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STUCKAGAIN HEIGHTS BLK 4 LT 2
Stuckagain Heights Block 4 Lot 2 #041-021-23 VONHTTA OCT 14 2013 Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Bax 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131367 PID Number: 041-021-23 ❑ New Upgrade Name: ABSORPTION FIELD Thomas and Teri Mader ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 6550 Farpoint Drive Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 .8 GPD/SF 11-11.5 Ft, LEGAL DESCRIPTION Depth to pipe invert from original grade 3-3.5 Ft. Gravel depth beneath pipe 8.OFt. Subdivision Block Lot Stuckagain Heights 4 2 Fill added above original grade - 1-2 Ft. Greve! length 47 Ft. Township - Range Section Gravel width 3Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 752 Fe Ft. Well >100, >100' N/A N/A >25' TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1,250Ga1. Surface Water >100' >100' NIA N/A Material - Steel Number of compartments Two Lot Line >5' >10' N/A N/A NA Foundation >5' >10' N/A N/A LIFT STATION Manufacturer Ca acit P Y Gal. Curtain Drain None Noted Pump on level at Pump off level at High water alarm at Remarks in. in. in. Existing Septic Tank Decommissioned in Accordance with Municipal Code Existing Absorption Trench Pump make and model Electrical Inspections performed by Connected with Flow Diverter Valve. PIPE MATERIAL Nouse to tank D3034 Tank to D3034 drainfield Installer - G & R Excavating Drainfield HDPE CO/MT D3034 Inspector BENCH MARK (Assumed elevation) 100.Oft MEA Inspection1" 10/12/13 10!12/13 Location and description _ dates: z Garage Slab. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engi p fk,.....gC•1 S# Conditional Approval: Date Q;• , �;� 49 TH r �� j ...• . ...!x�l... p • IWC"AEL I- ANDERSON e ,I �'.• CE -4381 °?y ®• ,Ilf^9F0'.,/0'f3-ij oaf'- Approved Date ��IlESSIOwA41" kilit �i\ `%e Inspection Report _1 '12Aey1 Munlclpallty of Anchorage DEVEOPMENT SERVICES DEPARTMENT Permit Number: 0SP131367 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 STUCKAGAIN HEIGHTS SUBDIVISION LOT 2, BLOCK 4 87,120 S.F. 10' Utility Easement ---------------- A B S1 23.5' 28.2' S2 31.T 33.4' C5 47.6' 37.5' C6 90.8' 82.7' M7 88.7' 80.7' FDV 135.1' 1 35.9' lin MsprpDMn �, rcnch C6 Al H FW e C5 47' Long x 3' Wide x W Etfective7 Depth MSO Meen Trench. S Four beat House 315.00' Existing Well Page 2 of 3 PID No. 041-021-23 i �J,'• V LEGEND %' 49th r ....... •i 0�. 0 M1 — Monitor Tube 0 ........................................... ..... FDV — Flow Diverter Valve PLAN Clean Out PLAN A.S-BUILT 0 � ' MICHAEL E. ANDERSON �� THO— Test Hole ;,'; No. CE -4381 �IlF••••.�{-13a.,�.F'� C5 — 2CO Clean Outi — Double Clean Out SCALE i•• = 50 �"Ok- ,M�P��•� Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: SW070050 91.0 H 97.0 � u1 UU 1,250 Gallon Septic Tank in x H Page 3 of 3 PID No. 051-021-29 ro U 41 ti rencn Lenguit - 784 Il/( No Groundwater — 91.0 .' 49th RSO PROFILE AS -BUILT �,MicaN0 `CE 4381 N IIF ••.. ti3.;{,T•"• 4 No Scale I�Pfp o� ^��•1•_,,,�p�._ 9(i.4 94.4 Finished Grade ngina roan ....__._.__._. Geotextile Fabric .____._._.__ .._.____._.__.. __._._.... _._._._..... Drainfield Rock 83.0 41 ti rencn Lenguit - 784 Il/( No Groundwater — 91.0 .' 49th RSO PROFILE AS -BUILT �,MicaN0 `CE 4381 N IIF ••.. ti3.;{,T•"• 4 No Scale I�Pfp o� ^��•1•_,,,�p�._ MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 ELMORE ROAD ANCHORAGE, ALASKA 99519-6650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Thomas and Teri Mader DATE PERFORMED: 1019/13 LEGAL DESCRIPTION: Lott BIOck4 Stucka ainHeights Subdivision TEST HOLE # 1 SLOPE� SITE PLAN 16 17 18 WAS GROUNDWATER NO OG/01- G/OL2 2 NET DROP 1 3- 10 L 4- 45 2 0 5 .75"/2.50" Silty Gravel DEPTH OF WATER None W/Sand 6 1.75" E 7 10/13/13 .63"/2.38" - 1.75" 5 GM 8 .50"/2.25" 1.75" 9 9:05/9:15 10- 16 17 18 WAS GROUNDWATER NO S ENCOUNTERED? NET DROP 1 10111 8:10/8:20 10 L IF YES, WHAT DEPTH? 2 0 10 .75"/2.50" P DEPTH OF WATER None 10 AFTER MONITORING: 1.75" E DATE: 10/13/13 .63"/2.38" - 1.75" 5 8:54/9:04- MICHAEL E. ANDERSON No. CE4381 BOH @ 18' COMMENTS: PERCOLATION TEST PERFORMED BY: MEA SEE SITE PLAN READING DATE GROSS TIME NET TIME DEPTH OF WATER NET DROP 1 10111 8:10/8:20 10 .50"12.25" 1.75" 2 8:211831 10 .75"/2.50" 1.75" 3 8:32/8:42 10 .50"/2.25" 1.75" 4 8:43/8:53 10 .63"/2.38" - 1.75" 5 8:54/9:04- 10 .50"/2.25" 1.75" g 9:05/9:15 10- .75"/2.50" 1.75" PERC RATE: 5-7 MIN./INCH PERC. HOLE DIAMETER: 8" TESTRUN BETWEEN 4.0 FT. AND 5.0 FT. PRE SOAKED PRIOR TO TEST. I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 10/14/13 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131367 Tax Code Number: 04102123000 Work Type: Septic Permit Effective Dates: October 11, 2013 to October 11, 2014 Design Engineer: ANDERSON ENGINEERING Subdivision: STUCKAGAIN HEIGHTS Site Legal Address: STUCKAGAIN HEIGHTS BILK 4 LT 2 G:2043 Owner/Address: MADER THOMAS H & TERI L 6550 FAR POINT DRIVE ANCHORAGE AK 995071261 Site Mailing Address: 6550 FARPOINT DR, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy io - 1-#2, r 3 / i Lot Size in Sq Ft: 87120 Total Bedrooms: 4 N Private Well N Water Storage /i: 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: PRIOR TO CONSTRUCTION: Additional percolation tests shall be completed such that the entire drainfield is within 30 feet of a percolation test substantiating the permitted design. Results shall be submitted with the final inspection report. Received B Issued By: y: Date: � a Date: �d MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 041-021-23 Property owner(s) Thomas & Teri Mader Day phone Mailing address 6550 Far Point Drive Anchorage, AK 99507 Site address Same Legal description (Sub'd., Block & Lot) Stuckagain Heights, Block 4, Lot 2 Legal description (Township, Range & Section) Lot Size 87,120 Sq. Ft. Number of Bedrooms Four (4) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field F1 Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank 0 Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. s (Signature of property owner or Permit/Rush Fees: 41530 Date of Payment: !3''// Receipt Number: Q6 d ?CT Permit No. ®SP/,313&7 Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. ANDERSON ENGINEERING P.O. BOX 340773 ANCHORAGE, AK 99524 522-7773 677-7766 fAX October 1, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 2, Block 4, Stuckagain Heights Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption trench on the subject lot has failed and must be replaced prior to the issuance of a Certificate of On Site System Approval (COSA). We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the four-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic system. The existing Septic Tank will be decommissioned in accordance with Municipal Code. The existing absorption trench will be left intact and tied to the new system with a flow diverter valve. Also identified on the plans are the locations of the existing well on this and adjacent lots and adjacent septic systems`. No conflicts exist between the proposed septic system and the wells on this or adjacent lots. Protective radii are shown to the adjacent wells. Drainage arrows and ground surface contours are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole placed on the lot indicated Silty Sand with Gravel (SM/GP) to a depth of 16'. The soil material became considerable more porous at 8' below the surface. No groundwater was encountered and none developed during the monitoring period. The percolation rate in the SM soil lense was determined to be 5.95 minutes per inch. We have designed the new trench with an application rate of .8 gallons per day per square foot. We are proposing to place a 47' long by 3' wide absorption trench with an 8' effective depth. The total depth of the system will be 10' with the distribution line at 2' below the existing surface. A flow diverter valve will be placed to connect the existing trench to the system for future use. Lot 2, Block 4, Stuckagain Heights October 1, 2013 Page Two Tha ground surface on the lot slopes to the west in the area of the absorption trench. The trench will be placed parallel to the contours of the ground as much as possible and in conformance with design criteria. A minimum of 1 00'will be maintained between all components of the septic system and the proposed well and from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments � � 1 X10 I VACANT w' > j -- _ > O o (v 1 j 11 I 1 � I IL Of ----------- ----------- //Zy O 1 1 \ � O O J j Iv 49th ;MICHAEL E. ANDERSON � AREA MAP '.;s' No43 :_: PLAT NO. 2006-171 STUCKAGAIN HEIGHTS SUBDIVISION LOT 2, BLOCK 4 87,120 S.F. / 5 1:59-n4 U8 W J .UV I SCOPE OF WORK Decommission Existing Septic Tank in Accordance with Municipal Code. Place New 1,250 Gallon Septic Tank and 47' Long x 3' Wide x 8' Effective Depth Absorption Trench. Place LEGEND Flaw Diverter Valve and Connect Existing Trench for Future Use. F' 49th MT - Monitor Tube FDV - Flow Diverter Valve0" """""""""""""""" FCO - Foundation Clean Out SITE PLAN MICHAEL E. ANDERSON TH - Test Hole - I��fT:, No. CE -4381 r CO - Clean Out ��F ••., no-Z-I,,Z' 4 2CO - Double Clean Out SCALE 1" = 50' ���'ROF.... li:� Contour Interval 2' - �1111110%;'Z,li*16 N IV 09 J os ment _ Existing AMorySDn % �_ irenU+ IIH ® Fw COW FCO 1,250 G Dn BePUt nrlk i ur edr om I Ho se 4]' Long x 3' Wi8 : 8' r OeD1M1 Aba rDG°^ Treeclive LencF. � I I I I I GO I Existing Well i t 1 t \ E N W \ O At / 5 1:59-n4 U8 W J .UV I SCOPE OF WORK Decommission Existing Septic Tank in Accordance with Municipal Code. Place New 1,250 Gallon Septic Tank and 47' Long x 3' Wide x 8' Effective Depth Absorption Trench. Place LEGEND Flaw Diverter Valve and Connect Existing Trench for Future Use. F' 49th MT - Monitor Tube FDV - Flow Diverter Valve0" """""""""""""""" FCO - Foundation Clean Out SITE PLAN MICHAEL E. ANDERSON TH - Test Hole - I��fT:, No. CE -4381 r CO - Clean Out ��F ••., no-Z-I,,Z' 4 2CO - Double Clean Out SCALE 1" = 50' ���'ROF.... li:� Contour Interval 2' - �1111110%;'Z,li*16 N LOT 2, BLOCK 4, STUCKAGAIN HEIGHTS SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS Four Bedroom Home Deep Trench System Perc. Rate: 5.95 Min./Inch 1,250 Gallon Septic Tank Application Rate: .8 GPD/SF 8' Drainfield Rock 4 Bedrooms X 150 GPD/.8 GPD/SF (Application Rate) = 750 SF Absorption Area 750 SF/16 SF/LF = 46.875 LF Trench Length THEREFORE: Construct a 47' Long x 3' Wide x 8' Effective Depth Absorption Trenches at the Location Shown. Flow Line Elevation in Trench to be 2' Below Original Ground Surface. Total Depth to be 10' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Maintain 100' Separation from Wells in the Area. Place Diverter Valve and Connect to Existing Absorption Trench. Natural Backfill 1'6" Geotextile Fabric 6^ 0 4" Perforated PVC (Holes Down) 01 3' Drainfield Rock TYPICAL DEEP TRENCH SECTION OF (NO SCALE) 0(E....• y NOTE: Grade Area Over Trench to Drain Away. : ••° Minimum 6' Separation From Bedrock. I......;. 49th y Minimum 4' Separation From Groundwater, i�s. k� Minimum 100' Separation From Wells in the Area. 0A MICHAEL E. ANDERSON Minimum 100' Separation From Surface Water or Streams: dila°.. No. CE -4381 (3 SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 2644120 SOILS LOG — PERCOLATION TEST 2 PERFORMED FOR: I L4C'T'L() (e DATE PERFORMED: LEGAL DESCRIPTION: r—� SLOPE SITE PLAN (FEET) 1 2 3 7 r Gross Time Net Time _,� 6; Ir t,ayev5 4- , 5 !�: a t3a 10- 1011 Ptl 17 19 WAS GROUND WATER S ENCOUNTERED? WO L a P IF YES, AT WHAT E DEPTH? Reading Data Gross Time Net Time Depth to Water L:gkT brown SHIT 8 , .. 9- bo t3a 10- 1011 Ptl 11 ' �✓ Lis _'--� 32 .., 100'r.? G.oaael pips 10ward -r1'e. Ota V4yG 13-0 +' Prvt i,ty NeT u6A01G 14 15 �. 16 17 19 WAS GROUND WATER S ENCOUNTERED? WO L a P IF YES, AT WHAT E DEPTH? Reading Data Gross Time Net Time Depth to Water Not Drop bo t3a 3 Ptl t0 117 N 20 r^ c /2 / PERCOLATION RATE t�, s]' ,i �-•Iminuteslinch) TEST RUN BETWEEN 'l FT AND .--_+l.r FT COMMENTS �-• "-"(rs' I..�rI Ij r�11 fl PERFORMED BY: Lee.. tF.nL er'i' CERTIFIEDBY: 72.008 (6/79) MUNICIPALITY OF ANCHORAGE /® 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 �J -/ /_�®� NAME9C.%.� /�EW f-�' l--C.)l_ Q_ .X N [-]UPGRADE MAILING ADDR 5s C`} LEGAL fJESCRIPTION / LOCATION,--w.y NO. OF BEDROOMS 0, DISTANCE TO: W IAbsorptl a ea A� c� Dwelling r c-•s •l PE I NO. �) H Z wF Manufacturer1 Wit.%C'C-,e,j Material''"" r ✓c- . No. of cotxlpartmen ur Liq. rep�cit in allons !{ /`� IF HOMEMADE: Inside length Width Liquid depth J toL DISTANCE TO: Well Dwelling PERMIT NO. Z Fa- Manufacturer Material Liquid capacity in gallons o W DISTANCE TO: Well / / �Ji`rvC` Foundation 'crest t lin ,'I"�/(G?L� h / PERMIT NO. J w Z Z w No. of lines ) ! Length of e chdine / �- : J Total lenggth of lined G�:Y-'""/ Trench widq , C a inches Distance hQ;t� ewlapt / �l H p Top of rile to finish grade el v9 Material eneath rile 6S inches Total et(egtiA absorption area (_ lyir w O Length Width Depth PERMIT N6. Qh_ w° Type of crib Crib diameter Crib depth Total effective absorption area w DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. W w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS- I f' SOILTESTRATING ✓ - Zi % f INSTALLER) Ce CX C REMi r ..G'.C`..10 rbc%�l,✓ �? / -_� .✓,7-r�_ , . �l ILI I TRD � DATE LEGAL 7U13 (Rev. 3/78) ._1 � o�W WKI I Q; 9. Y"xA L.. 1.xj, 9-1 V v! VA k 0 k I Li R 6 P1 kA R DEPARTMENT pc HEALTH 0ND ENVIRONMENTAL VOTECTION �- 825 ' STREET/ 8NCHORRGE, HK 9� �1 ' � ` ` 2(264-472C)~ >)^|u ( �r, P,—�1 - T , m 05 0H.U^8��1 -T ��jo-<'�/ PERMIT NO ( 810474 ) -'0 ,� .\ � �Y(-���1lL//I«- HPPLIC8NT ED HERZOG PO BOX 237 I44-7476 LOCATION STUCK8GRIN HTS LEG8L L4 82 STUCKRGRIN HTS LOT SIZE 100000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH / MAXIMUM NUMBER OF BEDROOMS 4 SOIL RATING (SQ FT/BR):- 1]5 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: R3. C3FTFl%KEEL.. THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF 8 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 IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). �L-H 1: F-. K E> 11 EE F:, - D-]:: C: "T' Fol 14 K EEL ���== fl2p F:l 0 . ...... 0 Fjl li�J� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANN' WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ----- -1F14C3 �_-. l P, Ri:i-� E.E: T, I CA 010 101 FT EE K E."K_ fl] -i p j I F� E:_� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ���7 X EE n3 Ex EE C2 EE P4 E3 EE K ���J_ [ CERTIFY THAT i: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SlGNED:......... APPLICANT ED HERZOG�/ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: tve-w-yoy1 114 CfLO(a DATE PERFORMED: 6- .J- �� I LEGAL DESCRIPTION: 4Q S' DEPTH SLOPE SITE PLAN FEET) I II— 1 2-- 3 , 3 t Gross Time Net Time Depth to Water IT l,vyers 4- sr a , r OK 10 e. ) 11 100 �Q'S ----- 12 �, more, a'.el p'qs l0 'towur•ci -T%,c 13 -0 Pro(ably RIOT u6A01e Itgl.`r brown SZvr 8 Date Gross Time Net Time Depth to Water Net Drop 9 sr a ,q0 OK 10 e. ) 11 100 �Q'S ----- 12 �, more, a'.el p'qs l0 'towur•ci -T%,c 13 -0 Pro(ably RIOT u6A01e to 4 14- 15 15 16 17 ON 19 WAS GROUND WATER S ENCOUNTERED? w o L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop ,q0 OK 4� to 100 30 3 :ill l0 .17 to 20 J PERCOLATION RATE S-1 51t5(minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: Lee—A RoL er - CERTIFIED BY: DATE: 72008 (6/79) i t* G( W vrn 15�1,� I Cyt U 1< D \ i J Rus • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Parcel I.D. 041-021-23 Certificate of On -Site Systems Approval Expiration Date: 1 -1 IT -14 1. GENERAL INFORMATION - Complete legal description Stuckagain Heights, Block 4, Lot 2 Location (site address) 6550 Farpoint Drive Anchorage, AK 99507 Current Property owner(s) Thomas and Teri Mader Day phone Mailing address Real Estate Agent 6550 Farpoint Drive Anchorage, AK 99507 2. TYPE OF DWELLING: F Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Piihlin Watar Svgtem ❑ WaiverNariance request for: Day phone TYPE OF WASTEWATER DISPOSAL: Individual Ej Holding Tank ❑ Community ❑ Public Sewer n Received by: COSA to be releas d to the ga ineer, unless otherwise requested by the engineer. COSA Fee $ atDU gt O 5V r-11k5y\ Date of Payment flI Id 41�J Receipt Number 00�Li�ato�i COSA# Cr�DCJ3\5-3 Date: IC). Waiver Fee $ Date of Payment Receipt Number Waiver # s pg. a k 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSDSI ATURE System #1 Approved for bedrooms System #2 Approved for _ bedrooms Disapproved Phone 522"7773 Date 10/13/2013 4; OF°A��®fir➢ °_- Conditional approval for bedrooms, with the following AFL E. AMDSRSC�d e CE-43at iS-- 14° °b0000m°..OL_ vd 6'(/, Original Certificate Date: /0 - 1,67 ` L-3 iJ The unicip it rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for error.- :u omissions in the professional engineer's work. 7, ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA bluesheet_t h 11 c If more than 1 septic system is on the lot: COSA Checklist # _of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Stuckagain Heights, Block 4, Lot 2 Parcel ID: 041-021-23 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 5/5/81 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 79 ft. Cased to >40 ft. Casing height (above ground) >12 in. FROM WELL LOG AT INSPECTION Date of test 5/81 9113/13 Static water level 37 ft. Well production 5 9-10 -m- WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 3.50 mg/L Arsenic N/D ug/L Date of sample: 9/9/13 38.6 ft. 6.2 9 - p.m - Collected by: Anderson Engrg. B. SEPTIC/HOLDING TANK DATA TankTypelMaterial Septic/Steel Dateinstalled 10/11/13 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping New Const. Pumper C. ABSORPTION FIELD DATA Y N Date installed 10112/13/13 Soil rating (g.p.d.e or felbdrm) •8 GPD/SF System type 5' Wide Length 47 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth 13 ft. Eff. absorption area 752 fig Monitoring tube Y Depression over field N Date of adequacy test New Const. Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. 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. LIFT STATION Date installed "Pump on" level at Datum in. E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons Manhole/Access (Y/N) "Pump off' level at in. High water alarm level at Cycles tested Meets alarm & circuit requirements? Septic tank/lift station on lot >100 On adjacent lots >100' Absorption field on lot On adjacent lots >100' 1 Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A A ' al containment areas >50' Manure/animal excrete storage areas >100' nim SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line >5. Water main >10, Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10' Water Service line >10 Surface water >100' None Noted >100' Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION 1. certify that l 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'sptinted Name Michael E. Anderson, P.E. Date 10/13/2013 COSA brown sheet_10-10-12.doc Absorption field >5 Surface water >100' Water main N/A Driveway, parking/vehicle storage >10, %0 DAMMAR E ANDMSON CE _ 4361 ea my o.a....N. 3 N r N C C C 2 STUCKAGAIN HEIGHTS SUBDIVISION LOT 2, BLOCK 4 87.120 S.F. S 89*54.08 W Sl b.uu SEPTIC VENT CERTIFICATION SCALE 1" = 50' 0 frl Septic Vent Certificotion Only. **ua%a,• ,* OF ALASk1♦ At C) a 49 TH% / Steven Callaghan �0, _ AV- ♦♦�fPP •��rS 7/0• ♦ • "pf, sionat vol �' :ngineer: -egal Description: lermit: teport Type: Municipality of Anchorage P.O Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 (907) 343-7904 Fax (907) 343-7997 http://www. mun i.ora/onsite Planning and Development Services Department On -Site Water and Wastewater Program On -Site SewerMell Submittal Comment Sheet ANDERSON ENGINEERING STUCKAGAIN HEIGHTS BK 4 LT 2 OSP131367 Septic As Built Review Completed By: -he attached paperwork has been reviewed and is being returned for the following reasons: partntr�nt 10/14/2013 J.Poet 1. Trench turned 90 degrees from permit. The ground surface in the area of the new absorption trench is virtually flat. The new trench was constructed parallel to the existing trench to save several large trees and to mitigate damage to the existing driveway. The entire absorption area of the trench was constructed in the percolation zone. The placement of the trench in the alignment shown resulted in a more efficient absorption system with easy access to the flow diverter valve and the old absorption trench. MUNICIPALITY 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 l.D.# 041-021-23 1. GENERAL INFORMATION P a v n%n 13Y HAA# 14A q°I03 aM (R kivOw.ii� Complete legal description Lot 2, Block 4, Stuckagain Heights Location(siteaddress ordirections) 9630 Basher Drive (Far Point Propertyowner Stu'.& Ilene Hirsh Dayphone 338-7552 Mailing address " 9630' Basher Drive Anchoragge AK 99507 Lending agency Day phone Mailing address Agent Clare Ramsey/Dynamic Properties Dayphone 261-7554 Address3ill C Street Suite 100 Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. !72-025(Rev. 1/91) From MOA 021 5. 6. 0 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 forthe 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 Address Firm S& S ENGINEER(Nr Phone 6 i �� a 7% 17034 Eagle River Loop Road No. 204 Engineer's signature DHHS SIGNATURE V Approved for t9 v l� bedrooms. Disapproved. Conditional approval for Date 16/Aq(2 S ROBERT C: COWAN � t�F CE -8801 ,•'�` , 1 Aa.'pr; Ci ti4- bedrooms, with the following stipulations: Additional Comments ILITIC Date / / - / 0 _2 7 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based 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 courtesyto purchasers of homes and their lendi ng 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(Rw. 1/91) Back MOA M21 \\� -V Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 2q Environmental Services Division Q0 ox P 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343- 744p4," P45�a Health Authority Approval Checklist Legal Description: i ;� 13 Lo ccr W Parcel I.D.: G t// A. WELL DATA Well type r1?1vA-ir4 If A, B, or C, attach ADEC letter. ADEC water system number Log present &N) y 6,S Date completed s 6-4 d d ' Total depth -7 H Cased to yU 'r Casing height (above ground) Sanitary seal ON) W S Wires properly protected (?/N) FROM WELL LOG AT INSPECTION Date of test r l r l o f C A� 2 `) Static water level 3 7 Well production g.p.m. �' Ct I f1•p•m. -X IC�i.1T.C'rC-i'd J,,'Y ✓oua'N / Pk"'J"31"c- WATER SAMPLE RESULTS: Coliform O Nitrate ) , a I Other bacteria 3 ° Date of sample: 10 K `) �i S & S ENGINEERING p Collected by:17024 Cagie Fj,, LOOP Rlad No. 2U4 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed 6/ S_/ '(�/ Tank size 0-5-0 Number of Compartments �)-- Cleanouts&N1 YC S Foundation cleanout( ))N) Y d` J Depression (Y& c High water alarm (Y, j) )v 0 Date of Pumping if R Pumper C. ABSORPTION FIELD DATA Date installed S� 8 / Soil rating (g.p.d./ft2 or 2/bdrm i % 3 j' System type e ^ i �4 Length .5 Width 3 Gravel thickness below pipe Total depth / 3 Effective absorption area Salo /ii Monitoring Tube present O)N) YEs Depression over field (Y/& r' `' Date of adequacy test G Bbl k Results Pass Fail) T" s for y bedrooi Fluid depth in absorption field before test (in.); r1 1 y Immediately afterG y %gal. water added (in.): 3- Fluid depth S (ins) Minutes later: 3 Absorption rate = o Y g p d Peroxide treatment (past 12 months) (Y/N) iv o,°r KNOW iJ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* "Pump on" *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: I Size in gallons "Pump off" level at* Septic/holding tank on lot tq 0 -f-- On adjacent lots Absorption field on lot / 0 0 r 4- On adjacent lots Public sewer main N / A Public sewer manhole/cleanout r Sewer /septic service line �LS -k Lift station / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: n0 r-f- Jva t �v �y r �Fa i Foundation S- + Property line Sy Absorption field � r ; Water main/service line d-3 - Surface water/drainage / 0 4' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r r + Property line 10 Building foundation /� -t Water main/service line 1° • UNOt z DILZIl4>,14 014vt Surface water /off Driveway, parking/vehicle storage area r° rev 4 Y6",c, d J Curtain drain N Wells on adjacent lots 160 -h F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review of Municipal records thAta'"( v�tems are in conformance with M 9 HAA uideline in effect on this date. H .........LAS �1P Signature Y �L,/ r 9t 3"! . 0 f�J.Q :2; �C)ti .9N ;4. G Engineer's Name i /Jvr4 r I o / J-rj `1 dd i ROBERT C. COWAN Date PP.�C.ti._ CE -8801 f, v HAA Fee $ 3 Date of Payment 7 7 aJ 91 Receipt Number G 4 g G `l ( 6 3 `f G) 72-026 (Rev. 3/96)* Waiver Fee $ _ Date of Payment Receipt Number /1�I ME Environmental Services Inc. moi■ Laboratory Division 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria Anchorage, 99618-1605 Tel907) 543 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Fax: (907) 561.5301 MUST BE COMF LETED BY WATER SUPPLIER I TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D. # 771=. PRIVATE WATER SYSTEM $1 Send Results 9k Send Invoice womrsys"m =6 Xn5 GINEERING afi1C1�a Fee um r Phone Number !7Q34-6;uqIe44yeR,� Read Illa. 204 Eagle River, Alaska 99577 v mg ess ty u p ❑ Send Results ❑ Send Invoice Company Name phot fume MxBmg AA ess City swe ztp Coot SAMPLE DATE: IF -0 Month SAMPLE TYPE: 9� Routine ❑ Repeat Sample (for routine sample with lab ref. no. ) ❑ Special Purpose SAMPLE LOCATION Day Year ❑ Treated Water tjf Untreated Water Time Collected Collected By Lo i- �- 131-oGx u -3o PM iso 3 C- T v G —K ,q p l v }r L) frWT S Blease Prim Comments: At ysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received I D - 2-1 —T Time Received 1160 1 % fir 1 Analysis Began ' 60 Analytical Method: 6//Membrane Filter ❑ MMO-MUG * Number of colonies/100 ml. Result* Analyst 996053 m013 �' ...-nbkt Jun ❑ Faxed Date: Time: Client notified of unsatisfactory results: ❑ Phoned Date. BACTERIOLOGICAL WATER ANALYSIS RECORD Spoke with Time: MMO-MUG Result: Total Coliform 66 E. Coll Membrane Filter: Direct Count l� G B wln(�rtl� Colonies/100 m1 Verification: LTB BGB COLIFIRM Fecal Coliform Confirmation Final Membrane Filter Results �G '�3 Coliform/100 ml Reported By . r Date 3.J Time /S7)7-) hrs Member of the SGS Group (SeciAtd GdnArale de Surveillance) El Faxed TNTC - Too Numerous To Count OB -other Bacteria ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA NOV-09-99 15:46 FROM -CTE ENVIRONIANTAL 5615301 T-700 P.03/03 F-551 dt�C CT&E Environmental Services Inc. -- CUE Ret'.# 99605300? Client Name S & S Engineering Project Name/# N/A Client Sample 1D Lt 2 Blk 4 Stbckagain Heights Matrix Drinking Water Ordered By Client PO# Printed Date/Time 11/08199 12:29 Collected Date/Time 10/28/99 14:30 Received Date/Thu* 10/29199 12:55 Technical Director: Stephen C. Ede PWSYD 0 Released B�M Sample Remarks: Parameter Totat Coliform Nitrate•N Allowable Prep Analysis Results PDL units Method Limits Date Date snit 10 09 W/o coli! 100M smis 92226 10/29/99 4DT 2.21 0.500 m9/L EPA 300.0 10 MA 10/29/99 10129/99 SCL MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES t r, v >> by : Division of Environmental Servicesan % On -Site Services Section '/�` �r✓' P.O. Box 196650 Anchorage, Alaska 99519-6650 7 yly `I 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING1 Parcel I.D.# 041-021-2,;HAA# pdbl '�nr�O L -OA S "L 1. GENERAL INFORMATION Complete legal description Lot 2, Block 4, Stuckagain Heights Location (site address or directions) 9630 Basher Drive (Far Point Drive) Property owner Stu & Ilene Hirsh Day phone 338-7552 Mailing address 9630 Basher Drive, Anchorage, AK 99507 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 'E! 2. NUMBER OF BEDROOMS: X al: 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: XXX Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Re, 1191) 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 S & S ENGINEERING Phone G Cl •age Itiver Loop Road ]To—.204 Address Eagle River, Alaska 99577- , Engineer's signature 6. DHHS SIGNATURE Approved for FO V R bedrooms. Disapproved. Conditional approval for Additional Comments 1-2 1IITIC Date ) / -7 Z 9 cj PC, i ROBERT C. COWAN F �s •5 CE - 8801 bedrooms, with the following stipulations: Date 7 - /I/ - 71 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based 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 their 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 #21 Municipality of Anchorage JUL 0Y 1999 • �.e DEPARTMENT OF HEALTH &HUMAN SERWt1�3L�- ITY OF ANCHURAGE Environmental Services Division cNVIRONMENTALSERVICES DIVISIOrA' 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: 1..6 i �X /3 Lackc I ST v(K/jw4.N /" I Parcel I.D. A. WELL DATA Well type )(1A, vdr r C Log present I(q„JN) Y , Total depth i q Sanitary seal WN) Date of test — 0 :1 If A, B, or C, attach ADEC letter. ADEC water system number Date comp feted S� _ �s-�/ Cased to FROM WELL LOG , /S -/S-) Static water level Well production WATER SAMPLE RESULTS: Coliform 77 5` g.p.m. 6d.? Casing height (above ground) ) Wires properly protected ON) Y4 © Nitrate q,3 AT INSPECTION G/°I/y�J 3 6,6-1 + g.p.m. a1r A 4l illi rrid O y P� /.1 c?' /4 '"'4jt�6 Other bacteria 0 G 0i/ `l °I Collected b S& S ENGINEERING Date of sample: y'1703 4 -agle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed (115-16-1 Tank size is S 0 Number of Compartments 2 Cleanouts (9/N) y'�1 Foundation cleanout &N) V4 S Depression (YO /v u High water alarm (Y/O c' Date of Pumping `is / 9 $ Pumper N o.ti'r 0 L- 11.° A C. ABSORPTION FIELD DATA Date installed 5 / Length k S / Width, Soil rating (g.p.d./ft2 o ft2/bdrm 13 S_ System type _ 3 Gravel thickness below pipe G Total depth Sy0 Z `! Effective absorption area }%r Monitoring Tube present �Vj'N) � a j Depression over field (Y/6) )`' Date of adequacy test / cl L°I `) Results Pas)/Fail) Pl� t S For Lr bedrooms Fluid depth in absorption field before test (in.); I j/'i Immediately after69l 1 gal. water added (in.): S Fluid depth S (ins) Minutes later: 3 C Absorption rate = G 0 0 f g•p•d• Peroxide treatment (past 12 months) (Y/N) N O,v/, k,v0w/-� If yes, give date _ 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* "Pump on" *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: / Septic/holding tank on lot / -Y-- Absorption Absorption field on lot 0 C /-i— Public sewer main N /n Size in gallons "Pump off" level at* On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer /septic service line � S 4 Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: /A Foundation S -Y Property line 5 f Absorption field S 4 - Water Water main/service line a -S- + Surface water/drainage ) 0 0 + Wells on adjacent lots /00 } SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: r i � Property line Building foundation / O -�- Water main/service line /10 Surface water Driveway, parking/vehicle storage area Uj"61 br cc2a r/V,[ 13R3VQ Curtain drain N (),, rL Ic N o w ✓ Wells on adjacent lots ) O O F. ENGINEER'S CERTIFICATION i certify that i have determined thru field inspections and review of Municipal recor, *t tQFpb5k tei in conformance with A A , uideli es in effect on this date. P ���'.• ""• it 11 y 9 Signature � "r_ 09th `i A.,» Engineer's Name �ti, // d rll3 a.2; � 0 c�.yr� L..��`ii���. ROBERT C COWAN ,--•�`�@ Date d) g apt E-8801 It HAA Fee $ d c1 C Date of Payment % 7 ! 9 Receipt Number 72.026 (Rev. 3/96)* Waiver Fee $ _ Date of Payment Receipt Number rzua Well Log For................................................................................................................................ Location......................................................................�...12 ....�<'..�� Distance to water while pumping........................................................at rate of................................................gallons per hour. .................................................................................... Driller DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE, ALASKA 99507 JUN -15-00 10:33 FROM -CTE ENVIRONMENTAL CT&E Environmental Services Inc. CT&E Ref -9 Client Name Project Name/& Client Sample XD Matrix Ordered By PWSfD PerawCer 992597001 S & S Engineering L4DT 2 BloCr 4 S{UCkag1UU Lot 2 Block 4 Sluckagain Drinking Water Results �7 5615301 T-770 P.01/02 F-072 Client P011 Printed Daterrime 06/15/9919:27 Collected Daterlinte 06/09/99 14:15 ReceivedAate/Time 06/1019912:00 Technical Director: Stephen C. Ede Released By AttouBole Prep Analysis POL unirs method Limits Dare Dace lnir Total Coliform 0 col/100m4 s111a 92228 06/10/99 KAP Nicrare•N 2.43 0.500 fq/4 EPA 300.0 10 mux 06/10/99 06/10/99 SCC Parcel I.D. # 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 1. GENERAL INFORMATION HAA# Complete legal description I,ot 2; E7.oc'.k a; Stucicacain ,-;eights Location (site address or directions) 9360 -usher Drive Property owner Chuc!c Day phone Mailing address 9360 Basher Drive Anchorage Al: 99507 Lending agency Day phone 333-1140 Mailing address Agent Jack Blair/ Remax Properties Day phone 257-0159 Address 2600 Cordova SSP. Anchoracie, AIC Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: q 3. 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. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rey 1/91. FFont MOA 921 5. 6. M 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. S & S ENGINEERING Name of Firm 17034 Eagle_R4ver-��.Phone Address Eagle River, Alaska 99577 Engineer's signature DHHS SIGNATURE XL Approved for - . 4 bedrooms. Disapproved. Conditional approval for Additional Comments Date 6 OF G� N Q7-1 6 G l q (. bedrooms, with the following stipulations: Date �- 2 / 9� 'The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based 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 their 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 (Bev. 1/91) Back MOA #21 ROBERT C. COWAN �2 L`C�sS CE -E -3O1•, It1 ��1. r�,.., `,` `�✓wry• �..� bedrooms, with the following stipulations: Date �- 2 / 9� 'The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based 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 their 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 (Bev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES `' Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343.R�CrV JUN 61996 Health Authority Approval Checklist muiiiclpallty HumtIr services coo Dept. Health Health Legal Description: 1_0 z (3 Lic /1G1- S Parcel I.D.: 0 /1/ - u,a 1 l 3 A. WELL DATA Well type P%'Ivd r% Log present 0*) Total depth `) If A, B, or C, attach ADEC letter. ADEC water system number Date completed J l S-/ 61 Sanitary seal" �/ r� S Cased to FROM WELL LOG Date of test Static water level 3 1 Well production WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: S'/ } 3 / `I t. B. SEPTIC OLDING TANK DATA Casing height (above ground) 1 / Wires properly protected (S'N) Y r' V AT INSPECTION g.p.m. g.p.m. �) • 1 Other bacteria D Collected by: S & S ENGINEERING 17034 Eatim Iver LOOP K09d No. 204 Eagle River, Alaska 99577 Date installed t= ( 5.. / V ) Tank size I Z IS ° Number of Compartments , ). Cleanouts (VVN)yrI Foundation cleanout (ffRN)/ �/ S Depression (Y"Date of Pumping �- / 73 1 (1 l Pumper I S' 4 A c- C. ABSORPTION FIELD DATA High water alarm (Y" '" 0 Date installed 5 /' Soil rating (g.p.d./W orkft2aidrY 1.3 5 System type T R 6N ` 14 Length li S Width 3 Gravel thickness below pipe 6 Total depth ) S ,v �,W ;1'f�£N,L l', i /mi>nec'r, �� .t'�-�•`'1I`7 (�. Effective absorption area •S r_1 Monitoring Tube presenta/ls!) YE s' Depression over field (Y/,N), -0, Date of adequacy test s `1 Results (Pass/Fail) q s For ) bedrooms Fluid depth in absorption field before test (in.); .� ria Immediately after 7 11 gal. water added (in.): 1l ) i Fluid depth `1 6 L} (ins.) Minutes later: K C, Absorption rate = 6o0 -1 a.p.d. Peroxide treatment (past 12 months) (Y/t) 14 o.v c 'l: �o.v,✓ If yes, give date — D. LIFT STATION Date installed Size in gallons - Manhole/Access (Y/N) "Pump on" level_a01— " - "Pump off' level at* High water alarm level at* _ *Datum Cycics-tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: l$eptic holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line /6e/ /' /oe 1-/ On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station tc�o�f SEPARATION DISTANCES FROMI SEPTIC I HOLDING TANK ON LOT TO: Building foundation �'+� / Property line 1 / Absorption field S Water main/service line 5 -) Surface water/drainage / o J /' Wells on adjacent lots Joe -r- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i Buildingfoundanon Surface water Curtaindraini�r).-/ L lee -�- Property L no Water mam/servtce ]me Driveway, parking/vehicle storage area me r us',) Foi qtr • - . '� ° w •� Wells on adjacent lots ) o (-i f F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance ivith HAA guideli es in effect on this date. Signature i / Engineer's Name /L�'v✓ifi Date C /(,/`/G HAA Fee $ /v . t__ o Date of Payment �Q L� / 47 Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number ROBERT C. COWAN CE -8801 + are 06/03/96 06:29 CT&E ESI ANCHORAGE d 9076941211 AiL -Ci&E Environmental Services Inc. IIFWLaboratory Division>•iwr/�sii►/'it//at'i/o/i/�'�o�'r�a®'���`�E Laboratory Analysis Report CT&ERef.M 962036.962036002 Collected Date 05/23/96 Client Sample ID L2 B4 Stuckagain Hgts. Matrix Dritildng Water Technical Director: Stephen C. PWSID 0 Released Sample Remarks o 200 W. Potter Drive, Anchorage, AK 996181608 — Tel: (907) $82-2343 Fax: (907) 561 3180 Peger Road, Fairbanks, AK 99709-5471 — Tel: (907) 474-8656 Fax: (907) 474.362, ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA, FLORIDA. ILLINOIS, MARYLAND, MICHIGAN, MISSOURI. NEW JF.PS.r-. Kesults 0C POL Units method Al loNable Prep Parameter Dual -353 Limits Oats -- 2.10 0.200 mg/L FPA -Z Nitrate -a 0 0 col/100m1 SH18 92228 (DN) Total Coliform U LT GY - Grc'.- o 200 W. Potter Drive, Anchorage, AK 996181608 — Tel: (907) $82-2343 Fax: (907) 561 3180 Peger Road, Fairbanks, AK 99709-5471 — Tel: (907) 474-8656 Fax: (907) 474.362, ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA, FLORIDA. ILLINOIS, MARYLAND, MICHIGAN, MISSOURI. NEW JF.PS.r-. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264.4720 Application Date� 1gV'Oe.- 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) g y L 2 rdC_K 4 6&A/ iVI,Cco— s 7 12 Al R 2 w sic, 6 Location (address or directions) (b) Applicant Name eNARLF_s 60AG Telephone: Home 33311 V6 Business %5q1290 Applicant Address 9631; 8A5ffa DR. &"" Alf 9Ig5-,9 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 0 ; Buyer -0 ; Other ❑ (explain); 2. TYPE OF RESIDENCE Single -Family CR Multi -Family ❑ Other Number of Bedrooms y 3. WATER SUPPLY Individual Well R Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite El Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/64) 5. ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DA a A AND INFORMATION 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 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 R ECS /A✓G Telephone ) 6&:o Address —1200 W .33jj &�f-Q gffCA 4K 99.005 Date 1A7/905 ����j eyse oee as 8�e� d e e eee m �e• ue. �ee eae ooa id '° Qo Pmfessiona�� 6. DHEP APPROVAL .C���� Approved forU bedrooms by y _ P �t-�G ate//'" Approved ��� Disapproved Conditional Terms of Conditional Approval r CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 NOV 19" 264-4720 Legal Description: Bg1_2 .L/./Ce,#6X11g 1115 RECEIVED rZ� ��u� .Sr<:6 A. WELL DATA Well Classification/� lC If A, B, C, D.E.C. Approved (Y/N) Well Log Present ((ON) Date Completed 5 /� /�� Yield 3_3 C 14 ccyy � _77cc�� �� Total Depth "1 Cased to �Depth of Grouting /I/ //I Static Water Level 3 V, / Pump Set At ala4 ivIll Casing Height Above Ground — Electrical Wiring in Conduit (y)/N) Separation Distances from Well Sanitary Seal on Casing 6)N) Depression Around Wellhead (Y0 To Septic/Holding Tank on Lot ] 1 t7 ; On Adjoining Lots /0'0 To Nearest Edge of Absorption Field on Lot (2.5 On Adjoining Lots / 00 To Nearest Public Sewer Line W/) To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Date Water Sample Test Results Comments `��� y�S% l � �i�ZV B. SEPTIC/HOLDING TANK DATA Date Installed io �� Size /2.5 0 No. of Compartments Standpipes ON) Depression over Tank (Y/(Q Air -tight Caps 'rN) Pumping/Maintenance Contract on File (Y/N) Foundation Cleanout gar N) Date Last Pumped for /n /9 Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) 4�1'4— Separation Distances from Septic/Holding Tank: To Water -Supply Well ] E) To Building Foundation 25 / To Property Line ] 0 To Disposal Field 15 To Water Main/Service Line N�%� To Stream, Pond, Lake, or Major Drainage Course /00 Comments Page 1 of 2 72-026(11/84) 62 L y s 6rcl<146-IVIA/ 1115 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1 1-36 Type of System Design 7 TFNC Date Installed ��,��gl Length of Field y,"� i Width of Field 7 Depth of Field l Z Gravel Bed Thickness / Square Feet of Absorption Area 5 yO Standpipes Present ON) Depression over Field (YQ Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation -.3 U Lot At /A To Water Main/Service Line N To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments / To Property Line 0 / To Existing or Abandoned System on On Adjoining Lots �16) To Cutbank (if present) N,A 100 t )t) i/_ Dimensions Manhole/Access 'Pump9ff' [evel at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I he e c ecked, veri/fled, or conformed to all MOA aLn�d HAA guidelines In effect on the date of this inspection. Signed v Date�/ / 6,a��eaggb� Company AFCS lI/C MOA No. �G " 02`7 4�� OF, Al 4 AY Receipt No. O az��.° ^ly d Date of Payment Amount: $ 62 J rqc,4Mr_-iV _S w�cc c oG Pt cr/ATGQ s9MP�` Page 2 of 2 #J 's 72-026 (11/84) r I IEROY C. REID, JR. 00f °° CE -2251 °;' `�`AV Q P °°., .•• M1v F. ALASKA bOIROWnTAL COIITROL S661M, InC. Cngineerinq fr Enuironmental Studies 11/19/66 CHARLES T BORG SELLER—CHARLES T BORG CHARLES T BORG 9636 BASHER 9636 BASHER ANCHORAGE ALASKA ANCHORAGE ALASKA 99507 99507 60611 LEGAL:STUCKAGAIN HEIGHTS SUBDIVISION BLOCK 4 LOT 2 ADEQUACY PEST FOR SEWER SYSTEM ADEQUACY TEST DATE -11/1.2./86 THE TYPE. OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 540 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 915 GALLONS. BASEL) UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 11/14/86 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE -11/12/863 A FLOW TEST WAS PERFORMED ON THE WELL. 915 GALLONS OF WATER WAS PUMPED AT A RATE OF 3.3 GPM OVER A DURATION OF 5 HOURS. THE DRAWDOWN WAS 9.2 ' WITH A RECOVERY TIME. OF 10 MINUTES AND THE STATIC WATER LEVEL WAS 38.1 FEET. THE WELI, IS ADEQUATIE FOR THIS 4 BEDROOM HOME. 1200 West 33rd Auenue. Suite B • Anchorage, Alaska 99503 • (907) 561-5040 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS �_ CQlCj TIME TIME TIME DATE DATE DATE SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY INSPECTOR INSPECTOR INSPECTOR 4fl INDIVIDUAL* MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT ECTLI19NRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 S. SEWAGE DISPOSAL SYSTEM • AUG 2 8 1981 ENVIRONMENTAL SANITATION DIVISION l %l / Telephone 264-4720 YEAR ON-SITE SYSTEM WAS INSTALLED. R C E I n kS REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE�FACVl DIRECTIONS: Complete all parts on page 1. Incomplete requests will not he processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE dig zCi�-o5 MAILING ADDRESS .l%/L C7 //- PROPERTY RESIDENT (If different from above) PROPERTY PHONE 2. BUYER PHONE Q 2 MAILING ADDRESS /%LUC' .t6/ 3. LENDING INSTITUTION PHONE 1,1914- 1 rIllre A 19IVle MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDE. CE NUMBER OF,BEDROOMS ❑ One Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER�SUL'Y 4fl INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM l %l / -21`/INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED / l 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line S. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 72-010 (Rev. 6/79)