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HomeMy WebLinkAboutSAMPSON ESTATES BLK 1 LT 4Sampson Estates Block 1 Lot 4 #051-822-22 Municipality of Anchorage Community Development Department Page 1 of 5 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:/Avww.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141082 PID Number: 051-822-22 ❑ New ❑✓ Upgrade Name: Wayne & Linda Armstrong ABSORPTION FIELD ❑ Dee Trench El Shallow Trench ❑Bed E] Mound Address 23710 Goliath Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.45 GPDfsF 12 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4 Ft. Gravel depth beneath pipe 8.0 Ft. Subdivision Block Lot Sampson Estates 1 4 Fill added above original grade 0 Ft. Gravel length 84.0 Ft. Township Range Section Gravel width 2.5Ft. Beds: Number of Lines N/A Distance between lines I N/A Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area 1344 Fe Number of trenches 1 Dist. between trenches N/A Ft. Well 102.7 107 N/A N/A 81 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity I 1250Gal. Surface Water 100+ 100+ N/A N/A Material Number of compartments Lot Line 55.3 10.4 N/A N/A NA Steel 2 Foundation 21.3 22.6 N/A N/A LIFT STATION Manufacturer - Capacity Curtain Drain N/A N/A N/A N/A Gal. Remarks Drain field orientation changed during construct- Pump on level at in. Pump off level at in High water alarm at n. ion due to heavy rainfall and walls collapsing in the old field. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL Housetotank 3034 Tankto - drainfield 3034 JR's Septic Dralnfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft Inspection t�` 5/16/2014 dates: 2" " 5/19/2014 3" 5/19/2014 0 Location and description - Southwest comer foundation at siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineers Stamp Conditional Approval: Date 0121 'k of AC 14i *yip �Q�q���*+, Steven ! : PEIi novaeAW' Approved Date az df4z inspection Keport_t-t-te.00e IRC c °a INSTALLED 1250a SEPTIC TANK --� 1 i REMOVED 1000a ,I TANK o - AX 4 R HO SE \� 1 w� G .1 W . -mow %S REPLACE --- oc FIELD (E) ca"r' (INSTALLED DRAIN FIELD 84.OLF x 2.5W x 8.0'ED x 13.1 'TD >+ ADD ±0.5' SAND TO ACCOUNT _ '-°E5 ! FOR BIOMAT REMOVAL _ — � RESERVE DRAIN FIELD (P) BASED ON CAT III SYSTEM) _— -- 72_SLF x 2.5W x 6.0'ED x 9.0'TD o C o m / NOTES: PANNONE ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SAMPSON ESTATES, BLOCK 1, LOT 4 DRAWN JRL WAYNE & LINDA ARMSTRONG 23710 GOLIATH DRIVE PLAN CHUGIAK, AK 99567 z 08/24/15 4 TH 1"=50' ..... . .. .. .. P.I.D. NO 5Y-843-22 •Stever R. Pannone PERMIT NO. I�P CE 8149 .�Aw OSP151082 �� ops" Sh2eOF 5 A B C DCO1 20.8 31.3 T1 25.6 30.7 T2 30.5 27.5 DCO2 31.8 26.8 C01 24.5 44.3 MT7 24.7 44.6 CO2 43.3 32.5 MT2 40.9 30.8 NOTES: PANNONE ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SAMPSON ESTATES, BLOCK 1, LOT 4 DRAWN JRL WAYNE & LINDA ARMSTRONG 23710 GOLIATH DRIVE PLAN CHUGIAK, AK 99567 z 08/24/15 4 TH 1"=50' ..... . .. .. .. P.I.D. NO 5Y-843-22 •Stever R. Pannone PERMIT NO. I�P CE 8149 .�Aw OSP151082 �� ops" Sh2eOF 5 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS 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 AND ATTACHED PES SPECIAL PROVISIONS. 2. SCOPE OF WORK: REMOVED SEPTIC TANK (E) AND INSTALLED 1250g SEPTIC TANK WITH DCO AND REMOVED AND REPLACED DRAIN FIELD (E). INSTALLED NEW SOIL ABSORPTION SYSTEM. -- 3. GROUNDWATER WAS NOT OBSERVED TO A DEPTH OF 16.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 15.0 FEET BELOW EXISTING GRADE. DRAIN ROCK 6" ABOVE PIPE INVERT - - 4" 0 PERF PIPE �—FILTER FABRIC 98.0 V ORg0E. SLOPE ON _ EAST (38.4%) n �+ ADO i0.5' SAND TO 71� 90.0 ACCOUNT FOR _ - o � BIOMAT REMOVAL DOES NOT TT® 50' 1 20.3 i— I-21 r� Sac- -160 86.0 SECTION (SCALE: 1"=10') - O� z z z z 2 �z z wow 5 �� w �� z of o� �U U U od p FILTER FABRIC o� V E Z U EL.103.0 n n EL.102.0 DRAIN ROCK 6" ABOVE PIPE INV 4" 0 DRAIN PIPE Li I--- 4.0 98,4 1250 g SEPTIC 98.2 98.0 TANK (P) 98.0 PROFILE 90.0 TRENCH SEE DESIGN 90.0 ABBREVIATIONS CU COPPER DESIGN PARAMETERS °H TESTIHOLE°N PIPE UPGRADE SEPTIC SYSTEM LEGEND TO FOUNDATION CLEAN OUT NO. BEDROOM: 4 (600 gpd) T# TANK CLEAN OUT NO. TANK SIZE: 1250g W WATER LINE/ C# CLEAN OUT NO. PERC RATE = 40.0 MPI WELL RADIUS Ec# EXISTING CLEAN OUT NO. SOIL RATING: 0.45 GPD/SF _ M# MONITOR TUBE NO. AREA ROD: 1333 SF SS NEW SEPTIC EM# EXISTING MONITOR TUBE NO SYS. TYPE: DEEP TRENCH 8.0' E.D. R. 1. RIGID INSULATION - _ DCO DOUBLE CLEAN OUT MIN LENGTH: 83.3 LF DV DIVERTER VALVE FS FLOW SPLITTER USE: OG ORIGINAL GRADE 84 LF X 2.5' WIDE, 8.0' E. D., 13.1' TO FG FINISH GRADE ±0.5 SAND TO BASE TS&V TOPSOIL & VEGETATE - TOTAL AREA: 1344 SF P PROPOSED E EXISTING RE REDUCTION FACTOR NOTES: 7�, NN N EN ����Dote RECORD DRAWING PP�ONBO 01002��17 ANCHORACK 99 L0 �E QF A qs�l� 08/17/15 PHONE (907) 272-8218 FAX (907) 272-8211 ig�P �yt) Scale NTS �"• •• �. P.I.D. NO SAMPSON ESTATES, BLOCK 1, LOT 4051-822-22 WAYNE & LINDA ARMSTRONG / S'teven R. an ne PERMIT NO. DRAWN JRL 23710 GOLIATH DRIVE �, Pc, CE 8149 OSP151082 DESIGN DETAILS CHUGIAK, AK 99567 +i�l���OF s1oNP�— sheet 3 OF 5 SOILS LOG - PERCOLATION TEST TH-4 SLOPE SIAE PLAN ORGANICS 1 2 3 SILTY GRAVEL 4 5 6 7 8 9 10 GM/ML/SM 11 12 13 14 15 16 17 18 19 20 BOH DATE PERFORMED: 8/31/15 X I:TH WAS GROUNDWATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? DEPTH TO WATER AFTER MONITORING? -DRY- DATE: 9/11/2015 COMMENTS: Test hole excavated SLOPE TH X READING DATE CLOCK NET TIME WATER LEVEL READING NETDROP -�MPE 1 831-15 1325 4.702" 2 1355 30MM 5.491" 0.789" 38.02 3 1356 4.702" 4 1426 30 MIN 5.471" 0.769" 39.01 5 14.27 4.702" 6 14:57 30 MIN 5.470" 0.768" 39.08 PEROLATION RATE 39 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 5 FT AND 6 FT - . Perc hole was PERFORMED BY: J.Lawendowsld. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIP7A�L�GUUITDL7I�NEES INN EFFECT ON THE DATE OF THIS TEST. Dcte RECORD DRAWING rt]ir1�O1rL ENG WC, LLL _,��c oF.A/-,gSll! 9/16/2015 P.O. BOX 102954 ANCHORAGE, AK 99510 „�Q.• + Scale PHONE (907) 272-8218 FAX (907) 272-8211 w • y f DRAWN JRL SOILS LOG SAMPSON ESTATES, BLOCK 1, LOT 4 WAYNE & LINDA ARMSTRONG 23710 GOLIATH DRIVE CHUGIAK, AK 99567 *: *// NTS .. .. P.I.D. NO -822-22 Steven f2. Panno.ne � PBRMIT N0. +PcsCE 8149 i� OSP751082 ��li�PRO ssiooP� Sheet 160F 1 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: OSP151082 Tax Code Number: 05182222000 Work Type: Septic Upgrade Permit Effective Dates: May 15, 2015 to May 14, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: SAMPSON ESTATES Site Legal Address: SAMPSON ESTATES BLK 1 LT 4 G:1560 Owner/Address: ARMSTRONG ANTHONY W & LINDA M PO BOX 770448 EAGLE RIVER AK 995770448 Site Mailing Address: 23710 GOLIATH DR, Chugiak This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 44396 Total Bedrooms: 4 N Privy N Private Well N 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 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: 1. The Engineer needs to do an additional test hole prior to the construction of the septic field. Construction may proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. 2. The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation test. The Engineer needs to do a additional percolation tests prior to the construction of the septic field. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. AMC 15.65.060.B.3 Received Issued By: slisl201S Date: Municipali of Ancho vqent Is, Y TG - epa ttment **** VARIANCE/WAIVER REVIEW **** Waiver#: 08V151020 COSA#: Permit#; OSP151082 PID#:016-822-22 Legal Description: Sampson Estates Block 1 Lot 4 Engineer: Pannone Engineering Services Applicant: Wayne & Linda Armstrong Your; request for a waiver of the required 50 feet horizontal separation from the absorption field to the excessive slope has been approved. The approved separation distance is 15 feet for the primary field and 30 feet for the alternatesite. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. The affected adjacent property owner(s) have been given a 7 day noticeregardingthis waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ®' Adjacent properties are not affected by this waiver. .. ....:...................................... ........................ NNW ..... .... Waiver is Granted: X Waiver is not Granted: Date: %S Approved by: Name of Reviews ..��.............. u.... u.................u..0 .......ru ."................... **** VARIANCEMAIVER REVIEW ■ MUNICIPALITY OF ANCHORA BM1 aTA APR 15 2015 Community Development Department Phone: 9WOPfi Dstuiler Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-822-22 Property owner(s) Wayne & Linda Armstrong Mailing address 23710 Goliath Drive, Chugiak, AK 00567 Day phone Site address 23710 Goliath Drive, Chugiak, AK 00567 Legal description (Sub'd., Block & Lot) Sampson Estates, Block 1, Lot 4 Legal description (Township, Range & Section) Lot Size 44396 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank 1ZUpgrade 1ZDuplex (D) F-1Holding Tank ❑ Renewal F-1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Drain field to slope >25% Distance: 35 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. owner or authorized agent) Permit/Rush Fees: 4 J50. W Waiver Fees: 02-15 Date"of Payment: Ll jt5 45 Date of Payment: �U15-j 5 Receipt Number: OQ63 Receipt Number: Permit No. OSP161072 Waiver No. OS V1S70a6 Permit App_::- : O W— NOTES: FOR CONSTRUCTION ALL 1250 -PTIC T K ', W_ - & EPLACE AIN ELD (E) offil7 i REMOVE 1 00Oq SEPTIC TANK �/XINSTALL D_CO Tv{,Pi 0µ.uLr x z.ovv x o.0 to x i Z.0 i u _ rx31P ` rn-PEs_ + ADD ±0.5' SAND TO ACCOUNT _ 26-1 FOR BIOMAT REMOVAL - RESERVE DRAIN FIELD (P)'— (BASED ON CAT III SYSTEM) 12.5LF x 2.5W x 6.0'ED x 9.0'TD-- - - --- o _ - m i PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SAMPSON ESTATES, BLOCK 1, LOT 4 DRAWN JRL WAYNE & LINDA ARMSTRONG 23710 GOLIATH DRIVE PLAN CHUGIAK, AK 99567 i ��vr.HLgS�1i 4/30/15 �y�9+t Scale "•" % P.I.D. NO 051-822-22 Steven R. Pannone PERMIT NO. 1 OF 5 Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveCaoaneneak.com 05 MAY 2015 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. 0. Box 196650 Anchorage, Alaska 99519 Subject: Sampson Estates, Block 1, Lot 4 Septic System Upgrade Permit Request Ladies and Gentlemen: I am writing to request a permit to install an upgrade septic system be issued for this property. The proposed systems will serve an existing four (4) bedroom house. Currently the lot is developed. The existing drain field is in failure. It will be removed and replaced with a new absorption field. The proposed system will utilize a 1250g septic tank with a deep trench type drain field. The surrounding lots are served by private wells. There are no wells on surrounding lots within 100 feet of this system. 1. Soils. One test hole was performed by Fenton Construction in 1984 and a second test hole was performed by Pannone Engineering in April of 2015. Groundwater was monitored for seven days. Ground water was not encountered in either test hole after the seven day monitoring period. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 0.5 gallons/day/square feet should be used for a conventional wastewater system. 2. Soil Absorption System Design. a. See Sheet 2 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography slopes from the north to the south at approximately 4% on the northern half of the property. The southern side has steep slopes ranging from 38% to 51% in the area to the south of the proposed drain field. There is a steep slope (38% slope) approximately 15 feet downhill of the eastern end of the proposed drain field and 30 feet downhill of the eastern end of the proposed reserve field area. See waiver request. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 5. Waiver Request: I am -requesting a waiver of the minimum distance to a slope of greater than 25%, beginning at a distance of sixteen feet (15') from the proposed drain field and thirty feet (30') from the proposed reserve drain field area. No additional earthwork is required as the drain line from two and a half (25) feet above the field does not daylight before fifty feet (50'). See design section on sheet 2 of 6. Drawing Markings: The Drawings are marked "For MoA Review Only'. When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells 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 Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 RESERVE SYSTEM ADVANTEX TANK SYSTEM WITH AX20 POD DRAIN ROCK 6" ABOVE PIPE INVERT 4" 4 PERF PIPE FILTER FABRIC LH84 ML ccSLOPE ON MIDDLE y - - � 30.0 mo 4-2.5 DOES NOT - - DAYLIGHT ® 50' -16.0" SECTION (SCALE: I"=107 TRENCH SEE DESIGN w w AQ oW o a o o� OU FILTER FABRIC o f Wjz DIP DUCTILE IRON PIPE DESIGN PARAMETERS AN ROCK BOVE PIPE INV I� n 103.0 LEGEND Fc T# III I NO. BEDROOM: 4 (600 gpd) ax2a I 4"0 DRAIN PIPE CLEAN OUT NO. 15009 S.TZE TANK (P) PROFILE TRENCH SEE DESIGN ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE DESIGN PARAMETERS TH FOUN"OLE UPGRADE SEPTIC SYSTEM LEGEND Fc T# AN CLEAN our TANK ANK CCLELEAN OUT N0. NO. BEDROOM: 4 (600 gpd) WATER LINE/ Cly CLEAN OUT NO. TANK SIZE: 15009 STEP W WELL RADIUS EcN EXISTING CLEAN our No. PERC RATE = 22.4 MPI Mg MONITOR TUBE NO. SOIL RATING: 4 GPD/SF SS EM# EXISTING MONITOR TUBE NO. AREA ROD`. 150 SF NEW SEPTIC R.I. RIGID INSULATION SYS. TYPE: DEEP TRENCH 6.0' E.D. DCO DOUBLE CLEAN OUT MIN LENGTH: 12.5 LF DV DIVERTER VALVE FS FLOW SPLITTER USE: OG ORIGINAL GRADE FG FINISH GRADE 12.5 LF X 2.5' WIDE, 6.0' E.D., 9' TO TSV TOPSOIL & VEGETATE TOTAL AREA: 150 SF P PROPOSED _ E EXISTING RF REDUCTION FACTOR NOTES: PAM P•� PHONE N +�y!'jN �BOXo1010 7 ANCHORAGE, CK 99 0 (907) 272-8218 FAX (907) 272-8211 /�g�p %* ���� ��°F..... i �y I'I 4 ll-I'•*�!. 04/30/15 FOR CONSTRUCTION Scale NTS P.I.D. NO SAMPSON ESTATES, BLOCK 1, LOT 4051-822-22 WAYNE & LINDA ARMSTRONG / Steven ' PF��• Pan / C 81 PERMIT NO. JRL DRAWN 23710 GOLIATH DRIVE CHUGIAK, AK 99567 �+ l'i�AOE . �� •p E= OSPI51082 DESIGN DETAILS Sheet 3 OF 5 PRO�ISIII 1 . ALL CONSTRUCTION WAS 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 AND ATTACHED PES SPECIAL PROVISIONS. 2. SCOPE OF WORK: REMOVE SEPTIC TANK (E) AND INSTALL 12508 SEPTIC TANK (P) WITH DCO AND REMOVE AND REPLACE DRAIN FIELD (E). INSTALL NEW SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS NOT OBSERVED TO A DEPTH OF 16.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 16.0 FEET BELOW EXISTING GRADE. DRAIN ROCK 6" ' ABOVE PIPE INVERT 4" 0PERE PIPE _�FILTER FABRIC ADD t0.5SAND TO ACCOUNT FOR 81OMAT REMOVAL COPPER DIP DUCTILE IRON PIPE TH A\ FC o� E FABRIC ➢ p - ; <o 0 0 R 0 CRAW PIPE n n EM# F, VI 03 R.I. RIGID INSULATION ow w w DIVERTER VALVE -16.0 FLOW SPLITTER OG ORIGINAL GRADE ADD t0.5SAND TO ACCOUNT FOR 81OMAT REMOVAL 1250 g SEPTIC TANK (P) PROFILE DESIGN PARAMETERS UPGRADE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 12508 PERC RATE = 40.0 MPI SOIL RATING: 0.45 GPD/SF AREA ROD: 1333 SF SYS. TYPE: DEEP TRENCH 8.0' E.D MIN LENGTH: 83.3 LF USE: 84 LF X 2.5 WIDE, 8.0' E.D., 12' TD ±0.5 SAND TO BASE - TOTAL AREA: 1344 SF DOES NOT DAYLIGHT 0 50' SECTION (SCALE: 1"'=10) COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC o� E FABRIC m <o 0 0 EXISTING CLEAN OUT NO. 0 CRAW PIPE n n EM# EXISTING MONITOR TUBE NO. R.I. RIGID INSULATION ow w w DIVERTER VALVE FS FLOW SPLITTER OG ORIGINAL GRADE FG FINISH GRADE LiU U U pV a 19,1 ri � O U � 1250 g SEPTIC TANK (P) PROFILE DESIGN PARAMETERS UPGRADE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 12508 PERC RATE = 40.0 MPI SOIL RATING: 0.45 GPD/SF AREA ROD: 1333 SF SYS. TYPE: DEEP TRENCH 8.0' E.D MIN LENGTH: 83.3 LF USE: 84 LF X 2.5 WIDE, 8.0' E.D., 12' TD ±0.5 SAND TO BASE - TOTAL AREA: 1344 SF DOES NOT DAYLIGHT 0 50' SECTION (SCALE: 1"'=10) LEGEND W WATER LINE/ WELL RADIUS SS NEW SEPTIC EAST 1 (38.47) ABBREVIATIONS Cu COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC o� E FABRIC zo ,S C# g U N ROCK 6" ABOVE PIPE INV EXISTING CLEAN OUT NO. 0 CRAW PIPE n n LEGEND W WATER LINE/ WELL RADIUS SS NEW SEPTIC EAST 1 (38.47) ABBREVIATIONS Cu COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. EC# EXISTING CLEAN OUT NO. M# MONITOR TUBE NO. EM# EXISTING MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE P PROPOSED E EXISTING RE REDUCTION FACTOR NOTES: 7���77�� 7�7�1 �97�7 LLC_��� ���\ Date FOR CONSTRUCTION P•O BOX 11010217 ANC ANCHORAGE, 99510 i:;! '��OF.k' kkI 4/30/15 PHONE (907) 272-8218 FAX (907) 272-8211�y++I Scale *; .*0, NTS R ..... ... .. .. P.I.D. NO SAMPSON ESTATES, BLOCK 1, LOT 4 / 051-822-22 Steven •R� Pannone WAYNE & LINDA ARMSTRONG / PERMIT NO DRAWN JRL 23710 GOLIATH DRIVE �r�c'• CE 81,� OSP151082 DESIGN DETAILS CHUGIAK, AK 99567 �lllF�SS10NP= Sheet 2 OF 5 4" JIM CAP 4" PUMP—OUT SLIDE SECTION OF 6" PIPE OVER THIS CONNECTION TO PROVIDE SHEER PROTECTION— EXTEND TO BRIDGE EXCAVATION RESERVE SYSTEM ADVANTEX TANK SYSTEM WITH AX20 POD 2EA ADVANTEX AX20 PODS 24" INSULATED AUXILIARY PUMP BASIP PASSIVE AIR ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE DESIGN PARAMETERS TH HOLE UPGRADE SEPTIC SYSTEM LEGEND FC FOUNDATION CLEAN OUT FOUNDATION T$ TANK CLEAN OUT N0. NO. BEDROOM: 4 (600 gpd) WATER LINE/ Cg CLEAN OUT NO. TANK SIZE: 15009 STEP W WELL RADIUS EC# EXISTING CLEAN OUT NO. PERC RATE = 22.4 MPI - M# MONITOR TUBE NO. SOIL RATING: 4 GPD/SF SS NEW SEPTIC EM# EXISTING MONITOR TUBE NO. AREA ROD: 150 SF - R.I. RIGID INSULATION SYS. TYPE: DEEP TRENCH 6.0' E.D. DCO DOUBLE CLEAN OUT MIN LENGTH: 12.5 LF DV DIVERTER VALVE FS FLOW SPLITTER OG ORIGINAL GRADE USE: FG FINISH GRADE 12.5 LF X 2.5' WIDE, 6.0' E.D., 9' TD TS&V TOPSOIL & VEGETATE TOTAL AREA: 150 SF - P PROPOSED E EXISTING RF REDUCTION FACTOR NOTES: P NN N EN r� u `i `Ol`li'i I�1VG �C, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 _���� �� OF' A� gsll' % *�49 TM �y*j�/ Date 4/3°/t s FOR CONSTRUCTION Scale NTS • • • • "'P.I.D. NO SAMPSON ESTATES, BLOCK 1, LOT 4 051-822-22 WAYNE & LINDA ARMSTRONG / Steven . Pannone (+'P�cys,C S PERMIT N0. JRL23710 DRAWN GOLIATH DRIVE ��i OSP151082 DESIGN DETAILS CHUGIAK, AK 99567 llk�, %�9FpFR GESSOFESS ONP� sheet 4 OF 5 SOILS LOG - PERCOLATION TEST WAS -GROUNDWATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? DEPTH TO WATER AFTER COMMENTS: Test hole excavated by JR' at least 1 hour. Last three readings repc READING DATE TEST HOLE 1 WATER LEVEL READING NETOROP OR ORGANICS 1 -- 2 GRAVELSAND 6.09 1.99 GM SILTMIX- 4.10 --- 4 ORANGE 2 1.34 5 12:04 -- 3 --- 6 12:34 30 MIN 5.43 4 5 GRAVELSAND GM/MUSM CLAY MIX - 6 STRATIFIED BROWN 7 8 9 10 11 12 BOH DATE PERFORMED: 4/2/15 SOILS LOG - PERCOLATION TEST WAS -GROUNDWATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? DEPTH TO WATER AFTER COMMENTS: Test hole excavated by JR' at least 1 hour. Last three readings repc READING DATE CLOCK TIME NETTIME WATER LEVEL READING NETOROP 1 412115 1100 -- 4.10 -- 2 11:30 30 MIN 6.09 1.99 3 11:31 --- 4.10 --- 4 12:01 30 MIN 5.44 1.34 5 12:04 -- 4.10 --- 6 12:34 30 MIN 5.43 1.33 PERCOLATION RATE 22.4 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 3 FT AND 4 FT WILL CONDUCT TEST HOLES 3(P) AND 4(P) AT TIME OF CONSTRUCTION TO INCLUDE RE -TESTING TH2. test ran for PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES:PANNONE ENG SVC, LLC —'SOF A j Date FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 (�• ..' �r90, k 4/30/2014 PHONE (907) 272-8218 FAX (907) 272-8211�y++ Scale j*: 4 TH *A� NTS ... .. ..... 1 P.I.D. NO SAMPSON ESTATES, BLOCK 1, LOT 4 .. . .. ..... / 051-822-25 WAYNE & LINDA ARMSTRONG Steven Pannone j PERMIT NO. DRAWN JRL IPFT E 81 ha i• � OSP151052 23710 GOLIATH DRIVE USS✓ SOILS LOG CHUGIAK, AK 99567 '�I�fDA70pNp�� Sheet 5 OF 5 ennla'ro,... onoi 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 PHPHONEEW ,1&rle,5/\ J/ %�.-)e' .ST� 't/�Z V �1r i C'�ZG% ❑UPGRADE MAILING ADDRESS ���'���5/�J j)"'Ts 22 / 111'k72/C l /1, 9y rs� LEGAL DESCRIPTION t /S A) K � Sao, s � Xr/1-1 LOCATION ifNO. P z&s 4f1c lv .- OF BEDROOMS 3 U1. DISTANCE TO: Well / t / 6 - Absorption area p Dwelling r% 5Z/4'See- glow /? 7" PERMIT NO. G' U f_ IIci () % F- 2 Manufacturer1 Material No. of c partments to Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth 2 DISTANCE TO: Well Dwelling PERMIT NO. 2 Z F Manufacturer-- Material Liquid capacity in gallons O w= 4& DISTANCE TO: Well r /�� Foundation 3 Nearest to Ike - / PERMIT NO. �j yU�� J LL z 2 w No. of lines Length of ea h line 'Z� .y2 Total length o Vines Trench width „ 04% inches Distance between lines /7 =` fJS 5lin w� `t F Top of file to finish gradeMaterial , Zi r beneath file 17Z Total effective absorption area 9 - 3 Jr inches /0�/ - Length Width Depth PERMIT NO. w C7 a F Type of crib Crib diameter 6rib-denSh Total effective absorption area Lu a ---------_ w N Well Building foundation Nearest lot line DISTANCE TO: Class Depth 51,7, 47 Driller e c cwk' Distance to lot line 35 PERMIT NO. DISTANCE TO: Buildin oundation Sewery�qe,/ Septitank Absorption ajea(s) OTHER — IALS PIPE MATERIALS 5' (/i/ LL �� SOILTESTRATING �-111 Q INSTALLER REMARKS I I ST/I 0 266/ 413< A/ roe - - — - MUNICIPALITY OF ANCHORAU- DEPT. OF HEALTH & `- zA N...- LINVIKUNM ° 'nnr©-e;� r r UAN J o° 1�t�=sem t N V -' � _ - DATE LEGA�– APPR �7 ennla'ro,... onoi ` 'Na" 'E'JI �����Ir""11 IH. C3 E_ ~ ° � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-472O 1 '-H-[E E-73�X4�� �� �W��� PERMIT NO: 840801 DATE ISSUED: 09/19/84 APPLICANT: FENTON TIMMERMAN ADDRESS: 2085 CAMPBELL PL. ANCHORAGE, AK 99507 CONTACT PHONE: 563-8236 LEGAL DESCRIP: SUBDIVISION: SAMPSON ` SECTIQN: 3 TOWNSHIV�: 15N LOT SIZE: 44396 (SQ.FT. OR ACRES) MAX BEDROOMS: 3 LOT: 4 RANGE: 1W Listed below are the options availabl% to you in designing system. Choose the option that best fits your site, ~r,��FT.Kho R- 0: E-- DEPTH TO PIPE' BOTTOM (FT.) 4.0 4.0 GRAVEL DEPTH (FT.) 0.5 TOTAL DEPTH (FT.) 4Q-5- / 4,5 . GRAVEL WIDTH (FT.) 2 5 �^ . ^�^� 26.0 GRAVEL LENGTH (FT.) 1_<i7.++~**-m�mp 50.0 GRAVEL VOLUME (CU. YDS. ~54.248.2 TANK SIZE (GALS) 1,000.0 ** '� / 1,000.0 ** SOIL RATING (SQ.FT./BR)` 349 284 BLOCK, 1 your septic ����������� ����][PM 4"0 3,5 7.5 5.0 ` 113.0 ** 83.8 1,000.0 ** 349 *� GRAVELLENGTA > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST. HAVE AT LEAST TWO COMPARTMENTS certify that: 1. I am f'amiliar with the requirements for on-site sewers and wells as set �orth by the Municipality of Anchorage (MOA) and the State of' Alaska, 2. I"�il� ,� and regulations, 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 ST -TION 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 RERORT; AND.(3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECT RICIAN� SIGNED APPLICANT: ISSUED BY DATE. ' DATE: � �~�-__ _9~___�~��___ y n, Lt4-solLS LOG MUNICIPALITY OF ANCHORAGE �.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 11 PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ��/i � C©r7S &C /76 DATE PERFORMED: '�?J ,p/ VIb LEGAL DESCRIPTION: DEPTH C7 �G�s f SLOPE I I I I SITE PLAN = S 1 2 3 4 5 � v 6 7 - 8 9- 10- 11 10 11 12 13 14 15 <_ �oopa'ooo' oaoaoe o0 oae a a 0 1 opo oo�v Ca'o�e oaee000 - _ Vol ' James R. Kinney 6 `` CE •• 6036 c 4 Q /-10/$ 41- 170 PSV/ws /� efor j 16 �/ / / 7� /6Q 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? /S 0 L O P E Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) 11 // TEST/ RUN BETWEEN1 / FT AND FT ^OMMENTS CC1 2 G/L'iCiPJ/' /-�/G/> O �u 7 O'P�QC�/' L ' fir /'"/C / <� /3 7cz. 6/0--a f'J,i' L lel G11�— PERFORMED BY: CERTIFIED BY: :-'<� DATE: l?� 72-008 (6/79) l� SOILS LOG 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: `t�� ` Jam'✓ %f-�� DATE PERFORMED:—�5 LEGAL DESCRIPTION: fi aZpfyf%Y�°E3a�i (..e'GL%gyp SLOPE SITE PLAN DEPTH (FEET) <� l✓/%CS 1 /i 2 4 v IV.. OF q�qs�'++ 5 \ \TH* i 4t4�Z.... ✓.. 6� fir' i JAMES R.KINNE)6%�� r C . CE -6036 ,��.. 7 1 �rF• ,•• N i �i1F�pROFESSl4`a,6 9L 10 _ WAS GROUND WATER 11 y ENCOUNTERED? 12 --._.._ e"i pk'��•.�e"? eta �7'` 13 141 15 16 17 1s 19 IF YES, AT WHAT DEPTH? S O L 0 P E NEW ■®■i�■■■.■■ Data Gross Time Net Time i� Net Drop INN ■■■U■■■■■. MEN ■■■■■■■■■■ RA A■ ONEMENEEME NEW MEMO ■■loommm®■■ ■omIm2al®o■ ■MIMEME111®■111 IEEE SON _ WAS GROUND WATER 11 y ENCOUNTERED? 12 --._.._ e"i pk'��•.�e"? eta �7'` 13 141 15 16 17 1s 19 IF YES, AT WHAT DEPTH? S O L 0 P E NEW ■®■i�■■■.■■ Data Gross Time Net Time Depth to Water Net Drop INN ■■■U■■■■■. �3 ■■■■■■■■■■ RA ONEMENEEME ■■loommm®■■ ■omIm2al®o■ ■MIMEME111®■111 NEEMMMEMEN mommommomm mommommmom Reading Data Gross Time Net Time Depth to Water Net Drop �3 RA vof-` 20t_] PERCOLATION RATE /0 (minutes/inch) = 3�� S r�aJ/S.�d L3h, / / TEST RUN BETWEEN 2' FT AND G � FT OMMENTS/7 `io,�� r'rlf:'.J i dip /4�i1 /,�Zfio i /."zm o; [ / =s /il /7d 'a co i;o�n ,-����.��'� Ul6�naJ SG��?ci jc d/OzJ' GJ�'iC'_. 2yUo/ Kj �FDATE:PERFORMED BY: 0 72-008 (6/79) co 00 0 James R. Kinney CE -6036 0 1� �� 0 p NaT6: LOULD N67 -CET — S 25 THE N.E. GOR. 6 .; MT L �a r`O p('�e.•OBCCO C6•ov�Ci,`-i L ' _ SURVEY CERTIFICATION: 1 hereby Certify that I hove su"Ved the property shown and 401 0scribed hereon and that the improvements situated thereon are within the property lines and no Weasels encroachments exist other then noted. p LEGEND: SET FOUND 7-IVGIIVEERS • PLANNERS • SURVEYORS PLEASE NOTE: y la the contract -or's responsibility to check top 5/8" REBAR 0 0 DRN. 6�: of foundation in relation to HUB & TACK ❑ 40 WEST BENSON BLVD. 272-9231 finish grade and building set- MONUMENT 0 ED backs In rotation to lot lines AL -CAP Q e CHKD.: �JCHOf '_ASKA 99503 582-5291 and as PK NAIL x IRON PIPE Q GRIM `.GAL D ON: Com= E LEVS. - DATUM IF. a •._ I . PLAN U -T L�p" - ASSUMED SCALE: / i 1= 4n ' 0 W (D N �3 W CD m �d as x v v m v m m r v m •n m m m m m -n TI m 'n -n a Czn O 3 O 3 O 3 O O O O 3 3 3 3 O 3 O 3 O 3 O 3 O 3 O > i i X 3 m p 77 � m Ooo r 2 :w €v to .0 v :r G Ec+ iV z 0 33 000000000000 (� i= A :c+ � a Y -3 —3 its 4-3 aq io C) m :N :0 XD 1p � OF :p, d F.' iN ti 7C C7 p � p 0 0 0 0 0 0 0 0.0 o o € n o on r -TI-Z .� -� .43 -M -� 'TIo -� `.� 0 0 0 0 0 kin ,Ox ,a3 0 III. 0 0 0 0 0 : C+ iIj 1011c),88 o °„�a 5��r'rjFd H o�Nd n'iij i its M kD :m :co :m Parcel I.D. 051-822-22 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: I a — ! I ° % Complete legal description Sampson Est. Block 1, Lot 4 Location (site address) 23710 Goliath Dr. Current Property owner(s) Anthony & Linda Armstrong Day phone _ Mailing address PO Box 770448 Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: (] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Municipality of Anchorage Individual IX Individual Water Storage On -Site Water and Wastewater Program Holding Tank (907)343-7904 snerr Community Class Well Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: I a — ! I ° % Complete legal description Sampson Est. Block 1, Lot 4 Location (site address) 23710 Goliath Dr. Current Property owner(s) Anthony & Linda Armstrong Day phone _ Mailing address PO Box 770448 Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: (] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual IX Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ . Waiver/Variance request for: Received by: - COSA to be released to the otherwise requested by the engineer. COSA Fee $ Date of Payment 1 1 .:iL-l!1 T CC Receipt Number ob OLE G COSA # 05C.15 13 hy Date: / /j 726 / 5 Waiver Fee $ Date of Payment Receipt Number Waiver # 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 7/13/2015 Conditional approval for bedrooms, with the following stipulations: By: =� I Original Certificate Date: r s /--7 '�.7 The Mun cipa4,,r,,e Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. - - 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory _ Well Flow Advisory Other COSAWUeshe t £ :., c If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Sampson Est. Block 1, Lot 4 Parcel ID: 051-822-22 A. WELL -DATA Well type Private . If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 9/21/1984 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 201 ft. Cased to 201 ft. Casing height (above ground) 12f in. FROM WELL LOG AT INSPECTION Date of test 9/21/1984 3/11/2015 Static water level 35 ft, 164 ft Well production 12 g.p.m. 4.0+ g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 2.92 mg/L .Arsenic ND ug/L Date of sample: 6/29/2015 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5/16/2015 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping New Pumper N/A C. ABSORPTION FIELD DATA 5/19/2015 2 2 0.45 GPD/SF Dee Trench Date installed Soil rating (g.p.d./ft or ft /bdrm) System type p Length 84 ft. Width 2 5 ft... Gravel below pipe 8 ft. Total depth 13.1 ft Eff absorption area1,344Monitoring tube Depression over field Date of adequacy test New Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test New in. Water added New gal. New depth New in Elapsed Time: New min.: Final fluid depth New in. Absorption rate >= 600+ g.p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum Size in gallons 'Pump off" level at in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot- 100+ Public sewer main 75+ Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout- 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation, 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOTTO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parkingtvehicle storage 0+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION. I certify that I have determined through field inspections and review of Municipal records that the above. systems are in conformance with -MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 7/13/2015 COSA canary sheet 2-5-15.doc - LOT 4 BLOCK 1 NOTE: Dimensions are measured to the wood trim. TRACT A I hereby certify that an accurate survey of the following described property: 13F �� A'to SAMPSON EBLOCK ESTATES (84-10) .'q.,,...,.,, iTH was made on August 5, 2015 :•Ic / and that the improvements ,,,�,,,;,,,I situated thereon are within the property lines and do not overlap or ncroach on the property lying adjacent thereto, that no m Kwobelnikoff improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, No. 3143-S : transmission lines or other visible easements on said property except ll�Iy� as indicated hereon. Easements other than those shown on the �►� record plat may not appear on this drawing. Anchorage Alaska, this 12th day of August 2015. G.i N uFl W W _ _0 Dg TK Tele. Pedestal N�2 36,25 0 / TV Pedestal R�680.00 rtt. Asphalt ® Drive I 0 Well ordetve 215 SCALE 1 " = 30' Covered Wood 16.3? 6.0+ Cantilever Deck & Steps 0' 15' 30' 60' 6•T ?� �, 6. 21+ 2 Wood Steps N N" 3.0 14 3' a.0 .2 . Ct 41+ CL Poa Wood Shed n P N r q No Foundation 12.2 `� 41 15.2 135 �, Open Sided Wood Shed 13.5+Deck o 43 No Foundation 93' 0 W Dante s £ '� 2 Plastic Sided "A" 13•x' CC Pad oo Frame Structure No Foundation ® p g.2 9D O Clean (Typ') Out LOT 5 2—Level Wood � o Wood Shed 10.1 Frame Residence o, No Foundation on Concrete Block Foundation cn z 0, .P w J .p ca LOT 3 v; 0 irn 4 LOT 4 BLOCK 1 NOTE: Dimensions are measured to the wood trim. TRACT A I hereby certify that an accurate survey of the following described property: 13F �� A'to SAMPSON EBLOCK ESTATES (84-10) .'q.,,...,.,, iTH was made on August 5, 2015 :•Ic / and that the improvements ,,,�,,,;,,,I situated thereon are within the property lines and do not overlap or ncroach on the property lying adjacent thereto, that no m Kwobelnikoff improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, No. 3143-S : transmission lines or other visible easements on said property except ll�Iy� as indicated hereon. Easements other than those shown on the �►� record plat may not appear on this drawing. Anchorage Alaska, this 12th day of August 2015. G.i N uFl W W MUNICIPALITY OF ANCHORAGE�� • u 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 Q Parcel I.D. # ��l /��Z�� HAA # ."%y11Q 1. GENERAL INFORMATION Complete legal description Lot 4; Block 1; Samp.bon Eztate3 Location (site address or directions) Property owner Wayne AwztAong Day phone 277-2439 Mailing address P U Box 770448 Eagle Raven, Alaska 99577 Lending agency Day phone Mailing address Agent A AA Day phone _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 '- 3. TYPE OF WATER SUPPLY: Individual well XX 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 XX 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) 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Phone _ S & S ENGINEERING 17034 Eagle River Loop Road No 204 Eagle River, Alaska 99577 rF� Engineer's signature Date 6. DHHS SIGNATURE Approved for 2Zae__i)bedrooms. Disapproved. Conditional approval for Additional Comments 411TIC .a c �^a�.� rsoRa nen �q.:rt^�a�euaA ' /�e0h� ,ea',e'�j Jam• -y bedrooms, with the following stipulations: Date�1; -Z,z T — — 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 N21 Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lb f A. WELL DATA H Well type '?\9-%QP-� If A, B, or C, attach ADEC letter. ADEC water system number Logpresent&N) Date completed �1'L\' �4 Driller Total depth %k Cased to Zn , Casing height Sanitary seal &N) Date of test Static water level Well flow Pump level Wires properly protectedp'N) FROM WELL LOG tZ.O C-,$ 'Ir g.p.m. LD, SEPARATION, DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main 1Jc- Sewer service line ZS -; On adjacent lots oak ; On adjacent lots O ``� `} Public sewer manhole/cleanout Al Petroleum tank 2`5 1 k WATER SAMPLE RESULTS: ry�n Coliform d G`LI1 (0� MA Nitrate �� t` x• Other bacteria ►"c' rA ii, Date of sample: 2 t Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed \— \t> -S-A Tank size \ ooCR Compartments Es CleanoutsP/N) 4 Foundation cleanout&N) Depression (YO I High water alarm (Y/Op Alarm tested (Y/N) '3 11" Date of pumping LP `c1 Pumper fZ- . ( sS Paa L -- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wei I(s) on lot \ On adjacent lots \ To property line �'e tAbsorption field �1 t k Surface water/drainage \bc�> 1 Foundation Water main/service line 72-026 (Rev. gist) Front - CONTINUED'ON BACK PAGE m AT INSPECTION o z —re 1'i'4 Z n m O CD Z } S.b ® g P Q0 m M < Z V� ri1 CD ^' Ti � m N O ® Vi 0i -; On adjacent lots oak ; On adjacent lots O ``� `} Public sewer manhole/cleanout Al Petroleum tank 2`5 1 k WATER SAMPLE RESULTS: ry�n Coliform d G`LI1 (0� MA Nitrate �� t` x• Other bacteria ►"c' rA ii, Date of sample: 2 t Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed \— \t> -S-A Tank size \ ooCR Compartments Es CleanoutsP/N) 4 Foundation cleanout&N) Depression (YO I High water alarm (Y/Op Alarm tested (Y/N) '3 11" Date of pumping LP `c1 Pumper fZ- . ( sS Paa L -- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wei I(s) on lot \ On adjacent lots \ To property line �'e tAbsorption field �1 t k Surface water/drainage \bc�> 1 Foundation Water main/service line 72-026 (Rev. gist) Front - CONTINUED'ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical "Pump on" level at Manufacturer Manhole/Access (Y/N) off" level at Cycles tested SEPARArT-rC N DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed \– iC) - Soil rating 'L " �Aa-- System type TR rc rlLi� Length LLet Width Gravel thickness 42,1 Total absorption area \ W Cleanouts present O/N) Depression over field (Yo Total depth 1 ) Date of adequacy test es – A7Z Results (a )/fail) for ���' L3J bedrooms Peroxide treatment (past 12 months) (Y& nj� 14t4nv Af If yes, give date —I —�-- SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot � �-Z,1 On adjacent lots � c, r--> Property line To building foundation On adjacent lots I;S�0- Cutbank To existing or abandoned system on lot �Pc Water main/service line 1 psi Surface water 10 k+_ Driveway, parking/vehicle storage area �2 Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING Signature Eagle River, Alaska 99577 Engineer's Name Date HAA Fee $ ��� Waiver Fee: $ Date of Payment 02 �Z/ Date of Payment Receipt Number eZ.7J *-?o Receipt Number 72-026 (Rev. 3/91) Back MOA 21 LAE IPfSTRU'CIIONS for WORKorder # 5-1277 Gate Report Printed: FEB "0 9- a 1:3:54 ij*•a,-a: Rei . :920660 sr'w • nr c� :51277 :rEE .0 Y.. �: 14.30hrs. Receive,- :FEB 14 92 C, 14:54 hrs, Frcrisea :FEB 21 92 4nalvsis Comaleted : 2- 1•-1-5 -L L�bcratc•ry Sucervisor :STEPhEh C. EDE Releaseo Ii'J : ,,,µ• Client Sampie ID: LOT4 ELI SMMPSON EST. -Bary) e POCINE SHM`FLE LLKTrp Rt: Rai ken;ri; s : Client Flame :5 & 5 ENGINEERING Ordered By :F" SHAFER Preserved with :AS REQUIRED PVJ5ID :UA MATRIX: WATER emtab Extraction Analysis Analyst mple# Test -Parameter Methnd Units i;ssuit Date Gate 3i4nature - 80153-NITPATE-N - - - - - - -El"A 35 --iTiC-j _---- -^ 57-- -2-1 C1. d of Sample# 3 Lab Instructions on WOP.f:order# 51277 1 Tests for this Sample. MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES] 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # C) '�) i -� D �)- a _ HAA # 0A 4)9 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4• Block 1• Sampson Estates Location (address or directions) Goliath Drive (b) Property owner Berry , Q'NN c-,tYyl: ,cs Telephone: (home) Business Mailing Address (c) Lending Institution First National Bank Telephone Mailing Address (d) Real Estate Company and Agent Red Carpet/ Greatland Real t)7-- John 21)rler • • • S • . . .r_ink MOS - AF= - -- Telephone (e) Mail the HAA to the following address: (or check her hold for pick up.) List contact person and day phone number below: S & 5 ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family N 3. WATER SUPPLY Individual Well IR Number of bedrooms 3 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 1�d 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 Z �o Z abed Hoeg (901L 'A08) M-ZL 'i{aoM s,aaauibua Ieuoisseload agl ui suolsslwo Ao saoaaa aol apsuodsaa lou si a6eaogouy jo AllledlolunW agl'panssl sl aleolllliao a aaolaq elep Wpaue ao suolloodsul lonpuoo lou op SHH4 do sa@Aoidw3 'sluawaalnbei alels pue leaapal uieliao Alslles olaapio ul suoilnlllsui bulpual alagl pus sawoq to saasegoind of /selinoo a se sigl scop SHHd agl 'uNsely to alelS all ul paialsl5ai aaauibuo leuolssa;oid luepuedapui ue Aq anoge 9 gdea6eaed ul UGAI6 suolleluesaidaa aql uodn Aluo paseq paleol;laao lenoaddV Ajpoglny glleaH sanss! (SHHQ) saolAaaS uewnH pue glleaH to luawlaedaa 96eaogouy;o L(lljedioiunn aql NOIIf1V0 leuoll!pUoO — — z algia eg�okOo 3390 _o% J i'�Vb°IV IMIVI��l.t• VV' J� t lenoaddy leuolllpuo0;o swial panoaddeslQ __x__ panoaddy Aq swooapaq aol panoaddy IVAOdddV SHHQ '9 n � algia LLS66 elselt/'aenla e16e3 ssaappy VNRI33NIVN3 S'8'3 G ?� ouoldalal wall to aweN 'uoiloadsul slll to alep agl uo loalla ul suolleln6ai pue 'saoueulpio 'sapoo alelS pue ledloiunN !le gl!m eouelldwoo UI sl walsAs lesodslp Jap3malseM Jo/pue Alddns aaleM al!s-uo all 'uolloadsul PUB uoile6ils9nui Aw woa; pue sal!l a6eaogouy to Al!ledlolunW all woal pauielgo uoilewaolui aql uo paseq legl AjpGA aaglanl ! 'uiaaaq paleolpui ainlonals to ad (l pue swooapaq {o aagwnu all aol alenbape pua leuollounl 'ales sl walsAs lesodslp jalumalseM ao/pue Alddns jalem alis-uo all legl snnogs lenoiddy Al!aoglny llleaH slgl to uollebllsanul AW lull L(}UaA I 'Molaq UMogs elep uo!lep!IeA all;o se pue olaaaq paxllle leas Aw Aq pag piao sy NOIIVWtIOdNI ONV VIVO `HOIAV3S 3l1d `SIS3I `SNOII03dSNl JNIOIAOHd Mild ONIH33NION3 '9 MUNICIPALITY OF ANCHORAGE (MOA) �fi� • +� Health Authority Approval (HAA) i CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: L-m� A Pe-� A. WELL DATA Well Classification 171If A, B, C, D.E.C. Approved (Y/N) tJ Q Well Log Present®/N) Date Completed Z� 8!q-- Yield -2-6d?__1 Total Depthl,0� Cased to tel— Depth of Grouting �— f Static Water Level Pump Set At Casing Height Above Ground 12, Sanitary Seal on CasingCMN) — Electrical Wiring in Conduit/N) Depression Around Wellhead (Y,(19)) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot \ 03� ; On Adjoining Lots 1t I I To Nearest Edge of Absorption Field on Lot UZ ; On Adjoining Lots L �� To Nearest Public Sewer Line '� To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by S (r� vis ; Dante Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed1—�)-&!tSize l E=3t�_No. of Compartments -21 Standpipes (DN) V Air -tight Capso/N) Foundation Cleanout (11N) Depression over Tank (YtV t!!4 Date Last Pumped k �4-,-r - )M- I Pumping/Maintenance Contact on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) N Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation I, To Property Line To Water Main/Service Line To Disposal Field 1_ To Stream, Pond, Lake or Major Drainage Course t �' Comments ���' c-� oV -k�?J�Pt �? 72-026 (Rev. 7/88) Front Page 1. of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /�� Type of System Design \ Date Installed " \ o epot- Length of Field �� I Width of Field Z Depth of Field \2- / Gravel Bed Thickness t Square Feet of Absortion Area a!ql ""-I' Statndpipes Present CON) Depression over Field (Y/6 N Date of Last Adequacy Test \ ~y� - tin Results of Last Adequacy Test -�Z4— SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 1 \ 2.- To Property Line To Building Foundation �Z Lot �/ ; On Adjoining Lots To Existing or Abandoned System on 1'a�) A - To Water Main/Service Line \ C> -tr To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION (� e Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments a Dimensions Manhole/Access (Y/N) "Pump Off' Level at t (Y/N) "Check Permitted Bedroom Rating Against HAA Request" 0lb Pumphrg-Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effea'6jte of this inspection,;,=j ak Signed5 - Company 17034 Eagle River Loop Road No. 204 fer GJ o ��e ' Date eagle River, 3� 8/ .e °` Yae nooeine �Pj al e._ MOA No. C� A. 3n•v: �; r ... pry.F :z.. %`'gnu nm'`:(�•.% Receipt No. -56 7 r (0'5 O 9 Receipt No. Date of Payment Amount: $ %O Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 CHEMICAL " 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 LABORPTORIES -Ai.cl ;)6 3211; a') 1.1,:30 hl, R. cei wId JAN 24 S9 A:n(J IJI.p3aW.'@q -11iih !6 nF,(;. C 'a' i,11 j- I e, , . Q Q t 1 .1 1:b EPORT Si V T!�E W�,� I (l-, ,),ite Rapyy Njflie4: JID! 26 �"9 "! 15:41, ('11911( N I, I C: : & ') E ,)i:bxtld By : RM hn Iy oiflpi c 'to d J, All k6 Y9 T T a at of I t LI e I. va Ir. EDC ins! iuo: I - lid) Ref 4 0 5 "1 eal) -)1111)1 If}: pirl1,Unote: 10Stedl Louis i T R A; � F, - I i 0 . 2, .1 (,'Oj,J,ECrj FeD bi Rj.". Iflpcli;! Inst t kbo` a fable ND= SA-! GT MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH a. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 2 (a) Legal Descrip� on (include lot, block, subdivision, section, township, range) �C?f'„,. Location (address 9,r dir etions) (b) Applicants Name � ,p/�,�ci . �U Teed/e hone Home Business Applicants Address GL?_✓�� T G �� ; ell, Q (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer ; Other (explain); 41 �r� J (d) Lending Institution L'We lir uli>f�/q.,rr mZf� /1� Telephone_ Ad ,ss 113,22 (e) Real Estate Co. & Agent Address Telephone (f) Mail the FAA to the following address: �rfi j kms) i` �d•Ii V 2. Type of Residence Single—Family Multi—Family Number of Bedrooms '3 - 3. Water Supply Individual Well Community Other (describe) 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 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] 5. ExagiReerin$ Firm Providing Inspections, Tests, File Search, Data and ingormation As certified by my seal affixed hereto and as of the validation date shoran below, I verify that my investigation of this Health Authority Approval shows haat 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 ow -site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula— tions in effect on the date of this inspection. Name of Firm X�%✓�iiy_ ^� Telephone 7L- Addres Date %0 :%'% fE b. DEEP Approval Approved for Approved Terms of Co itional (ENGINEER SEAL) �('oo`o o`�w-�'`�o/`•�.. /a.00bo Cool> : �o.0000a000.o..oc: James R. Kinney CE .. 6036 bedrooms By �i ate d `� Disapproved Conditional ®� Approval - W_ Tliw pproval THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT— ATIONS 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 REQUIRE— MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: MUNICIPALITY OF ANICHORAG DEPT. OF HEALTH i & ENVIRONMENTAL Pzci=CTION J AN 10 1985. Well Classification A, B, or C, D.E.C. Approved(Y/N) Well Log Present Y ) /q,4 c4,,/ Date Coupleted geZJ-8K Yield. Total Depth zp/ Cased to 261 Depth of Grouting Static Water Level 35ihe ) Purr Set At /%�. • Casing Height Above Ground . Z _Sanitary Seal on Casing &_)L/ Electrical Wiring in Conduit o /N) Depression Around tbllhead (Y ( Separation Distances from Well: To Septic/Holding Tank on Lot /0,3 r On Adjoining Lots To Nearest Edge of Absorption Field on Lot //Z /; On Adjoining Lots > 1&) To Nearest Public Sewer Line &� To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot A,11 Water Sample Collected By %sih ; Date-���' S �� Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size / No. of Ccapartments Z. Standpipes /N) Air -tight Caps Y ) Foundation Cleanout (YIN) Depression over Tank (Y ,../ Date Last Pumped NPS Pumping/Maintenance Contract on File (Y ) /�� - for Holding Tank High -Water Alarm (Y/N) /1f Temporary Holdirg Tank Permit (Y/N) !n/ Separation Distances f=an Septic/Holding Tank: To Water -Supply rAbll /00 To Building Foundation To Property Line 50 To Disposal Field i To Water Mair/Service Lire To Stream, Pond, Lake, c;r Major Drainage Course Comments Receipt # ad Date Paid:-- Amount: aid•. - c, Amount: (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 3 Type of System Design loee> A,461 Date Installed Cf -Z/ Length of Field /�'�� y' 17� Width of Field z jeft4- Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 17 Standpipes Present s /N) Depression over Field (Y/N) /V Date of Last Adequacy Test NPS Results of Last Adequacy 'lest N/ Separation Distance from Absorption Field: To Water -Supply X11 //Z Iq To Property Line �i/rarf/ To Building Foundation �z To Existing or Abandoned System on Lot Cr. Adjoining Lots To Water Main/Service Line N1Q- To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course /,///q To Driveway, Parking Area, or Vehicle Storage Area %0! Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Tested for Electrical Codes(YM) Comments Vent- (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or confcrmed to all MOA HAA Guidelines in effect on the date of this ins:Zte Signed gam,,, e Date J� elf Company / QJe L"±nje %n5 MOA No. Srb1/-+VU KB1/d5/s (Page 2 of 21 or RSA 00 .. ossa 000e v�s�srr- ° ` �.. ......-...��ae.... f. James R. Kinney CE - 6036 'NIP i... ,ais 2-15-84