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HomeMy WebLinkAboutSAMPSON ESTATES BLK 3 LT 13I am �d ks O�116LrL S w u51 -8\I-34 Municipality of Anchorage Page 1 or 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: SW940187 PID Number: 051-811-39 Name: Wastewater System: gNew ❑ Upgrade M M & M Contracting Address: ABSORPTION FIELD P. O. Box 670485 Chugiak, Ak.99567 Phone: No. of Bedrooms: ❑Deep Trench ❑Shallow Trench q Bed ❑ Mound ❑ Other 688-12.36 3 LEGAL DESCRIPTION Soil Re 8 Total D�eptoriginal grade: j GPD/Sq. Ft. ,hfro oiw Lot: Block: Subdivision: Depth to pipebottom from original rade: Gravel depth beneath pipe 13 3 Sampson Estates d• 0 3 iD Ft. 0.5 Ft. Township: Range: Section: Fill added a ove original r e: Gravel length: Z t Ft. 39 Ft. WELL: ® New ❑ Upgrade Gravel width: Num3eroflines: Distance between ' Ft. Ft Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ; Private 182 Ft. 181.3 Ft. 684 SQ. Ft. Sad 303 Driller: Date Drilled: Static Water Level:I st Iler: t`� �� & i=1 Contr. Date i to I�d 9�/ �4 Sullivan [nater Well 7/94 145 Ft. Yield: Pump Set at: Casing Height Above Ground: TANK 2 GPM Ft. 24 ° Ft. SEPARATION DISTANCES Meptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Anch . Tank Capacity in gallons: 1000 From Tank Field Station Tank Sewer Lines Material: Number of Compartments: WeIP 122 130 -- _ _ _ _ Steel 2 Surface 100+ 100+ -- -- -- LIFT STATION Water Lot Size in gallons: Manufacturer: Line 32.5 42.9 - 'Pump on" level at: "Pump off" level at: High water alarm at: Foundation 7. 0,_ 11.6 Curtain Pump Make & Model Electrical Inspections performed by: Drain BENCH MARK Remarks: Entire bed insulated with Location and Description: 2'r HDF. Corner of foundation 100.0 Assumed Elevation: 100.0 f� opO6090��OOQ� tl� ; cy coeo°IA Q Z q Inspections performed by: Dates:1st 8/10/94 ®,.�.© Kenneth M. us 0 Final 2nd 9/7/94® a , 1% J' °o rI- 7116,/ 01110 cy/' Department of Health uma ervices approval 1 0 goo go , ,�/)��R0rFS,,Q�P Reviewed and approved by:: Date:le 72-W3 (Rev. 9/91) MOA 25 AS -BUILT WASTEWATER ABSORPTION SYSTEM LOT 13, BLOCK 3, SAMPSON ESTATES P11). 051-811-39 SW940187 or ®* 9 TH 0 N KENNETH DU US04 - �� ��SSIONA � r. A -D = 39.2' B -D = 14.1' A-E = 14.0' B-E = 39.8' PREPARED FOR: KND ENGINEERING MM & M CONTRACTING 22041 PTARMIGAN DR P❑ BOX 670485 EAGLE RIVER, AK, 99577 CHUGIAK, AK, 99567 694-2359 688-1236 DATE 8-10-94 DRAWING It SCALE: r - 50• AS - BUILT AS -BUILT DETAILS WASTEWATER ABS❑RPTI❑N SYSTEM LOT 13, BLOCK 3, SAMPSON ESTATES 7,+5'__9 , 93,35 IMPORTED SA D PER MDA SPEC FINISHED GRADE IMPORTED SAND PER MOA SPEC 15.65.060(D) (DEPTH VARIES WITH SLOPE) 16' 00 .twOF Al, 0 * 49TH**+/ KENNETH DUFF / www se A�Oh'ESSIONAL �� � 1: CD w MEASURED GROUND WATER 86,1 rr �z o� rz zw O J £ U y , O 1 6 c' ❑ c❑ co BENCHMARK c❑ co 100.0 VARIABLE DEPTH OP S ND TO MAX. 3' M7 co co PREPARED FOR: M M & M CONTRACTING P. ❑. BOX 670485 CHUGIAK, ALASKA 99567 688-1236 16' KND ENGINEERING 22041 PTARMIGAN DR EAGLE RIVER, AK, 99577 694-2359 DATE: 8-10-94 DRAWING #< NUT -TO SCALE AS—BUILT W r r z a W p wo �a Q W J J Q Q Q J U U W w Wzu w U J J " J J n II U zU 7,+5'__9 , 93,35 IMPORTED SA D PER MDA SPEC FINISHED GRADE IMPORTED SAND PER MOA SPEC 15.65.060(D) (DEPTH VARIES WITH SLOPE) 16' 00 .twOF Al, 0 * 49TH**+/ KENNETH DUFF / www se A�Oh'ESSIONAL �� � 1: CD w MEASURED GROUND WATER 86,1 rr �z o� rz zw O J £ U y , O 1 6 c' ❑ c❑ co BENCHMARK c❑ co 100.0 VARIABLE DEPTH OP S ND TO MAX. 3' M7 co co PREPARED FOR: M M & M CONTRACTING P. ❑. BOX 670485 CHUGIAK, ALASKA 99567 688-1236 16' KND ENGINEERING 22041 PTARMIGAN DR EAGLE RIVER, AK, 99577 694-2359 DATE: 8-10-94 DRAWING #< NUT -TO SCALE AS—BUILT OWNER OF LAND 1)Li'FEi 01" WELL ADDItESS ..._C? -(5 4. .. �° { "%� _`��Y!alr"3SQ'IC I.t'.VE:1,G1.IYA"E'E:R 1'I LEGAL DESCRWrIOht_.:.., � i't:.1 3 _-v _�J "� _ DRAWDOWN FF, DATE - Stavted:.. Ended C ALS, PER HR m C. KIND 01; CASINI. KIND OF FORMATION: Frarn_ C Ft. t6 Ll _.Ft, -_._S , B _r f+.i- 'a (.. From. -_.__. Ft. w -1't. _ -- -- 4 w• From— Ft, From Ft. to—- Ft, ------------- Fro -4 - MLSCL. INMRMATION: DRIL,LER'SNAMt ._lh•C-....--.._,_..--_ __.:__._._. Ftan3-4 Ft. to- Frcrm� Fi. to. _..Fl.� ....,. W Ft. to.,.. t�..f�'vff dC; r E'roin, f f.lo 1tR Al 0t t'rmn_.__-, t. to ---,--.Ft.. C V..L•'-. a.� .... _.•_..._:_ 4 � nays k; 't) I�t.Io_.1.+«t..•,.:_F$.F1.t,> SEP 2 01994 _.Ft.•--�_"" "®• �t Front. /rte ) w 1Al / •C P`1,Ak r+J � + '- i.;. f r. a__Ft. ta—_-_I't•w_ . --- -- , Fro 177__..-__.'"-� Ft, fo &Npicipality.at r-, .. ' ----Dot. Healt�7 & Humar '�,v turn - .... From ��Ft. to. 4. From_..,. -._Ft. to -..:.Eit._t3:. FrorSS..­.,,.,_,.B't. to-- Ft. f'.. 1 1 - wrom_ Ft. to Cl.._ ,..._._. - From. From--..,....Ft.to.__�Ft.'''`t"�_-__.___to_ ____.. Front Ft, to— ­ Fl, Franz____ -,.•-Ft. toT _Ft.-_�.....or..,..�_,_---. _.. . From From __Ft. to.__—�'t -- ..._ _._....._..<_ -_. From .....:_ ._..Fl, to FP. _• ._.........__�. -f- --. F'rom___Ft. to --Ft. From.._..._. Ft. to...r__.._._Ff.____............_....,,,,.,..• ..._.:.,.....__ From _.Ft, _ r��.•n•., .,_ _� . �m� MLSCL. INMRMATION: DRIL,LER'SNAMt ._lh•C-....--.._,_..--_ __.:__._._. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940187 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:M M & M CONTRACTING INC OWNER ADDRESS:20441 PTARMIGAN BLVD. EAGEL RIVER, ALASKA 99577 PARCEL ID:05181139 LEGAL DESCRIPTION: SAMPSON ESTATES BLK LOT SIZE: 41163 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 3 LT 13 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 6/21/94 EXPIRATION DATE: 6/21/95 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 B ISSUED BY: DATE: e� DATE: (O 2 / — / T KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11 /FAX (907)696-8111 June 13,1994 On -Site Services DHHS 825 L Street Anchorage, AK 99501 Dear Sirs: REF: Lot 13, Blk 3, Sampson Estates Attached is our request for an on-site well and sewer permit for the above lot. As shown on the site plan, there are no conflicts with existing on-site wells or sewer systems or with potential reserve areas. This lot has an elevation difference, as illustrated on the soils log, of between 3- 5% from south to north and an approximate 2% slope running east to west. As a result of the high water table found in the initial monitoring and the grade differential we have designed a bed system that will be partially above grade and utilize imported sand. All organics will be removed prior to construction and in- situ material will be inspected for consistency. There is adequate area directly east and north of the proposed sewer site to install a replacement system. The natural slope will provide positive drainage away from the proposed absorption site. The design is based upon testing and percolation data performed on September 13, 1993. At that time, no water was encountered. The monitoring tube was installed and monitoring occurring on May 12th and June 13th of this year found water at 3' and 7' below grade respectfully. The percolation rate reflected on the soils test was 4 min./inch and was taken between l'- 2'. Refer to drawing 94-S2- 0506 for computations. I feel that the proposed above grade design will adequately handle the fluctuating water table. There is no surface water within 150 feet of any portion of the proposed installation. The design will incorporate three lateral distribution lines within a bed 38' long and 15' wide. The difference between the original soil grade after the organics are removed and the bottom of the sewer rock shall be filled with imported sand per MOA specification. It is anticipated that high density insulation shall be used over all areas with less than 4' of cover. REF: Lot 13, Blk 3, Samson Estates Ttune 13,1994 Page 2 of 2 Thank you for your consideration of this request. If there are any questions, please call me at 696-6111 or leave a message at 694-2359. Sincerely, Kenneth M. Duffus, P.E. KND Engineering Attachments: On -Site Sewer Application Wastewater Absorption System Details Site Plan Soils Log/Percolation Test SITE PLAN ELL RAD WASTEWATER ABSORPTION SYSTEM LOT 13, BLOCK 3, SAMPSON ESTATES 4 WEL RAD 3 SEPTIC PROPOSED ABSORPTI❑N 11 SEPTIC 3 -BEDROOM WELL , 10' 0 468 BASIS OF V 16 WELL AW /AV V4;� O...ALS ' f4 QTH *� #� IIENNEM DUFFUS-' 7116 -CE .'�', Ar 881014hu .4v Nk'%"4":wp- x TEST HOLE :1 !i rPE 1000 GAL SEPT TANK IC WELL ELL R A BLERVE WELL RADI LLSEPTIC 14 6 15 SEPTIC SEPTIC L❑T SIZE, 39,925 SF LESSi PERIMETER HOUSE FOOTPRINT 14,175 SF TOTAL AREA AVAILABLE FOR ABSORPTI❑N SYSTEM 25,750 SF 'REPARED FOR: KND ENGINEERING MM & M CONTRACTING 22041 PTARMIGAN DR P❑ BOX 670485 EAGLE RIVER, AK, 99577 CHUGIAK, AK, 99567 694-2359 688-1236 DATE 6/3/94 DRAWING k SCALE, r = 166 94-S1-0601 BOTTOM OF FIELD NO LOWER THAN 90.3 BASIS OF ELEVATIONi 100.00 R CENTERLINE MONUMENT SARAH CIR DESIGN DETAILS PERFORATED LATERAL DISTRIBUTION PIPES P M. WASTEWATER ABS❑RPTI❑N SYSTEM ❑. O LOT 13, BLOCK 3, SAMPSON ESTATES T//ESTT HOLE FDII GRADE co 0 100 0 GAL SEPT T N K UNCLASSIFIED FILL Ll 2.0 Q w w C. 0. OC,❑ ¢ ? 02' HD INSULATION OVER ENTIRE FIELD & ALL PIPES W/ LESS THAN 4' COVER 2s s s as M J ■x FILTER FABRIC OVER ENTIRE FIELD o C,❑, 15 MIT 4' ❑LID DESIGN CRITERIA, w F o `q TZ SOIL RATING; 4 MIN/IN = USE ORIGINII ... `�<Q , GRADE SE ABS❑RPTI❑N AREA ¢ W FOR VERTICAL SEPARATION DESIGN MINIMUM SIZE 15'W X 1'D X 38' LONG < 3'C❑VER 2' HD INSULATION REQUIRED OVER FIELD & PIPES IF INSTALL 1000 GALLON SEPTIC TANK. INSULATION TOP OF MINIMUM COVER 933 o u PREPARED FORS KND ENGINEERING M M & M CONTRACTING 22041 PTARMIGAN DR to .. LliCArCH O 34 N DPE 1 ORI EAGLE RIVER, AK, 99577 CHUGIAK, ALASKA 99567 694-2359 688-1236 DATEi 5-24-94 IDRAVING # NOT TO SCALE 94—S2-0506 1000 GAL,TCTR E 5' MIN S. T. ................K.... SEWER ROCK MAX F— x s `?.t4N z , z.St iznV'S_'r `M1, i . i-.. z_ TTOM ❑F FIELD 90.3 "'" • i' 2 — — — zB z IIP TED SAND PER HDA SPEC 15.65.D60(D) ORIGINAL GRADE roP OF GP SOIL 3 381 (MIN) a MEASURED GROUND WATER 8k BOTTOM OF FIELD NO LOWER THAN 90.3 BASIS OF ELEVATIONi 100.00 R CENTERLINE MONUMENT SARAH CIR 4' PERFORATED LATERAL DISTRIBUTION PIPES P M. N ❑. O T//ESTT HOLE FDII GRADE co D 100 0 GAL SEPT T N K UNCLASSIFIED FILL Ll 2.0 Q 2' HD INSULATMN 7--j I 5 C. 0. OC,❑ I.OSEWER ROCK 5 O C. 0. w 2s s s as M o C,❑, 15 MIT 4' ❑LID DESIGN CRITERIA, 3 BEDROOMS X 150 GPD/BEDROOM = 450 GPD `q TZ SOIL RATING; 4 MIN/IN = USE 0,8 GPD/SF (BED) ... `�<Q , 450 GPD r 0.8 GPD/SF = 563 SE ABS❑RPTI❑N AREA Ar i BED DESIGN WITH MIN❑R FILL 563 SF 4 15'W = 38' LF BED FOR VERTICAL SEPARATION DESIGN MINIMUM SIZE 15'W X 1'D X 38' LONG < 3'C❑VER 2' HD INSULATION REQUIRED OVER FIELD & PIPES IF INSTALL 1000 GALLON SEPTIC TANK. INSULATION xFSlxarx DvxauH REQUIRED IF BURIAL DEPTH LESS THAN 4'. PREPARED FORS KND ENGINEERING M M & M CONTRACTING 22041 PTARMIGAN DR \ `+r P. ❑. BOX 670485 EAGLE RIVER, AK, 99577 CHUGIAK, ALASKA 99567 694-2359 688-1236 DATEi 5-24-94 IDRAVING # NOT TO SCALE 94—S2-0506 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: MM&M Contracting DATE PER LEGAL DESCRIPTION: LOtl 3,B1 k3 Sampson Est Township, Range, Section: SPr �T15N R1 W SLOPE SITE PLAN j Organic 1 rc Elev 2GP IR fll 4 H2O 5/12/94 6 1 GM Silty Sand 7- H2O 6/13/94 E 9d J? ML Hardpan 10 Date WAS GROUND WATER NO Net Time ENCOUNTERED? 0 8125/91u S 11 L 1 IF YES, AT WHAT 0 N/A 5 min 3 DEPTH? P 12 7' BG 6/13/94: ;' E 5 min 4 Depth to Water ADer3' BG 5/ 13 Monitoring? Date: 14 15 16 17 1s 19 0� Sarah Circle Reading Date Gross Time Net Time Depth to Net Water Drop 0 8125/91u 1 5 min 5 min 3 5/16111 5 116" 2 10 min 5 min 4 9/1611 " 3 20 min 10 min 7 1/16 2 112" 4 25 min 5 min *311 " 5 30 min 5 min 5 11211 " * Add 4ater Hole presoaked prior to es 20 4 8" PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN —1— FT AND —2 —FT COMMENTS Use bed design shallow excavation, not, to PxrPPri 1' depth fill to +1' with MOA Spec Sand/ bottom of eys Pm PERFORMED BY: KND Engineering/ Cal 1 Kenneth Duffus CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Amichorage POU_,. i 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840335 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 13 Block 3 Sampson Estates Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log reeds to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Bandt Su ` Keith E. Supe visor Environmental Engineering Program KEB/ljw enc: Copy of Permit SwP/057 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET., ANCHORAGE, AK 99501 264-4720 10 F-4—:. I -F FE !E-5 FE L4 EE F;'.' -&: L4 E=- L_ PERMIT NO: 840325 DATE ISSUED: 05/11/84 APPLICANT: C/O S 8. S ENG' G. BRYAN ROFF ADDRESS: SRB 196X EAGLE RIVER., AK 99577 CONTACT PHONE: 694-2979 LEGAL DESCRIP: SUBDIVISION: SECTION: 3 LOT SIZE: 41163 <SQ.FT LOT LOCATION: SARAH CIRCLE MAX BEDROOMS: 3 FD'F=- FZ fel I -IF SAMPSON LYVO". LOT - 13 TOWNSHIP: 15N RANGE: iW OR ACRES) BLOCK: 3 i LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR. SITE. ---- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - E_ E-1 L4. E> FR Fl 11 r4 00, DEPTH TO PIPE BOTTOM (FT. a -t.3. 0 3. 5 2. 5 GRAVEL DEPTH (FT.) 0. 5 .1. 5 TOTAL DEPTH (FT.) 4. 0 4.0 0 GRAVEL WIDTH (FT.) 23. 0 5.0 0 'GRAVEL LENGTH (FT.) 44.0 1:14. 0 102.0 GRAVEL VOLUME (CU.YDS.) 37. 4 42.2 TANK SIZE (GALS) 1,000. 0 1:000.0 ,SOIL RATING ( SQ. FT. /BR) 224 243 DEPTH TO PIPE BOTTOM -C 3.5 FT. REQUIRES INSULATION DEPTH TO PIPE BOTTOM -C 4.0 FT. MAY REQUIRE A LIFT STATION GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I CERTIFY THAT: 1. 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOR) AND THE STATE OF ALASKA. 2. 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS. I AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. 1 WILL ADHERE TO ALL NOR 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. 1 UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 3 BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOR BUILDING CODES., THEN (1) FIN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED.; <2> AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (2) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. I GNED'DATE: APPLICANT: w0 S , S. ENG-'�BRYAN R F ISSUED BY DATE: ------- ------ ----- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: t-- /< 2 .J --•�• DEPTH C) r4 N\ Q- tN 2 3 4 7 8 9 10 SO LS LOG v jj-S' ❑ PERCOLATION TEST DATE PERFORMED: S--' �>--P ( SITE PLAN 11 /� Gross Time WAS GROUND WATERS ENCOUNTERED? Depth to Water �`✓/ / s � l( O 12 / / �y / ��f 4 IF YES, AT WHAT E 13 foe �( `� DEPTH? CC � .d 7 j� �4 14 l ',4* ate, *-t /!� � �Ej 117� Cy yyyf� '�i' �. O•4p6 � 3 15 16 Lam' .� 6niA11 A. 1d87k°�`' N 19- v 20 COMMENTS A ro� a/Y// Reading Date Gross Time Net Time Depth to Water Net Drop / s � l( foe til 7le'/ l e v' U /!� � �Ej 117� Cy ,?�V PERCOLATION RATE TEST RUN �BETWEEN � ry SFT PERFORMED BY: CERTI t �] y'�!�9pE}At I tim , LV SIVER, -'9bP'610A 72-008 (6?79)f�'I, (minutes/inch) f FT DA vit 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. # 051-811-39 HAA #. 1. GENERAL INFORMATION Complete legal description Lot 13, Block 3, Sampson Estates address or directions) Sarah Circle ,W 1< 638-1236 .��Prbberty owner '& PR Contractin Day phone ..` q {.,M.ar.c C+NTn•:,rxia. MKAYrTF6. P. Box 670435, Chugiak, Alaska 99567 . Mailin�q addres.�s qy� YY.t.'...'.1p:FFiYI Lending agency""AAti,`' Day phone Mailing address ..h Agent" v `," Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: XX Individual well 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: �r 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. l further verifythat 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, Ken Duffus, P. E. Phone 696-6111 Address 20441 Ptarmigan Blvd. Eagle River, Alaska 99577 Engineer's signature ( -Date- 6. ate 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments — By. oAd Date cl a Z 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. r .72-M (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 13, B lk 3. Sampson E s tParcel I.D A. Well Data 051-811-39 Well type Ind. If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 7/94 Driller Sullivan Total depth 182' Cased to 181.3 Casing height 2 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG Date of test 7/94 Static water level 145' Well flow 25 Pump levell unk SEPARATION DISTANCES FROM WELL TO: AT INSPECTION -MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION .p.m. g.p:ff. p 1 6 1994 RECEIVED Septic/holding tank on lot 122' ; On adjacent lots 100+ Absorption field on lot T ,1 0 , ; On adjacent lots inn+ Public sewer main NA Public sewer manhole/cleanout NA Sewer service line NA Petroleum tank 25:14 WATER SAMPLE RESULTS: Coliform A/ 1�.vg77� Nitrate . s� W Other bacteria A/ o Date of sample: &a3� Collected by: B. SEPTIC/HOLDING TANK DATA Date 4 Tank size 1000 Compartments 2 (Y/N) `� Y Foundation cleanout (Y/N) Y Depression (Y/N) N ;r alarrn,(>Y/N); arm tested (Y/N) mper i SEPA /TION DISTANCES R'OM SEPTIC/HOL50 G TANK TO: Well(s) on lot 122' On adjacent lots 100+ Foundation 7. 0' To property line 32.5' Absorption field 7.91 Water main/service line 251+ Surface water/drainage 100 !+ 72-026(3M)•Front CONTINUED ON BACK PAGE C. LIFT STATION N/A Date instal Size in gallon'�� Vent (Y/N) "Pump High water alarm level Meets MOA electrical codes (Y/N) _ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA :ss(Y/N) "Pump off" Level at tested Surface water Date installed 9/7/94 Soil rating (GPD/Ft2) 0. 8 Systemtype _ Bed Length 39 ' Width 161 Gravel thickness 0.51 Total depth 4. 2 ' Total absorption area 684 SF Cleanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test NA — New Results (pass/fail) for Bedrooms Water level in absorption field before test After test Peroxide treatment (past '12 months) (Y/N) If yes, give date SEPARATION DISTANCE F130M ABSORPTION FIELD TO: Well on lot 1301 On adjacent lots 1001+ Property line 42 _ 9 To building foundation _ 11.6 To existing or abandoned system on lot NA On adjacent lots +100, Cutbank 100 '+ Water main/service line 251+ Surface water 1001+ Driveway, parking/vehicle storage area 501+ Curtain drain 1001+ E. ENGINEER'S CERTIFICATION t certify that! have checked, verified, or conformed to all MOA and HAA guidelines in effect on the,l�t,this inspection. Signature / Engineer's Name KND Engin ing, Ken Duf fus , P. E. Date 2111(,- S �Z HAA Fee $Dd 6 v Waiver Fee $ _ Date of Payment Date of Payment Receipt Number DD oz%� Receipt Number. 72.026 (3193)' Back NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 • FAX 274-9645 KND Engineering 20441 Ptarmagm Blvd Eagle River AK 99577 Attn: Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: Lab Number Method -------------------- A133377 EPA 353.3 A133377 Sampson Est B 3/LB Water Parameter ------------------------ Nitrate-N Reported By: ArldXony J. Lange Chemistry Supervisor Report Date: 08/31/94 Date Arrived: 08/24/94 Date Sampled: 08/23/94 Time Sampled: 6:45 Collected By: * Definitions * B = Below Regulatory Min. H = Above Regulatory Max. E = Estimated Value M = Matrix Interference D = Lost to Dilution MDL = Method Detection Limit Units Result * ----------------------- mg/l 0.56 Date Date MDL Prepared Analyzed ----------------------- 0.10 08/26/94