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HomeMy WebLinkAboutSAMPSON ESTATES BLK 3 LT 10��5�- �1�-3to Municipality of Anchorage Page of Z 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 9Z 0019 PID Number: 05/^ 8'11 - 3b Name: Wastewater System: ❑ New Upgrade Address: 95�a7 ABSORPTION FIELD 2 251 /S 4/4P50/41'.la �7l/)k Phone: No. of Bedrooms: ❑ Deep Trench ❑ Shallow Trench A'Bed ❑ Mound ❑ Other Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION Dp- a GPD/Sq. Ft. 2'S Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipet 0, 5 Ft. 3 SAMPSON � Ft. Township: Range: / r A' (iV Section: Fill added above original grade: D as Ner 1t9-0-0—Ft. Ft. Gravel length: 3� Gravel depth MDT" ----[Distance Number of between lines: WELL: ❑ New4y/57//VCP Upgrade ao Ft v "� ef-t s -v Ft. Classification (Private, A,B,C): Total Depth: Ca '`p Total absorption area: � 77-,>0SC2. Pipe material: 14STNI 303 GR1V T 1"" FL Ft. Driller: -DaW rifled: Static Water Level: Installer: C7E/v, eO�a, Date installed: v5 /ry Ft. (71,?e6�/ Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Rob4o;Private Manufacturer: A /1 Capa � � Tjallons: From Tank Field Station Tank Sewer Lines "M Material: Number of Compartments: Well // N/A /mor � 1--), 57-' A11A /ao I Surfac 1,114 N/A N/A /A N 1 LIFT STATION Lot Line 1,114 a c/ Ss- %� A s� ' Size in gallons: / 2 50 Manufacturer: i1�1c114-T/1�11G Foundation r A//A Pump on" level at: "Pump off' level at: High water alarm at: ,( / ` 1 A 3� � /S_ N/A Curtainl Drain �1� /✓/� /l A11A A11A Pump Make &Model Electrical Inspections performed by: 0/2:E1-1 GEN, �.1pNT BENCH MARK Remarks: Locationand Description: 7/ 7,9 7' fi ✓4 i /a b le 4 i'P �. 4 N � / � G 7— �Gr !_ � C ii ✓hsGf'e /anger 6 eirc4�<f as 4 Assumed Elevation: yy�J ENGIHEER'SS$EAL 74,< Al lf�oaPe x e � a . f •6 tle^., `..i,.e Dates: 1st 05 amu dacaa uaaee� nnr. `y Inspections performed by: V�nao+ec ea w^o^o• xa 2nd__0 Louis A. Bu*era a Department of Health d Human Ser ^c s approval CE -6736 G pp �(�, �` s �y T�Q Date: P�R0FFSS���p�� Reviewed and approved by: 72-013 (1/91) MDA 25 Permit No. Page of 2 Municipality of Anchorage 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 I anal nmc; rrintion* �]_' & /o ? Sw"'�'sd ' 4d t-' PID No.: Z -4,1 3� N,.92'36 j5 6 159' 64' LOT 10 TO NATURAL 1.25� P.V.C. SOIL MOUND w 39� No / 5• o_ so 5" Nr 3•�� Z TH2 0 REPLACED 1250 TANK LIFT STAT DESK �p09 f PN 39.9• S�NGN VSA CANTILEVER TANK.. N SWING TIES TUBE LEANOUT D LEACHFIELD ELEVATIONSr0R of REAR DECK ENGINEER'SS,EAL (NOT TO SCALE) as�SNM�e ELEv = loo.00' f z ` PRESSURE LINE AS NEEDED TO MAINTAIN 2' COVER ORIGINAL21 35 PSI --,00.2 GROUND 2' INSULATION LEVEL 8 1 y _ a l 972' 97.2'._. FIELD 6' GRAVEL ; r+� �o ooc�. o¢r co •x� 93.6• 93.4' J Y o' cr '� Louis A. BUtera �; J GWT 892.7 CL -6736 °P/wESs0P 72-013 A (2/91) MOA 25 WOOD WALK A -CI = 60' B C = 15' _ A D -=.. 58.7` rq B—D: = 18.5 TUBE LEANOUT D LEACHFIELD ELEVATIONSr0R of REAR DECK ENGINEER'SS,EAL (NOT TO SCALE) as�SNM�e ELEv = loo.00' f z ` PRESSURE LINE AS NEEDED TO MAINTAIN 2' COVER ORIGINAL21 35 PSI --,00.2 GROUND 2' INSULATION LEVEL 8 1 y _ a l 972' 97.2'._. FIELD 6' GRAVEL ; r+� �o ooc�. o¢r co •x� 93.6• 93.4' J Y o' cr '� Louis A. BUtera �; J GWT 892.7 CL -6736 °P/wESs0P 72-013 A (2/91) MOA 25 WOOD WALK I N d PLK _ ...SCALE 1.00• 1" = 50' \3�" TEST HOL X3'2 9 • - MONITOR 0 - SEWER C _....WEL '.� ��5_ S9 10' UTI ITY ESN'T. ¢ — WELL +FFFHI++fF - PROPOSE is.o — _ S 88'04042 E - — - - EASEMENT 181.00 S'AMPSpN DRIVE TUBE LEANOUT D LEACHFIELD ELEVATIONSr0R of REAR DECK ENGINEER'SS,EAL (NOT TO SCALE) as�SNM�e ELEv = loo.00' f z ` PRESSURE LINE AS NEEDED TO MAINTAIN 2' COVER ORIGINAL21 35 PSI --,00.2 GROUND 2' INSULATION LEVEL 8 1 y _ a l 972' 97.2'._. FIELD 6' GRAVEL ; r+� �o ooc�. o¢r co •x� 93.6• 93.4' J Y o' cr '� Louis A. BUtera �; J GWT 892.7 CL -6736 °P/wESs0P 72-013 A (2/91) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES c�o� P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 L vblU ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920079 DATE ISSUED: 5/11/92 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 5/11/93 OWNER NAME:SHUE LAWRENCE E II & OWNER ADDRESS:22511 SAMPSON DR CHUGIAK, AK. 99567 PARCEL ID:05181136 LEGAL DESCRIPTION: SAMPSON ESTATES BLK 3 LT 10 LOT SIZE: 40899 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS UPGRADE SYSTEM MUST BE INSTALLED IN ACCORDANCE WITH THE APPROVED ENGINEER'S DESIGN DATED 5/2/92. THE DEPTH TO GROUND WATER IN TH-2 MUST BE CONFIRMED NOT TO BE AT A DEPTH OF LESS THAN 7.0 FEET BELOW GROUND LEVEL PRIOR TO CONSTRUCTION. RECEIVED BY: It ISSUED BY: Fl DATE: O ✓lid/ 9 Z - DATE • �Z �///J�/�� / "_� �%l j �/ /_ %/ , i, , / ''�'i "✓t ;� ,;Li -,:: � ,, { �-�n��lL ;/ , ,. � �_ (. �: �, � '�� %. i �.�� � 619 Louis Butera, P.E. Registered Civil Engineer April 29, 1992 John Smith, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Sampson Estates, Lot 10, Block 3 Narrative Dear Mr. Smith, The proposed. septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The area has large lots allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, this is an upgrade of an old system that utilized gravity feed. 4. Drainage will not be altered, and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 ^ Fax (907) 694-3297 r LOT 5 WELL +100' I I� CONCRETE PRIVATE WELL +100' I BLOCK PRIVATE WELL +100' FOUNDATION LOT 6 s ea "44 0 044' 0Ff 30' E 95' N X2.36 75 9> a �5q. N 7pe,29 e 4 I2% %z 28' LOT 10 64' ABANDON LOT 11 18' EXISTING BED FIT BED EXIST. T NK TO NA URAL tAI• REMOVE AND EPLACE o WITH 1250 TANK SOIL OUND� AND LIFT S ATION / PRIVATE WELL +100' '4 24' p6GK H w 0 6' I.25' P.V.C. y,pp a 0 oN �6 m o b' b. A c; H2 e0 6.6• $ 0 0 N P }1W20 STOR FRAME 2 RAME z 50 n QQp4 ti'�1' ¢Q�PpW� HOUSE ` 2 E PMtiV'I 39.9' v �1 S�NGN Vsp CANTILEVER WOOD WALK 83' I 'N IPV �pp9 )W 100' 2` 0 v / 76' 73.2' �y l0' UTI ITY ESM'T. / WELL 10' UTI ITY ESM'T — S 88.04'042 E / 181.00 SAMPSON DRIVE TEST HOLE 0 – MONITOR TUBE 0 – SEWER CLEANOUT + – WELL NO SURFACE WATER +100' HHI++HI+ – PROPOSED LEACHFIELD NO KNOWN CURTAIN DRAINS – — – – EASEMENT rk SEPTIC SITE PLAN�°,s�� LEGAL: LOT 10 BLK 3 SAMPSON ESTATES �°�� o OWNER: DONALD PIERCY m o 4�7 O0 as �0oo ee a9.ae eneb ue CONTRACTOR: N/A® m JOB # 92-027 DATE: 04/30/92 SCALE 1" = 60 Ij9�'0. lODisAfsurora C ee CE -6736 EAGLE RIVER ENGINEERING SERVICES �l��Fy ..,...,a.a.aa,.�• ��'� P.O. Box 773294 i��'0190FExS ,-� EAGLE RIVER, AK 99577 (907) 694-5195 FAX. (907) 694-3297 EAGLE RIVER ENGINEERING SERVICES P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 7z-vzi doe Sampson Estates Lot 10 Blk 3 SHEET CALCULATED BY CHECKED BY OF L.B. 05/01/92 DATE PROOO MI�lm. Grt . Mm 01171. SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM Revised 05/01/92 LEGAL: LOT 109 BLOCK 3, SAMPSON ESTATES A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health, and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. SEPTIC TANK 1. Remove and properly dispose of the existing septic tank. 2. Replace with Anchorage Tank 1,250 gallon lift station. Wire to code by licensed electrician. Control panel to be placed in garage. C. BED 1. The bed is to be located centered on the natural soil mound 100' from the well. 2. The bottom of the bed shall be level, plus or minus 1.5". 3. The total depth of the bed excavation is not to exceed 3' at any point, or 4' above recorded high water table level at test hole H2. (8.0 below top of TH #2 monitor pipe.) 4. The sewer line is to replace the existing sewer line that leads to the existing bed. 5. The bed gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3'0 or equivalent is to be placed over the leachfield. Leachfreld cover is to be sloped 2:1 away from bed at edges. 7. The area over the bed is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED-LEACHFIELD DIMENSIONS: TOTAL DEPTH = 3' (See C.2. above) GRAVEL DEPTH = 6" below pipe BED LENGTH = 24' BED WIDTH = 24' SOIL RATING = 0.8 GPD/ftz BEDROOM CAPACITY = 3 SEPTIC TANK SIZE = 1,250 with lift NOTE: Bac llLt,)iole with compacted sandy material. Utilize sand for any fill material. is •'1' o. oa d4�tG+• ,�. Twenty-four (24) hours notice required for all inspections. H S�q•O.M.•a •b•ea••Gee••nob io �- ................® �! Louis A. Buteto CE -6736 ,•'�?� 1. pROFESS10NP4+ a 49 3 F1 a Municipality of Anchorage e*• ••a++°• eB° ""'°"""" t DEPARTMENT OF HEALTH & HUMAN SERVICES / e, ,,,...•... ..... •• 825 "L" Street, Anchorage, Alaska 99502-0650 Louis A. P,utera SOILS LOG — PERCOLATION TEST ,j�%� CE�6736 t ROFEW PERFORMED FOR:�/ ['r ? DATE PERFORMED: LEGAL DESCRIPTION: N; ^ s° r Er¢ jo r /v t4/k 3 Township, Range, Section: Ts SLOPE SITE PLAN -fil r l rel -1 11 12 13 14 15 16 17 18 19 CG •` J moose sF�,�j yr�ve (gym) W/ /ayerr of BrowN S... d• 6�a.�� Csm) L Si )f3 SG,.i�-ru,..[ Gra ✓C� WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 11 ji� t S L 7,7 O P E Depth to Water After Monitoring? 7,/ Date: ■■■■■■■■■■ Reading Date Gross Time Net Time Depth to Water Net Drop TEST RUN BETWEEN `i FT AND S FT COMMENTS 7,l %- / - dei/ ,.• %ao - f C/l�%� /� /M-ric. QhcQ 4f" y/ /rwe.I' s16 .. y 16 Eagle River Engineering SerVCOS I �'� CERTIFY THAT THIS TEST WAS PERFORMED IN Y/ib 3 ,� . 3 v / 0 ,....., y 'P1/6 72-008 (Rev. 4/85) S 20 PERCOLATION RATE �y U (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN `i FT AND S FT COMMENTS 7,l %- / - dei/ ,.• %ao - f C/l�%� /� /M-ric. QhcQ 4f" y/ /rwe.I' /ed, 7;1-1 •,. Te it //. /e A� .Z Eagle River Engineering SerVCOS I �'� CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: I . Box 102U4 ACCORDANCE WITH ALL J rEr�l ^ At4 RUI AL GUIDELINES IN EFFECT ON THIS DATE. JM DATE: ✓/� 4-5185 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: %�:'/ e r C y -DATE PERFORMED: LEGAL DESCRIPTION: se+ fr? jor/v t4Jsr 3 Township, Range, Section: T,s.,/ f / w Sec 3 SLOPE SITE PLAN 1 o N 2- 310 3-1o 4- 5- 6- 7 5 67 d- 8- 9- 10 910 11 12- 13- 14- 15- 16- 17 21314151617 18 19 Lrs tt S./r /o�K° yJ� WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Y/,- t S L 9 P E Oeplh to Waler Aller i av 9 Mnnilnrinn9 7rs _ gale: Reading Date Gross Time Net Time Depth to Water Net Drop SOAK 7/6. s • S.'3s- rJ 20 G IL—JI PERCOLATION RATE 2.7 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN y FT AND S FJ COMMENTS �'� jrr elg0 o�crJ Eagle River Engineering Services I 77:5 CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: ACCORDANCE WITH ALL S MW;,gJS 95PS��YIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008(Rev.4/85► uu A2 *_ 72-013 (Rev. 3/78) __ " MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION a ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME/��f� PHONE NEW ( ✓ V ❑ UPGRADE MAILING ADDRV§S _ (AJC 52120 - 6 Z, ZAI'Ll/7 Z-& 14�1Gt LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Uy TO: Well Well JO � / k) Absorption ala Dwelling f PER T/ N�O ?T$ v z Z. 3 w Q Manufacturer C / / M ei�? / No. of compaents 7 e L WF Liq. apacity in gallons IF HOMEMADE: Inside length Width Liquid depth �.-- z DISTANCE TO:/44 Well Dwelling PERMIT NO. j 0 02 Manufacturer F T Material Liquid capacity in gallons O Well Foundation Nearest lot line PERMIT NO. Lu 2 DISTANCE TO: .W.I LL z No. of lines h of ea c I' Total length of lines Trench width Distance between lines F Z w inches Top to finish Material beneath tile Total effective absorption area ccH of tile grade a inches ,� Width J Depth fr 7I PER IT JVQ .a �ujLength Qa Q Type of crib Crib diameter - Crib dept) `� Total effective absorption area LU 11 a _. i /i't C✓�✓/G h �fJ /� .571 W DISTANCE TO: WQIIy '1 / /UtJ ( W Buildinzu�dayion CJ Barest lot line Class V Depshd� t; DdL ` Distance to lot line PERMIT NO. J r W � DISTANCE TO: Building founds on Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATI NG 2rCfUfv G .SU L. e INSTAL}'EjS �� !!ss REMARKS 'r oe 0 W-7 c e G Sc ilC i��Lvfr L/� 7 _S 4,.`'.. 0 )4z Ai - 3r f s APPROVED �. t Z k sr t{I �,� a+•"a'"' DATE LE L �i �3+ { �J 72-013 (Rev. 3/78) __ " i MU" I s—= I F'"L— I T' kO '_e F F-1 t .1 �=1-1 � � � RI; E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE: Flt: 9501 264-4720 X 0 r-4 - •- 2 T E---: E L-A E= FR 8_ L-J E= IL I F" E_ FR r-1 s -r PERMIT NO: 840223 ENGINEERED DESIGN GATE ISSUED: 04/20/84 _:4 APPLICANT: BRYAN ROFF ADDRESS: BOX 15000-62 WAS ILLA: AK 99687 CONTACT PHONE: 376-156 LEGAL DESCR I P : SUBDIVISION: SAMPSON ESTATES LOT: 10 BLOCK : • 3 . SECTION: = TOWNSHIP: 1.5N RANGE: 1W LOT SIZE: 40114 -;:SCJ.. FT. OR ACRES. LOT LOCATION SAMPSON DRIVE I CERTIFY THAT: J. I AM FAMILIAR WITH THE REQUIREMENT'S FCR.ON—SITE SEWERS AND WELLS AS `_=.ET• FORTH BY THE MUNICIPALITY IPALIT`,' OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2..l WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODE'S AND REGULATIONS. AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. <:. I WILL ADHERE TO ALL MCRA 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. IF A LIFT STATION IS INSTALLED N AN AREA COVERED BY MGA BUILDING CODES. THEN (1) AN ELECTRICAL PERMIT ND INSPECTION MUST BE OBTAINED: f:2) AS—BUILTS WILL NOT BE HPPp— _ •e' D �1 I THC 1LIT rd LECTR I CAL INSPECTION REPORT, AFdC� •; ? THE ELECTRICAL 4dC i !'1U' `T C:•i A LICENSED ELECTRICIAN. SIGNED DATE: APDL I CAr B .YAN ROFF ISSUED BY------ DATE: —�/p —��----------------- —-------- ' ������ ��� ���������� ' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET/ ANCHORAGE, HK 99501 264-4720 �����FZ 6 �. ���0 F" EE I _T" PERMIT NO: 84022] DATEISSUED: 04/20/84 HPPLICANT: BRYAN FOFF HDDRESS: BOX 15000~62 WHSILLH/ HK 99687 CONTACT PHONE: ]76^7567 ' LEGHL DESCRIP: SUBDIVISION: SAMPSON ESTATES LOT: 10 BLOCK: ] SECTION Z T[�NSHIP: 15N RANGE: 1W ������ � ���� �� LOT SIZE40114 (SQ FT O LOT LOCATION: SHMPSON DRIVE MAX BEDROOMS: ] LISTED BELOW O YOU IND SYSTEM. CHOOSES YOUR SIT 0--i E3 DEPTH TO PIPE BOTTOM "'FT. 0 GRAVEL DEPTH (FT. ) 4.5 TOTAL DEPTH (FT. ) 8 5 � -GRAVEL WIDTH (IF-jr. 5 GRHYEL LENGTH (FT. ) 510 GRAVEL VOLUME (CU.YDS 2]6 TANK. SIZE (GALS) ,000.0 ** SOIL RHTING �SQ.FT. /BR)\ `��� 152 \ \ ) IGNING YOUR SEPTIC ��. I----��F�I�A 4. 0 ]. 5 0 `� 7� 5 0 5. 0 0 50. 0 �5. ] ]7. 0 0.0 ** 1/000.0 ** 152 152 ** ' I CERTIFY THHT� ' 1. I HM FHMILI HE RE OR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE IPHLITY E (MOH) FIND THE STATE OF ALASKA. ':2. I~WILL INSTHLL THE SYSTEM IN NCE WITH ALL MOH CODES AND REG ULHTIONS, AND IN COMPLIANCE WITH THE C:, RITERIH OF THIS PERMIT. ] I WILL ADHERE TO ALL. MOH AND S TE OF HLHSKH REQUIREMENTS FOR THE SET BACK DISTHNCES FROM HNY EXISTING WELL|WHSTEWHTER DISPOSAL SYSTEM OR PUBLIC SEWERR8E SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR H MHXINUM OF ] BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF H LIFT STATION IS INSTALLED IN HN AREA COVERED BY MOH BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT HND INSPECTION MUST BE OBTAINED.; (2)HS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT/ HND (]) THE ELECTRICAL WORK MUST BE DONE BY R LICENSED ELECTRICIAN. SIGNED - DATE: ' HPPLICHNT� BRYH��ROFF ISSUED BY DATE: --- ------ --- --- ------ -�~`~_����� 0 SOILS LOG MUNICIPALITY OF ANCHORAGE yc DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION I] PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: i - SCh c*i' V / DATE PERFORMED: LEGAL DESCRIPTION: G ` c 3 `�' "��� V� L12 OPE SITE PLAN 1 CJ � 4 r 5 14 15 16 PF;j2CO1- 19 -`01-J 7 -)FS- -r 17 18 , ; bAwl A. ft -ii r f .,�m 20 MENM MENMOMM MEMO MEMO 0hJOE ■IEE MEMO MEMO MEMO MEMM WAS GROUND WATER ��/f% ((�' S ENCOUNTERED? L 0 '1 -1 P IF YES, AT WHAT If Reading Date Gross Time Net - Time Depth to Water Net Drop tt 1 2G' 30 0410 Y /7"30 /O <Q %2 12),S-0 10 1 -� I� PERCOLATION RATE_ NEST RUN BETWEEN _ COMMENTS PERFORMED BY: py sid'89E, - ,*'("q"?-- CERTIFIED 72-008 (6/79) -- _-- ��(minutes/inch) 14� FT AND -2— FT DATE I I N JICIPALITY OF ANCHORAGE 4�-� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Roff's Construction, Inc- DATE PERFORMED:_ T. 15N, R. 1W, Section 3, LEGAL DESCRIPTION: Lot 10, Block 3, Sampson Estates Subdivision, Peters Creek DEPTH SLOPE SITE PLAN (FEET) F 1 2 Organic Topsoil SILTY SANDY GRAVEL (GM) Brown, Moist, w/Organics SANDY GRAVEL (GW -GM) w/ Trace Silt Brown, Moist, Cobbles Present t0 SILTY SANDY GRAVEL (GM) Brown, Slighty Moist, 11 Cobbles Present WAS GROUND WATER -ENCOUNTERED? 12 13 14 15 Total Depth 15' 18- 19- T, 819; No. 4977-C a . IF YES, AT WHAT DEPTH? S No L O P E SOILS LOG (No y �3 PERCOLATION TEST /IS/0 Alas Reading Date Gross Time Net Time Depth to Water Net Drop y/1$/$� 16H:,h 1ovx;A 301��u1 1E)VWIIn 11 et 20— <; PERCOLATION RATE 3r3 (minutes/inch) 3r5 FT -AND _�_FT V" TEST RUN BETWEEN COMMENTS It is suggested that the septic field ated with 2" rigid board insulation. Reccomend 1 0 sq ft. per bedroom. PERFORMED BY: Douglas C. Bonham CERTIFIED BY: Allan W Murfitt DATE: 04/19/84 A.W. Murfitt Co. M.O.A. No. ST84-015 Name: Address: City: Phone: Job Location - Crew: Date: Notes: Depth Well Log PROTECTION MUNICIPALITY OF ANCHORAGE • T 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. # 051-811-36 HAA # W C 1. GENERAL INFORMATION Complete legal description Samson Estates, Lot 10, Block 3 T15N R1W Section 3 Location (site address or directions) — 22511 S son Drive, Chugiak Property owner Lawrence F- Shile ShitTT Day phone 688-6616 Mailing address 22511 Sampson Drive, Chugiak, AK 99567 Lending agency N/A Day phone Mailing address Agent Cathy Olmsted/Jack White Day phone 694=5500 Address 10928 Eagle River Rd Eagle River, AK 99577:. Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X — Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature 6. DHHS SIGNATURE _ Approved for Disapproved. Conditional approval for By: bedrooms. Date F. �oae f5.1�1 iV)� a �tm BJH+O + � � C � O�UV+ u+.• a Louis A. 6u!era �b CE -6736 ���j f�ST �o C7 �4$aDPROFF5514NP'a ,s bedrooms, with the following stipulations: Additional Comments 4tlTlr Date 1�111,dz 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 DHHSdo 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 a21 Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: -&ef P-SQAJ F5Y-• L "p&if Parcel I.D. 05'J — S y i ._ 3 6 A. WELL DATA Well type R& t/411167 If A, B, or C, attach ADEC letter. ADEM water system number Log present (Y/N) -Jes Date completed 12' Drilleryh'�/A✓ Total depth / sz-a' Cased to /5-,2 1 Casing height Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level /22-1 Well flow Pump level fjd kA.011JXI SEPARATION DISTANCES FROM WELL TO: r Sept ic/`hediQg tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Wires properly protected (Y/N) g.p.m. AT INSPECTION -t- /2 u 03 / OG �az /221 of e1J k,,V6wn/ ; On adjacent lots 't /oo Z / LU CV R Q Q Z V � LL1 Z O Cx0 f' W ; On adjacent lots * ivo ' Public sewer manhole/cleanout - 14 Petroleum tank tiolve Coliform Nitrate ©• �� �f� Other bacteria Date of sample: n3r� 5 2 Collected by: S B. SEPTIC/HOLDING TANK DATA Date installed �/ S Z Tank size 2.5O Compartments 2-1 Cleanouts (Y/N) Foundation cleanout (Y/N) Y Depression (Y/N) Al High water alarm (Y/N) /�'4 �" `� S +"' Alarm tested (Y/N) N1A Date of pumping A�l4 00r -e✓ Pumper /V/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot / 2 On adjacent lots _f /00 Foundation To property line SS Absorption field 31 Water main/service line Surface water/drainage ~/4 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed 0 SSZ /g'/g Z Manufacturer AWCF41J/V415(< r,*JiC Size in gallons 1/2 Manhole/Access (Y/N) Vent (Y/N) — X "Pump on" level at 41Y "Pump off' level at High water alarm level 4,q Cycles tested /V W Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: // Well on lot (Z5,_ 1 On adjacent lots ¢��a r Surface water y/A D. ABSORPTION FIELD DATA Date installed —05V —/�,z9 Z Soil rating 0, G f04)F1 2 (System type Length �t Width Zot Gravel thickness y r 4o Total depth 2 S r Total absorption area 7 2 to Cleanouts present (Y/N) Z6 `; Depression over field (Y/N) /✓O Date of adequacy test — /V -4-4y Results (pass/fail) p4LS5 for 'Z bedrooms Peroxide treatment (Past 12 months) (Y/N) NSA If yes, give date IV/4 SE=PARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot lDO ¢ On adjacent lots /oo y Property line- 2 ine To building foundation 3 t To existing or abandoned system on lot a On adjacent lots 3y r Cutbank N114 Water main/service line Surface water Driveway, parking/vehicle storage area Curtain drain N/q E. ENGINEER'S CERTIFICATION -¢ /O) e /e I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date i HAA Fee $. �;Z0 Date of Payment C? Receipt Number 0o 72-026 (Rev. 3/91) Back MOA 21 lj Waiver Fee: $ Date of Payment Receipt Number 0 r 17034 Eagle River Loop Road ROBERT A. SHAPER E«g16River,Alaska 20577 CIVIL I:NOINlCR 8042970 ** WELL FLOW TEST DATA SHEET ** mob -- g {), � _ _ / r fl I:,,rr l DATE OF TEST; - L& C32�' PROJECT... .�..... �_.- + e.... LOOATION OF WELL (LeOaI D9600 tfon): "'r \n wYr 3 calCMf WELLDEPTH: + FT. CASINO: —FT. 014120N: �~ DATE DRILLING COMPLETED: 7--'434 DRILLER:. STATIC WATER LEVEL (TOP of Ca51n t' '+ FT. DATE: CLOCK ELAPS80TIME 61NCG PUMPINGiTARTEDI DEPTH TO DRAWDOWNI RECOVERY PUMPING RATE,QPM REMARKS TIME OT011"D, MIN. WATER, FT. k y ` (awl) 0 0 Start piemd 061 Q 0 r. tP S is Ia t5 _ p0 26 G. D ,0 40 46 50 65 6o (I hour) T. Lp go 12D 2 h4ure ISO t9 haus)dr q ••••• •• XQU100 210 240 (4 hours) %1k11' �• • $41 fa •'o RECOVERY u u• .au . • 0 i..00 J. HAM t 0 •� •� 10 p 4 +w 16 � 2D 26 04 Commentat: � �, •t'�ov ;a , q „� pP S: USM Flow Is not Guarent"d Wbs+oquent varlstions Can Ocour. 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 Parcel I.D. # �� X11"�� HAA # V 1. GENERAL INFORMATION Complete legal description Lot 70; Bkock 3; Sampson Estates Location (site address or directions) 22511 Sampson D4ive Property owner Mailing address Lending agency Donatd Pien.cy Day phone Day phone Mailing address Agent Ban.baka Cnit-tenden JACK WHITE COMPANY Day phone 694-5500 Address 10928 Eaq e RiveA Road Eagte give t, AtaAka 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: 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 N21 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 S & S ENGINEERING Phone 17034 Eagle River Loop Road No. 2Q¢ Address Fag)a River laslca 40577; Engineer's signature RECOMMEND APPROVAL ON THE CONDITION THE SEPTIC SYSTEM IS UPGRADED FOR A 3 BEDROOM CAPACITY. 6. DHHS SIGNATURE Approved for bedrooms. Date�— Disapproved. Conditional approval for _��_ bedrooms, with the following stipulations: Additional Comments U/J�rrc� �� ti�1Or/JCaYI JLi� rr vS'v� C %�� Int /�4— ,471 ck /99z- Sl1Tlr 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 H21 41- Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: "-r- �0 f7try- $ ' 1 Parcel I.D. I_MV14114J_iLl Well type f lLiuberf- If A, B, or C, attach ADEC letter. ADEC water system number "1't�' Log present 'KY N) Date completed `5 't2 'G' Driller t>og->0' Total depth lS2 Cased to Casing height IZk Sanitary seal1(&N) FROM WELL LOG Date of test Wires properly protected ON) � AT INSPECTION MUNICIPALITY OF ANCHORAGE �j L. `l I— ENVIRONMENTAL SERVICES DIVISION Static water level t22' 1Zti' MAR 0 9 1992 Well flow ,5�.O g.p.m. S.ty"M � L V Pump level YL%le RBGor�rAe.7.)r>Fb VlL- ED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot t cro �k ; On adjacent lots 1 Cb i k Absorption field on lot 00 Lk ; On adjacent lots rpt Public sewer main a Public sewer manhole/cleanout Sewer service line 2`� L Petroleum tank 2� , WATER SAMPLE RESULTS: / Coliform A00 e%AL Nitrate O• cA `� Other bacteria �o Date of sample: 3 " Z '�y Collected by: S & S ENGINEERING 17034 Eagle Kiver Loop Road lWo—. 2U4— Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed Cleanoutgd�/N) — High water alarm (Ye Date of pumping 3'4,9 Tank size %000 Compartments Foundation Foundation cleanout®/N) j Depression (Y(1 ) Alarm tested (Y/N) '1 �' -7- Pumper CESS Pd -' L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot 1001k On adjacent lots (00 ' �- To property line i—n' k Absorption field 12, Surface water/drainage \'Ob `_ Foundation °v' Water main/service line 10 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 "Pump on" level at Meets MOA electrical codes (Y Manufacturer Manhole/Access (Y/N) SEPARATION_D4- ANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots at tested Surface water Date installed 4 -�-�?-$g' Soil rating 21,S ` /E717— System type L)`6J14�%)a%> 3E� Length `�7�2 Width Total absorption area 7-4% ♦ r i Gravel thickness X11 Total depth _ S Cleanouts present/N) Depression over field (Y& A Date of adequacy test Le `( � Results(pass/dLrj><\ for /k bedrooms Peroxide treatment (past 12 months) (Y�) rD JjO— /4rlatiIf yes, give date tib pcYP�o�• /hIS'�W"t1�ti� C"AVD"[-.r'vi 15 6-M, C> ST'C�rjka lrr; /- rOT is A-qA-7.4,43c E SEPARATION DISTANCE FROM ABSORPTION FIELD TO:�'� ° ~"`^GS7� S � r .E�-F5`,Pc(t t Cj � F.-R—Fw� artacwA �� �x,�� Well on lot lob t On adjacent lots_loo� '- Property line 10� + To building foundation On adjacent lots Surface water 1I1JD �� Curtain drain E. ENGINEER'S CERTIFICATION Lo To existing or abandoned system on lot '-� —Cutbank l,- Water main/service line (p\ -I. - Driveway, parking/vehicle storage area 'moo �-'r I certify that f have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. l rir I�Fi S & S ENGINEERING �F 17034 Eagle River Loop Road No. 204 Signature 3 g n River, Alaska 99571 Engineer's Name n, — Date h r d` HAA Fee $ %D Waiver Fee: $ Date of Payment ,fir i �� y Date of Payment Receipt Number ^� =�s^�3 �� ��� Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEM,C11EM, ICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FAX: (907) 561.5301 Client Sample ID LID B3 SAWG SON EST. PWSID UA Collected MAR 2 92 B 13:45 hrs. Received MAR 3 92 4 14:45 lus. Preserved with AS REQUIRED Analysis Completed YAR 4 92 Laboratory Supervisor STEPHEN C. EDE Released By : ANALISIS RESULTS for INVOICE t 51599 Chemlab Ref.# 92.0824 Sample I 3 Matrix: WATER Client Name :S & S ENGINEERING Client Acct :SNSENGP BPDt Reqt Ordered By Send Reports to: 1)S & S ENGINEERING 2) FOt :NONE RECEIVED •••••_..••••..••••_..••••.•••••.••••_ _.....`.'. Results. .•r`Uni...F.•}--'•-•Meth......•-•-Allowable Limits od Parameter ----- ----- --------------------- --------0.93 -------411 ------------- - NITRATE -N — - EPA 353.2 1 Sample ROUTINE SAMPLE COLLECTED BI: RAI. Remarks: .................................................. 1 Teets Performed See Special Instructions Above UA -Unavailable ND. Nona Detected See Sample Remarks Above NA. Not Analyzed LT -Less Than, GT -Greater Than afNINI SGS Member of the SGS Group (SociAtd G6n9rale de Surveillance) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES n-7 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL b% 25 / - Oa,09 OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date - / A/ /2.7 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, rang Location (address or directions) (b) Property Mailing Add (c) Lending Institutil Mailing Address N me Telephone Business (d) Real Estate Company and A ent ,4 Address ( L Qpl 2 7,24�%9—c��c� Telephone , (e) Mail the HAA to the following address: or: Check here El, if hold for pick up. List contact person and day phone number below. S & S ENGINEERING 17034 Eagle Ri*er Loop Road lo. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family 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 the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ri 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 r, & S ENGINE RING Telephone Address 17034 Eagle River Loop Road No. iN Date DHHS APPROVAL Approved for fhb (f3)bedrooms by 'a'O'"'`d Date Approved L� Disapproved Conditional Terms of Conditional Approval CAUTION S- 20 -9 1 - 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. Page 2 of 2 72-025 raev 8186) Back MUNICIPALITY OF ANCHW6frtIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVICES I LVAIII(M AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MAY 19 1987 264-4744 ® Legal Description: L- �t / U 3 3 RECEIVE A. WELL DATA Well Classification S F If A, B, C, D.E.C. Approved (Y/N) Well Log PresentON) Date Completed �A't" ?��y Yield Total Depth— Cased to Z� Depth of Grouting Static Water Level / 2 Z' Pump Set At ys Casing Height Above Ground — Electrical Wiring in Conduit (6/N) Separation Distances from Well Sanitary Seal on Casing 61N) Depression Around Wellhead (Y& To Septic/Holding Tank on Lot /to" -F ; On Adjoining Lots i To Nearest Edge of Absorption Field on Lot /(Db ; On Adjoining Lots To Nearest Public Sewer Line �-ZA To Nearest Public Sewer / Cleanout/Manhole To Nearest Sewer Service Line on Lot S Water Sample Collected by S S LNL��N�=L ; Date s- Water Sample Test Results SA 7-1 5,P-AC-r2DP–Y Comments 4✓'« /Lv M 7=_ r�le9 B. SEPTIC/HOLDING TANK DATA Date Installed S 3 Size / c>(>v No. of Compartments Foundation CleanoutON) Date Last Pumped S �i5tlg N/A -;for N1A )'JIA Temporary Holding Tank Permit (Y/N) A/l Standpipes/N) Depression over Tank (Y/& Air -tight Caps (&(N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Z Separation Distances from Septic/Holding Tank: To Water -Supply Well eloy To Property Line 1014 To Water Main/Service Line Course a/)q- Comments Page 1 of 2 72-026 (Rev. 8/86) Front To Building Foundation 0 To Disposal Field To Stream, Pond, Lake, or Major Drainage IML� , -4 s➢8q - oz.Z C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z z5"/���ZS �a/Z Type of System Design Date Installed �/��% Length of Field yZ Width of Field �� / Depth of Field s J ��.rTH Z J 5 4 r'7 Fiu' Square Feet of Absorption Area Depression over Field (ON) — Results of Last Adequacy Test M Gravel Bed Thickness v /c�/Z`b�S1o7ib Standpipes Present(9/N/) Date of Last Adequacy Test 5- /VA � SR�ts � r F-4?-- Z r�R, Separation Distance from Absorption Field: To Water -Supply Well l00u To Building Foundation Lot �' To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area D. LIFT STATION Date Installed Size in Gallons i To Property Line �d On Adjoining Lots To Existing or Abandoned System on 3� 7,/ — To Cutbank (if present) Nh ^J/A /4 Dimensions Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MO and H A guidelines in effect on the date of this inspection. Sign� S ENGINEERING 34 Eagle River Loop Roado. ate � 8 Com pp;eRiver, Alaska 99577// MOA No. ��o 3 Receipt No. Date of Payment Ohs C Amount: $ X nedr` Se t6 Page 2 of 2 72-026 (Rev. 8/861 Back N: l i tiJi. 1 LAB INSTRUCTIONS Report Printed: MAY 13 87 ? 07:32 i.AORKORDER # 483 CHENLAB REF #:6222 ORDER DATE: MAY 13 87 DATE RECEIVED: MAY 12 87 VIA: HAND DELIVERED CLIENT: S & S ENGINEERING ACCT NO: SNSENGP BILLING ADDRESS: 17034 EAGLE RIVER LOOP RD. , #204 - EAGLE RIVER. AK 99577 (907) 694-2979 CONTACT PERSON: (907) 694-2979 PURCHASE ORDER # VERBAL REO # FRCHISED: MAY 14 87-&-lPLS RECEIVED: l tY 12 87 ORDERED BY: SPECIAL INSTRUCTIONS: COPIES HELD FOR riCK UP. Chemlab Client Parameter Sample # Sample Description Matrix To Test Method Uri its Result 1 L1O. 83 "#AiPS[NEST. 120153 -NITRATE -N mg!1. x'61! LID. B3 SAMPSON EST. AL OLIFORM col/100m] cl Am rI 41 91 J? � r c/ ,g � m � c j 91 � r r � m � c j I T 91 I T L �. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date /0 (a) Legal Description (include lot, block, subdivi ion, section, township, range) /_ B® Al 3 xct��-s0M S'2; Location (address or directions) �® AJ RZ (b) Applicants Name PP 1���� �e Telephone - Home Business Applicants Address __gO4 (c) Applicant is (check one) Lending Institution ;-Owner/builder �®; Buyer E::1 ; Other 1::� (explain); (d) Lending Institution iV 10 Atj Telephone Address (e) Real Estate Co. & Agent /U 0 "V4!5 - Address Telephone pL�0 (f) -K&U the HAA to the following address: A 'E' ENGINEEe' kIQ 2. Type of Residence Single -Family Multi -Family Number of Bedrooms 0 3. Water Supply Individual WellKI Community Other (describe) Public El Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 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 Address Date 6. DHEP Approval Approved Approved �f Disapproved Terms of Conditional Approval CAUTION Conditional Telephone THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. d _ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 WELL DATA Well Classification If A, B. or C. D.E.C. Approved(Y/N) Well Log Present (Y Date Completed Yield_�un. Total Depth /SZ Cased to 1,5- 2 Depth of Grouting Static Water Level r2 Pump Set At 1 5-6 f Casing Height Above Ground 3O Sanitary Seal on Casing (Y ) Electrical Wiring in Conduit (Y Depression Around Wellhead ( ) Separation Distances from Well: To Septic/Ue14!;;g Tank on Lot On Adjoining Lots BUD J g 'D To Nearest Edge of Absorption Field on Lot O D -�- On Adjoining Lots /Ul2� To Nearest i -e -Sewer Line �� AJ 1 /4 To Nearest Public Sewer r Cleanout/Manhole A) /L_ To Nearest Sewer Service Line on Lot 2 Water Sample Collected By Ste• S—g7xt �,q /w ; Date /V0 Water Sample Test Results S/1 Tl sFA C T - CamTents B. SEPTICS TANK DATA AJ'6IJrF Date Installed -'j 6? Size le Standpipes (Y ) Air -tight Cap Depression over Tank (K ) Date La Pumping/Maintenance Contract on File (Y�' Holding Tank High -Water Alarm (Y/* %a- �� No. of Compartments 2 (Y ) Foundation. Cleanout (Y W) Pumped .e e w A' ; for Temporary Holding Tank Permit (Y %4 Separation Distances from Septic/Holding Tank: To Water -Supply TAbll To Building Foundation ! 2 To Property Line To Disposal Field 0 r To Water 44aWservice Line /6 �-� To Stream, Pond, Lake, or Major Drainage Course !J I Comments A,)O N r [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA P:IIiNIC".Ll C' ': ,' '_J 0,Or NODI 11934 Soils Rating in Absorption Strata Type of System,De'sign Date Installed 5 �g Length of Field -2 Width of Field 2 Depth of Field Gravel Bed Thickness (� Square Feet of Absorption Area ,SS6 2 i� / �. Standpipes Present Y ) Depression over Field (Y Date of Last Adequacy Test N� �✓ Results of Last Adequacy lost /C % / !� Separation Distance from Absorption Field:, To Water -Supply Well /CXR To Property Line l /f To Building Foundation 2 6 r To Existing or Abandoned System on Lot % ✓-4D /,) C' ; On Adjoining Lots ,,Rd f To Water- Service Line /0 ems- To Cutbank(if present) ti Q To Stream/Pond/Lake/or Major Drainage Course o n.! i^ To Driveway, Parking Area, or Vehicle Storage Area lie - Comments iJ 0 nr /_� D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N). "Pump On" Level at "P Off" Level at High Water Alarm Level at Vent (YIN) Tested for Pumping s 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 aa i ]LIGr `'S` Date ±-7 Wiffl, ALAS ray Company MOA N .0 0 KB1 /d5/s [Page 2 of 21 -A 30<�b-1 1 h� R*Wrt A. Sh■hr No. 1437•F. 2-15-84 EL R " r R*Wrt A. Sh■hr No. 1437•F. 2-15-84