HomeMy WebLinkAboutSAMPSON ESTATES BLK 3 LT 3Sampson
Estates
Block 3
Lot 3
#051-811-29
i17G
Municipality of Anchorage Page of
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: SW940323 PID Number: 051811 g
Name:
KNO Engineering
Wastewater System: gNew ❑ Upgrade
Address:
ABSORPTION FIELD
20441 Ptarmigan Eagle River
Phone:
No. of Bedrooms%
✓ M0
Deep Trench ❑ Shallow Trench 9]i$ed ❑Mound ❑Other
696-6111
3
LEGAL DESCRIPTION
Soil Rating: 0.4
a from original grade:
Tv a Depth
GPD/Sq. Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
3 3 Sampson Es
3-5Ft.
.41 Ft.
Township:
Range: _
Section:
Fill added above original grade:
Gravel length:
7 6 '-'Ft.
O Ft.
WELL: New ❑ Upgrade
Gravel widtf 61 ✓
Number of lines:
Distance between lines:
1 5
Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material: ASTM F81 O
Ft.
Ft.
1 91 F, SD. Ft.
D 3 0 3 4
Driller:
Date Drilled:
Static Water Level:
Installer:
MMM Contracting
Date installed:
9/94
Ft.
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
15 GPM
u n k n Ft.
2 Ft.
SEPARATION
DISTANCES
EX Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer: /
Steel
Capacity in gallons: 1 O O 0 '
From
Tank
Field
Station
Tank
Sewer Lines
.Ak
Material:
Number of Compartments:
weir
105'
105'
--
--
100'
Steel
2
SurfaceT
STATION
Water
1 00' +
1 00' +
--
--
--
LotSize
82'
10'
--
--
--
in gallons:
Ma facturer:
Line
"Pump on" lev at:
"Pump off' level at:
High water alarm at:
Foundation
10'
10'
--
--
--
Curtain
--
..
---
—
— — —
Pump Ma S Model
Electrical Inspections rformed by:
Drain---
Remarks: Ori g nal design modified
BENC . MARK
after permit from pressurized
Location and Description:
Finished floor
system to gravity feed system.
Assumed Elevation:
100 0
EN INNW,k JE L
•Q`.4%to
•e*0
• °
*a`4c�7l�l..
Inspections performed by: B C S &! A s s o c i a t e s Dates:1 1st 9/ 9 4
°°-0.°°".�•
2nd
�•• *else*I�•O• •, • •op°ae �
9nZO Kenneth /:. us o <u
:° CE 7116
Department of Healt4,aod Huma vices approval
•' �+�
�8o9Ff ;;0l.`�P���'`�
Date: �°Z` `
�AP17�FESS + `�
Reviewed and approved by:
72-013 (Rev. 9/91) MOA 25
WATER AND WASTEWATER ABSORPTION SYSTEM
SITE PLAN AS -BUILT
LOT 3 BLOCK 3 SAMPSON ESTATES SUB
\EXIST \
SEPTIC
P.I.D. 051-811-29
SW 940323
tip ��1 4i ,•;•
13 LOT 2
IA
o r EXIST WELL
dr `no v +;
E
V1
w
Tao 3 LL1
o - ptic Vents Typ,
CT
11,9cs
S ca
Q
L❑aT 1 rx0 o
ICD
^,
TA�
f
i F A44,S,%
rt 49TH
BMMM IL DOT
� C&-7118
�R163s`9910 =
\ 23500
LOT AREAL 41,000 SF S 8 9° 5 5' 0 8 // W
LESS PERIMETER SETBACKS,
BUILDING FOOTPRINT, WELL RADIUS, 2L500SF
TOTAL AREA AVAILABLE FOR ABSORPTION SYSTEM, 19,50D SF
MM&M CONTRACTING, INC
P❑ BOX 670485
CHUGIAK, AK, 99567
KND ENGINEERING
20441 Ptarmigan
-AK
Blvd,
EagLe River,
99577-8736
(907)696-6111
DATEo 11-20-94
DRAWING R
SCALD V = 50-
AS -BUILT
Ld
0
0
x
ra
Ld
(4
0
CL
E3
CC
0
LL
Q
H
J
0
Cn
d'
M.
C.O.
AS -BUILT DETAILS
WASTEWATER ABSORPTION SYSTEM
LOT 3, BLOCK 3, SAMPSON ESTATES SUBD.
m W
o q � 101,96' O
o
E
P.I.D. 051-811-29
SW 940323
W
100.27' 0
g CO 9e,s8' S C3
P
O 98,40' o
s
1111 111 i❑RIGINAL GRADEJJ& FINISHED GRADE
_"Q;ft!7�\
OF AZ A
�� *ek Qq� k'I
KMNr 8 Y Dui /
-7118
1
76.0'
varies
115
76' BED
85,51'
BOTTOM OF TEST HOLE
M.T. 95,48'
C.O.
0
======E) 95.52'
O
1 /
O00O /
Note,
1. Finished floor used as Bench Mark (Assumed Elev. 100' ).
2. Original design modified after permit from pressurized
system to gravity feed system.
MM&M CONTRACTING, INC
PO BOX 670485
CHUGIAK, AK, 99567
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
907-696-6111
DATE, 11-20-94 DRAWING #
NOT TO SCALE I AS -BUILT
tr
wrr#tftrb Orating luig
by
DOC Co. dba
SULLMN WATER WELLS
P.O. BOX 670272, CHUG IAK, ALASKA 99567 • TELEPHONE 688.2759
OWNER OF LAND I I i%/ r DEPTH OF WELL 5 r`�' 3
ADDRESS y;' C� %; ' }� ( Iu L/ �- `' jSTATIC LEVEL OF WATER FT. L
AJ
LEGAL DESCRIPTION = r DRAW DOWN FT.
DATE. - Started Ended `� �" GALS. PER HR
PERMIT NUMBER KIND OF CASING
KIND OF FORMATION:
From i Ft. to C Ft.
L g j 'r ST.i C K J From
Ft. to -
Ft.
From. Ft. to--�I—Ft.
�f` <
(4 i'7�i.` /� From
Ft. to
Ft.
From-A_Ft. to �Q' Ft:
i T
k r't - From
Ft. to
Ft.
From Ft. to - Ft.
ti ' t' /� From
Ft. to
Ft.
From --.Lt' t' Ft. to - ' Ft.
- f
From Ft. to
Ft
From -, Ft. to r- Ft.
} ' t
!7 ^v C� ` E%`' r� J" Fr im
Ft. to
Ft.
From > Ft. toJ ; ';) Ft
S pis it '; n i1 J 1= �- _ From—Ft,
to
Ft.
From Ft. to 1 ? Ft.
�/% !
r `T f i[l (;> ": + From
Ft. to
Ft.
' '� �/I Ft.
`�'`" /
'�'= / 4m
Ft. to
Ft.
From _ Ft. to <�
From Ft. to Ft.
�� X
/` From
Ft. to
Ft.
L
y =Y �
From Ft. toFt.�
` `�}
From
Ft. to
—Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft. —
From - Ft. to - Ft.
From
Ft. to
Ft.
From Ft. to Ft
From
Ft. to
Ft
MISCL. INFORMATION
DRILLER'S NAME
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES �3
P.O. BOX 196650, 825 "L" STREET, ROOM 502 G
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW940323 DATE ISSUED: 8/29/94
DESIGN ENGINEER:KND ENGINEERING FA �'IZi EXPIRATION DATE: 8/29/95
OWNER NAME:M M & M CONTRACTING INC
OWNER ADDRESS:20441 PTARMIGAN BLVD
EAGLE RIVER, AK 99577-8736
PARCEL ID:05181129
LEGAL DESCRIPTION: SAMPSON ESTATES BLK 3 LT 3
LOT SIZE: 41609 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
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 DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS) .
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
Cup DATE : gr Y
DATE:
KND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11 /FAX (907)696-8111
August 9,1994
On -Site Services
DHHS
825 L Street
Anchorage, AK 99501
Dear Sirs:
REF: Lot 3 Block 3 Sampson Estates Subdivision
Attached is our request for on-site well and septic permits for the above lot.
As shown on the site plan, there are no conflicts between the on-site wells and
the sewer systems or with potential reserve areas.
This lot is generally flat with a 1%- 2% slope running south to north and west to
east. There is adequate area directly southeast of the proposed well site on the lot
to install both an original and a replacement system. The natural slope will direct
drainage away from the well areas. No surface water was encountered on the lot
and no water was encountered in the test holes or after monitoring.
Due to the location of the proposed structure and the natural slope a 3 bedroom
S.T.E.P. packaged system was designed for this lot. Due to the size of the
absorption beds three test holes were drilled. Although two holes were
conducted in late 1993, the third hole completed in 1994 matches the previous
percolation data and soils.
Thank you for your consideration of this request. If there are any questions,
please call me at 696-6111 or leave a message.
Sincerely,
Kenneth M. Duffus, E.
KND Engineering
Attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details
Site Plan
Soils Log/Percolation Test(3)
DESIGN DETAILS
WASTEWATER ABS❑RPTI❑N SYSTEM
IOT 3, BLOCK 3, SAMPSON ESTATES
o O Z O
z z a
2-
w
W W J Q
J J
U U U
FINISHED GRADE
OR]
1250 GAL.
S.T.E.P.
MIN. 5 f- MIN 5'-
3.0 TYP.
'3.0'TYP.
M.T. o
2" SOLID MANIFOLD
bfN
in
in
w
0 0 0
FILTER FABR]
SEWER ROCK
BOTTOM OF BED 4.0'
BOTTOM OF TESTHOLE 15.0'
NO WATER
HOLE SPACING CALCULATIONS
1. 5 PSI RESIDUAL HEAD
2. 138 LE DISTRIBUTION LATERALS
3. 1/8" HOLES, .44 GAL/HOLE
4. 138 LF/(30/.44) = 2' SPACING
5. HOLES PLACED UP, SPRAY
COVERS OVER EACH HOLE
N IN.
N t L S.T.E.P. ' TO HOUSE
RECEIVED
1 1/4" PVC WITH
H❑LES AT 2.0'
M o SPACING, ENDS
CAPPED
15'
DESIGN CRITERIA:
OF ALA 0 O
49TH -11
�*
KENNETH DUFFUS
7116 -CE �k4
d p e/-2i/fty, �
�OF'ESSIONAI' F'
AU, G) 3 0 1994
Municipaliiy of Anchorage
Dept. Health & Human Services
3 BEDROOMS X 150 GPD/BEDROOM = 450 GPD
SOIL RATING: 23 MIN/IN = USE .4 GPD/SF
450 GPD / .4 GPD/SF = 1125 SF ABS. AREA
BED DESIGN WITH 1125 SF, MAXIMUM 15' WIDE
1125 SF / 15'WIDE = 75' LONG
0.5' MINIMUM DEPTH OF GRAVEL
2" HD INSULATION REQUIRED OVER FIELD & PIPES IF < 4'COVER
INSTALL 1250 GALLON S.T.E.P. TANK, INSULATION
REQUIRED IF BURIAL DEPTH <4'.
PREPARED FOR: KND ENGINEERING
M M & M CONTRACTING 22041 PTARMIGAN DR
P. 11, BOX 670485 EAGLE RIVER, AK, 99577
CHUGIAK, ALASKA 99567 694-2359
688-1236 DATE: 7-21-94 DRAWING #
NOT TO SCALE 94-S2-07-10
/ 3 L
�, r
SP o r � r
0
WELL
WELL
9
9
OF AZ
AgTH
KENNETH DUFFUS
NJ, 4
7116 -CE �4Q'
4 4 A�01'�"SpH/4�l®
1250\BED
ORIGINALSEPTIC SITE
12 SEPTIC
ECEIVED
AUG 3 0 1994
Municipaiiry 0) FVnchorage
Deft. Health & Human Services
2
o WELL
NOTE; PLATTED DRAINAGE
EASEMENT DOES NOT CARRY
WATER.
NO WELLS / WITHIN
OF LOT LINES
0
0
163.00
SEPTiC
13
SEPTIC
LOT SIZE: 41,609 S. F.
LESS: PERIMETER
HOUSE FOOTPRINT 2 2,10 9 S. F.
TOTAL AREA AVAILABLE FOR
ABS❑RPTI❑N SYSTEM 19,500 S. F.
,REPARED FOR: KND ENGINEERING
M M & M CONTRACTING 22041 PTARMIGAN DR
P. ❑, BOX 670495 EAGLE RIVER, AK, 99577
CHUGIAK, ALASKA 99567 694-2359
DATE: 7-21-94 DRAWING #
SCALE: V = 100' 94—S1-07-10
SITE PLAN
I
WASTEWATER ABS❑RPTI❑N SYSTEM
LOT 3, BL CK 3, SAMPSON ESTATES
2
SEPTIC
/ 3 L
�, r
SP o r � r
0
WELL
WELL
9
9
OF AZ
AgTH
KENNETH DUFFUS
NJ, 4
7116 -CE �4Q'
4 4 A�01'�"SpH/4�l®
1250\BED
ORIGINALSEPTIC SITE
12 SEPTIC
ECEIVED
AUG 3 0 1994
Municipaiiry 0) FVnchorage
Deft. Health & Human Services
2
o WELL
NOTE; PLATTED DRAINAGE
EASEMENT DOES NOT CARRY
WATER.
NO WELLS / WITHIN
OF LOT LINES
0
0
163.00
SEPTiC
13
SEPTIC
LOT SIZE: 41,609 S. F.
LESS: PERIMETER
HOUSE FOOTPRINT 2 2,10 9 S. F.
TOTAL AREA AVAILABLE FOR
ABS❑RPTI❑N SYSTEM 19,500 S. F.
,REPARED FOR: KND ENGINEERING
M M & M CONTRACTING 22041 PTARMIGAN DR
P. ❑, BOX 670495 EAGLE RIVER, AK, 99577
CHUGIAK, ALASKA 99567 694-2359
DATE: 7-21-94 DRAWING #
SCALE: V = 100' 94—S1-07-10
SITE PLAN
WASTEWATER ABS❑RPTI❑N SYSTEM
I FIT '2 RI nrk '2 CAMPCfINI PCTOTFC
®�
OF ALSO o
9 TH� v
Ev
bN KENNETH DUFFUS
l
�ssro;s�L �
LET SIZE:
LESS: PERIMETER
HOUSE FOOTPRINT
TOTAL AREA AVAILABLE FOR
ABS❑RPTI❑N SYSTEM
PREPARED FOR:
M M & M CONTRACTING
P. ❑, BOX 670495
CHUGIAK, ALASKA 99567
41,609 S, F,
2 2,10 9 S. F.
19,500 S. F.
KND ENGINEERING
22041 PTARMIGAN DR
EAGLE RIVER, AK, 99577
694-2359
DATE: 7-21-94 DRAWING #
SCALE: r = loo• 94—S1-07-10
3E
2RY
DESIGN DETAILS
WASTEWATER ADS❑RPTI❑N SYSTEM
LOT 3, BLOCK 3, SAMPSON ESTATES
7 � J
¢ o
w w z
J J Q
U U E
1250 GAL.
S.T.E. P.
kMIN. 5'-1 �- MIN 5'
in
D
M.
15'
FINISHED GRADE
FILTER FABRIC
SEWER ROCK
o
-A l�I�
�L
,�/-2' SOLID MANIFOLD
5'
O o o
oo
5� S,T.E,P,
TO HOUSE
MIN, I
-�1 1/4" PVC WITH
HOLES AT 2.0'
SPACING, ENDS
CAPPED
.Apr OF Aj lk
9 T *44
E�O
N KENNNETHH DUFFUS
7116 -CE A4'
A�U�'ESSIOi3A>• �' �
BOTTOM OF BED 4.0'
BOTTOM OF TESTHOLE 15.0'
NO WATER
HOLE SPACING CALCULATIONS
1. 5 PSI RESIDUAL HEAD
2. 138 LF DISTRIBUTI❑N LATERALS
3, 1/8' HOLES, .44 GAL/HOLE
4. 138 LE/(30/.44) = 2' SPACING
5. HOLES PLACED UP, SPRAY
COVERS OVER EACH HOLE
// Z c Z A01
t
DESIGN CRITERIA:
3 BEDROOMS X 150 GPD/BEDROOM = 450 GPD
SOIL RATING: 23 MIN/IN = USE .4 GPD/SF
450 GPD / .4 GPD/SF = 1125 SF ABS. AREA
BED DESIGN WITH 1125 SF, MAXIMUM 15' WIDE
1125 SF / 15'WIDE - 75' LONG
0.5' MINIMUM DEPTH OF GRAVEL
2" HD INSULATION REQUIRED OVER FIELD & PIPES IF < 4'COVER
INSTALL 1250 GALLON S.T.E.P. TANK. INSULATION
REQUIRED IF BURIAL DEPTH <4'.
PREPARED FOR:
M M & M CONTRACTING
P. O. BOX 670485
CHUGIAK, ALASKA 99567
688-1236
KND ENGINEERING
22041 PTARMIGAN DR
EAGLE RIVER, AK, 99577
7-21-94 DRAWING N
TO SCALE 94-S2-07-10
3.0
TYP.
T o
4.5'
6'
0
15'
FINISHED GRADE
FILTER FABRIC
SEWER ROCK
o
-A l�I�
�L
,�/-2' SOLID MANIFOLD
5'
O o o
oo
5� S,T.E,P,
TO HOUSE
MIN, I
-�1 1/4" PVC WITH
HOLES AT 2.0'
SPACING, ENDS
CAPPED
.Apr OF Aj lk
9 T *44
E�O
N KENNNETHH DUFFUS
7116 -CE A4'
A�U�'ESSIOi3A>• �' �
BOTTOM OF BED 4.0'
BOTTOM OF TESTHOLE 15.0'
NO WATER
HOLE SPACING CALCULATIONS
1. 5 PSI RESIDUAL HEAD
2. 138 LF DISTRIBUTI❑N LATERALS
3, 1/8' HOLES, .44 GAL/HOLE
4. 138 LE/(30/.44) = 2' SPACING
5. HOLES PLACED UP, SPRAY
COVERS OVER EACH HOLE
// Z c Z A01
t
DESIGN CRITERIA:
3 BEDROOMS X 150 GPD/BEDROOM = 450 GPD
SOIL RATING: 23 MIN/IN = USE .4 GPD/SF
450 GPD / .4 GPD/SF = 1125 SF ABS. AREA
BED DESIGN WITH 1125 SF, MAXIMUM 15' WIDE
1125 SF / 15'WIDE - 75' LONG
0.5' MINIMUM DEPTH OF GRAVEL
2" HD INSULATION REQUIRED OVER FIELD & PIPES IF < 4'COVER
INSTALL 1250 GALLON S.T.E.P. TANK. INSULATION
REQUIRED IF BURIAL DEPTH <4'.
PREPARED FOR:
M M & M CONTRACTING
P. O. BOX 670485
CHUGIAK, ALASKA 99567
688-1236
KND ENGINEERING
22041 PTARMIGAN DR
EAGLE RIVER, AK, 99577
7-21-94 DRAWING N
TO SCALE 94-S2-07-10
Municipality of Anchorage
t DEPARTMENT OF HEALTH 8 HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: ASI P.r.Q Pd- ('�}.�. tiCtlnT/ Ul) En-qjn_PPxjnq DATE PER
LEGAL DESCRIPTION: L o t 3 B 1 k 3 S -a -m p s o n E s t Township, Range, Section: S e d
DEPTH SLOPE SITE PLAN
1
Silty Loam
2
3
4
5
/ i%
7
8-
9-
10-
11 -
12-
13-
14
15
1s
17
18-
19-
20-
COMMENTS
81s20
COMMENTS
Perc Hole Elev
Gni/ Silty Sand
WAS GROUND WAT
ENCOUNTERED?
s
IF YES, AT WHATN/A L
DEPTH? P
E
Depth to Water After,
Monitoring? 1T% Date; 9/ 1 3/ 9 3
ME, NAME
.R,..E■RMEMME
ON
,■■
0 "MEMO
MENno
MEN on
e
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
0
25/93-
1
4:10
10
min
4
1/2"
1/2"
2
4:20
10
min
4
15/16"
7
3
4:30
10
min
4
4:40
10
min
5
13/16"
5
4:50
10
min
6
l/4"
7/16"
6
5:00
10
min
6
3/4"
60
min
2
3/4"
PERCOLATION RATE 23. (minutes/inch) PERC HOLE DIAMETER _'�_
TEST RUN BETWEEN 6 FT AND 7 FT
Hole presoaked prior to testing
PERFORMED BY: CAL/ KM.0 I Kenneth M. Du f f U&TIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 9./ 13/ 9-.3
72-008 (Rev. 4/85)
' EER
'S SEAL)
Municipality of Anchorage 100 00
t DEPARTMENT OF HEALTH & HUMAN SERVICES A* a'�° 00%r/'dQ
825 "L" Street, Anchorage, Alaska 99502-0650 I
1 MI ° ti
SOILS LOG —PERCOLATION TEST /° °.00
enhn Od/ % C 7116
PERFORMEDFOR: M Con.traCtl_-n Cl/ K.ND Engineering DATE PER 0 100 °
FqESS
LEGAL DESCRIPTION: %%Lt 3 n tTownship. Range, Section:
S e C 1- T1 5`I—®I-t+l
DEPTH SLOPE SITE PLAN
1
2
3
(
r, ``a4
5
6
7
8
9.
10-
11 -
12-
13-
14-
15-
16
17
18
19
20
COMMENTS
Organic
Silty Loam
Perc Hole Elev
Silty Sand �\
WAS GROUND WAT
ENCOUNTERED?
IF YES, AT WHAT L
O
DEPTH? N / A. P
E
Depth to Water Afterr-) 9/1 3/93
Monitoring? Date:S / 15/9 4
Ldve
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
0
/23/93 5;00
-.
4"
-
1
2
3
4
5
r 5:05
5;15
5:25
5;35
5;45
5 min
10 min
10 min
10 min
10 min
3/16"
5/8"
1/16"
112"
15/16"
3/16"
7/16"
7/16"
7/16"
7/16"
45 min
1 15/16'
PERCOLATION RATE __2.3_ (minutesnnch) PERC HOLE DIAMETER_}.! _
TEST RUN BETWEEN 4 FT AND 5 FT
Hole presoaked prior to testi.nq
PERFORMED BY: rAi ./ K M n I Kenneth M D'I f f i1 c CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9/i 3/93
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 -L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Co n t ra c t l n g #3 DATE PERFORMED`�v� -5:/-1'5 /-94
LEGAL DESCRIPTION:L D t 3 810 Sampson Est _Township, Range, Section: Sec 3- T1 5 N MR
W
DEPTH SLOPE SITE PLAN
rtt" urDanl'C
1
Si'l ty- Loam
Course Silty Sand
Perc Test Elev
Silty Sand
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L
DEPTH? N/A A O
( P
_ E
ZZI
Depthto Wate
Monitoring?
A 5 / � 3 / 9
Monitoring? Oale:
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
0
5 15 9.4 0
0
3"
0
1
5 mi:n
5
min
3
5/16"
5/16"
2
15 min
10
min
3
13/16' 112"
3
25 mi;n
10
min
4
3/81'
9/16"
4
35 min
10
min
14
7/811
11211
5
45 min
10
min
5
3/8"
1/2"
45
min
2 3/8"
u "
PERCOLATION RATE (minutesrinch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN _y,.__ FT AND 5 FT
COMMENTS Hole Persoaked prior to test
PERFORMED BY: CAL / K^9 D I Kenneth D u f f u s CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5-/ 2.3 / 94
72-008 (Rev. 4/85)
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/0nsfe
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
051.811-29
1. GENERAL INFORMATION
.M EOL
COSA# QSCIGt/0Z/q
Expiration Date: �f — / — / 6
Complete legal description Lot 3, Block 3, Sampson Estates Subdivision
Location (site address) 22713 Sampson Drive Chugiak, AK 99567
Current Property owner(s) Zachary Laron Zpsir Day phone
Mailing address P.O. Box 670571 Chugiak, AK 99567
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD /or pickup.
2. NUMBER OF BEDROOMS: ThrDe (3)
3. TYPE OF WATER SUPPLY:
TYPE OE-WASTEWATERDISPOSAL:
Individual Well
0
Individual On-site
❑�
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD] issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering
Address P.O. Box 240773 Anchorage. AK 99524
Phone 522-7773
Engineer's Printed Name Michael E. Anderson, P.E. Date MO/2010
�'_ ;weuEi E NZMSoN � ,t ,
6. DSD SIGNATURE I� - CE -4381
: �z`r�
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:
(Rw ,+W
Municipality of Anchorage
• "' Development Services Department •-
Building Safety Division
On -Site Water& Wastewater Program `•
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 3, Block 3. Sampson Estates Subdivision Parcel IDf� O.i 7 - 811-A?
A. WELL DATA ,
Well type Private If A, B, or C provide PWSID #_
Date completed 911994 Sanitary seal (Y/N) Y
Total depth 155 ft. Cased to 155 ft,
FROM WELL LOG
Date of test 911994
Static water level 121 fL
Well production 15 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 6.45 mg/L
Arsenic: N/D ug/I Date of sample: 5112/2010
B. SEPTICIHOLDING TANK DATA
Tank Type/Material sepuc/steei
Well Log (YM) Y
Wires property protected (Y/N) Y
Casing height (above ground) >18 in.
AT INSPECTION
5/1312010
125.8 ft
60 9 -
p.m -
Other bacteria 0 colonies/100 mL
Collected by: S. Gilbert
Date installed
9194
Tank size 11000 gal. Number of Compartments TWO Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (YM) N High water alarm (YM) N
Date of pumping 1010912009 Pumper Sanitary Pumper
C. ABSORPTION FIELD DATA
Date installed 9194 Soil rating (g.p.d.te or f?/bdrm).4 GPDIsF
System type - Shallow Bed
Length 76 ft. Width 16 ft. Gravel below pipe .41 R
Total depth fL Eff. absorption area 1,216 f? Monitoring tube Y Depression over field N
Date of adequacy test 5/13/2010 Results (Pass/Fain Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 500 gal. New depth 5.5 in.
Elapsed Time: 1.440 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N)
'Pump on, level at_ in. 'Pump off" level at _
in. High water alarm level at in.
Datum Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
On adjacent lots >100•
Absorption field on lot >too'
On adjacent lots >100'
Public sewer main N/A
Public sewer manhole/cleanout N/A
Sewer/septic service line >25
Holding tank N/A
Animal containment areas None
Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >5' Property line>'
Absorption field >5
Water main N/A Water service line
>10' Surface water >low
Wells on adjacent lots >too -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >70' Building foundation >10' Water main >10'
Water Service line 1110' Surface water >100'
Driveway. parking/vehicle storage 1125
Curtain drain None Noted Wells on adjacent lots
>100'
F. COMMENTS:
2
G. ENGINEER'S CERTIFICATION "67IV
�Q.'� •v�f �j
I cert' that 1 have determined through field in
certify g inspections and
review of Municipal records that the above systems are In
1„1,1«IMN
conformance with MOA COSA guidelines in effect on this date. IIIN„, •,1
� 1„ rticxkt-e: �Noarsal
Engineer's Printed Name Michael E. Anderson, P.E.
Date 5=12009�IS•u'•'14`4�Aw
/ P>rOfESS10�a ��
COSA Fee $ 41 Cl 0 Waiver Fee $ _
Date of Payment r- -2 0 -/ O Date of Payment
Receipt Number D 9 3 Receipt Number,
(Rev. 11105) .
SGS ReLN
1102110001
Client Name
Anderson Engineering
Printed Date/Time
Project Name/N
Kitchen Sink Sampson Est 3/3
Collected Datefrime
Client Sample ID
Kitchen Sink Sampson Est 3/3
Received Datefrime
Jtatriz
Drinking Water
Technical Director
Sample Remarks:
05/1 82010 14:57
05/122010 19:00
05/132010 10:00
Stephen C. Ede
Allowable Prep Analysis
Parameter Results LOQ Units Medved Contain ID Limits Date Date Init
Metals by ICP/MS
Arsenic
ND
5.00
Waters Department
Total Nitrate/Nitrite-N
6.45
0.100
Microbiology Laboratory
E. Coli
Negative
1
Total Coliform
Negative
1
ug/L EP200.5 C (<I0)
mg/L S%f204500NO3-F B (<I0)
05/13/10 05/17/10 SCL
05/13/10 AYC
100mL SM209223B A 05/13/10 DLC
100mL SM209223B A 05/13/10 DLC
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 101049
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 3, Lot 3 of
Sampson Estates subdivision. This inspection revealed a nitrate
concentration of 6.45 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage
• Development Services Department
Building Safety Division
�- On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D._ HAAtt nsas�3
1. GENERAL INFORMATION Expiration Date:
Complete legal description
Location (site address or directions) 22 7f3yf is 1iV
Current Property owner(s) r< <,iG S Day phone all,—
Mailing address D/l Wt1Ajx • ,�j},�t h� �1 Q Cq �7 S
Lending agency Day phone
Mailing address
Real Estate Agent 5u , .110 (� a ( Day phone..? q2--c-/.?2n
Mailing Address �i�ucinr,Ttnl t .r .1' .1� P ._ _
Unless otherwise requested, HAA will be held by DSD for pickup
2. NUMBER OF BEDROOMS: .�
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
)E3
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
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
title (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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of
Address
Engineer's Printed Name
5. DSD SIGNATURE
J/" Approved for �_ bedrooms.
Disapproved.
Phone G 74.1- 7Oz0o
Date /,q /SOS
a
q �4 ,.N.•.•.•�
*S.gTH =>
........ .........c. `.
COI siev .Enq �, �✓
J'J, ;• PC 6456v
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: a Cy ��� Original Certificate Date:ItVt / qe)f�5—
JRw Ov02)
Municipality of Anchorage
' Development Services Department
JBuilding Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST'
A. WELL DATA
Well type, If A. B, or C provide PWSID #
Date completed Y�v Sanitary seal (Y/N)
Total depth /SS ft. Cased to ISS I.
FROM WELL LOG
Date of test 9
Static water level
Well production /$� 9 -P.M.
WATER SAMPLE RESULTS:
Well Log (Y/N)5/ 7-
Wires properly protected (�Y/N)V
Casing height (above ground) in.
AT INSPECTION
t US
ft.
6 * g.p.m.
Coliform �2 colonies/100 ml. Nitrate /. V6 mg./I. Other bacteria (0 colonies/100 mi.
Arsenic: = mg./I. Date of sample: 26?Y/0S Collected by: O i
B. SEPTIC/HOLDING TANK DATA
Tank Type/MaterialdK Lm5r/ �4m6L Date installed
Tank sizegai.' Number of Compartments Z Cleanouts (YIN)
Foundation cleanout (Y/N) Depression over tank (YIN) L_J( High water alarm (Y/N)
Date of pumping —7W
/--?5 r Pumper
C. ABSORPTION FIELD DATA
Date installed ��T Soil rating (g.p.d./ft2 orliF" O System type _&Eid
Length 76 ft. Width 14 ft. Gravel below pipe P p ft.
Total depth 7 /2
ft. Eff. absorption areat ft' Monitoring tube V Depression over field
Date of adequacy testi 3- //bs Results (Pass/Fail) W-rs For -3 _bedrooms
Fluid depth in absorption field before test O In.
Elapsed Time: 41CO min. Final fluid depth _0 in.
Water addedV570 gai.-r New depth—0 in.
Absorption rate >= Sot g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) 424YA If yes, give date
D. LIFT STATION
Date inEy
Size in gallons anhole/Access (Y/N)
"Pump in. "Pump off" level at _ in. High water alarm level at
Ein.
Datum Cycles tested Meets alarm & circuit re cements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
i
Septic tan0ift'siabon on lot /00'r"
Absorption field on lot 10014 -
Public sewer main A/�/l
Sewer /septic service line SO •�
On adjacent lots /40) �f' on adjacent lots Za Q /'-
Public sewer manhoWcleanout
Holding tank /4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation St Property line ��t Absorption field S t
Water main A1.411 Water service line 2
$ 'f' Surface water
r
Wells on adjacent lots /60
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /0 it Building foundation /G1 f, Water main M/4
Water Service line
_ Surface water /o t1 I * Driveway, parkingtvehicle storage Z S rf
i
Curtain drain d!IAWells on adjacent lots 4-16 r
F. COMMENTS
PSE• N..^,�•gS,`II
G. ENGINEER'S CERTIFICATION a%y�.••' 1 �•.,+9�1
1 certify that 1 have determined through field inspections and�• ; 49L1► .:ir,
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date. .. ..
"��.
S f F� 6 C: 'S we^ 25
W.
Engineer's Printed Name .� I��s�t. PE 62sb
Date
HAA Fee $Waiver Fee $
�� yr IJP Date of Payment
Date of Payment �1
Receipt Number(8S Receipt Number
(Rev. 12/01)
10-07-05 01:35pw FPCY-CT&E ESI, S;S ENV SERVICES
SCS Krim
1055339001
Cwent Name
NorthRim Lagirccring
Project Numeif
Sampson Est 831-3
Client Semple ID
Sampson Est E331.3
htatrlx
Orinkmg Water
9075E15301 T-016 P.02/04 F-365
All Doleinlmcs are Alaska Standard Time
Printed D. ell Ime
10106,'2005 16:07
Colierted Daterrlme
092&W1113 16:00
Ro:clnd Dale/Thno
07129.2005 14:33
Technical Director
Stephen C. Edr
MID 0
Santo:c Rc:ner3s- —'
Microbiology Laboratory
Towl Culi:uno
0
coVIDOnd. SN204Y2729 A (<=1) 09.19/03 TLF
rxxnv.
Reavits PQL
Url:s htahxl
Canwinv to
Limits
Dow
Dam* heli
Niheto-N
1.36 0.100
mg'L F.?A 333 2
8
1"10)
09,79/05 AZS
Microbiology Laboratory
Towl Culi:uno
0
coVIDOnd. SN204Y2729 A (<=1) 09.19/03 TLF
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE
FOLLOWING DESCRIBED PROPERTY:
Esr.�flcor'.
AND THAT NO ENCROAC I�MENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THS EXISTENCE OF ANY
ONS
WHICH
EASEMENTS,
CH DONOT COVENANTS,
ON THE REOR STCORDEDISUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
Alr yo'
DATE:
GRID:
Hu//S6�
FB: /vB 39
DRAWN:
.aivgf�
ATES
�F- OF A�
M �' 4•••iM�� �s�}�
Cum* Mbk Sw.rE
-J;LS-6919
29
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services it
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 1. D. # D S / S// Z `j HAA # k i�O D ) LiWA
1. GENERAL INFORMATION
Complete legal description
I
an 65Z &e� 5 L64
Location (site address or directions) Son
Property owner �i[,4'zl �✓�e5 Day phone �)0 '
Mailing address IFD 3oK %n80� 2z�n�. ak1 —7
g9f4e I
Lending agency
Mailing
Agent _
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
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
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
t
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I 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 KND Engineering Phone
an Rvd.
Address IjEagle River, AK 99577-8736
Engineer's signature
6. DHHS SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
c
4UTIr
Date r�ic3 hf7
AW A% 02
p�` OF A�,gS�i
: %
, %!� Kenneth M Duffu
CE 7116
• ��
r
bedrooms, with the following stipulations:
Date Y_30_97
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 orderto 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 engineers work.
72-M Mev. 1/91) Back MOAT
MUNICIPALITY OF ANCHORAGE
ENVIRONM NTA4-SERVICES DIVISION
Municipality of Anchorage SEP 18 1997
DEPARTMENT OF HEALTH & HUMAN SERVICES �"
Environmental Services Division V
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: �7i1 �M��1FiGs ,mac Parcel I.D.: 1)51 S 11 Z
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) ` Date completed 9
i
Total depth 15-5) Cased to J55 Casing height (above ground) 2
Sanitary seal (Y/N)
FROMWELL LOG
Date of test 9/91/
Static water level / Z
Well production
Wires properly protected (Y/N)
AT INSPECTION
0892
/25
g.p.m.. to ':545 g.p.m.
WATER SAMPLE RESULTS:
Coliform � Nitrate . 7
Other bacteria
Date of sample: 9,8��% 7 Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed _ Tank size 1000 Number of Compartments Cleanouts (�Y//,,N)�_
Foundation cleanout (Y/N) _ Depression (Y/N) _ High water alarm (Y/N) 14
Date of Pumping 4A Pumper J 25 8u:
C. ABSORPTION FIELD DATA
Date installed 9 Soil rating (g.p.d./ft2 or ft2/bdrm) 4), i System type
Length %% I Width /!o Gravel thickness below pipe Total depth 3 5 r
Effective absorption area . /Z1(0 Monitoring Tube present (Y/N)--L— Depression over field (Y/N) A
Date of adequacy test 9 S Results (Pass/Fail) haS For bedrooms
Fluid depth in absorption field before test (in.);_ Immediately after gal. water added (in.):
Fluid depth (ins) Minutes later: /80 Absorption rate = 7J`L5 + g.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at' _
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
mp on" level at"
'Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
"Pump off" level at'
Septic/holding tank on lot /00 �4" On adjacent lots X00 `4-
f
f
Absorption field on lot IDO On adjacent lots /DD 4-
r f
Public sewer main /D b f Public sewer manhole/cleanout /DD 'I'
Sewer /septic service line
I+ Lift station A,114
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation /D '4 Property line /U I Absorption field 164-
It
Water main/service line Z 5 f' Surface water/drainage DO + Wells on adjacent lots /bD `k
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / b f 4� Building foundation /U f4� Water main/service line
Surface water / U cD -I' Driveway, parking/vehicle storage area
Curtain drain /00 -r- Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name
Date 9A8 If 7
HAA Fee $ �12 G� '
Date of Payment ell/ S- 1 /
Receipt Number
72-026 (Rev. 3/96)`
Waiver Fee $
Date of Payment
Receipt Number
1
2S4
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M•• ••H• IM•••••CIZ
••N••••u.•
p'SS Kenneth M. Du lij
(4 �'.• CE 7116 �? �4�100n
' SEP 15 —7 1 ........... I .........
97 02 14PM NTL RNCHORRGE P. 1/1
or
NORTHERN TESTING LABORATORIES, INC.
P.400
3330 INDUSTRIAL AVENUE FAIRBANKS, AI ASKA 99701 (907) 466-3116 • FAX 4563125
8005 SCHOON STREET ANCHORAGE, ALASKA 99518 (90'7)349-1000 • FAX 349-1016
DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
KND Engineering
Date Received: 9/9/97 Time Received= 16:55
20441 Ptarmigan Blvd.
Date Analyzed: 9/10/97 Time Analyzed: 16:30
Date Reported: 9/15/97 Time Renorted: 12:44
Eagle River AK 99577-3736
Next Sample Due:
Comments
Phone Number:
S = Satisfactory
Fax Number:
U = Unsatisfactory
POS = Positive Test Result
Collected by: KND
ND = None Detected
TNTC = Too Numerous To Count (>200 Colonies)
Sample Type Untreated Routine
CG = Confluent Growth
Method of Analvsis: Membrane Filtration (SM 9222
HSM = Heavv Sediment Masking, Results Mav Not Be Reliable
B)
$A = Sample Age >30 Hours But <48 Hours, Results May
Not Be Reliable
Old = Sample Age >48 Hours, Too Old For Analysis
Comments: R = Resample Required
NT = No Test
# Colonies/100 ml Colonies/ml
Sample Sample Total' Fecal Other' HPC"
Date Time Coliform Coliform Bacteria Result Lab# Location Comments
9/8/97 10:30 0 ND 0 NT AC5632 Hose Bib, southslde, L3 53 Sati6factory
Sampson Estates
Sherds L. Trask Environmental Analpt 9115/97
Northern Testing Laboratories, Inc Anchorage. AK
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111111111 P.1i1
SEP 17 '97 01:14PMINTL ANCHORAGE
NORTHERN TESTING LABORATORIES, INC.
HOON
EiA3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907)466-$'116 • FAX 466-3125
8005 S INDUSTRIAL
STREET ANCHORAGE, ALASKA 99518 (907) 349-1000 • FAX 349-1016
KND Engineering
20441 Ptarmigan Blvd.
Eagle River. -AK 99577
Attn: Ken or Dee
our Lab #: A151900
Location/Project= Lot
3Bl8ibk 3, Samth pson
Est.
Your Sample ID: Hoge
ide
Sample Matrix: Water
Comments:
Report Date: 09/16/97
Date Arrived: 09/09/97
Date sampled: 09/08/97
Time Sampled: 1030
Collected Bp".." r: D i.
** Definitions **
B = Present in Blank
H Above Regulatory Max
E Estimated Value
M Matrix Interference
D Lost to Dilution
MAL Method Detection Limit
Lab Units Result * MDL
Number Method Parameter ---------------
3.74 2.5
AIBI900 sM 4500E - Nitrate -N
Reporte y: aniel J. Bacon
Operations Manager
Date Date
Prepared Analyzed
- -----r^09/11/97
MUNICIPALITY OF ANCHORAGE .
• 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
tt
Parcel I.D. # 0518112 9 HAA #
1. GENERAL INFORMATION
Complete legal description I o t 3 plk 3 S a m n g n n F c t a t e -
Location (site address or directions) not assigned
Property owner MMM Contracting / KNo Enaineerbayphone 696-6111
Mailing address 20441 Ptarmigan Blvd Eagle River, .AK 99577
Lending agency
Mailing address—
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
Day phone
Day phone.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I 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 KND Engineering Phone 696-6111
Address 2,0441 Ptarmigan RIvd Fanlp River, AK 9 q 5 7 7=
Engineer's signature Date 1 1T2 2 1911
OF q�
1r • Kenneth M Du f �61
16
6. DHHS SIGNATURE �4%"R Fa p�P�'�
X Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
: Additional Comments
Jj'"'+ ti 1
;i ;1" By: Date /•T i
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 orderto 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-M(FW.1/91) Back MOA821 - -
Municipality of Anchorage
immm
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L o t 3 B 1 k 3 S a m n s o n E s tat tercel I.D. 051811 2 9
A. Well Data
Well type Private If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Y Date completed 9/ 9 4 Driller S u l l i v a n
Total depth
Sanitary seal (Y/N)
15 5' Cased to 155 1 Casing height
Wires properly protected (Y/N)
Y
2'
FROM WELL LOG AT INSPECTION
�+
Date of test 9/94
3
Z
Static water level 121 '
(M7)
<
Wellflow 1 5 g.p.m.
g.p.m.M
;^'
m o
Pump levell u n k n
n
M
SEPARATION DISTANCES FROM WELL TO:
y
Septic/holding tank on lot 1 0 5 ' ; On adjacent lots 10 0 ' +
z
Absorption field on lot
105'
; On adjacent lots 1 no, +
Public sewer main N/ A Public sewer manhole/cleanout N.1 A
Sewer service line
WATER SAMPLE RESULTS:
N /A Petroleum tank N / A
Coliform 0 Nitrate 3 68 _Other bacteria
Date of sample: 11/4/94
B. SEPTIC/HOLDING TANK DATA
Collectedby: KND Engineerin
Date installed 9/94 Tank size 1 0 0 0 a a l Compartments ?
Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N)
High water alarm (Y/N) N Alarm tested (Y/N)
Date of pumping N / A
mper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 1 0 5 ' On adjacent lots 101 ' Foundation
To property line 82.1 Absorption field
Surface water/drainage 100'+
N
1 01 Water main/service line N / A
72-026(3W)•Front _ CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pu on" level at
High water alarm level
Meets MOA electrical Cool s (Y/N)
SEPARATION
Well on lot
FROM LIFT STATION TO:
D. ABSORPTION FIELD DATA
On adjacent
Manhole/Access (Y/N)
Date installed O/g 4 Soil rating (GPD/Ft2) 0. a System type B e d
Length 76' Width 1 6' Gravel thickness .41 Total depth v a r i e s
Total absorption area 1 2 1 F s f Cleanout present (Y/N) Y Depression over field (Y/N) N
Date of adequacy test N / A Results (pass/fail) N / A for Bedrooms
Water level in absorption field before test n After test
Peroxide treatment (past 12 months) (Y/N) N If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1 05 ' On adjacent lots
To building foundation 1 0 '
Property line
To existing or abandoned system on lot N / A
On adjacent lots 1 0 0 ' + Cutbank 1 0 0 ' + Water main/service line N./ A
Surface water 1 0 0 + Driveway, parking/vehicle storage area
Curtain drain N / ,A
E. ENGINEER'S CERTIFICATION
55'
I certify that 1 have checked, verified, or conformed to all MDA and HAA guidelines in effect on the date of this inspection.
OF
DD,
160
•' °a
ii
4 f
° "rx
Signature �f��i�. 1,i .c.
�.:.deft 4 ..,.:::.::. �y
. ap•3enD �I
fY
Engineer's Name Kenneth M. fus, P.E.e1"
• ee o
Date 11/22/94
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W4
A0FESSIO�P�
HAA Fee $ C/0Waiver
Fee $
Date of Payment y, 9
zk
Date of Payment
/ \
Receipt Number t zz6_
7 1/
Receipt Number
72-026 (3193)' Back