a rN N Q °O 0 ey W QoRN m m $ �oa \ w� �2S K'yg52 ` s 00 a� yN m� awl N. a $ I Z ��, 62Os2�iy Q e° � y c c � 0 3 wM68�ry$$ � m R 3 E C F Q ¢ c m �o$8�58$8 ° a N Q °O 53M�M ey W QoRN J '�p N N O m a n Q e° � y c c � 0 3 � m R 3 E C F Q ¢ c m ° a N Q °O ey -O 3 N ^ N n m Nin J h � O j l+mZ y Q ,�• Q � n �rww y N N `�Oy o 3 Q h Q h V N O e fwpQ � Q N U y¢ VV J 0 m e v o z cS o a v3 m ry R;i U -11W W y g, spy j o wU `c h Q Q Q dopa Q S� W a a N I $ yD ,v o ° S b iovt U t a « d N W op�c m P O 4°j O 1� « U 4j0 C 141 a g o f I i 4 Gt e 9C t.➢: avc v�¢u aoaE`o .v. 'a y a m a 2 i O y Jwo°u Ee y� a a f Municipality of Anchorage ° ` -- Development Services Department Building Safety Division _ On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. QJ4/' 0Z1 13CI COSA# 0671 022Z 1. GENERAL INFORMATION Expiration Date: / O — / S-- Oct Complete legal description STUCKAGAIN HEIGHTS #2: BLOCK 2. LOT 2 Location (site address) 9611 BURNING BUSH DRIVE *ANCHORAGE, AK 99507 KfNT-- Current Property owner(s) SUSAN RAFTS Day phone 344-5666 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 2800 E 72ND AVE $ANCHORAGE. AK 99507 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENG114EER 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 riles 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 BlIg-0eers Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any otherperson or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE / y Approved for bedrooms. Phone 337-6179 Date Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: t. e o Lovf to,c1f On-S;7_c / .�_ Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements f3jF �Q/� ro � OI yo j`�: • ON-SITE•• •••�Gr's WATER AND WASTEWATER . PROGRAM o •• Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date: 7- (Rw 11NS) Municipality of Anchorage (• �1 Development Services Department Building Safety Division 41' On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/22/2009 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATAe L wEXISTING Rao 6/9/1981 - 220 ftp/bdrm TRENCH Date installed 5/6-8/2003 Soli rating (g.p.d./ft'or ft'/bdrm) 1_2 gpd/1tr System type DUAL TRENCH 88 TOTAL UNKNOWN 7 & 5 Length 32 & 37 ft. Width 5 ft. Gravel below pipe 3 & 4 ft. 07.8-8.5 WEST/ 010.3 1981 TRENCH 760/ : Total depth •7.1 EAST ft. Eft. absorption area 640+ ftv Monitoring tube YES Depression over field NO Date of adequacy test 0'7/6/2009 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth In absorption field before test DRY in.. Water added 750 gal New depth DRY in. Elapsed Time: = min. Final fluid depth DRY in. Absorption rate >= 750+ g.p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — **TEST PERFORMED ON WEST (2003) TRENCH ',ONLY. NOTE: 1981 SYSTEM WAS NOT IN USE AND DRY. NO PRE—SOAK REQUIRED PER JEFF POET. FD. FS, C01 do MTI UNABLE TO BE LOCATED. Legal Description: STUCKAGAIN HEIGHTS #2; BLOCK 2, LOT 2 Parcel ID: _D /'0;Zai'3� A. WELL DATA 'PER GEG INSPECTION."ASSUMED BASED ON SURROUNDING WELL LOGS. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed 1982 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth '294+ ft. Cased to "040+ g, Casing height (above ground) 12 in. FROM WELL LOG_ AT INSPECTION Is Date of test 7/6/2009 z Static water level ft. 72 ft. Well production 9.p -m. 2.6 g.p.m. WATER SAMPLE RESULTS: LColiform _(� colonies/100 mt. Nitrate 2&J mg./L. Other bacteria colonies/100 ml. Arsenic: ug./L. Date of sample: 7/6/2009 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA "LOCATED (BURIED IN DRIVEWAY) Tank Type/Material SEPTIC/STEEL Date installed 5/6-8/2003 Tank size 1500 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/22/2009 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATAe L wEXISTING Rao 6/9/1981 - 220 ftp/bdrm TRENCH Date installed 5/6-8/2003 Soli rating (g.p.d./ft'or ft'/bdrm) 1_2 gpd/1tr System type DUAL TRENCH 88 TOTAL UNKNOWN 7 & 5 Length 32 & 37 ft. Width 5 ft. Gravel below pipe 3 & 4 ft. 07.8-8.5 WEST/ 010.3 1981 TRENCH 760/ : Total depth •7.1 EAST ft. Eft. absorption area 640+ ftv Monitoring tube YES Depression over field NO Date of adequacy test 0'7/6/2009 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth In absorption field before test DRY in.. Water added 750 gal New depth DRY in. Elapsed Time: = min. Final fluid depth DRY in. Absorption rate >= 750+ g.p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — **TEST PERFORMED ON WEST (2003) TRENCH ',ONLY. NOTE: 1981 SYSTEM WAS NOT IN USE AND DRY. NO PRE—SOAK REQUIRED PER JEFF POET. FD. FS, C01 do MTI UNABLE TO BE LOCATED. D. LIFT STATION Date installed "Pump on' level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump off" level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field ••5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *11 Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage B'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *WR x{030026 **EXACT DISTANCE TO OLD FIELD UNKNOWN. 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 JEFFREY A. CARNESS Date _ `7 /13 COSA Fee $ 9, 5— O Date of Payment . 1 / -5� 9 �� Receipt Number n 3 5_�C to (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number SGS RCEN 1093234001 Client Name Garness Engineering Group, Ltd Project Name/N Stuckagain Heights 92 Lot 2 Client Sample 11) Stuckagain Heights 92 Lot 2 Matrix Drinking Water Sample Remarks: Printed Daterl'ime 07202009 8:40 Collected Datefrime 07/062009 17:30 Recei\ed Datcrrime 07/072009 8:00 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Contamcr ID Limits Date Date Inst Metals by ICP/MS Arsenic Waters Department Total Nitrate/Nitritc-N Microbioloov Laboratory Colony Count Total Coliform Fecal Coliform ND 5.00 ug./I. EP200.8 C (<IO) 07/13/09 07/15/09 NRB 0.540 0.100 mg/L S%1204500NO3-F B (<IO) 07/08/09 LCB 0 col/IOOmL SM209222B A (<2(X)) 07/07/09 SDP 0 col/IOOmL SM20922213 A (<I) 07/07/09 SDI' 0 col/IOOmI. SM209222B A (<1) 07/07/09 SDP ,56.0 1 Z 3„6 1,5 0,0 S 30' YTIUR [uCMENT I v Co J Q' .rF1i!! xa :pn :V I N �p'�6-•• � I ro I W I O I I � O P to O Y CI O I 17 0 Z I 0 �Ylh) h I Ln Y'LL ri I r J :o I N Y a o Y , 0 N7Y O a • , m pP e m I I 1 I I • I I e , n' • P • I 1 3 I > I Pe O I J •� O O P � I w � � , \ • \ �OD•s2� i n N • JN�N�nO\'� ,I T3w CZ�Z �o SC W4 00 r ^ Well Log Alaska Now—doll/Vernb Drl(Iling 12241 Avon . Anchorage. Alaska 99516 .Well Owner (907) 345-4417 Allen elitism Of Subdivision I Lot Well Log Ft. Below Surface W -M ZMdl Well Depth (ft) Date of Com lotion 132 7/28/94 Drlllln hethod Use 1roUry stic Cost n T pe welded Diameter (tn.) Depth (11 Weight (IDs/fl) to 130 17 LD Finish of Well 7 oe open end �--D—iia--m--e—tte--rte� l._. Static Water Level Leval (ft.) Dete 35'6-toc I 7/2B/94 Pumping Level Below T of C (ft.) After (hra) Pumping (.p.m) Grouting Via Material Nos I Pump H.P Capacity Toe —�I Isubmersible Setting (ft) Remarks very tight formation. much development required to extract 20 qpm. well was drilled under my jurudiction and this report Is true to the best of my knowledge and Nowell ki I i•• I • 4 0 Y 7 y a Y { .1 7 - W s '•j cc 'y ¢ Fo Q 3 to y O •+ ! t. 1: " t z. N ki i M 9 I i•• I • 4 0 Y 7 a Y { .1 7 - W s '•j cc 'y W a LIS Q 3 v y O i M 9 1 I i•• I { ! r' s '•j 1 ,i 'y ti z. N 0 } i . p O 0 O O O O O O O O O O w-www.wwwww.www' { ' tE '•:�i ".tib j ! "�•,� '` j '•j ! : • i V� „ � = i :.moi. ..i -.., • ; .; ..;- ...} } ••.j : p 0 0 �. wwwwwww'wwwww 1 ,i i z. N 0 Municipality of Anchorage ' Development Services Department:. Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ' (r ( +A Parcel I.D. 041-021-39 HAA# 0��t Q ?S 1. GENERAL INFORMATION Expiration Date: Z cZ - $ - O 3 Complete legal description STUCKAGAIN HEIGHTS SUBDIVISION #2: LOT 2, BLOCK 2 Location (site address or directions) 9611 BURNING BUSH DRIVE ' ANCHORAGE. AK 99507 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HAYDEN do BETH GREEN Day phone 333-6771 9611 BURNING BUSH DRIVE * ANCHORAGE. AK 99507 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results doscribed the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readilyldentifmable features. The operational life of alt wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKW WC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for S bedrooms. Disapproved. 337-6179 Date Z 0 Conditional approval for bedrooms, with the tllowing stipulations: A. KiDtness., —7953 ; ..k j f as sion�°oo Attachments: L� HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other PKIJUMAIv1 ; By: Original Certificate Date: 9-43-03 (Rev. 12101) Municipality of Anchorage Development Services Department Building Safety Division On-Sfte Water & Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage. AK 99519.6650 www.cLanchorage.ak.us (907) 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: STUCKAGAIN HEIGHTS S/D 2; LOT 2 BLOCK 2. Parcel ID: 041-021-39 A. WELL DATA *TEST PERFORMED BY STEVE BOLAN P.E. Wen type PRIME If A, B, or C provide PWSID# N/A Well Log (YM) NO Date completed -1982 Sanitary seal (YIN) YES Wires property protected (Y/N) YES Totai:depth 250+ fL Cased to 40+ ft. FROM WELL LOG Date of test $tatlo water levet _ ,._ R Well production g.p.m. WATER SAMPPW REQ LTS: &toColiform Ot" colonies/100 ml. Nitrate 2.3 mg./L. Casing height (above ground) 12+ in. AT INSPECTION •4/10,2003 65 ft, 2.2 g.p.m. Other bacteria c1 colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 8/11/2003 Collected by: STEVE BOUW P.E. 8. SEPTIC/HOLDING TANK DATA Tank.Type/Material STEEL Date installed 5/6-8/2003 Tank stee 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout(Y/N) —YES Depression over tank (YM) NO High water alar (Y/N) N/A Date of pumping NEW Pumper — C. ABSORPTION FIELD DATA Date installed 5/6-8/2003 Soil rating .p.d. rftJbdr) 1.22 System type TRENCH Length 32 & 37 ft, Width 5 ft. Gravel below pipe 3 do 4 ft. Total depth�7.t. Eff. absorption area 640+ ft2 Monitoring tube YES . Depression over field NO Date of adequacy test NEWT Results (Pass/Fall) — For 5 bedrooms Fluid depth in absorption field before test „ - in. Water added =gal. New depth lin. Elapsed Time: _ min. Final fluid depth — in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) — If yes. give date — D. UFT STATION Date installed Size in gallons I "Pump on" level at in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ Absorption field on lot 1009+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Sewer/septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 100+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One •1'+ Building foundation 10'+ Water main N/A Water service line 100+ Surface water 100'+ Driveway, parking/vehicle storage 1'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ - F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and q 9* review of Munidpal records that the above systems are in """"' """ """" conformance with MOA HAA guidelines in effect on this date. lvn •. a ..4 .a...ss:... Engineer's Printed Na a JEFFREY A. GARNESS �" E-7953 4 �,r Date 03 �M"O a.-•---„.��� HAA Fee $ 3'75 — Date of Payment 1 -21 -as Receipt Number �' ” CUP (Rev. 12/011 Waiver Fee $ Date of Payment Receipt Number Steve Bolan 4341 Rendezvous Cir NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 (90714SG•3116 • FAX 455 3125 5751 SILVERADO WAY; UNIT N ANCHORAGF,AW^KA 99313 (9071349.1000 -FAX 349.1015 POUCH 340043 PRUDHOE BAY. ALASKA 99734 (907) 6592145 • FAX 659.7146 DRINKING WATER ANALYSIS REPORT FOR COLIFORM BACTERIA Anchorage AK 99504 Date Received: 8/11/03 Date Analyzed: 8/12/03 Date Reported: 9/5/03 Next Sample Due: Time Received: 14:00 Time Analyzed: 13:00 Time Reported: 10:36 2GM✓(s• v Kerry A. Lynch Environmental Analyst 915W (ReVf3ed) Northern Testing Laboratories, Inc Andwage, AK 848-4 ZOO/200'd SSZ-1 -so 1d ae10:01 EOOZ-SO-daS Comments Phone Number. (907)677-3536 S F Satisfactory Fax Number. ' (907)729.3691 U c Unsatisfactory POS = Positive Test Result Collected by: SB ND = None Detected Sample Type: Untreated Routine TNTC = Too Numerous To Count (>200 Colonies) CG = Confluent Growth Method of Analysis: Membrane Filtration (SM 9222 B) HSM = Heavy Sediment Masking, Results May Not Be Reliable TLIT = Sample Age >30 Hours, Too Long In Transit R =Resample Required Comments: Method reporting limit is <1 cfu/100mL, NT = No Test report 0 cfu/100mL at client request. • # Colonigs/100 ml **# Colonies/mi Sample Sample Total' Fecal' Other" HPC" Date Time Coliform Coliform Bacteria Result Lab# Location Comments 8111103 07:00 0 0 0 NT AX3154 Stuekagain Heights e2, Satisfactory Lot 2, alk 2 2GM✓(s• v Kerry A. Lynch Environmental Analyst 915W (ReVf3ed) Northern Testing Laboratories, Inc Andwage, AK 848-4 ZOO/200'd SSZ-1 -so 1d ae10:01 EOOZ-SO-daS Aug 21 03 09:29a Hilma Shavings 907-729-3691 p.3 NO THEMN~TESTING LABORATORIES, INC. 3330 )NDUSTR:AL AVE NU,: FAIRBANKS, ALASKA 99701 (907) 456.3116 - FAX 456-3125 5761 SIL VERADO WAY: Ui1T N ANCHORAGE, ALASKA 99518 1907) 349-1000 - FAX 349.1018 ( POUCH 340043 PRUDHOE BAY, ALASKA 99734 (507) 659-2145 - FAX 659.2146 Steve Bekin, P.E. c/o Hayden Green Property 4341 Rendevous Circle Anchorage, AK 99504 Attn: Phone: (907) 677-3536 Fax: (907) 729-3691 NTL Lab#: A308929 Client Sample ID: Bolan/Green Client Project: Hayden Green Location: 7:00 Sample Matrix: Water COC #: 4128 Comments: Analysis Method Parameter SM 4500 NO3E Nitrate -N Reported By: Wendy Mitchell Anchorage Laboratory Manager Report Date: 08/18/03 Date Arrived: 08/11/03 Date Sampled: 08/11/03 Time Sampled: 7:00 Collected By: SB Flap Det-initions MRL - Method Reporting Limit MCL - Maximum Contaminant Level B - Present in Blank 11 - Exceeds Regulatory Limit M - Matrix Interference J - Estimated Value D - Lost to Dilution U - Less Than Reporting Limit Prep Prep Analysis Result Units Flag MRL MCL Method Date Date 2,30 mg/L 1.00 10 08/16/03 ,46'0 l Z 3„6 L,SO,O S 70' UTILITY EASEMENT - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I I O'. Q CF) `r : : U) 0�� N Lj•.• oma I Ul k ti� &49 :a•0� o� I in O�OO���oa N W I ❑ I = 3 ❑ I o❑ I ❑ t N I c I Z A�N3 I N v Ec 10 I a uW I J N7 ° u I I I I I I v I A ° m I m m � I � I o I J � ySn6 • � . I ID ❑ ci ro rl Ln C3 N pz W yya��D:WO <0SZORD _ FigI F0`W Y m aZwo 7 $ (Dw2O fu¢B�rR vQ' z y1 p O.W O i U� Z rcilw K yI 4 ZsZozo¢ �O h Vw�U �s�J w oox� a z w4 N U LL 2b z � z rc � 06 75 00 °w >; g w UO f O w pp NyS O O V jO 6 Z2E, w i W Z$ Op O Z)o Ill o m u 0 w 0 w= o Wm _W_ Viz' w 80 W= ow < O z w R w H RESIDENTIAL WELL INSPECTION LEGAL: Blk 2 Lot 2 Stuckagain Heights #2 PID NUMBER: 041-021-39 OWNER: Hayden & Betty Green LOCATION: 9611 Burning Bush Dr. Anchorage, AK 99507 TYPE OF WELL: Private WELL LOG: NOT AVAILABLE WELL YIELD FROM TEST: 2.2 Gallons per minute DATE OF INSPECTION: April 10, 2003 WELL TEST PROCEDURE: The well was pumped at a constant rate while the draw down was constantly monitored with an acoustic probe. At the beginning of the test the static water level was 65 feet from the top of the casing. At a pumping rate of 3.2 gallons per minute the water level dropped to 250 feet from the top of the casing after 4 hours of pumping. A total of 768 gallons were pumped. The well was then allowed to rest for 30 minutes and it recovered to 205 feet. This gives a recovery rate of 2.2 gallons per minute. THIS WELL WILL, PRODUCE MORE THAN 3 GALLONS PER 11ILNUTE FOR MORE THAN FOUR HOURS. The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceeds this requirement. Rug 21 03 09:29a Hilma Shavings 907-729-3691 DEPARTMENT OF HEALTH & IIUMAN SERVICES Public Health Service The Alaska Area Native Health Service Facsimile Cover Sheet To: Jeff Gayness Company: Alaska Water & Wastewater Phone: (907) 337-6179 Fax: (907) 338-3246 From: Stephen Bolan, P.E., Asst. Env. Engr. Chief Company: Office of Environmental Health & Engineering Alaska Area Native Health Service 4141 Ambassador Drive, Suite 300 Anchorage, Alaska 99508-5997 Phone: (907) 729-3711 Fax: (907) 729-3691 Date: August 21, 2003 Pages including cover : 3 Comments: Here are the test results for Hayden Green's well. Please let me know when I can come by and stamp the forms for the City. P.1