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HomeMy WebLinkAboutSAMPSON ESTATES BLK 1 LT 8mQ%oo"lA & a ZI r� �' os� -Baa-a� MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://wvAv.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241252 Work Type: SepticTank Upgrade Tax Code Number: 05182226000 Site Legal Address: SAMPSON ESTATES BLK 1 LT 8 G:1560 Site Mailing Address: 23844 GOLIATH DR, Chugiak Owner: WESTERMAN DAVID J & LISA A Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 8/14/2024 8/14/2025 40256 ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: ( S .S " Ctn Date: _ r I 2 �2- � Issued By: `�, L Date: 4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone. 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 05182226000 Property owner(s) WESTERMAN Mailing address Site address 23844 GOLIATH DR Day phone Legal description (Sub'd., Block & Lot) SAMPSON ESTATES BLIK 1 LT 8 Legal description (Township, Range & Section) Lot Size 40,256 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field Fj Initial El Single Family (SF) El (w/wo, ADU) Septic Tank 0 Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage El THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: NONE Distance: NA I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: � L'- o Waiver Fees: Date of Payment: Receipt Number: 0p Permit No. '� Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client FormsTermit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System for Sampson Estates Block 1 Lot 8 Dear Reviewer, The above referenced property is currently served by an older septic system with a leaking tank that needs to be replaced. The tank is collapsing and requires prompt replacement. Our review of available documentation and field investigation show that this project will not adversely impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. As shown on the plan, the tank will be greater than 10’ from the house foundation. The tank will be of MOA approved construction. The tank must be covered with a minimum of 2” moa approved insulation and 3’ of cover or a minimum of 4’ of cover without insulation. The repair must be performed by a moa certified installer in accordance with MOA requirements. If groundwater is encountered during excavation of the tank hole, an alternate tank type may be required. Repair of the proposed system will not negatively impact adjacent lots. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leach field, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 8/12/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241252, Curtis Townsend, 08/14/24 CHARLES G BALZARINI CE-13854REG IST EREDPROFE S S I O N A L E N GINEER 6/23/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241252, Curtis Townsend, 08/14/24 Municipality of Anchorage Page of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW 0 2 0 3 tel- PID Number: 05 t " & ZZ " ZIP Name:c `(ft.` G 3 D rca 6 i o L.. Wastewater System: 0 New XUpgrade Address: P.(9(3 0,K 6705'cl0 cyue.rak II ABSORPTION FIELD Phone: k9$$-s 5 -4 0 Ar No. of Bed ooms: ❑ Deep Trench O Shallow Trench K Bed []Mound O Other LEGAL DESCRIPTION Soil Rating:urOGPD/Sq Ft. Total Depth from original grade: Lot: Block: A . S A s Subdivision: g i �i�(.�Z Depth to pipe bottom from original Gravel depth beneath pipe /�A �oFt. (�,J MQS ,rade: Fl ,J Township: Range: Section: Fill added above original grade:® Gravel length: —75–Ft. Ft. 0 New 0 Upgrade Gravel width: O Numb oliines: DstanabelwFeglinFt. if Ft. Ft. Classi(icati n (Priya .C): Total Depth: Exr Cased To: Total absorption area:? }y�,q� Pi material: Ft. Fl. `56SO.Ft. I i 70 x+10 Driller. Oate Drilled: Static Water Level: Installer4 W Date installed: /'1 •1`--7_D / Pt-; Ft. ner Yield: Pump Set at: Casing - t Atwve Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding O S.T.E.P. To Septic Absorption Lilt Holding Publiemrivate Manuf tu�r: t Capacity in gallons: G` From Tank Field Station Tank Sewer Lines n Well O 116% 4Z% Material: Number of Compartments: +Surface LIFT STATION Water Lot (�j 1 ri �s Size In gallons: Manufac Line I „(. Foundation as t VVV "Pump on" level at: "Pump off level a . High water alarm at: Curtain bV1 Pump Make 6 Model Electrical Inspections performed by: Drain e Remarks: BENCH MARK Location and Description: . t br'►'1 o S 001/77 D Assumed Elevation: DO Ft E *` S & S ENGINEERING t Inspections performed by: 17034 Eagle River Loop Road, i>`Fat1s Eagle River, Alaska 99577 m-0at 2nd- g -'� I5 Ar„ � ROBERT G COWAN CE-8801 Department of Health and Human Services approval +%�'� •.. • ���`'�= Reviewed and approved by: Date: 72-015 (Rev. 9/91) MOA 25 PERMIT NO. SW020347 PAGE 3 OF 3 municipalityof Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Tewl�ephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 8, BLOCK 1, SAMPSON ESTATES S/D P.I.D. NO. 051-822-26 FINAL GRADE C01 =94.0' CO2=94.0' C01 MT1 CO3 CO2 MT2 C04 MT1=93.4' MT2=93.3' NO WATER FOUND 83.3' B.O.H. CO3=98.6' C04=99.1' ORIGINAL GRADE CO3=94.0' C04=94.0' SCALE-N.T.S. F__A___f B C FCO 8.5 30.5 - ST1 25.0 39.5 - ST2 3 3. 0 45.0 - DBL1 37.5 49.0 - DBL2 38.5 50.5 - DV 40.0 51.5 - 001 66.0 - 1 97.0 CO2 110-0' - 93.0 CO3 69.0 - 100.0 C04 11 1.0 - 96.5 MTI 68.5 - 97.0 MT2 108.0 - 94.0 CO3=98.6' C04=99.1' ORIGINAL GRADE CO3=94.0' C04=94.0' SCALE-N.T.S. PERMIT NO. SW020347 PACE 2 OF 3 Municipalityof Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 *Anchorage, Alaska 99519-6650 • Tegl'ephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 8, BLOCK 1, SAMPSON ESTATES S/D 00, GOLIATH DRIVE 0 T2 rW 100' WELL RADIUS . (APPROX. LOCATION) 5 10� �TELECOM. TBM P.T.D. NO. 051-822-26 Jo a/ti EXISTING 4 14 USE M / DV (DIVERTER VALVE)JI I EXISTING 1250 GALLON DBL1 & DBL2 SEPTIC TANK (VERIFIED 9/27/02) ,---. 7 TOP_ OF SLOPE I f SE4 EP PR,MPttl/ PEN -TION �ROX. COC% / �EPEA SCALE:1'-40' i' C2 4t1 y 7� ROBERT C. COWANt ��c�fr�� CE -8801 �+ A �� F, j,) , .............�� Depth 2- o 3- 4- �.O 5- 0' ' --O 6- 7- 10- 11- '12- 13- 14- is- is- 17 - 18 -1 - 710- 11- 12- 13- 1415- 1s- 17 - 1E 19- 20- CO."l."IEws (C)Ct Q --N I'GS WAS GP.OUNDv1ATER Municipality of Anchorage ENCCU:1T_ �0T Development Services Department -w Building Safety Di%is;cn O Yc On -Site Water and Wastewater Program Depth toWater After 4700 South Bragaw SL Monitoring? P.O. Box 126650 Anchorage. AK 99512 6650 Date: www.d.anchcra(:e,ak.us (907) 343.7 -ON Soils Log - Percolation Test Performed For: Legaf Description: ^^ / ne rtee Depth 2- o 3- 4- �.O 5- 0' ' --O 6- 7- 10- 11- '12- 13- 14- is- is- 17 - 18 -1 - 710- 11- 12- 13- 1415- 1s- 17 - 1E 19- 20- CO."l."IEws (C)Ct Q --N I'GS WAS GP.OUNDv1ATER ENCCU:1T_ �0T -w $ IFYES,ATWF'ATDEPTW L Depth toWater After P Monitoring? E Date: _r4 4:�Z, GO 0. yo ROBERT C. COWAN )ecr•��• CE -6801 7,4rJ tilt i%` '`••......_ 'rL���> Date Performed: vz rcrc;,t n..arrur�rnr_.-rex Im. wesrcil Y -RC HQLE DI: IETER TEST P.UNEETNEEN *j F7 611D�_FI` PERFORMAED BY: —j �rJC�(til( fz(l�(,- I CERTIFY THAT THIS TEST RYAS PERFOR2AED IN ACCO DANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ri'/A) /o Z EN r rcrc;,t n..arrur�rnr_.-rex Im. wesrcil Y -RC HQLE DI: IETER TEST P.UNEETNEEN *j F7 611D�_FI` PERFORMAED BY: —j �rJC�(til( fz(l�(,- I CERTIFY THAT THIS TEST RYAS PERFOR2AED IN ACCO DANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ri'/A) /o Z MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW020347 Legal Description: SAMPSON ESTATES BLK 1 LT 8 Design Engineer: 0003 S & S Engineering Owner Name: Signe To[ Owner Address: PO BOX 670590 CHUGIAK , AK 99567-0590 q/'z-T q: jopM o-wtta4 Sal/ Date Issued: Sep 16, 2002 Expiration Date: Sep 16, 2003 Parcel ID: 051-822-26 Site Address: 023844 GOLIATH DR Lot Size: 40256 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ 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 calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: 5118-/a z Date: G O 2 motticipatity of Aiiciidiragc • beVelophieht gelivicbs bepel-tmeht building Safety Division , On -Site Water and Waste%kater Program 4700 South 6ragaw St. P.O. box 196650 Anchorage, AK 99519-6650 www.cl.anchotage.ek.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.b. ��% —go?a —02(4:3 Permit Number SW 020347 Property owner(s) 51 G tJ F 7 O Day phone Un - S Z 0 Mailing address (1) P, o �o a 5_`1 U Mailing address (2) C VkA. 01 ADZ .. PO4 Zip Code '�'t 95 Legal description (Lot,13lock & Sub'd.) or `b S A rep rzyiL C.s�4� LS Legal description (Section, Township & Range) Lot Size_ o , 2 5 _4tc+ _S_ .Pt. Number of Bedrooms THIS AOPLICATION IS I=OR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ' THIS PROPERTY CONTAINS: Not Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 1 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) Permit Fees: Waiver Fees: bate of Payment: `1 /it r lO Z Receipt Number: 0 3 S Y (� 0 (Rev. 12/00) Date of Payment: Receipt Number: S & S ENGINEERING Eagle River, Alaska 99577 S&S ROBERT C. COWAN, P.E. CML ENGINEERS NineepunG ALASKA (907) 694-2979 7 FAX(907)694-1211 September 3, 2002 HEALTHAUTHORITr APPRwALS MUNICIPALITY OF ANCHORAGE Development Services Department SEWER EXTENSIONS MAIN EXTENSIONS P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 8, Block 1, Sampson Estates Subdivision SEWER & WATER INSPECTION It is requested that you issue a permit to upgrade a septic system to serve the existing four bedroom dwelling on the referenced property. ENGINEERINGSTIAIES ANDREPORTS One test hole was excavated and a percolation test was performed on 8/7/02. The approximate location of the test hole is located on the attached site plan. At the time of excavation ground water was not encountered, and after monitoring the test hole for seven WELL INSPECTION &FLOWTEST days the test hole was found to be dry, as shown on the attached soils logs. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve SITEPLANS areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. ROADDESIGN If you require additional information, please contact us. Sincerely, SOVEST Robert C. Cowan, P.E. PERCOLATION TEST RCC/jhm Enclosure STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 DESIGN CRITERIA: 4 BDRM = 600 GPD SOILS = 0.8 CPD/SO.FT. 600/0.8 = 750 SQ.FT. REQ'D. TRENCH CRITERIA: 9" DEEP 6' EFFECTIVE 2.5' WIDE b3.r 'LONC i 100, (If47 w 44 A COC,gr1l �V)& 23 7 �s x AR oklc LIP" rring STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS -BUILT SURVEY DRAWN BY: WILLIAM D. FLEMING IT IS THE RESPONSIBILTY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. 17034 EACLE RIVER LOOP ROAD EAGLE RIVER, ALASKA 99577LOT 8, PHONE# (907)694-2979 )AAWN BY: FAX# (907)694-1211 J.H.M. V -T11• rcc EC4� EXISTINC 1250 CALLON TANK GOLIATH Dit►v r, • 10' ELEC. k TELECOM - WITH A 1300 GALLON HDPE.--- SEPjIC 7PNK.�----� 10, r ��}•`. I x x N � N N4 I1 X` — 1M V 10 EXISTINC TRENCH In e`9 \ INSTALL" DNERTER ^� . ED \ 2 VALVE 0: CH \\ 4' \A< INSTALL DOUBLE EXISTING W \\ CLEANOUT b c0 10' lm -T \\ o µOUSE o 46' 17034 EACLE RIVER LOOP ROAD EAGLE RIVER, ALASKA 99577LOT 8, PHONE# (907)694-2979 )AAWN BY: FAX# (907)694-1211 J.H.M. V -T11• rcc EC4� EXISTINC 1250 CALLON TANK 1, SAMPSON ESTATES BY: °AIL: SHLLI: R.C.C. 9-4-02 1 01 CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. ALL PORTIONS OF SYSTEM WITH LESS THAN 3.5' OF COVER REQUIRE INSULATION. i 1- = 50' �SEpT A ARE rtEl L p ZoA �.ov-- OF. Ai r%,kx ol +f R06ERT C. COWAN /eft GE -8801 (TO BE PUMPED. CRUSHED k ABANDONED - AND REPLACED - -TOPOF ,j — $LOPE WITH A 1300 GALLON HDPE.--- SEPjIC 7PNK.�----� r I x x N � N N4 I1 1 — 1, SAMPSON ESTATES BY: °AIL: SHLLI: R.C.C. 9-4-02 1 01 CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. ALL PORTIONS OF SYSTEM WITH LESS THAN 3.5' OF COVER REQUIRE INSULATION. i 1- = 50' �SEpT A ARE rtEl L p ZoA �.ov-- OF. Ai r%,kx ol +f R06ERT C. COWAN /eft GE -8801 DESIGN CRITERIA: 4 BDRM = 600 CPD SOILS = 0.8 GPD/SO.FT. 600/0.8 = 750 SO.FT. REO'D. TRENCH CRITERIA: 9" DEEP 6' EFFECTIVE 2.5' WIDE LONG STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS—BUILT SURVEY DRAWN BY: `YILLIAM D. FLEMING IT IS THE RESPONSIBILTY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. PROPOSED TRENCH Pring CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. ALL PORTIONS OF SYSTEM WITH LESS THAN 3.5' OF CO//VEER REQUIRE INSULATION. KGOLIATIJ DRIVE T. 10ELEC. & TELECOM. ESM. _ EXISTING TRENCH U) INSTALL o DIVERTER Q VALVE 1 INSTALL DOUBLE ISTING co MT `\V . CLEANOUT 4 BEDRpOM 10'no HpUSE r 0 ,46' 1 O 1-4 1 22 '-EXISTING 1250 GALLON TANK (TO BE PUMPED, CRUSHED ' & ABANDONED - AND REPLACED TOP WITH A 1300 GALLON HDPE,, --- - _ _ SOF SLOPE SEPTIC-ZANK� M CIS! Ln Ln c%4 Ln Lo ll�v ... a 17034 EAGLE RIVER LOOP ROAD EAGLE RIVER. ALASKA 99577 LOT 8, BLOCK 1, SAMPSON ESTATES S D PHONE# (907)694-2979 )ro*N by; FHLCKLD BY: JAIL: SHLLI: SCALL.FAX# (907)694-1211 J.H.M. R.C.C. 9-4-02 2 OF 2 1 1` _ I IERT C COWAN /e CE - 8801 L'. Performed For: Legal Description: LO'r [Depth eel) 0a-(o-A-;jIt9 1- v ENCOUNTERED? 2- s 3-' •4,.0 0 Depth to Water Alter 4- Monitoring7 Imo./ 7 E 5_ o 6- -7-8-9- 7- 8- 9- .1 0 10- 111 12- 0! 13- �0 14-�0 15- 16- °••� 17- 18- 19- COMMENTS PERFORMED BY: PERFORMED IN/ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99519.6650 www.cl.anchorage.ak.us (907) 343-7904 Soils Log - Percolation Test 'O I✓ • 9 1: tr Pso J WAS GROUND WATER ` /O ENCOUNTERED? /�/ s IF YES. AT WRAT DEPTN7 0 Depth to Water Alter p Monitoring7 Imo./ 7 E Date: S M, �� ,O F ROBERT C COWAN 1 Q f CE 8801 Date Performed: 5T rian F— PERCOLATION RATE a j . (f (minutesMch) PERC HOLE DIAMETER TEST RUN BETWEEN �'�--i5� -FT AND c FT WITH ALLSTATE AND MUNICIPAL UIDELW� I'—' - ` T ON THIS DATE. HAT THIS T ESJ S�tPO =— rox./ m, • �LIY�YO�� PERCOLATION RATE a j . (f (minutesMch) PERC HOLE DIAMETER TEST RUN BETWEEN �'�--i5� -FT AND c FT WITH ALLSTATE AND MUNICIPAL UIDELW� I'—' - ` T ON THIS DATE. HAT THIS T ESJ S�tPO =— S& tnGineeRrnG ROBERT C. COWAN, P.E. CPALENGINEERS (907) 694-2979 FAX(907)694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM KALTHMA HOrM GALS CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS SEWER & WATER LWN EXTENSIONS REFERENCE: Lot 8, Block 1, Sampson Estates S/D September 3, 2002 SEWER6 WATER MPECTICN GENERAL: - 1. The scope of this project includes the installation of a 1300 gallon HDPE ENGINEERING STUDIES septic tank and a new trench to serve the existing four bedroom residence ANDREPORTS located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design WELL INSPECTION drawings, Municipal permit with any special provisions or conditions, and all a PLOWTEST applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground SITE PLANS utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. ROAD DESIGN 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing SCILTEST their own systems must also receive prior approval from the Municipal Health Department. PERCOLATION SEPTIC TANK INSTALLATION: TEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. STRUCTURALS Construction shall include two 4" cleanouts for pumping access. MECHANICAL INSPECTIONS 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER• ALASKA 99577 Page 2 Lot 8, Block 1, Sampson Estates SID September 3, 2002 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCII/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. 6. A subsurface disposal field may not be located on a slope greater than 25 percent unless there is an approved exception documented. Page 3 Lot 8, Block 1, Sampson Estates SID September 3, 2002 MINIAIUAI MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 8, Block 1, Sampson Estates SID September 3, 2002 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE p 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 Z_ � �. PHONE NEW ❑UPGRADE /(/" MAILING DRESyS� rFFF/-----», 7-7/3-62 o 2!0J -7 LEG61 DESCRIPTION IO%� J `^'�) 'W J �7 LOCATION V NO. OF BEDROOMS O DISTANCE TO: W� J T AbsorptiogaEa f Dwelling, / G PER _ T ,.7 C/ / 7 Y P Q W F Manufacturer ,�pp / �' No. of com tments N Liq. a acity in gallons IF HOMEMADE: Inside length Width _ LicImd da❑ b i ,�;� Ce DISTANCE TO: Well 1 Dwell' 17 PERMIT NO. Jaz O z h Manufacturer Material Liquid capacity in gallons Well Foundation % Nearest I ine j76 PER T = DISTANCE TO: f zNo. of lines Length o m q Total len inq Trench idth /r Distance b ee lines LU F w inch— Top of tile to finish grade / �— Material beneath tile // Total effec e sorp ' area inches p Length Width Depth PERMIT NO. w C7 Q h Type of crib Crib diameter // epth Total effective absorption area a a LU G' Lu Well , . Building foundation Nearest lot line DISTANCE TO: Class - Depth rifler � , fl - v Distance to lot line PERN}}T( �. .j /� L ll Lu Buildin oundation Se r line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS SOI L TEST RAT G INSTALLER t C REMARKS C Q sq � ,cNY`• g p $ � a�c•E COE.9C*T rt H •s Ibborf A. Shafer a i • O. o - •O e. ms•"e L APPROVED7' gE f•� p - DATE LEG��� {' S?G� �P.'de 9u��5 J-0 N 00 OD O z CIO �4 s4 6 u): w LL. w W fx. < U. 0: V: z om WMA > 0 iz-A CC 4� LLI cn Lij X 0 co w u LF r. LL a3 ux 9102 d WIN9NNOM.N3 4-? r - 0, z CIO �4 s4 6 u): w LL. w w fx. � U. 0: V: 4J 0 0 4J: 4� 4J U): LF r. a3 ux 9102 d WIN9NNOM.N3 4-? r - fO HAV3H �O '103 4P 3f)A*HON-.V Ao,: AliWdlDlNnw. . . . . . G2 O 0 0 0 0 . 0 O . 0 . r; 44. CD t i 4-i w uw u,w ui (D:; C4 0.1 W N;0: -r ci fLi C\J:: --i p OD: cn: cq U z LO 6 Fa C4 z CIO s4 u): w LL. w w fx. � U. V: 4J 0 0 4J: U): LF r. 9102 d WIN9NNOM.N3 W: r - fO HAV3H �O '103 3f)A*HON-.V Ao,: AliWdlDlNnw. . . . . . G2 O 0 0 0 0 . 0 . 0 . 0 . . . . u): w uw u,w fLi C\J:: --i p OD: cn: cq co: .-1 Ln: fl rO s4 M: 4-J: 61 61; o cx w -:I Cz o a4: z 0 r, LQ fu* Z O V) Q 0 �4: V) LQ Ul Q U): W C4 -I w LLJ Z iw; z CIO s4 w LL. w w fx. � U. 4J 0 0 LF r. 9102 d WIN9NNOM.N3 fO HAV3H �O '103 3f)A*HON-.V Ao,: AliWdlDlNnw. . . . . . G2 O 0 0 0 0 . 0 . 0 . 0 . . . . w uw u,w z CIO s4 4J ci d, ci N: fl rO s4 M: 0 r, fu* 1 0 (0: Q 0 �4: Ul Q U): -a Ul of W. LL. Lu Ll. 0 n Ln: r-: m 1� co M 0 0 O 0 0 0 L•. uw CFU. cn: Lo: cci 1—'. N (\I N o) 0 0 0 0 0 o 0 0 w C4 � c a a w ce C4 U- LJ. L. il. L4 Lt. w L" U. Li. z x z CIO irJf'ICIt.ALITY ^F Cir D KP N.,._N 7 F im Al -T' AND A?INC M "iTAL "OTECTION F L .,Ta. -€T, ANCAORAGL, AK 99;01 vii—S ITv ­ERMT NO. 34 ,'5 )ATE ISSUED: :'o 0'7134 APPLICANT: ?0 L LU FK11N Avu?E5 ? , :rX 771`,3% R L= ?1 .,a. A.K 7 CC^i?ACT PH 1)N H:, +2a-61' i _EEli AL JLSC'?IP,-U:.;LTVISI'JNi: Q,A^''SJN }'ST "T S ! v'T°LOCK: 1 CTIO`J: 3 TO JN SH' TP: 15N R'.uF 1'r,' LOT SIZE: eG_`:5 1:,viaFrC?F.S) YAX :Y E D R 0 V iS. 4 LISTED urL n A:;'H T HE 0�Ti0'J5 A'JA,ILlf-,L: TC YOU IN D.S1fiNIN G YOUP SEOTT C 3Y 3 T;_'iX. CHDOS Th'_ 0DT10N T 4 A T ..EST F T T S Y C 0 R IT'=, TP t"iN .DRI`v _ ✓ETH 1rJ PYC �:iIT-�)�� {tT.) f ;Sa n k.t1 GRAVEL DEPTH (FT.). 5 3.5 T G T A L EPT;i (FT.) 1'J.- 4.5 '•5 G R A V L wIDT14 (FT.) '-.5 •� 5• CRAVE_ LE -NTH (FT.) >>,' 4'.0 72. GRAVEL VOLUME (CU.YDS.) 35.,_ Z7,S -5 51, TANK STI (GALS 1,250.0 �* SOIL RATING (S ... T.I':;) 1 > 165 165 kik TA7INK -J 3T H V= rA 1..'_A ST Tii0 L) j' -`P A 'R T`.1 F N Tj I CE?TIFY THA i . 1. Apt FAMI TAR ',n!T!4 Tit ? �UTS FOR 0"1 -SITE S;:' ERS AND ;TELLS AS SET FORTi� ti Y T H _ *.util ,I?A_iTY �F A N C H 0 9 A G {°nNtD THE STAT= OF ALASKA. WILL Z:.v"I ILL THE SYS 7M., '%.41 ACCORDANCE VJIT=H ALL 'I 0A C 0 D E S AND REGULATIONS, A 01 :'i CC 'P_I'hCF. iATTH T't Cu1TS?i OF THIS ° *SIT. T kILL AD-F'E TO ALL 'riCA rtND �T .TS :ALA-3K.A '?FDU'1 ._+'_NTS FOR THE ')'_;:T TACK NCC n N ?' NC in=LL, TASTE ATE+ ! ISP=iSAL SYSTEM, OR. PJPLIC DISTn+�:.,, F:RU A.if �X �T SEW ZRACE SY3T 0`4 TH S LR AN,Y 's,DJAtv',T 0'. ,.v, Y LOT, 4. T UND=RSTAND THAT THIS .P ..'liT Iv VALI> �OR A 'hAXI-'•1U'' OF 4 =39-:DR00'YS AND A:=JY LlL A n.r":::1T sIi'LL 'c:J_R: xN ADD11 ONAL PEyMIT. IF A L : F T T>,TICN IS 1'xST4LL_D „N AN AN_3 C 'V ''ED 'Y F)A ?;iLDING CODES, THi:N, (1) A'N EL>>CTF,ICA.L P_R4llT ANO iNSPECTe",`t MU --T ! C.-TAI�+tEJ, (c) AS--UIL S :JILL NOT ,_ AP?F:lV._�, ; :T-,O'JT A% _L _C "w IC AL. IVSPECTiO^; ?.'DO'aT: AND (u) TH" ELECTRICAL '.JOR,K 1 Li 3T Y .D -------_-�--_-_---s__--_-__ JT Gid_ D*T' �F---�t-- --(-_ APPLTCAiT: FiF__L LUFKI"i Gj` _ `SU D FY ----- ---__ c_«--------------- �T - -- -- — - - - - MUNICIPALITY OF ANCHORAGE r (IL-1 PERCOLATION v' DEPARTMN OF HEALTH AND ENVIRONMENTAL P� VECTION TEST 625 L. Strttt, Anchorage, Alaska 99501 26"720 SOILS LOG — PERCOLATION TEST RFORMED FOR: B010 Glr'fr DATE PERFORMED: 8 - lo- 83 LEGAL DESCRIPTION: sa_*nT S b g�� 1— 1116NR1v/ V10iE ST Z cl nae SITE PLAN 1' 2' 3 4- 5 6 7 8 9 10 11 12 13 14 15 i6 17 16 19 20 COLI M E loose 1 d� y.�I,r 6re.. n. 6 0 44. 1 or i*149 s ea. ' ..... ...t. io �+ Len C. Rtht Jr. ,� J' •.� 2251-E {� �pROFESSIO'%� ' ���1�4`t•'1 Co; ■m; �t P {r+ WAS GROUND WATER o ENCOUNTERED] L L P E IF YES. AT WHAT DEPTH? ,A. I b ori r" Reading Hate Gross Tirrre Net Time Depth to Water Net Drop r1 v.y2- cc ' s s 23 -sz — 4134 g'� B b 41.30 01 PERCOLATION RATE /0 (minutes/inch) TESTj3UN BE//T��WEEN .-3 — FT AND 3�' FT 77V/ PERFORMED BY: -D nrr CERTIFIED 72-008 (6/79) DATE: r—/ 7,—F t Municipality of .Anchorage O a� • • Development Services Department Building Safety Division. On -Site Water and Wastewater Program ' t 4700 South Bragaw St.." " P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTII AUTHORITY APPROVAL Fdk A 51NGLE rAMILY DWELLING Parcel I.D. • 051-822-26 HAA #_0�>04q Z • Expiration Date:�{- 'I. GENERAL INFORMATION Complete legal description Lot 8, Block 1, Sampson Estates Subdivision Location(siteaddressordirections) ••23844 Goliath Drive, Chugiak, Ak. 99567 Current Property owner(s) Dennis & Signe Tal Day phone 688-5204 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P. 0. Box 670590, Chueiak, Ak. 99567 Unless otherwise requested, HAA w9l be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:; Individual Well Individual Water Storage Community Class Well Public Water System .4 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual On-site) ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of Ville (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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. Gf S. it •!: STATEMENT OF INSPECTION BY ENGINEER r , As certified by my sea] affixed hereto and as of the validation date shown below. I verify that my investigation';,.."' based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on ;.•r ::i site water supply and/or waste'water-disposal system is(are) safe;�,junctional and adequate for the number of ` .•f.'+ • :ji: bedrooms and type of structure indicated herein. l further verify' at Pased on the jnforrpation obtained from the Municipality of Anchorage files and from m investi anon:and ins tion, 'the on-site water supply and/or P wastewater disposal system is(are) in compl)ance with :all,apQGcatile Municipal and State codes, ordinances, `', ::; r;•; and regulations in effect at the time of ins6ilation.1-. ,•. Name of Firm S & S tis i EriS € J1i1 151 it 'ir' — _•.:i': `�. _694-2971) Address 17034 /js, y . •fZ f?.{ ).:: •`, t 3 I3aQle River Lp. Rd 'Ra'1"Pf`1?;bbr :Ajit`• ,99577. Engineer's Printed Name Robert 'C: Cowan' '' Dated=26' :';^t.•i `'ti !.tea i..` - ,'i ' i7 . •• ij',.I .�' . r. fw •\•G, �r!.y • •. 'z 75 ift CWCOWAN _ ,71 Y;.. Y' • . r 'o ,?' .;A••F.. ,J i��'iC .''r..�e t. ''"-'. ' :',t. .('• '.:'i='�%^%. 1'�'Si.`,•.'i •; �..?.::. .fir. � � ••'. �. �. •b. •'t . .. � :.; .!(:'.''i`•:: ". : t .r 1 111--- : . ' ... .. .r'• - .) .•r.��±.-. :,:r,-?4.� �:'ir•r. .Lai.: ; -T,:a: :.�1,� 'r�C:'r , ,� � � , {r• ' ,. DSD SIGNATURE )` y .i`.<' 'y ;.''�''RosCE:880.1 Approved for, `4- bedrooms. <` ' :. ,•, ;',:' ,fit}Fi•:�� .:. �.`C . Disapproved. .' , ..:..;:•,,:,,,:, r4, , :::: .l yv�1`t rc�s�O�A. Conditional approval for ;.bedrooms,twitF the joilowing'stipulations: ''j fji L),•iyi:r::t��Ata{<.�,�:�, r.!iil,":.'%.rA.� +'' �: .. 1.., , )1. ,1`Fti\i; Vit: jam.; 1:: ij:•if i; � "�'�'[,(':i isf.' :! wJ,:"{)}a:.l•i�:C:.{�i'�i�'btt:..:•e5'•i .. ..'r,. �.i,.J.r. .. ..iia. ..: .., •, t: �S'• u��: i•''n t: � 1"mow •[ • ''[ r[.'r•,,.:�', .d. L Additional Comments" Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other - By: Original Certificate Date:_ /0—/-03 (R.v. 0102) 0 WATER•AND, .. R ' PRO �C►JJ111 Maintenance Agreements Supplemental Engineer's Report Other - By: Original Certificate Date:_ /0—/-03 (R.v. 0102) 0 r. . .... ..._...I. I.. - - ........ ..................... _........ Municipality of Anchorage ' Development Services Department *At Building Safety DivisionOn-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L77'8:13W 1< I i ";A--%eSo#J �5+� Parcel ID: _O!-AZZ-'Z.!✓ A. WELL DATA Well type 1�zffp If A. B, or C provide PWSiD # _ Well Log (YIN) 14 Date completed 7/ V/ Sanitary sea] (Y/N) Wires properly protected (Y/N) y 7'T f Tptal depth l&) it Cased to AO_fu Casing height (above ground) in. FROM WELL LOG Date of test li Static water level / 7� ft Well production 10 g.p.m. WATER SAMPLE RESULTS: AT INSPECTION G 2 v� Z ft 2—.4- 9— p.m- Coliform colonies/l00 ml. Nitrate 10, ( mg./l. Other bacteria 0 colonies/100 mi. Arienic: "' mg.A. Date of sample, collected by: B. SEPTIClHOLDING TANK DATA Tank Type/Matedai r Date installed --I/Z-4 Tank size �S� gal. Number of Compartments Cieanodts (YIN) y Foundation cleanout (Y/N) `/ Depression over tank (YIN) High water alarm (YIN) Date of pumping 2 Pumper %TQ 1.c C. ABSORPTION FIELD DATA Date installed A&I/a Sod rating (g.p.d./fe or fl?/bdrm) .. System type Length _ _fL Width _ 10 fL Gravel below pipe Total depth JL1 R Efl. absorption area -�a?ifC Monitoring tube Depression over field At Date of adequacy test ,� Results (Pass/Fail) 9� For 4 bedrooms Fiuid depth in absorption fie' efore test ^ in. Water added_ gal. New depth_ in. E?apsed Time: _min Final fluid decth _ in. Abscrpttcn re >= g.p.d, i Any rejuvenation treatment (past 12 mo.) (Y/N 3 type) N if ;res. cave date c D. LIFT STATION Date installed /✓ Size in gallons Manhole/Access (YIN) "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/144tatien on lot 1& 1 t-7— On adjacent lots O O 1 "� Absorption field on lot 100 t -t- On adjacent lots l oy I T Public sewer main A.) Public sewer manhole/cleanout h - oar—S septic service fine "% 1'r Holding tank At SEPARATION DISTANCES FROM SEPTIC/H&H*N6 TANK ON LOT TO: f Building foundation % -t' Property One 'f Absorption field Water main #1A Water service line I 4-- Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: f Property line Building foundation Water main r6.-• Water Service One Surface water L &Z) / Driveway, parkinghrehide storage l0 Curtain drain 4eas on adjacent lots F. COMMENTS A L-xIA• IVA;7�. �) -6v ti G. ENGINEER'S CERTIFICATION ;1 7l} I certify that I have determined through field inspections and . • review of Municipal records that the above systems are in M• conformance with MOA NAA guidelines in effect on this date. �R;e ,c.;t"AN I rc Engineer's Printed Name IN BE R T C • C© "ii1^�+t °r ` Date 0 3 HAA Fee S 3 -7 Date of Payment Receipt Number n tf Z� 3 r, (Rev. 12101) Waiver Fee S Date of Payment `f /-, 9.%a 3 Receipt Number O Jf A 3 Sf 9-23-03; 5:21PM; ;907 5615301 a A- 2 J SGS Ref # 1036117001 Cllent Name S & S Engineering Project Name/# Lot 8 Blk 1 Sampson Estates Client Sample D) Lot 8 Blk 1 Sampson Estates Matrix Drinking Water All Dates/Times are Alaska Standard Time Printed Daterime 09/23/2003 15:00 Collected DatrJTlme 09/19/2003 15:15 Received DatdTime 09/19/2003 16:23 Technical Director Ste . Ede Rell1 v� Sample Remarks: Parameter Qualifiers Results PQL Units Method Container ID Allowable Prep Analysis Limits Dem Dem Inst Waters Department Nitrate•N 2.10 Microbiology Laboratory Total Coliform 0 0.100 mg/L EPA 300.0 B (<-10) co1/100mL SMIS9222B A (<=1) 09/19/03 JJB 09/19/03 KC GOLIATH pR1VE V U rn (fl Q S 850 8, „w 78.54' ' £L'L = l "00' E9-8 f 0' E EC. _TELECOM. ESMT, N ✓ g N N � t.t r O V ± ry a O 22, rl ' any f/ ias� \ NSF w n,F ,8 13, d N-5 C O G `O1' ib o Q rAi c• n ^' A.7 O 7 =� n'p•f�6 fn Zr" as o�o� �»a� 40 %6N Ni N m OAV G N A o N 1• yN D or Ar Ar O, i _ ♦ W Q3 c my qv• ". M CL in G A U A # O • ZI > % (i1 3 m ^ ^coeb y.q DON sor •*� �0 7• 19ap ti A m ^ C 7 p m u m m Ls' C, Q£ 0 7 <D 7 Cl. O t-li' -'' k C]. O -s K Kol W V U rn (fl Q QD W any f/ ias� \ NSF w n,F ,8 13, d N-5 C O G `O1' ib o Q rAi c• n ^' A.7 O 7 =� n'p•f�6 fn Zr" as o�o� �»a� 40 %6N Ni N m OAV G N A o N 1• yN D or Ar Ar O, i _ ♦ W Q3 c my qv• ". M CL in G A U A # O • ZI > % (i1 3 m ^ ^coeb y.q DON sor •*� �0 7• 19ap ti A m ^ C 7 p m u m m Ls' C, Q£ 0 7 <D 7 Cl. O t-li' -'' k C]. O -s K Kol W N GOLIATH RIVI S 850W 8 `W O !0' E EC. •£CLQ►1 ,00.9££,1 iA3- IF I A , o O Cl 14.4 4 Q JJJ� b b f 1 y 1 LocA-T(otis /fes r" W; 03cri o - nif i I co 7 OZ! y � Cb b A 1%0 + 1 p y O O CL h y X -'4'b a.a :O GOLIATH RIVI S 850W 8 `W O !0' E EC. •£CLQ►1 ,00.9££,1 iA3- IF I A , o O Cl 14.4 4 Q JJJ� b b f 1 y 1 LocA-T(otis /fes r" W; 03cri o - nif i I co 7 OZ! Mw00.Cdot8 S b`�p „—C z CL h ? �; -'4'b a.a :O 3, Vol r10 Y � 3V 'D O C D In � J d y N� C y V •� a ... `, N w C U N O W Cn W •� n Ar s Ch 40 V,Air d' w / o� ; cL..`.� D • a •� V N a • F r N` Clow: N D O 4) v „010 U v J ��i : u• i w O r O d` NOn Mr im'D N� � W • :•Q�o'� C c- v c YJ C7 _; _ September 26, 2003 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVILENGINEERS (907) 6942979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services Planning Office SEWEER WNEXTE IONS P.O. Box 196650 Anchorage, Alaska 99519 SEWER&WATER INSPECTION REFERENCE: Lot 8; Block 1; Sampson Estates Subdivision ENGINEERING STUDIES ANDREPORTS Request you issue a lot line waiver between the onsite septic bed and the west property line for the referenced lot to 2 feet. This waiver was made necessary due to a design change. The Municipality of Anchorage Onsite Branch was informed of this change telephonically on 9/26/02. We do not anticipate any adverse effects on WELLINSPECTION aFWWTEST neighboring wells, septic systems, reserve areas or drainage patterns by the granting of this waiver. Field observations made during construction of the onsite septic field indicated that the SITES original soils testing was not indicative of the soils for redesigned field. Additional soils evaluations were conducted, resulting in a design factor of 0.8 gpd/ftO. ROADDESIGN If you require additional information, please contact us. Sincerely, SOILTEST RobertC. Cowan, P.E. PERCOLATION TEST TES RCC/mje STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER OISPOSALSYSTEAI DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577 9/30/2003 Municipality of Anchorage Mark Begich, Mayor Building Safety Di -vision I1.0. Box 196600 • 4700 Dragaw Strect Anchorage, Alaska 99519.6650 • (907) 343.8301 • F x (907) 343-8200 h ttp://E��E��•.mun i.org Robert Cowan, P.E. S & S Engineering 17034 Eagle River Loop Ste 204 Eagle River, AK 99577 Subject: Waiver Request for Sampson Estates Block 1 Lot 8 Waiver Request #WR030086 Parcel ID #051-822-26 HA030492 Dear Robert Cowan: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 2.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely,, Q Jeffrey W. Poet Engineering Technician On -Site Water & Wastewater Program 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.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#:30 0086 PID#:051-822-26 HA#:30 0492 Permit#: Date Received:l9 29103 Legal Description: Sampson Estates Block 1 Lot 8 Engineer: S & S Engineering 17034 Eagle River Loop Road Ste 204 Applicant: Slone Tol Waiver Requested: 2 foot waiver between the onsite Septic Bed and the West Property Line Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: I / Waiver is not Granted: List Conditions or Reasons for above: Date: d 3 By: 6-,,Nae,6f Reviewer Rec#: 42351 Amount: $IAQ.02 Date Paid: 912912003 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES �1t Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. #Tt�� �,��� HAA # 1. GENERAL INFORMATION Complete legal description Lot 8, Btock 1, Sam hon E-6tate-6 2. 3 4. Location (site address or directions) 23844 Gotiath Drive Property owner Roy 8 Rita LuU i.n Day phone 688-4380 Mailing address P U Rnx 771582 Eaate Riven Ah 99577 Lending agency Nanthtand Montaaae Co. ATTN:Donna Day phone Mailing address Anchona e Aka6ka �s_i_n.. AURORA pRoPFRIIES Day phone 688-4039 Agent Navicy Itah Address p,0, Box 671923 Chu .gk A.2 ka- 99567 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well Public water M NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: XX Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. 91 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 Phone l�,�� Address Zig✓, cn Poadl`lo.204 Engineer's signature DHHS SIGNATURE // Approved for �ti 1 r,_( 5% bedrooms. Disapproved. Conditional approval for Additional Comments Date bedrooms, with the following stipulations: By: / Date 7— / a -- 9 / 111TIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their 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 421 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1- T- 0 1 SA<MPSorS EsP Parcel LD A. WELL DATA f7 S / - � -,x- a_ - �t- to Well type ?2- 1V cfl- If A, B, or C, attach ADEC letter. ADEC water system number Log present/N)y Date completed 9' L�- S1 Driller 'rte Total depth 1 fid` Cased to 1160% Casing height IZr� Sanitary seal ON) � Wires properly protected &N) V e C2 FROM WELL LOG AT INSPECTION Date of test - �' 4 07 LU Static water level i LU Well flow g.p.m. A, Dg.p.m. i z @ F I VV-' 3 ) Cie Pump level g W SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Iota ; On adjacent lots ODl } Absorption field on lot lib' ; On adjacent lots kt>c> Public sewer main a' IA- Public sewer manhole/cleanout Public sewer service line '1 Petroleum tank - 25 N + WATER SAMPLE RESULTS: Coliform D LoV �1 oo " a Nitrate � 9 � Other bacteria )Jo,4r Date of sample: 2 L ' S Collected by: S & S ENGINEERING need No. 204- 17034 Eagle Riv r Loop Eagle River, Alaska 995;7,- B. SEPTIC/HOLDING TANK DATA Date installed 01 � 2� ' 84 Tank size I7-570 Compartments Z Cleanoutsa'N) q Foundation cleanoutON) y Depression (Y/A JtJ High water alarm (YA /4 Alarm tested (Y/N) "IIA Date of pumping In I -%l -2 LESSPrso[, P0.yi "Al z' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r Well(s) on lot D o On adjacent lots / 0 To property line /b Absorption field .12 - Surface water/drainage Foundation 2q ' r� Water main/service line /0 72-026 (Rev. 72-026(Rev. 3/91)Front MOA 21 - - - - CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N — Manufacturer Manhole/Access (Y/N) "Pum vcles tested _ SEPARATION -D STANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed %' e4 Soil rating System type TP_f5J .,4 Length 5-5 Width 30Gravel thickness & Total depth /b Total absorption area LGo Cleanouts present fZN) y Depression over field (Y& Date of adequacy test Results /fail) PAS 5 for A70 ✓2 ('4.) / bedrooms Peroxide treatment (Past 12 months) (Y&1.}y/t If yes, give date ^14� SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /10 7 On adjacent lots /00 1 f- Property line /arw To building foundation `/ `, To existing or abandoned system on lot -J/,4 On adjacent lots 30 Cutbank 7 d- , r /J/,4- Water main/service line /d Surface water /� 7 Driveway, parking/vehicle storage area J Curtain drain E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature i , Engineer's Name `�I I ';" ,!!ak=� jA r /sem/�� Date A F: HAA Fee $ 11 �� Waiver Fee: $ Date of Payment S ` Date of Payment Receipt Number7 ' 71 Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WOREorder# 35774 Date Report Printed: JUL 2 91 @ 10:30 Client Sample ID:LB B1 SAMPSON EST PWSID :UA Collected JUN 27 91 @ 14:55 his. Received JUN 28 91 @ 16:30 hrs. Preserved With :AS REQUIRED Analysis Completed :JUL 1 91 Laboratory Super s r :S EPHEN C. EDE Released By : C .......................................... Chemlab Ref #: 913106 Lab Smpl ID: 3 Matrix: WATER Parameter Tested Result Units ----------------------------------------------------- NITRATE-N 1.9 mg/l Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO # PO # NONE RECEIVED Req # Ordered By :R SHAFER Send Reports to: 1)S & S ENGINEERING 2) Method EPA 353.2 Allowable Limits ------------- 10 .............................................................................................................. 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than ANNSGS Member of the SGS Group (Societe Generale de Surveillance) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ////3 (a) Legal D scriRtion (include lot, block, subdivis on, section, township, range) !� .HCl i�'1 x'49 /�✓ 45!0 Locatn (address or directions) / r4-` `rte ALJ Q v 1+ -37,63 (b) Applicants Name LLf Telephone - Home Business Applicants Address n0 603-e (c) Applicant is (checone) Lending Institution ; Owner/builder ; Buyer = ; Other [� (explain); (d) Lending Institution '01J L7_ J �' Telephone Address (e) Real Estate Co. & Agent Address Telephone ivLoA �)r (f) the HAA to the following address: SR13 116&j 2. Type of Residence Single -Family Multi -Family Number of Bedrooms Other (describe) 3. Water Supply Individual Well N4 Community E= Public M 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 §tatus. [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 regula- tions in effect on the date of this inspection. Name of Firm Telephone $ & EEN01WESi3 jr4 Address Date ,PH a94 -��57O{1 j fZ17 plp+�� eee�e seo V ®9 .W'0(4 . °• es° - n no a° .ae vse�eo e 6. DHEP Approval ftbwt 1l c5\gym �3a o iro 657E Approved for 6"p C`a bedrooms •"°.° :� � Date Approved Disapproved'FES Conditional Terms of Conditional Approval CAUTION 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. RR4/ej/D1 [Page 2 o 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: 5, o MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & zENVIRONMENTAL PROTECTION DEC 13 IPA" Ey E D soo, Well ClassificationPp- IL)A If Ar B. or C. D.E.C. Approved(Y/N) Well Log Present((YAO Date Completed Yield6, L=/ Total Depth Cased to /fj� ' Depth of Grouting -- Static Water Level 7 Pump Set At u L Casing Height Above Ground Z r1 Sanitary Seal on Casin (Y ) Electrical Wiring in Conduit (Y ) Depression Around Wellhead (Y• Separation Distances from Well: To Septic/14sk%'*ng Tank on Lot /ou „L ; On Adjoining Lots `bo e To Nearest Edge of Absorption Field on Lot t/(� r ; On Adjoining Lots 100 f To Nearest Public Sewer Line hal t -N- To Nearest Public Sewer ) r Cleanout/Manhole !) /�- To Nearest Sewer Service Line on Lot Water Sample Collected By S ,*tS Date /Z 10 6- B 54 Water Sample Test Results -r �44c Z"ax Caments B. SEP`rIC/W8MWG TANK DATA Date Installed Z B'�Size %Z �(� No. of Ccartments 2 Standpipes ( A Air -tight Caps (Y Foundation Depression over Tank (Y Date Last Pumped Pumping/Maintenance Contract on File (Y/a ; for Holding Tank High -Water Alarm (Y/N' fl& Temporary Holding Tank Permit (Y/P6///,,- Separation Distances from Septics Tank: To Water -Supply W211 To Building Foundation r To Property Lire To Disposal Field l Z r r To Water Main/Service Line 4- To Stream, Pond, Lake, Or Major Drainage Cleanou (/M) Course AJ L) h --J IF Comments /-' o �-1 Receipt # 5 SSSS Date Paid: Amount: , O [Page 1 of 21 2-15-84 C. ABSORPTION FIELD_DATA Soils Rating in Absorption. Strata `�� Type of System Design Date Installed //.,& °,/ Length of Field ,j JL Width of Field r�7� Depth of Field /D 01 /Gravel Bed Thickness -z c� Square Feet of Absorption Area G�p Standpipes Present /Y,)M) Depression over Field (YX179 to of Last Adequacy Test N Results of Last Adequacy Test /1211 { Separation Distance from Absorption Field: To Water -Supply Well //0 r To Property Line /d To Building Foundation 41 T To Existing or Abandoned System cn Lot 10�/ 0 rrF On Adjoining Lots -o � To Water.Service Line To Cutbank(if present) iCJCJ4�r� To Stream/Pond/Lake/or Major Drainage Course Aro r,. _ To Driveway, Parking Area, or Vehicle Storage Area L Comments --v a P -J D. LIFT STATION Date Installed Dimensions Size in Gallons Ma ole/Access (YM) "Pump On" Level at " f" Level at High Water Alarm Level at Vent (YM) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedrocm Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed a a V.sBhIGINf=>~RlM[14 Date bil pp Company )'11VER, ALAS C -A zow MOA No. KB1/d5/s [Page 2 of 21 11;g v OF44 `1% �u tx 10 .� `�']j � � :�,.• 'tip ill. f!'t Y �, f9 �'•"n ,»Delo oo� r J., Fhahsrt �l. $fizf�r � W'el 1Y Ea Nn. 1•}57• ,krs x:a 2-15-84