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HomeMy WebLinkAboutSAMPSON ESTATES BLK 1 LT 18SGYN k, X51- b S3- loG En 72-013 (Rev. 3178) MUNICIPALITY OF ANCHORAGE / • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW ❑ UPGRADE MAILIN D ESS, .V,x LEGAL DESCRIPTION Lot 18 Block 1 Sampson Estates S/D LOCATION NO. OF BEDROOMS I Absorption Dwelling ( PF,RJVIIT NpO U Y DISTANCE TO: _ - I—} E iZQ Manufacturer Material/ No. of compartments -7L wF �� �I w Liq. capacit in gallons l�� IF HOMEMADE: Inside length Width Liquid depth Y DISTANCE TO: Well Dwelling PERMIT NO. Jaz 2 Z F Manufacturer Material Liquid capacity in gallons O w= DISTANCE TO: Well ���- Foundation Z2 1 G. Nearest lot line � .5 PE (VI� ro ITrE14 -f � LL z No. of lines I Length of each li a Total length of line 7 Trench widt Distance between lines F Z w q O inches Top finish /i Material beneath tile Total effective abs rOon area sF of tile to gradey� rte:// p / inches Z Length Width Depth PERMIT NO. w 0 Q F Type of crib Crib diameter Crib depth Total effective absorption area w 1 Lu Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J W � Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS A,67ft an 34 C, T, q SOIL TEST RATING INS LLER /ngyp REMARKS T XN6P'T DEVANX 8 © pp Nee— APPROVED DATE LEGAL 72-013 (Rev. 3178) F r WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either to, Ib or to.) A.D.L. No. Borough ch gAn Subdivision ampson Lot 18 Block 1 Ib. 'A glre. _of_of_of —1 Section No. Township N I SO Range E[3 wODISTANCE Meridian AND DIRECTION FROM ROAD INTERSECTIONS Street Address and Area of Well Location 3. OWNER OF WELL:Mr. Trent Slaymaker P.O. Box 110787 Aadresst Anchorage, Ak. 9951 - l Feet Below 2. WELL LOG Fee Surface Material Type Top­-7— Bottom 4. WELL OEP (}Inst) 201 ft. . 5. DATE OF COMPLETION 12 — 5 — Gravel and sand 0 18 6. "pcoble tool XURotary oDriven CDug 11 Auger Jetted O Bored 0 Other: Sand witb some gravel and — silt 18 112 7. USEXnDomesflc 0 Public Supply C1 Industry p Irrigation 0 Recharge O Commerical p -rest wait ❑ Othsr: Gravel and sand 112 TUU Gravel, silt, moist 160 170 170 180 S. CASING: O Threaded X®{Welded dtam. 6 In. t201 ft. Depth Weightlbs./ft. in. to ft. Depth Stickup ft. Gravel, silt moist 180 182 Gravei sUt Cry -IbZdlum.- rave , boulders, 188 201. 9. FINISH OF WELL: Type: Diameter: SIol/Mesh size: Length: Set between ft. and ft. Backfilling Gravel pack Clay Sand and water 201 205 1O. STATIC WATER LEVEL: ft. E] Above or O Below land surface Dote used: -- --- 1171JAI/C/p.4Equipment OP ENV EPoto O AN 11 . PUMPING LEVEL below land ure ace and YIELD fl. after r / pumping g.p. ft. after rs. pumping —g.p m. itl(� 12.GROUTING Wali Grouted: Yes O No Material: O Neat Cement O Other: VJP 13, PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. 0 Subm. O Jet O Centriflcal O Other 14. REMARKS: Production Of 10 GPM 16. WATER WELL CONTRACTORS CERTIFICATION: - 15. Water Temperature __a OF OC This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; - Magnuson Drilling AA 5.385 Registered Business Nome - Contract License Number Addre33:P.0. Box 770504 E le River., Ak. 99577 Signed: Dols: Dec. 71, Authorized Representative - - Form O2-WWR (11/81) Copy Distribution: WHITE-Stote DOGS, PINK -Driller, CANARY- Customer y MUNICIPALITY OF ANCHORAGE Department,", Health and Environmentaj��rotection 825 Street, Anchorage, AK. 9501 264-4720 # # HANDWRITTEN PERMIT # # # Permit # WELL AND/'ON-SITE SEWER PERMIT Applicant: /ie J %i91� Mailing Address: zAy I m i ' % Location: Phone Number: Legal Description: 5r,,57AJ e► / &,' � G � Lot Size: Type of Soil Absorption System Is: Trench: 1,,-' Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: `3 Soil Rating(sq.ft/br) 3 The Required Size of the Soil Absorption System Is: DEPTH% �`� LENGTH _ GRAVEL DEPTH �-- WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ � GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(Z) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feetl for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # # # PERMIT EXPIRES DECEMBER 31, 1 9 u 3 # # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residens remodeled to include more tha 3 bedrooms. Signed: Issued by: p ican Date: r5/ SWP/024(1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE I(� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264-0720 TEST SOILS LOG — PERCOLATION TEST /710a-Srg3--Loq e/ PERFORMED FOR:_} DATE PERFORMED: LEGAL DESCRIPTION: I 1. I -.N-�est Srsc. ?� BL—" Lo t '1441--j 77 / I Ej_EJ_IJJ_ mL _� LOPE SITE PLAN tr 1 Id l% 1 /.O. J1 11 07 COMMENTS P—(05 13 t of Wwmw � � Reading Date Gross Time Net Time 20' Net Drop NE1111 //110 1 ..5-/ 015 1,57 mm 06/ �,Jo • y9 . Da ,� 63 ■■ WAS GROUND WATERS!IO L ENCOUNTERED? !�1 oT14L-5- P IF YES, AT WHAT EDEPTH? ,—' 9` �/ � � � i i i i i ► �I'1 � � Reading Date Gross Time Net Time Depth to Water Net Drop f o7 //110 1 ..5-/ 1,57 06/ �,Jo • y9 . Da ,� 63 �/ Su/�pp'' PEFf0DLATION RATE �°���5' �� /d (minutes/tii6h) 40 TEST RUN BETWEEN FT AND FT PERFORMED BY: -�/ %/I. CERTIFIED BY DA SV 53 -azo 72-008 (6/79) MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M DIVISION OF ENVIRONMENTAL SERVICES M 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # �� 0 0,3 // HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ,���m-�� �0 Telephone : (ho mey - a�� Business Mailing Address (c) Lending Institution Mailing Address (d) Real Este Address Telephone Telephone 0201 (e) Mail the HAA to the following address: (or check hereXif hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Road No. 204 Eagle RiveL, Alaska 99577 2. TYPE OF RESIDENCE Single -Family X Number of bedrooms 3. WATER SUPPLY Individual Well 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 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. 72-025 (Rev. 7/88) Page 1 of 2 S 77 Z to Z abed MOe6 (98/L'n2y) 9L0 -9L •�1oM s,laaulbua leuolssa}o1d ay; u! suoisslwo 10 s1o11a 101 a!glsuodsal;ou si abelogouy to A;IIedioiunW ag1'panss! si aleoiplAeo a alolaq e;ep azAleue 10 suolloadsu! Ion puoo lou op SHHa to saeAoldwE] 's;uawaainbaa alels pue Ielapal uie;aao A;dies o; laplo ui suoi;nil;su! bulpual 1lagl pue sawoq to siesegolnd o; Asallnoo a se slg; saop SHHa ag1 'eilsely to alelS agl ul palalslbal aaaulbua leuoissa}oid;uapuadepui ue Aq anoge g ydeaBeaed ul uaAlb suol;e;uasalda) aql uodn Aluo paseq paleol;iaao lenolddV Al!joglny glleaH sanssi (SHHa) s901Alas uewnH pue gllu@H lo;uawlledap abelogouy;o Aj!IedioiunW aq1 NOany.O . lenolddy leuolilpuo0;o swig1 leuol;lpuo0 panoiddesie panoaddy Aq swoolpaq .�ao+ss�doy�o � cT� . �LS't'L 'aN '• . ,j.... .. 10l panolddy 1VA0Hddd SHHa 's ale(] 6� LLS66 eMsely'aaAIH 016e3 'ON peoll doo-I jaA1a el5e3 17COLL ssalppd JNI?133NIEJN3 S'S S auogdelal Wald ;o aweN •uoi;oadsul sigl }o alep aql uo 1081}e u, suoi;elnbal pue 'seoueuipao 'sapoo ale;S pue ledioiunN !!e ql!M aoue!ldwoo ui si walsAs lesodslp 1aluma;seM 10/pue Alddns 1alum ells-uo ag; 'uol;oadsui pue uollebl;sanu! AW woe} pue s91!1 abelog0uy to AliledioiunN ag; woe; pauielgo uollewlo;u! aql uo paseq ;eq; A)laaA 1aglln; ! •uia.iag pa;eolpui aln;onils;o adAl pue swooapaq }0lagwnu eql 101 alenbape pus leuollounl 'a;es si walsAs lesodslp lalemalseM 10/pue Alddns 1aleM a;Is-uo aq; leq; snnogs lenolddy Allloglny glleaH slgl }o uolleb!;sanu!AW leg! All1aA I 'Molaq UMOgs alep uollep!!eA aql;o se pue o181aq pax!}{e leas (w Aq p9l;!1180 sy NOIldWdOdNI OMd V.LVO `HOdd3S 3'11.4 `S1S31 `SN01103dSNl E)NI01A08d VY81.4 ONIa33NION3 'S MUNICIPALITY OF ANCHORAGE (MOA) MUNICIP vCHoeAGr lealth Authority Approval (HAA) fi ENVIRbWAE ICES D'VIs1tdAECKLIST - FEBRUARY 1984 343-4744 1q8 Legal Description: Lo -r RE CE IV ED A. WELL DATA Well Classification 1 ND! ✓lOv,—L If A, B, C, D.E.C. Approved (Y/N) ' Lg— Well Log PresentON) Date Comleted \12' 15-- 83 Yield S-4AFt 4 - Total Depth Z Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing'ON) — Electrical Wiring in Conduit/N) Depression Around Wellhead (Yo!* )_J SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot On Adjoining Lots /4 - To Nearest Edge of Absorption Fieldonof �� /Y ; On Adjoining Lots To Nearest Public Sewer Line r To Nearest Public Sewer Clean out/Man hole / To Nearest Sewer Service Line on Lot Water Sample Collected by S �4/�915L/,Q ; Date Water Sample jTest Results Comments TEs,T E3 E3 B. SEPTIC/1-10LOING TANK DATA Date Installed I' 4 43 Size )tea No. of Compartments Z Standpipes (N) Air -tight Cap<Yi N) Foundation CleanoutgWN) _ Depression over Tank (Y& f J Date Last Pumped "_7'Z'-- ioe Pumping/Maintenance Contact on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) a Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPT[ C/H6tBtNG£ TANK: To Water -Supply Well fp -2- To Building Foundation `s 8i To Property Line / o /f To Disposal Field To Water Main/Service Line o To Stream, Pond, Lake or Major Drainage Course Comments 0112 pu"P//h4 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 3 12Type of System Design i Date Installed Af — 1 4 Length of Field 79 Width of Field 2 ,S Depth of Field Gravel Bed Thickness v Square Feet of Absortion Area / 02�7 Statndpipes Present 4?N) S,/ Depression over Field (Y& /S Date of Last Adequacy Test ZZ— 88 Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well f To Property Line �� { To Building Foundation 2�? To Existing or Abandoned System on Lot To Water-Main/Service Line /W_ On Adjoining Lots *2>011 - To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course _ To Driveway,. Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed' Size in Ga on� "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) . _ "Pump Off' Level at Pumping Cyste`during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company S & S ENGINEERING 17034 age ask RoadceY Date Eagle River, Alaska 9957 9 MOA No. Receipt No. 3J� 6S X20 Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. �T ' ITU11,M'01- Waiver '0" Waiver Fee: $ 4'. OF A Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 9397 Date Report Printed: SEP 27 88 @ 18:44 Client Sample ID:L18, B1 SAMPSON EST. PWSID :UA Collected SEP 22 88 @ .13:30 hrs. Received SEP 23 88 @ 14:00 hrs. Preserved with :4 DEG. C Analysis Completed :SEP 26 88 Laboratory Supervisor ,STEPHEN C. EDE Released By?�% i Special Instruct: Cheralab Ref #: 2752 Lab Smpl ID: 1 Matrix: WATER Parameter Tested Result/Units NITEA"1E-11 0.79 rag/l Client Name S & S ENGINEERING Client Acct SNSENGP P.O.# NONE REC"D I Req # Ordered By : RJS Sena Reports to: 1)S & S ENGINEERING 2) i i Allowable Method Limits ----------------------------- EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. 'aa ..................................... ° 1TestsPerformed See Special instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Descrip Application Date (9/7/9s- lude lot, block, subdivision, section, township, range) Locatign (address or directions) C/o g®/ ,::t 2�' D i e) .2.0 <3i (b) Applicants Name ,Cle��s/L Telephone-�7Home Business Applicants AddressPQ Da j4Z 4j,QGcsf� (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer ; Other [� (explain); (d) Lending Institution Telephone Address (e) Real -.Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family f_X__j Multi -Family Other (describe) Number of Bedrooms 3. Water Supply Individual Well M Community = Public = Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Z I 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 21 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��yg ,¢ iJl�'dd?f�1 C axm_1-2(1y"ICS TelephoneS-�V'6-6 L_v Date Ow CLLt 4'v / - (ENGINEER SEAL) 6. DHEP Approval "Q Approved fort s''�.L=bedrooms Approved Disapproved Conditional Terms of Conditional Approval CAUTION 0 Ate'""az o�•oo•oeaoa lit ue tY bfi V a•• eooeoe• 1• ee•esff. >�• ae .• y C. Reid, 1 , No. 2251•E ,• _�� 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 21 N MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE Application Date _13/K/9_5 1. General Information (a) Legal Description (include lot, _� /8 � nel , / /l Location (address_or,directions) subdivision, section, township, range) (b) Applicants Name��"" Telephone - Home Business ,S4,e- �. Applicants Address&&//d 7e% !7"`"�c�s 44/=LeA (c) Applicant is (check one) Lending Institution Owner/builder ; Buyer ; Other � (explain); ` � Ae P. f/'` /"IIZra=st.- : . m Telephone (d) Lending Institution --- Address (e) Real Estate Co. & Agentlrsysr,v�i�� Address Telephone (f) Mail the HAA to the following address: &0 / 1111 /& COV L: :" b/'t 'g rai���? e'0 �0 2. Type of Residence Single -Family Multi -Family Number of Bedrooms 3. Water Supply Individual Well 10 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 OnsiteEZI 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] ,v8" 9/ S� ,mss 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, �1 2 y2 P e� �j %lU�l� Telephones Address Date 3181 9-�- �C1CL^C.C(lG�LC-% I E�j(ENGINEER4 SEAL) (�vvTTG�-CG�c� 6. DHEP Approval ' Approved for9'046 bedrooms BJ4y Disapproved CAUTION ,0000aawoao��� ��A ao rs a 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 ,IATA 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 L/I MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: A. WELL DATA MUwIOPAur, OF ANCHOa, DEPT. OF HEAM I & [I' V1901NMENTAL PR"TCCTION IJAR U 8 1985 Well Classification Pn'(i 1If A, B, cr C, D.E.C. Approved(Y/N) Well Log Present (Y ) Date Completed /-��/83 Yield /d h - Total Deptk_ Cased to -2 C)/ �� Depth of Grouting Nv7dc-7x cos1l a Static Water Level pilo + ohPump Set At Casing Height Above Ground Sanitary Seal on Casing Electrical Wiring in -Conduit A) Depression Around Wellhead (Y v Separation Distances from Well: To Septic/Holding Tank on Lot /0,2 y % mon Adjoining Lots >/OU To Nearest Edge of Absorption Field on Lot �p>2 �fv-: On Adjoining Lots >/yU Z To Nearest Public Sewer Lire btl/q- To Nearest Public Sewer Cleancut/Manhole ��v4- To Nearest Sewer Service Lime on Lot Al (k Water Sample Collected By Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date v ME Date Installed l'r/4/q,3 Size . 1 aSYo No. of Canpartments Standpipes Y ) Air -tight CapsY ) — Foundation Cleanou (Y ) Depression over Tank (Y ✓ Date Last Pumped </ �✓ Pumping/Maintenance Contract on File (Y/N_�'Ifor A)t,4 _ Holding Tank High -Water Alarm (YM) A)) Temporary Holding Tank Permit (Y/N) Separation Distances f=an Septic/Holding Tank: To Water -Supply Well /oa "� T® To Building To Property Line ✓ To Disposal To Water Main/Service Line A)/A- To Stream, r5:7� Foundation S" i Field 'z--- Pond, Lake, or Major Drainage [Page 1 of 21 Receipt # Date Paid: Amount: 2-15-84 kl b' /d / S,� ca 4-&-d C. ABSORPTION FIELD DATA D. Soils Rating in Absorption /Strata 3/a _ Type of System Design Date Installed /l/8 ��r�Length of Field Width of Field ,�� Depth of Field Gravel Bed Thickness �U Square Feet of Absorption Area /pay/ P _'Standpipes Present1/N) Depression over Field (Y/ j ®- Date of Last Adequacy Test A -11A Results of Last Adequacy lbst 'LYA- Separation Distance from Absorption Field: To Water -Supply Fell _ a ©� To Property Line /n To Building Foundations ri To Existing or Abandoned System or Lot Miff ; On Adjoining Lots ?fid _� 0 To Water Main/Service Line "'/A- To Cutbank(ifpresent) YW,4 To Stream/Pond/Lake/Gr Major Drainage Course loo To Driveway, Parking Area, or Vehicle Storage Area Cormmnts VSee ce c cQev1�� ®.S77�rr�,o i l•�UCI.e A ..a Date Installed " Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for A Electrical Codes Comments Dimensionsj� Manhole/Access (YM) 10 "Pump Off" Level at �� -- - - Vent (YM) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom 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 Date if Corr>pany MOA No.�p.2 KBl /d5/s (Page 2 of 21 OF A44Z� � App, �9 °0° ✓f= A E� 7e,d Jr. No 2251 C 'Amir ri., .:''. 2-15-84 ALASKA MUIROWnTAL COnTROL SCRUIUS, InC. Bngineerinq & Bnuironmental Studies March 7, 1985 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Subject: Lot 18, Block 1, Sampson Estates The subject property's on-site septic system was installed in November 11, 1983. The as -built reflects a gravel depth of 96" (8'); however, on the soils log, the SM layer (perced) extends from 4-14.5'. The bottom of the system was installed at 10.5', but the excavator installed 1.5' of gravel in the GM layer (no perc). The total effective absorption area should be 1027e-sq.ft., not the 1264 q ft. reflected on the as -built. It should be noted that the corrected absorption area is adequate for 3 bedrooms, the same bedroom number that the permit was issued for. Mr. Slaymaker has indicated that the residence has not been occupied. During the health authority site evaluation, no occupancy was noted. Mr. Slaymaker provided the receipt for pump installation, indicating that the well could not be utilized until that time. Based upon this office's observations and the well -pump receipt, this office requests that the septic tank pump receipt be waived. If this office can be of further assistance, please contact us at 561-5040. Sincerely, L. D. Montgomery Approved by: ry\ o �g Y Fob' (• ."\ 5k, �: VI 6 V� O OF .rp OJ 0(.C��eORotl LOn l •'^T`�L +9nn�ege6199V9 e0 * C. Reid, Jr. No. 2251-E ( t `isaA rh Auenue, Suite B • Anchorage; Alaska 99503 • (907) 561-5040 1 .1J IIIIIII, -. 4%AGN USON DRILllNG &CDN UCT CATER WEL 6 Uew3149 P.O. BOX 770504, EAGLE RIVER, ALASKA 99577 May 31, 1984 Mr. Trent Slaymaker P.O. Box 110787 Anchorage, Ak. 99511 Pump installation Lot 18, Bk. 1 Sampson Sub., Chugiak, Ak. 1/2 HP pump .................................$ 451.00 189 ft. of 1" galv pipe @ $ 1.50 per ft..... 283.50 204 ft. of # 12-3 well wire @ .75 per ft ..... 153.00 Pitless adapter installed ................... 100.00 Backhoe work ................................ 250.00 Pump installation - 2, hrs @ $50.00/hr..... 125.00 Total $ 1362.50 Less 10 % 136.25 Tota 1 $ 1226.25