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HomeMy WebLinkAboutSAMPSON ESTATES BLK 1 LT 1Sampson Estates Block 1 Lot 1 #051-822-19 Municipality of Anchorage ' Development Services Department Building Safety Division Onsite Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 Page of www.ei.anchorage ek.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW070210 PID Number: 051.822.19 Noma Wastewater System: ❑ New ® Upgrade AdtraN BOX 6711283 Chuglak Alaska 99567 ABSORPTION FIELD O Daae T-xh O Shallow Trarrh 0 Bad O Mataq Odw Ph" NunWr N BeboarN LEGAL DESCRIPTION Boa RNrp TNN D"M horn °^D"N Wade BlackLot slltOmumc 0.5 GPDI12 0.5 Ft. 1 1 Depth baw bosom kom «ronN vada Gravel a.pn benaaln Pwa Sampson Estates 0.5 Ft. 0.5 To waP Renee Section. FA added above onVw grads Ft GravN La gth. 2.5 Ft. 60 Ft. Well: ❑New ❑Upgrade G..N wmn_ NIfbw of r»s Dntanp llw l.tea G4aMratgn(PnvNa. A B. C). ToW Dwth: Caasd ro' Exist' 15 Ft. TOW absogxw, area 3 5 Fl Pp Material Ft. Ft 900 Fe 3034 PVC MW Data Onlied sW� wale, L" 114talw Data katalbd AK Divers 8/2512007 T,,krFt Pury SN al CS" HspM Abe.a GM cPM Ft. FL TANK SEPARATION DISTANCES ❑ Septic [] Holding 0 S.T.E.P. O Other. To Septic Absorption Lit Holding ubiriPrivate M-ka— cw.rilT From Tank Field Station Tank Sewer Una Exist' WON 100.7 185.2 - 87 ""°"N' Steel Nu of Cuff, «.a slat" We. 100+ 100+ LIFT STATION Lot U" 55.7 15 sq. GN Fa«amw 25 112.1 j 'P"W m• l..N et •Pury Nr amel at Hgh w«er eve at I /— in h Cvlen Drrn nr� e� ./y+ - 50+. I - Purp Maks a MOON El* k V%PentorM W,,l d by RemaMa Verified exlsfg tank by exposing 8Inspecting. BENCH MARK Lonlwn and Daarnpwn Back Deck Aau.nW ElavMwn 100.0 FL Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1" 8124/2007 Engineer's Stamp 2n° 8/2512007 '�%sssslae P�� .. Cq Development Services Department Approval ��. ............ �,• ♦♦ Conditional Approval Date: � AdTM S T} ♦ 0 ...a......T.....�I ....,..o.. . ........... ♦ice •Steven •�n.. P. Ponnone:.*)`ie Aff d♦ Reviewed and approved by: Date: �/- a. -o z S': No ♦o�����'4 '�?'r •��eese�'-E551a� O' AREA SERVED BY PUBLIC WATER SYSTEM 7%1 //-EXIST'G AREA AREA EXIST'G DRAIN FIELD IN FAILURE. TO BE REUSED - 7 �EXIST'G SEPTIC AREA 7%1 RECORD DRAWING 8/29/07 . .fix. �Al +•.�•.... CE 8149 100.7 EXIST'C ` HOUSE \°\ �£XIST'C 1 _ X SEPTIC 23-423.3 \� 55.7 TI v 7� T2 185.2 II JI 1 INSTALLED DV 8 DCO 7%1 7% THl MI TH2 C 15.0 M4 7% C6 C5 C4 i M2 � 1 M3 71 _� OF SCOP 3 30%A 30%A 30%A PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Lot 1 Block 1 Sampson Est. Alan and Patricia Gebauer PO Box 671283 Chugiak, AK 99567 Y� � WELL a NEW DRAIN FIELD UPGRADED 15'Wx6OLFxO.5' ED, 0.5'TD BED EXIST'G SEPTIC 2 AREA SWINGTIES CO A B FCO 51.3 3.3 DV 58.4 34.6 T2 56.0 31.1 T1 54.9 25.5 CI 57.9 32.2 C3 131.5 111.6 C4 143.9 146.8 C5 138.5 142.1 C6 133.3 138.2 M1 130.9 112.1 M2 143.2 124.2 M3 144.8 147.5 M4 132.0 136.7 08-28-07 Scole 1'.50' P.I.D. NO Swo70210 RECORD Street PLAN 2 or 6 n o m 1lIO NV31a aN3 NaV31V {i 39m k1olINow �L Q� t 2.5' } 4 IAC.• W $ 5• t. m } w } U ni3walmo 3n V- rW lnoNv3,a : r :•:.� � N N W } �f i } I SN a ua NV313 ua NV31a a� 3AWAN3lV3Na y 31WNV" ppb F f S Z ■ 14 Q a 4 0 $ 0 U ino NV313 N aL XI 1110NV313 Nalvamoj RECORD DRAWING 8/29/07 REVISED Date OFA(' P oNN0oNE4 ENGSVC,9951008-28-07as-za-o� j g • y % PHONE (907) 272-8218 ANCHORAGE. AX (907) 272-8211 Scale NTS / Lot 1 Block 1 Sampson Est. P.I.D. N leven'R. Pa' 'ne'� Alan and Patri22-11 cia Gebauer II�4f�,,',•$129�0�.•',�/ PERMIT N0. P❑ Box 671283 SW070210 ..... Chugiak, AK 99567 RECORD Sheet ��� DETAIL 3 0l 6 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW070210 Legal Description: SAMPSON ESTATES BLK 1 LT 1 Design Engineer: 0062 PANNONE ENGINEERING SERVI( Owner Name: ALAN 8, PATRICIA GEBAUER Owner Address: PO BOX 671283 CHUGIAK , AK 99567-1283 Date Issued: Aug 22, 2007 Expiration Date: Aug 21, 2008 Parcel ID: 051-822-19 Site Address: 023612 GOLIATH DR Lot Size: 65812 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3_ The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by tatting (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THE UPPER 6' OF THE MOUND SYSTEM IS TO HAVE TOP SOIL AND BE VEGETATED SUFFICIENTLY TO PREVENT EROSION. Received By: Date: d$ ' Z5'6 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907)343-7904 F^ ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 651— 8otd' 1,9 Property owner(s) Alan 8 Patricia Gebauer Day phone 240.0760 Mailing addressP.O. Box 671283, Chualak. AK Zip Code 99567 Site address 23612 Goliath Dr, Chualak Zip Code 99567 Legal description (Sub'd., Block & Lot) Sampson Est, Block 1, Lot 1 Legal description (Township, Range & Section) Lot Size 65,812 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field Septic Tank ❑ Water Storage ❑ Holding Tank Privy Private Well Number of Bedrooms 3 THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal El 2 v S tl- '2 o -v tP,w # oua L certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Date of Payment: Date of Payment: Receipt Number: Receipt Number: (Rev. 11/05) Holding Tank Privy Private Well Number of Bedrooms 3 THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal El 2 v S tl- '2 o -v tP,w # oua L certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Date of Payment: Date of Payment: Receipt Number: Receipt Number: (Rev. 11/05) 2 v S tl- '2 o -v tP,w # oua L certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Date of Payment: Date of Payment: Receipt Number: Receipt Number: (Rev. 11/05) Pannone Engineering Services, LLC Consulting Engineers 91 07) 272-8218 August 21, 2007 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Sampson Estates S/D, Block 1, Lot 1 Septic System Upgrade Permit Request Ladies and Gentlemen: P.O. Box 102954 ge, Alaska, 99510 I am writing to request that a permit to install an upgrade to the existing septic system be issued for this lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The surrounding lots are developed and served by private water systems, which are over 100 feet from the proposed soil absorption system. The lot is served by a private water system. 1. Soils. The soils were investigated during August of 2007. Ground water was encountered in the test hole at a depth of eight and a half feet and stabilized at a depth of seven feet below ground level. Bedrock was not encountered in the test holes. It is my opinion that the overall soils appearance of the soils, an application rate of 0.5 gallons/day/square feet should be used using a standard treatment system. 2. Trench Design. a. Percolation Rate: b. Application Rate: c. Number of Bedrooms: d. Design Flow: e. Min. Absorption Area: f. Total depth: g. Effective Depth: h. Width: i. Minimum Length: j. Design Length: k. Effective Absorption Area: 1. Septic Tank Size: 5-15 Min Per Inch 0.5 gpdpsf 3 450 gallons per day 900 sf 0.5 feet 0.5 feet 15 feet 60 feet 60 feet 9000 sf 1,000 gallon if required 3. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches containing water. 4. Topography: Lot 1 slopes at a rate of approximately seven percent to the south, and then steepens to 30% on the southern quarter of the lot. The proposed installation will be located in the central portion of the lot, greater than 50 feet from slopes greater than 25%. Page 1 of 2 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: C:\Work\Letters\1-1 Sampson Est.001.doc 28 1 27 AREA DEVELOPED NO WELLS W/IN 200' OF PROPOSED UPGRADE — / GOLIATH �7IVE / -AREA-SERVED BY PUBLICFI BMJ Y WATER SYSTEM ° EXIST'G \ �/ SEPTIC AREA nl ` �� '/ I 3 4 Exisr'G THIS P OJECT OUSE— �� \ n REA DEVELOPE EXIST°[j 1 2 0 WELLS W/IN SEPTIC "" 00' OF PROPOS 0 AREA DEVELOPED AREAMi �EXIST'G PGRADE NO WELLS W/IN SEPTIC 200' OF PROPOSED nl I �,d` AREA UPGRADE EXIST'G I1 SEPTIC AREAAREA DEVELOPED / NO WELLS W/IN 100' OF PROP SED UPGRADE CREEK-,\/ .e •= ISSUED FOR CONSTRUCTION 8/21/ 7 / T7 ... A(\ \\ PMNONE ENG SVC, LLC REVISED Date \ 08-19-07 „�•"' '•:9S���+ P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Scale * • TH • * �� 1'-100' •... P.I.D. NO Lot 1 Block 1 Sampson Est. 51-822-1 ••D`teven onnone•/ Alan and Patricia Gebauer PERMIT NO. (+�� 0 /2 �0` � Ch giak x AKPO Bo1283 9567 DESIGN S «txxXx \1\\ter PLAN 1 1 OF 6 AREA SERVED BY PUBLIC WATER SYSTEM 7%1 EXIST'G SEPTIC AREA EXIST'G DRAIN FIELD IN FAILURE, TO BE REUSED - 7%1 �EXIST'G SEPTIC AREA 7%1 V_ EXIST'C TANK 7% INSTAL L�V &DCO —TH1 7% � / r4t'£LL PROPOSED DRAIN FIELD UPGRADE 15'`W\\x60LFxO.5' ED, 0.5'TD BED `EXIST 'G SEPTIC AREA >< r 5vk"V ISSUED FOR CONSTRUCTION 8/ /07 31% I 30% � PANNONE ING SVC, LLC REMSEO Date 0.... f1�) P.O. BOX 102954 ANCHORAGE, AK 99510 0e-19-07 wcoQ. PHONE (907) 272-8218 FAX (907) 272-8211 Scale D P.I.D. NO Lot 1 Block 1 Sampson Est. 51-622-1 Steven nAoite �4, CE 8149/ Alan PO Box Patricia 671283 bauer —PERMIT NO. �I�i�21/�t� Chugiak, AK 99567 DESIGN sheet \\ �"� PLAN 2 of 6 IM NV313 ON3143" iV ySQ 3a%W011N0N lal 2 " .J' w �...alp y f w 5. •j'u m } o w r 7 1-.. ON3 N0Y31V T ♦1 3WlW0lJN0W ••�` LLO 1.1.1 A10NV3W %f;!•}'A s } 5' Q. f i f'�0'S' � ltt1 NV310 �� 1D l/x7 NV310 ® 3AWAW31N3N0 K^ 8 t 3+ i yy 310NNVW pq C E O Q IM NV313 Nd W Illi L10 NV310 N011VONrai ISSUED FOR CONSTRUCTION 8/21/07 REVISED Dote OF A/,. �p p pX�j0 4 MANCHORAGE,ICAK 999L10C 08-19-07 *�P'. fy*�// PHONE (907) 272-8218 FAX (907) 272-8211 Scole NTS ..... P.I.D. NO �j Lot 1 Btock 1 Sarlpson Est, 51-822-1 %'14eveCE 8149 Alan and Patricia Gebauer PERMIT N0. PO Box 671283swo7xxxx =4 Chugiak, AK 99567 DESIGN sheet DETAIL 3 of 6 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: 3 -BEDROOM HOUSE, NEW DRAIN FIELD, VERIFY INGEGRITY OF EXISTING SEPTIC TANK, REUSE EXIST'G FIELD. INSTALL DIVERTER VALVE. 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 6.5 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 3 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. DESIGN PARAMETERS NO. BEDROOM: 3 TANK SIZE: 1,000 gallon PERC. RATE: 5-15 MPI SOIL RATING: 05 gpd/SF APPLICATION RATE: 300 SF/BR AREA ROD: 900 SF SYS. TYPE: BED, 0.5'ED, 15'W MIN LENGTH: 60 LF VSL* 6OLFx15'WIDE,0.5'ED,0.5' TO TOTAL AREA: 900 SF ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN-OUT Tq TANK CLEAN-OUT NO. C# CLEAN-OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DV DIVERTER VALVE DCO DOUBLE CLEAN -OUTS LEGEND WATER LINE/ WELL RADIUS —•—•—•—•— EXIST'G SEPTIC — NEW SEPTIC CHAINLINK FENCE ISSUED FOR CONSTRUCTION 8/21/07 O"� PANNONE ENGINEERING SVC, LLC F A(gs�l+� P.O. BOX 102954 ANCHORAGE, AK 99510 y PHONE (907) 272-8218 FAX (907) 272-8211 Lot 1 Block 1 Sampson Est. 4.annone% Alan and Patricia Gebauer 00 CE 8149 / PO Box 671283 9/...... Chugiak, AK 99567 REVISED Dale 08-19-07 Scale NTS P.I.D. NO 51-822-1 PERMIT NO SW07xxxx DESIGN NOTES sneer 4 o1 6 TEST HOLE 1 0 X a u OR Organics SLOPE ,Y. S� J 1 Root Root Mass V 2 ` I I 3 Silts 50% SM Silt/Rock L \ / 4 Sands t / 3.75" 5 4 \ J J 6 Silt 7 Little/Rocks _V�V SM Some Sand 9 TEST 10 HOLE —Tmi GM Wet IlBDH Silt/Rock 12 13 WAS GROUND WATER SLOPE 14 ENCOUNTERED? Y 15 IF YES, AT WHAT TEST HOLE DEPTH? -11.0 16 DEPTH TO WATER AFTER 17 MONITORING? -8.6 DATE, 8/19/07 18 19 READING CLOCK WATER TINE NET TIME LEVEL NET DROP 20 READING t tt:04 y _ 2 11:1! 10 MIN 3.75' 1.75 3 1:19 2• _ 4 1:29 10 MIN 3.88" 1.88 S 1:30 2• — 6 1:10 10 MIN PERCOLATION RATE 57 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 4 FT AND FT DATE PERFORMED: 08-12-07 COMMENTS: Test hole excavated by Flintstone Excavating Test Hole was presoaked before pert test Test ran for 1 hour- last 3 readings reported. PERFORMED BY: Michael Wehr. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE OF THIS TEST ' OFA(g'5AW6n PANNONE ENG SVC, LLC LLC REVISED Date Awc�y(� P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE 08-19-07 Scale j*; (907) 272-8218 fAX (907) 272-8211 1'-50• .....P.I.O. Lot I Block 1 Sampson Est. NO e ' �� Alan and Patricia Gebauer 51-azz-1Sfe PERMIT N0. sw07.. �'•. CE ata9 i .08�21�Oz% P❑ Box 671283 .r •• =� 1 FR Chugiak, AK 99567 TEST Sheet S% HOLE 1 5of6 3.75" 1.75 TEST HOLE 2 OR Organics Root Moss SLOPE SITE rLAN t.. 7 -� 1 2 ` I 3 c / 4\ c � Sandy Silts 50' Well graded 5 SM Sond - 50% wetter with c .>• \ 6 depth /J 3.94' 1.94' v 7rE /J 8 9 Water B 8.5 TEST 10 HOLE 2 BOH 11 12 13 WAS GROUND WATER SLOPE 14 ENCOUNTERED? Y 15 IF YES, AT WHAT TEST HOLE DEPTH? @ 8.5' 16 17 DEPTH TO WATER AFTER MONITORING? - 70' 18 DATE- 08-19-07 8/20/07 -6.5 19 READING CLOCK WATER TIME NET i1NE LEVEL NET DROP 20 READING 1 11:37 � 4.0' - 2 12:27 30 MIN 5.89' 1.89 3 12:28 4.0" - 4 12:38 30 MIN 5.88" 1.88' 3 1259 4.0' - 8 1:29 }0 MIN PERCOLATION RATE 15.4 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 4 FT AND FT DATE PERFORMED 05-12-07 COMMENTS: Test hole excavated by Flintstone Excavating. Test Hole was presoaked before perc test PERFORMED BY: Micheal Wehr. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST At 1%, PADNNODNE4 ENG SVC, LL REVISED Dote = ��OF . GE, AK 510 PHONE FAX D6-,9-D7 Scale .-V � (907) 272-8218 (907) 272-8211 * TH ... ' P.I.D. NO 51-822-, .... ' "' Lot 1 Block 1 Sampson Est. gone i / SieveCE II�'Fq•., Alan and Patricia Gebauer PERMIT NO. 8149 r, 08/21/07•' �% �t)11yOFESS PO Box 671283 TEST swo7..KK sneer Chugiak, AK 99567 HOLE 2 6 of 6 3.94' 1.94' 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 NAME PHONE EW _ -MJ=7 ❑ UPGRADE MAI LING ADDRESS O , I �-7 O L,�: LEGAL DESCRIPTION - LOCATION NO. OF BEDROOMS ,. Well Absorption area Dwelling i PERMIT NO. Uv DISTANCE TO: 1 Od l �- �3 F z W Manufacturer Mate ial No. of cornE2 Tnts � N Liq. capacity in gallons Inside length Width Liquid depth . IF HOMEMADE: aDISTANCE TO: Well Dwelling PERMIT NO. Z Z Q Material Liquid in 2 h Manufacturer capacity gallons Well oundation Nearest lot line PERMIT NO. LU y DISTANCE TO: J W Z No. of lines Length of each line F otal length of lines Trench width Distance between lines P Z w inches xCC I- Top of tile to finish grade 10sterial beneath tile Total effective absorption area D inches Length I Width r _ may._ Depth i a �.s (� s,' 'I� PERMIT NO. ��03� W Type of crib Crib diameter Crib depth Total effective absorp ' area LU 0 Well Building foungation Nearest lot line t DISTANCE TO: I I p `7f, k c7 -)— Class Depth Driller Distance to lot line PERMIT NO. J W � Building oundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING t�,7 INSTALLER / l o . p REMARKS v 1 �•i�iy.J .90a GG ort. -'S `� IV,.pp '. y W 'F4690 LP 3 .'^, a6ticnh - ,N1 " �9 ai levt. e'� R 3Gn 006 vY4 nun No. 1457-[ e• APPROVED ki 96 4- ENGINS, HINa - DATE LEGAL yp ER, „m'�u��� r, ,ilia ��+H. ALA4.9-a 6 .4 / n-nts (RP„ snR) --- -- a .JN OF VJELL (Please complete either to, !b or lo.) _J Lo Borough Subdivision I t TD loss ] 1%��qs _ l �____—I r _ An ch Sar.pSOTit — —J iTof of i.� Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Well # 2 Street Address and Area of Wall Location WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 6 Geophysical Surveys Drilling Permit No, A.D.L. No. Suction No Township IJ❑ Range E� td or l dion- -----� SO yr 3. OVINER OF WELL: Mr. -Ray }fie Tetier Shasta Construction Address: I 1241 Denali _ Anchorage, Ake 995 "1 2. WELL LOG Foot Below Surface q VgELL DEPTH: (final) 5. DATE OF COGIPLETIO 1 CJ2 st 1 - 1 5 -[} TRP —� B -to Material Type � ____ ,y g, Cable tooll'Re krry LJ Driven Ll Uug G a v e 9sit g I fbarl Auger DJotted-) Bored Other 1 ravel, S- f,C1Jr0W7 T7 7, USi�-Lj Uoma¢fic n Public Supply ❑ Industry Irrigation ❑Commericalacarga Grey:ardpan'—_-_- 1 5 Grey_hae eTr j -- — r9� Toa, 11joll ❑ Other: —-- --- any._=vja --- -' CASING: Ej Th(r]e�a]ded �.'.. We ldod Idiam.—F_-_in. tol(q41. Dapth Weight 17 Ibs./ft. ----------�---- diem. 1n. to ft. Depth Sticlmo_ft. II 9. FINISH OF WELL: Typo: Dlamater:_ Siotlhlash Sl.ic:_ — Longth: _! Sot between ft. and ft. _—_. —---__---.—�_---_�-__--- D�Ir _ _ P�S_-�Gj�\c Dachiilting ._ __-_- Gravel Poch R 10. STATIC VIA) ER LEVEL: _ ft, Do9a Above 0 Below land or surface Equipment used: II. PUiSPING LEVEL below load surface and YIELD .P. after hrs. Pum Ping_—_g.P. m. ft. , after .-_ _hrs. pumping __—q.p.m. 12. GROUT NG Yell Grouted: EJ You ❑ No -- ---- -�- Material: E Neat Cement r-1 Other: 13, PUMP: (if available) HP. Length of Drop Pipe ft. capacity g. P. in L, Subin. Jot Contrifieal Other RGNIARK S: ------------ —�---- Production of 20 GVM 16. WATER WELL CONTRACTOR'S CERTIFICATION: 54.'at . er Tem F �J C L1 I his 'veli was drilled undernn ju Oscillation and this report is L ue tile Ve �my %nowledge and belief( Magnuson Dr Ming t7,A ���?� 1 Regislorod'r�Busines7s i,7 Name p� Conti, c Li. h iso P!u rn bur P? O0 B0 'f 10504 Dagl0 _ %e._ p H o AJ �J Address: �, k 8 Signed ��,e{'%j��.•rY.�*' /I ..�*�' ¢��� �f `j.l':�%'���-...r� DCIa:--�\I IJV Aulhorl Ced Raptesoniolivo�/ Form 02-WVIR (II/III) Copy Distribution: WHITE -Stale UGGS, PINK-Drillor, CANARY-Customof ` ~, ������1" L_ �� ��� ��� ^ DEPARTMENT [\ �EALTH AND ENVIRONMENTAL F]TECTION ` 825 L STREET, ANCHORAGE, AK 99501 264-4720 ^ , . �P4 E3 I _T_ LE ��&YJ EE V4 1=1 L.. FZ M I T, PERMIT ND: ~~^ 850300 / DATE ISSUED: 06/14/85 ~ APPLICANT: RAY PELLITIER SHASTA CONST, INC" ADDRESS: 200 WEST 34, SUITE 556 ANCHORAGE, AK 99503 CONTACT PHONE: ' 274-0156 LEG'AL DESCRIP: SUBDIVISION: IVISIN: SAMPSON ESTATES LOT. I BLOCK- 1/ SECTION: 3 TQWNSHIP: 15N RANGE: 1W LOT SIZE:` 43560 (SQ.FT. OR ACRES) MAX BEDROOMS: 3 Listed below are the options available to you in designing your septic ` system. Choose the option that best ;its your site. �- F --,c I-= 1'%JCl� F_� WW= �� ��][U4 DEPTH TO PIPE BOTTOM (FT. ) 4"0 4.0 3.0 ** GRAVEL DEPTH (FT") 2.0 0"5 3"0 TOTAL DEPTH (FT.) 6,0 4.5 6.0 GRAVEL WIDTH <--T.) 2.5 20.{p� 5.0 GRAVEL LENGTH (FT.) 124.0 ** 30.8 �~' 58.0 GRAVEL VOLUME (CU. YDS. 28.8 28.2 37"6 TANK SIZE (GALS) 1,000.0 ** 1r000"0 ** 1r000.0 *� SOIL RATING (S(1.FT./BR) 165 165 185 ** DEPTH TO ^ PIPE BDTTOM < 3"5 FT, REQUIRES INSULAT%3N . ** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST' -TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipali-ty of Anchorage (MDA) and the State of Alaska. 2° I will install the system in accordance with all MQA codes and r'egulations, and in complfance with the design criteria of this permit.. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater, disposal system or -public sewerage system on this or any adjacent or nearby lot. � 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED, (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE GONE 13Y LICENSED ELECTRICIAN. SIGNE DATE: APPLICArq1IF- SHASTA CONST, IWC. ISSUE!) BY �w�~��� ������ ^ _ �4�,_^ DATE: a nicIl my of Anchorage POS -:H 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES. X �� MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840945 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 1 Block 1 Sampson Estates Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt, Supe visor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 m ^ ` �Lil R'hA I.. !E.� JE 1F:'; �I -IF- `e" E]i P- �PA CIP IF-7e�: w7li 1E..3 RE:: ` ��PA�TMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ^ 825 L STREET, ANCHORAGE, AK 99501 264--472O C]", 11Nq- .11": �� IEE3 ![EE: U.__. L.... F::" 1EE: T-7iflil"I '.1': "IF' PERMIT NO: �ATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LESAL DESCRIP: LOT SIM. MAX BE� OOMS: 840945 11/13/84 STEVEN SKAGGS P O BOX 670690 CHUGIAKr AK 99567 688~2831 SUBDIVISION: SAMPSON, ESTATES LOT: 1 SECTION: 3 TOWNSHIP: 151\1 RANGE: 11WI 1.51A (SQ.FT, OR ACRES) , 3 � 4144T J41-4 Listed below are the oPtion� available to you in designing your s�ptic � � � �� system, Choose the optionthat best fits your site" ~ �..... ... ..... �~._~�_��`~��-� �E'.ED3 PVJ 1`30,-,�Ze"� I P"11 DEPO TH TPIPE BOTTOM (C --T.)0 T^) � 4^- 3"0�** GRAVETL DEPTH (FT") � ~ 0. 11 3^0^. TOTAL DEPTH (FT.) 6"O \ ^ GRAVEL WIDTH (FT") 20^0- � 5,[p GRAVEL LENGTH (FT.) 38"0-� 58"0" GRAVEL VOEUME (CU"YDS.) ` 28.` 37.6 TANK SIZE (GALS) 1�000"0 SnIL RATING (SQ^FT./BR) 165 165 ** DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4`0 FT. MAYREQUIRLIFTE A IFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ^ ����..... ��^... ... ..... I certi"v that: 1" I am familiar with the requirements For on~sitehewers and wells as set {orth by of Anchorage (110A) and the State oIF Alaska. 2" I will install the system in �ccordance with all MOA codes and regulations� and in compliance with the design criteria of this permit, 3. I will adhere to all MOA and State al" Alaska requirements For theset back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby 4, I understaa nd that this permit aid a is vl{or a maximum of 3 bedrooms and any enlargement will requirean additional permit. IF A LIFT STATION IS 'INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES� THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND <3)THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN � SIONED ^~ DATE: � � APPLICANT: STEVEN S. I'... C -J a / ISSUED BY ` DATE �� ������������~����������~�..... .......... ......~'.......���-�� � ' SOILS LOG MUNICIPALITY OF ANCHORAGE �r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ,+�*S 1�" �yr.S NC%%��n �S/'%fS S /DATE PERFORMED: LEGAL DESCRIPTION: �oh'+pSO+�. �S -s t/ a�fK / �-I-S y )e S'ee SLOPE SITE PLAN /A 2 o vJ 3 O 4 5 v 6 8 Q o© 9- 10 10 11 12 13 14 156 tt6�1 ■■■!■■■■■■ ■ ■E■�■■m■■■ ■1R■NI■■■■■■ ■1■■■I■■■■ 0110MI■■■■■W ■1■■E®■■■■W EI■■E■■■■■■ Niff—aM'2■■■■■ ■1■■■■■■■■■ ■11MENNNEE■ ■■f©ff■■o■ ■■■■■■■■■E Ole Aoie WAS GROUND WATERS O b ENCOUNTERED? NO L 0 P E IF YES, AT WHAT DEPTH? Reading Date A Net Time Depth to Water ®F. A(q kd 16 ••°°•a 17 fr tj 9:1 H 4,, A ,4 18 .. ............ �•� `1, 2225-E 19 JUNE 25, 1971 's Reading Date Gross Time Net Time Depth to Water Net Drop 20 Vi-Zf>p.1it, PERCOLATION RATE Q (minutes/inch) /6jS TEST RUN BETWEEN FT AND FT COMMENTS ,5104e 4 7` ,A -e,+ c $" jLe ® `io a� PERFORMED BY: Bit, -/e^ " . CERTIFIED BY: e S DATE: 72-008 (6/79) 1c.ctlQ vwl oc'15 Municipality of Anchorage • -� Development Services Department Building Safety Division " On -Site Water and 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. 051-822-19 COSA q IMP 3(0 Expiration Date: a — 8 O & 1. GENERAL INFORMATION Complete legal description Sampson Estates, Bilk 1, Lt 1 Location (site address) 23612 Goliath Drive Current Property owner(s) Allen & Patty Gebauer Day phone 240-0760 Mailing address P.O. Box 671283, Chugiak, AK 99567 Lending agency Day phone Mailing address r Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System 3 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 On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for 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 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R Pannone, P.E. Date 11/6/07 Engineers Comments: In conducting an adequacy test,11 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. 71c operational life of all wells and septic systems depend on the local soil condition, ground water •J ( q aha levels that may fluctuate during the year, and the water usage of the family being served by the system. �•�p'-"» a0a 71csc conditions are outside the control of the evaluator of this system. All systems eventually fail and e_,j a� satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PPS can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational i requirements of the MOA DSD. TTe content of this report is for the sole benefit of the owner listed i�teven R. 'onnone: above. Any reliance upon or use of this report by any other person or party is not authorized nor will it #4 No. CE 81 49 confer any legal right whatsoever. raj"Uo�,,, 5. DSD SIGNATURE a0aagto�.••• Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: WASTEWATER COSA Checklist X Well Flow Advisory Septic System Advisory Nitrate Advisory Municipality of Anchorage .. ' Development Services Department =� Building Safety Division ` On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Boot 195650 Anchorage. AK 99519.6650 www.muni.org/onsb PM 343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Sampson Estates, Blk 1, Lt 1 Parcel ID: 051-822-19 A. WELL DATA Well type private If A. B, or C provide PWSID rt Date completed 11/15/1984 San" seal (Y/N) lL Total depth 192 ft. Cased to 192 ft. FROM WELL LOO Date of test 11/15/1984 Static water level ril Well production 20+ g.p,m. WATER SAMPLE RESULTS: Well Log (Y/N) Yes Wires properly protected (Y/N) Yes Casing height (above ground) 18 in. AT INSPECTION 8/25/2007 52 ft. 7+ Coliform 0 colonies/100 mL Nitrate 0386 mg/L Other bacteria-,8coionies/100 mL Arsenic: NO ugfl Date of sample: 7/32/2007 Collected by: GEG B. SE:PTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 9/17/1985 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Yes Foundation cleanout (Y/N) Yes Depression over tank (Y/N) No High water alarm (Y/N) N/A Date of pumping 4/15/2007 Pumper Xs Pumping C. ABSORPTION FIELD DATA Date Installed 8/25/2007 Soil rating (g.p.d./W or fe/bdmt) 0.5 System type Bed Length 60 ft. Width 15 ft. Caravel below pipe 0.S ft. Total depth. Eft. absorption area 900 fe Monitoring tube _YM Depression over field No Date of adequacy test 8/25/2007 Results (Pass/Fail) New For 3 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 Size in gallons N/A Manhole/Access (Y/N) "Pump on" level at _ in. "Pump off level at _ in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/ilft station on lot 100.7 On adjacent lots 100+ Absorption field on lot 185.2 On adjacent lots 100+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 80 Holding tank 75+ Animal containment areas 100+ Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 25 Property line 55.7 Absorption field 75 Water main 100+ Water service line 80 Surface water. 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 15 Building foundation 13LS Water main 100+ Water Service line 100+ Surface water 100+ Driveway, parkingivehicle storage 50+ Curtain drain SO Wells on adjacent kris 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION ............ I certify that I have determined through fleld inspections and review of Municipal records that the above systems are in .'„. _........00 conformance with MOA COSA guidelines in effect on this date. i _ !mm� { j ,Steven R Ponnone? i Engineer's Printed Name Steven R Pannone, P.E. No r 8149E Date 11/6/2007 SSS �. •• / � ejae..•o• COSA Fee $ Waiver Fee $ Date of Payment 11/1)1, ID -4- Date of Payment -'T Receipt Number olq� f Receipt Number (Rev. 11/05) { -6A ` ts. j Il.i •n FMa .n a •°n It t#�it r`4, � . e, • D • 1 •a-cq� r 1 . . ' �_,• �� �\ '' ' AS -BUILT w, �. 1 he by*certify that 1 have surveyed the following described nib •-PmT'�'rtY;--L - T%eiaiCJ '- •4. j �•� '' `� 't{a.s t'�- ' _ - -- R.Y►I �j Anchorage Recording Precinct, Alaska, and that impve- g gro �; 11•f -e7 �. 'Y.rf.rt : �G�:„•w�. `. ments situated thereon are within the Property lines and do not overlap or encroach on the property lying adjacent thereto, that - - no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, ' ' transmission lines or other visible easements on said property except as indicated hereon. Dated at/Eagle River, Alaska . , this 'I6 -y.. day of M? t 2vQL t ROBERT C.1O11NSON W P4 i SCALE: Registered Land Surveyor No. 880 -LS 30 , &,x n -N%, Eagle River, Alaska 99577'" phone (907) 6942543 . . 11-08-07;15:11 ; SGS Ret. 0: Client Name: Project Name: Client Sample ID: Matrix: PWSID t 1075989 Pannone Engineering Sampson Estates, 1.7, B1 Sampson Estates, L1, 81 Drinking Water ;907 561 5301 # 2/ 2 SGS Environmental Services Inc 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 All datesAlmes are Alaska Standard Time Printed DateTme: 11/08/07 14:10 Collected Date/rime: 11/07/07 8:30 Received DateTme: 11/07107 9;j)5 Technical Director. Stephen Ede-// Released Allowable Prep Analysis Parameter Results PDL Units Method Limits Date Date Init Coliform Bacteria 8 OB, No Coil 92228 11/07/07 11/07/07 sh An -23. 2001 3:MY- Game, 1Eosioosr43 GtogP. ltd S(:.S ket:O 1073756001 C11eatName ()arnessUginccringGroup. Ltd. frojectNamcIN Samirm)ULIBI Client sample lU SatnpsonUstLIBI Metrix DrinklnR Water rwslu 0 S=pk-Remarks. / . 11o•000I P. I An Detcsfflmet are AIA%ke Standard Time printedDaldAmt 08/130007 10:13 Collected Datc/fime 07/31/2007 9:00 Received DatcfTime 07!3121107 14:15 Tetbnkel Director 5tenbcn C.Fde Allumble Prep Arwh-,iz Pounder RtnJlt p()I. !Inns Mcdw Cmtaixr ID Limits tate MIC lout Metall by ICP/M4 Am -ale ND 5.00 uZ& I:P2KS c (cin) OMM OVUM TK Fater* Department Total Nltratt/Nhri(e N O.1S6 0.100 mVI SM2041noNO3•r 11 (<l0) OPA7/07 )UN Microbiology Laboratory ToutCoO(orm 0 wVIOOmL SM209222R A N) 07RV07 Slip MUNICIPALITY OF ANCHORAGE • t Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES M}i 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel l.D.# nrn)— k,qeA-1eA HAA# v\(:,\0'I(—T-)LF1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1; Block 1; Sampson Estates Subdivision Location (address or directions) 23612 Goliath, Chugiak, Alaska (b) Property owner Lew Reed Telephone ; (home) 688-0410 Business, 55272515 Mailing Address P.O. Box 670872, Chugiak, Alaska 99567 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent FORTUNE PROPERTIES/Carol Bennett 3000 A. Street, Anchorage, Alaska 99503 Address - Telephone 562-7653 (e) Mail the HAA to the following address: (or check here [A, if hold for pick up.) List contact person and day phone number below: c , ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family IR Number of bedrooms 3 3. WATER SUPPLY Individual Well G2 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site iX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 'liver Loop Road No. 204 Address 17034 3 , taa§ca 9{577 Date Telephone ` Z,?;2 y// 0 /1?/ - LI G1 Y/GI �.yOGC�I r3� 6. DHHS APPROVAL Approved for 3 bedrooms by Date Approved Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) a ` CHECKLIST - FEBRUARY 1984 ENYIR�NMENTAL' io'l 'td 343-4744 FSB Legal Description: Lr-rr—j F21 ,g_ t II [[�� A. WELL DATA` E C E I V E D Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Presento/.N) _Date Completed 11- �S_A4 Yield '5, 1 GiPI°1 Total Depth 1612-' Cased to 19f Depth of Grouting Static Water Level 145`t' Pump Set At k JIG Casing Height Above Ground 12? } Sanitary Seal on Casing ON) �!J Electrical Wiring in Conduit CV/N) Depression Around Wellhead (YAM td SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot \00 ; On Adjoining Lots lhn To Nearest Edge of Absorption Field on Lot ki On Adjoining Lots \ 0 a'* To Nearest Public Sewer Line J A" To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 7_ Water Sample Collected by G� FAL�14Vf EQ-A"AU' ; Date 7-'15"�A 1 Water Sample Test Results �"y��s� a� '�` � � t�%Tt� Comments B. SEPTIC/HOLDING TANK DATA Date Installed 9-1'1-55 Size \Doo No. of Compartments StandpipesYom% 1) T—Air-tight Caps ON) Depression over Tank (Y/&� 0 2 Foundation Cleanout o/N) 4— Date Last Pumped Pumping/Maintenance Contact on File (Y/N) ! ; for Holding Tank High -Water Alarm (Y/N) r,- Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well loo' To Building Foundation 2A To Property Line \ o• *- To Water Main/Service Line \n' 'k - To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments PJ(-4PC� u> 72-026 (Rev. 7/88) Front Page _1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1u,Ste>g, Type of System Design Date Installed —4s 'S' Length of Field 38 Width of Field Lo` Depth of Field 9 Gravel Bed Thickness �? Square Feet of Absortion Area Statndpipes Present4�?N) V Depression over Field (Y/Q Date of Last Adequacy Test Results of Last Adequacy Test 9# . SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well \ 1 To Property Line 1 a \ a To Building Foundation To Existing or Abandoned System on Lot 'A� ; On Adjoining Lots To Water Main/Service Line 1a t "— To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course lbw I -I- To To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On""Level High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N)). Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe( inspectiort, i si,stJ^�;ziiVf� Si ned 1703/, is; l fiver Loop Road Noa 204 � g LagleRiver, Alaska 99577 Company Date 2 �� l MOA NoOb-? Receipt No. U� s " ao2 �'�d�/ ��a'S�� Receipt No. _ Date of Payment — �� — �� Waiver Fee: $ az> Amount: $ / %l/. Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 orv:tkrenlae of this o •moi �: °'Engineer n E 6 ueoe��oe��e (..-,DEOFCHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.o 5633 B STREET e ANCHORAGE, ALASKA 99518 - TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 31751 Date Report Printed: FEB 6 91 @ 08:57 Client Sample ID:L1 B1 SAMPSON EST Client Name S & S ENGINEERING PWSID :UA Client Acct SNSENGP Collected FEB 3 91 @ 13:45 hrs. BPO # PO # Received FEB 4 91 @ 13:10 hrs. Req # Preserved with :AS REQUIRED Ordered By R. SHAFER Analysis Completed :FEB 4 91 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)S & S ENGINEERING Released By G [� __-------_`___2)_______' Chemlab Ref #: 910377 Lab Smpl ID: 3 Matrix: WATER Parameter Tested Result Units ---------------------------------------------------------------------------- NITRATE-N 0.15 mg/l Sample ROUTINE SAMPLE COLLECTED BY: R.J.S. Remarks: 1 Tests Performed See Special Instructions Above ND= None Detected See Sample Remarks Above NA= Not Analyzed LT -Less Than, GT=Greater Than Allowable Method Limits ------------------------------ EPA 353.2 UA=Unavailable 10 rte, Y. " 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 2544720 Application Date July 16, 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1; Mock 1; Sampson Fatatez 4 Location (address or directions) (b) , Applicant Name Tirn Fenton Telephone: Home Business 563-8236 Applicant Address 2085 CambeU P.2ace, Anchorage, Alaska 99507 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 91 ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address���%�� (e) Real Estate Company and (f) Address Telephone Ke HAA to the following address: S 9 S Enginee)t ing SRB 196X B'ag.l?e R,i.vm, A.eaaha 99577 TYPE OF RESIDENCE Single-Family[O Multi -Family ❑ Number of Bedrooms Other 3. WATER SUPPLY Individual Well [5 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 6 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 (71/84) 5.' ENGINEERING FIRM PROVIDINU INSPECTIONS, TESTS, FILE SEARCH, DA1 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 S & S ENC21WEERINQ- Telephone ' 2_q 2 Address SR B 196X JUL 1 Date EAGLE RIVER AK 99577� 1,0186 6. DHEP APPROVAL Approved for bedrooms by it��-C_� ate Approved Disapproved Conditional Terms of Cord Kill Approval 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) MU CIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCH �TH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIONCHECKLIS 64-4720UARY 1984 ,JUL Legal Description: Z- �A-it.nf�tJs�/ A. WELL DATA RECEIV ED / N Well Classification S. e - If A, B, C, D.E.C. Approved (Y/N) Well Log Presen�tq //W Date Completed 1�' � S �� Yield 1 S Total Depth _1' Cased to — Depth of Grouting Static Water Level Z> Pump Set At u1< p � Casing Height Above Ground Sanitary Seal on Casing �,'` Electrical Wiring in Conduit(/Pdy-Depression Around Wellhead (*0 Separation Distances from Well: To Septic/Holding Tank on Lot `Ub1 ; On Adjoining Lots To Nearest Edge of Absorption Field onlq_, Lot Ito , ; On Adjoining Lots l b0 1 + ,.J To Nearest Public Sewer Line To Nearest Public Sewer _ +F- Cleanout/Manhole ¢^ / To Nearest Sewer Service Line on Lot Z 3 Water Sample Collected by `� S �i�(�!; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed g� /7'8� Size %� a o No. of Compartments Standpipe( Pd')' Air -tight Caps/Ddb Foundation Cleanoutow- Depression over Tan{�&J Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Date Last Pumped / i�K for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well %bO r To Building Foundation To Property Line %a � �- To Disposal Field B 3� d - To Water Ahairr/Service Line ` To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �0 13 2 Type of System Design �£ Date Installed Length of Field 36, Width of Field t Depth of Field O's -, Yl Gravel Bed Thickness Square Feet of Absorption Area J (off Standpipes Presental w- Depression over Field tY20 Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well r To Building Foundation Lot ttt A - To Property Line I b To Existing or Abandoned System on On Adjoining Lots 33�� To Water hia+ Service Line 3� To Cutbank (if preset) To Stream/Pond/Lake/or Major Drainage Course "j r �— To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons Dimensions Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify tht h v checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ENGINEERING Date JII[ 18Ia86 SRS IM CompanMOA No.S Receipt No. ' 1 t�01- A CaC�� 4,V 1 , .• ) Date of Payment Amount: $ Page 2 of 2 72-026 (11/84 \* "rt- S StuW%- 4 i► Mysw.af} lmb