HomeMy WebLinkAboutSAMPSON ESTATES BLK 2 LT 3oia�
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MUNICIPALITY OF ANCHORAGE
DEI TMENT OF HEALTH AND HUMAN SERX S
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
Y
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
DISTANCES
FROM TO
SEPTIC
TANK
ABSORPTION
FIELD
WELL
Address
WELL
Phone(s)
' 7_ I
Permit No.
0 3
No. of Bedrooms
LOT LINE
L e l %
O I C
LEGAL DESCRIPTION
Lot
Block
Z
Subdivlson
I
FOUNDATION
(
l
Township, Range, Section
1 /'
N te(.,
AS -BUILT DIAGRAM (Show location of well,
driveway, water bodies, etc.)
septic system, property lines, foundation,
TANKS
SEPTIC ❑ HOLDING
V
Manufacturer
Capacity in gallons
ZS0
Material
Z
No. of Compartments
TYPE OF SYSTEM
V -TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from
original grade
4, O FT
Total depth from original grade
L? FT
ik
Int
CIO
ALA 7g
_
w
\
Fill added above original grade
V.0 FT
Gravel depth beneath pipe
SIQ FTI
Gravellen - -
0 FT
Gravel width
Z -, 5r FT
Total absorption area
(p�Q SQ FT
Distance between lines
L� FT
Number of lines
Soil rating
SQ FT
Pipe material
Pipe
1 7 ✓�
Installer
Date Installed
WELLS
PRIVATE ❑ OTHER (Identifv)
Classification (A,B,C) ' \ /
-�_l�'y�_,
Total Depth
FT
Cased to
FT
Fill
6 It
_
-
Installei
Date Installed:
REMARKS:
Scale:
Inspections Performed by:
ENG!XC
�..+),° y at
Date:
S & S ENGINEERING
17034 Eagle River Loop Road No. 204
I w4a Mver. Alaska 2915,77 P.Prlifv that this inspection was perlormed according to all
Municipal and State guidelines in effect on this date:
Health Department Approval: Date:
72-013 (3/85)
It
LV:
O
MM
VI:
z
U5
. L_P q�P -'x� �ii' -:l� L _ ]K �V, 11 J N m'!4 D -A V - H C]II^�en�. rT.::;",
' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
^ 825 L STREET, ANCHORAGEr AK 99501
264-4720
PERMIT NO:
DATE ISSUED:
860243
07/21/86
APPLICANT:
LARRY H. NEAS
ADDRESS:
4901 CAR�LYNN
CIR.
ANCHORAGE� AK
99516
CONTACT PHONE:
` 346-2471
LEGAL DESCRIP:
SUBDI�ISION:
SAMPSON ESTATES
LOT: 3
BLOCK: 2
SECTION: 3
TOWNSHIP: 15N
RANGE: 1W
LOT SIZE:
1.43A MCI. FT.
OR ACRES)
MAX BEDROOMS:
4
^
Listed below are
the options
available to you
in designing
your septic
system, the option_that
best~f ts your~s
i
�Choose
-1 NOZ NEE If"] M t- I
EN PEE 13
tAP F�',,e:N :11: 11 ",411
DEPTH TO PIPE BOTTOM (FT.)
4^0
4.0
4"0
GRAVEL DEPTH (FT.)
5,0
0.5
3.5
TOTAL DEPTH (FT")
9"0
4,5
7,5
GRAVEL WIDTH (FT.)
2,5/
22L0
5,0
GRAVEL LENGTH
(FT.)
64.0
44.0
69.0 �
GRHVEL YOLUME
(CU,YDS")
32.6
35.9
51"2
lANK SUE (GALS)
1;25O.0 -3:. x.
1,250.0 **
SOIL RAI lNG (SQ.FT"/BR)
159
159
159
** TANK MUST
HAVE AT LEAST
TWO COMPARTMENTS
certiY'y that:
�amiliar with the requirements �or on�site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska,
2. I will install the system in accordance with all MOA codens and regulations,
and in compliance with the design criteria of' this permit"
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well,wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot"
4. I understand that this permit is valid [or a maximum of 4 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES;
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS~BUILTS
WILL NOF WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRI CAI j L k.3ED ELECTRICIAN.
SIGNED // DATE: 7--_�'� /o
.... ....
�`
� -\
APPLICANT: EAS
DATE:
ISSUED BY
,' .
(EN R'S SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Lcv-rq 1 e6L!& �1� I DATE PERFORMED: �u� V
LEGAL DESCRIPTION: S hPSOrI L3l/-" Township, Range, Section: , - 31150 ]2_I(101
DEPT SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
O'rVil Cs
S1 [+Vj SQ%t[A { K4 Vt
Ujkt' I��s�, scLKd y
vccu 5 atiw ¢ S+ SecmS
•'t'A n
f'3
WAS GROUND WATER
ENCOUNTERED? ylo
S
L
IF YES, AT WHAT O
DEPTH? P
E
Depth to Water After Sd 1 13
u
Monitoring? Date:
e_- I
■■■■■■■■EMMMMMMMM
■.
■■■■■■■■■■
■■■■■■■■■■
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
3
10
38-
2-,&-
,&-
61
6l
v7_
tv
.Zr
iv28
�oj'F' LO Vo 6' • .1 9
PERCOLATION RATE_ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN `a —FT AND FT
6 vin 2—
PERFORMED BY: /fCLS (I �"���°` CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINESINE E/CT ON THIS DATE. DATE: / J L�
72-008 (Rev. 4/85) %'z�fl�SC<( S y -t'- %'v/2-'
`70
r /-
i
Cr
aai�s J
��>2 APP`Dx,n,Q>'C AFS.
F
ArP0.
i
J—yl.
w`
Q Se i9c 4r
f
0 - a s T-og
`5or
* �9rt
C
•
LER C. R'FID, JR.
TN �s LOQ tl��'. E - 2251 ,..•:
COM010pi-i t liitL�
0 7 � �1PProfaecs.si
0 dvoals° f jD�
+_ VtYA
I hereby certify that I have surveyed the following desm�Wed
property:
Mo7cFff
Anchorage Recording Precinct, Alaska, and that the improve -
1/ VCy ; X ���w f ,r le �{, ments situated thereon are within the Property lines and do not
overlap or encroach on the property lying adjacent thereto, that
Fl, -Lb VFR(!`y 14 7' .Sopfi'� l no improvements on property lying adjacent thereto encroach
on the premises to question and that there are no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
p ` rrfcs; [� 7e!! �:- c..•; , Dated at Eagle River, Alaska
d . 4 a� n� au T/ dv, ay this. --f � da% of QFC , 19 g
R013ERT C. JOHNSON •7 r
\ SCALE Registered Land Surveyor No.40-LS
Box 77-04%, Eagle River, Alaska 99577
Phone (907) 694-2543
MUNICIPALITY OF ANCHORAGE fi
® DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services ���
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ��j�� - �� - Z� HAA # 4 09'Q cl� Z-0
1. GENERAL INFORMATION
Complete legal description Lot 3; Block 2; Sampson Estates Subdivision
Location (site address or directions) NHN nelilah Circle
Property owner Thomas Nelson Day phone 688-1177
Mailing address P.O. Box 670292, Chugiak, Alaska 99567
Lending agency
Mailing address
Agent _
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xxx
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev.1/91) Front MOAa21
5. STATEMENT OF INSPECTION SX ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm ------ C Fc iilGINEERING Phone
17034 Eagle River Loop Road No. 204
Address Eagle iver,, AAlaska 99577
Engineer's signature
6. DHHS SIGNATURE
Approved for _ bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date
OF
�c
.a 0
649I,U
arms •ea u.a.etloa 1•
H.�NYY00�.•.• rvr�. as -•eve __
t, ROGER J. SHAT
•. No.
,410 "ROEESSO".
bedrooms, with the following stipulations:
UJITlr
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 021
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Le, -r SD�PS64 Parcel I.D.
F—sr. slfl
A. WELL DATA `
Well type Ptzt\I ren;, If A, B, or C, attach ADEC letter. ADEC water system number N
Log presentDYN) Date completed Driller
t
Total depth 1 Loc:;Cased
to
Casing height
_Z LA k -
`
Sanitary seal ON)
J
Wires properly protected/N)
FROM WELL,LOG
AT INSPECTION
Date of test
2- S-gS
1 y- S -� y
F�
o
i9
Static water level
Well flow
g.p.m.
g. �
rn O
Pump level
®
v o
20
SEPARATION DISTANCES
FROM WELL TO:
fa
Septic/holding tank on lot
0
; On adjacent lots
d�
Absorption field on lot
$moi t
; On adjacent lots
Public sewer main
�
Public sewer manhole/cleanout
Sewer service line
ZS
Petroleum tank 2s��
WATER SAMPLE RESULTS:
Coliform (] %02"%4• Nitrate \. o e;' Wlyl l:. Other bacteria f A D f.�E
Collected by: S & S ENGINEERING
No. 204
Date of sample: 2 - Z -� y Eagle
Eagle River, Alaska 99577
B. SEPTIC/HOLDING TANK DATA
Date installed -7 Tank size \ 2-Sd Compartments b
CleanoutsON) Foundation cleanout/N) � Depression (YdD
µ
High water alarm (y, Alarm tested (Y/N) t_OL�-
Date of pumping 1 't- -
Pumper S'- 6__" -5f -50L_
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot � :u % On adjacent lots \ v o I Foundation �S
t
To property line \ o Or- Absorption field
S t Water main/service line
Surface water/drainage k oy
72-026 (Rev. 7/91) 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)
SEPARATE gISTANCE FROM LIFT STATION TO:
on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" level at
Cycles tested
Surface water _
Date installed " ti u - �31 Soil rating (3R-- System type
Length L91 Width 11� •S t Gravel thickness �, Total depth �1 t
Total absorption area I-0'1 0 � Cleanouts present&N)
Depression over field (Ya h1 Date of adequacy test
Results Mail) P f V- bedrooms
Peroxide treatment (past 12 months) (YO If yes, give date
�
SEPARATI N DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1 On adjacent lots 1 t Property line 1 C 1k
To building foundation 30 To existing or abandoned system on lot —A
On adjacent lots Cutbank 41 Watermain/service line
Surface water lC)v Driveway, parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
1 certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on
S & S ENGINEERING
19034 Eagle River Loop Road No. 204
Signature -,. hE Rives; Alaska 99577
Engineer's Name
Date
date of this inspection.
HAA Fee $ Zb e CYO Waiver Fee: $
Date of Payment l 2' -1 — ci --.?—
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Date of Payment
Receipt Number
CHEMICAL & GEOLOGICAL L9tBORAI URA
A DIVISION OF COk4PAEnCIAL TESTING Ik ENGINEERING CO.
5633 STREc? ANCHORAGE. ALASKA 99518 TELEPHJNC (907) .582 X313 FAX: (907) 581-5301
ANALTSI3 R13OLI3 for TMYOICE # 61295
CheRlab Ref.# 42.6664 Sanp14 # 1 Metrlx: NATER
Client Sample ID 0 82 SAMPSOW ESTATTS Client Natse :s & 9 ENGTNEERIAG
PNBID UA Client Acct 9NSRNGP
Pb# :NONE R1kCETYEQ
Collected 12/x2/92 4 10:BPO;35 hrs. Hot
Received 12/03/92 4 14120 h'e. D.doYad By :R, 5HAYBA
Preserved with
Anolysie Completed 12/04,/92 $end Reports to:
Laboratory Superyfeoc STEPHRM f. EDT lis S $ ENGINEERING
Re148,eed By : 2)
Fw6piOaPab xwx F.•I ♦i•wbaY..iix... .........................
.vY YiFFw" ^
^"--a..._a li ub.'e.ineuw.sn..ww --
..'..................
.w.wn.EYMn.nwwwww. -
paremeter R4suJ.ts Unite MAthod Ailovabia Li wta
- - .... _.. -- ----_-----
-----------------_-. -'- 1,OB ---
NITRATE4 rq/1 IDA 353.2/304.0 11
Semple ROUTINE SAMPLE COLLEGSED BY: &.3•
Remarks:
wv•wvawns a ooze•^.wzuov vww.
1 Tonto PerfotW See Sp'ciel Instructions Aboyo GA -Unavailable
ND- None Detected 34o Sample Remarke Aboya
NA- Not Analyzed L1 -Lase Shin, GT-Grestet Than
Ate r,58 Ivternber of the $GS Group (vocl610 406rafe da Surveillance)
= MUNICIPALITY OF ANCHORAGE D S S�
+ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0';,
1
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date NovembeAe 19, 1987
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township,
Lot 3; Block 2; Sampson, Subdiv.Z6 .on
Location (address or directions)
(b) Applicant Name Lanny Neas Telephone: Home 346-2471 Business
Applicant Address 4901 Can -Lynn UjLc2e, Anehonage, A.2aska 99516
(c) Applicant is (check one): Lending Institution El ; Owner/builder 1� ; Buyer ❑ Other ❑ (explain);
r
(d) Lending Institution A.2aska Mutual Bank Telephone
Address Anehonage, Ataska
(e) Real Estate Company and Agent TARGET REALTY/Bab Padgett
Address P.O.. Box 774627 Eag_te RiveAc A.Caska 99577
Telephone 694-2388
(f) Al the HAA to the following address:
S 9 S ENGINEERING
17034 Eaale R.i.veA Loop Road, Suite 204
E,g2e R.iveA Mask 99577
4. SEWAGE DISPOSAL
Onsite RTC 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 (11/84)
Page 1 of 2
5. ENGINEERING FIRM PROVIDINI +SPECTIONS, TESTS, FILE SEARCH, DA SND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm Telephone (6%i�2�t 9
S & S ENGINEERING
Address
Date
Eagle River, Alaska 99577
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
lN1CIPAL11Y OF ANC"(0AECKLIST - FEBRUARY 1984
ENl/MENTAL SEkV10ES D1V1S1ON 264-4744
NVIRO
NON) 3 0 1987 Legal Des ription: V++` � t. -3 -e -72L Z
A. WELL DATA f cc J \t D
Well Classification � t" -k -,) \`/ 1 9 /�—� If A, B, C, D.E.C. Approved (Y/N)
Well Log Present qN) Date Completed 42 Yield
1 1 f
Total Depth \ LP15- '^C Cased to � Depth of Grouting
Static Water Level 1 �`� /II Pump Set At Q � 7 r
Casing Height Above Ground Sanitary Seal on Casing (E1)
Electrical Wiring in Conduit ON) Depression Around Wellhead (Y/40
Separation Distances from Well:
To Septic/fig Tank on Lot / ; On Adjoining Lots a�
To Nearest Edge of Absorption Field onLotj ; On Adjoining Lots c90
To Nearest Public Sewer Line �/A To Nearest Public Sewer
Cleanout/Manhole G t.� \ / To Nearest Sewer Service Line on Lot 2 5
Water Sample Collected by J S� (� ; Date
Water Sample Test Results
Comments
B. SEPTIC/H6=1413 TANK DATA
Date Installed 71 Size 0-15iQ No. of Compartments
Standpipes IDN) Air -tight Caps (DN) �L-/ Foundation Cleanout (DN) -T
Depression over Tank (YoDate Last Pumped
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) N Temporary Holding Tank Permit (Y/N) h'.
Separation Distances from Septic/Heldrrrg Tank:
r
To Water -Supply Well —
To Property Line
To Water Main/Service Line
Course
Comments
Page 1 of 2
72-026 (Rev. 8/86) Front
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1�� ` /� Type of System Design
Date Installed 1 - l ('0 Length of Field b-
� I
Width of Field 2' Depth of Field 1
Gravel Bed Thickness
Square Feet of Absorption Area �� �� Standpipes PresentO?N) y
Depression over Field (Y/6V Date of Last Adequacy Test 1�
Results of Last Adequacy Test
Separation Distance from Absorption Field: I I
To Water -Supply Well 1 gs To Property Line
To Building Foundation To Existing or Abandoned System on
Lot r%� 1 ; On Adjoining Lots 1'1�
To Water Main/Service Line fl -I To Cutbank (if present) cJ
To Stream/Pond/Lake/or Major Drainage Course A c:::�� )-�-
_I__�-
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION IV I
Da tailed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
"Pump Off" Level at
** Check Permitted Bedroom Rating Against HAA Request **
Vent(Y/N)
Cycles during Adequacy Test. Meets MOA
I certify that I have checked, verified, or conformed to all MO and HAA guidelines in effect on the date of this inspection.
SignedS a& S ENGINEERING Date G Z
Com 17034 Eagle River Loop Road No. MOA No �� ✓�
P�gl ,
Receipt No. �:.- ,:,,,,<,::,
Date of Payment O _ k %
r
U
Amount: $ / Q in ' s al.
Page 2 of 2
72-026 IRev 8/86) BaCk
J.
�• "C'
T.
iif t S:itC1"6
H£MICAL & GEOLOGICAL LABORATORIES OFALASKA, INC.
563aeSTREET ANCHORAGE, ALASKA 99518 TELEPHONE 79562 «q
FEDERAL TAX o,92-0040440
MA
JAMR pEgEF .
Glei :t ! R 9
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