HomeMy WebLinkAboutSAMPSON ESTATES BLK 3 LT 16Onsite File
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Sarnpson
Estates
Block 3
Lot 16
#051 �81 1 �42
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program. 4700 Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650 Page of
www ci.anchorage.akus (907) 343-7go4
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTIONREPORT
Permit Number. SWO70213 PID Number OSM11-42
Wiliam Dougherty
Wastewater System: 0 New Upgrade
Ad�
22435 Sampson Drive Anchorage, AK99567
—
ABSORPTION FIELD
688-6206 N� of 8.&� 4
OD"I)TliiiiCtl 111W�Twcl 13BW cililmic,
LEGAL DESCRIPTION
Iscil R.Wq
TitutiCapittima�
.6
7
el� 3 LA: 16 Sampson Estates
DWM 0 Me wWW Wiictr
oiwii o"in P"
3 Ft.
4 Ft
Tmrwvp RwW
G� LWVM
1-3
100 Fl.
Well: El New El Upgrade
'i'"v C9 ii�
'"2
D���
5
>10 Ft
C� (Pnvow & a. c)
Existing
T" DWM I C� W
T" M. -Mm �
fte M�
Ft. Ft.
1.000 Fe
ASTM D3034 PVC
Dift lr�
FIL
Barr Excavating
8125 to 9/5/2007
ft""" SM a
C�VH
FLI
FL
TANK
SEPARATION DISTANCES
0 Septic 0 Holding [I S.T.E.P. [I Other.
TO
��
Septe
Absorption
Uft
Holding
lublic/lInvitits
M --i— ,,,,r?=ty
Froir,
Tank
Fwld
Station
Tank
S�r Lin,
A chorage Tank
i�250 GM
wa
>100'
>100'
NIA
N/A
>2V
M�
Steel
TWO
ls�wtitw
>100'
>1100'
N/A
WA
LIFT STATION
LM 1.0
�5-
>I(r
N/A
NIA
F�
>10'
NL/A
N/A
_
C� D�
I None
Noted
Pwvm�&M�
F 1� P� by
lt�
Existing Septic Tank Pumped. Crushed and Buried On Site.
BENCH MARK
� iiirii cieixrv�
Diverter Valve Placed and Existing Absorptim Trench
Bottom of Siding
Connected.
100-00 F1
Inspections performed by: S. Gilbert Dates: I' =5/2007
U V
2ndam=07
A
Development Services Department Approval
491"
Conditional Approval Date:
.... 01
ilf..Mc ...
. . ...
ICHAEL F ANM711rj Id
CE -4331
Reviewed and approved by: t-XA Date: -s- /,r
_Lih
Municipality of Anchorage
DEVEOPMENT SER\nCES DEPARTMENT
4700 Bragaw Street Anchorage, AK 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Page 2 of 3
Permit No.: SVM70213 PID No. 051-8111412
Existing Septic Tcnk.
Pumped. Crushed cnd Buried
3MMI-13UN
LOT
r-31tAir-3 11)unulvlz�IUIN
16, BLOCK 3
40.420 S.F.
S\Pl 491h
-#, -" � No CE�'
PLAN AS -BUILT a —T. --A
444- SS10
SCALE 1'- 4(r %%%%SSW
Municipality of Anchorage
Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW070213
PID No. 015-811-42
103.5
C14 C40
rn U) 00
2' InsuLation
498.3*8.1
1.250 Gallon
Septic Tank
10 0.5
2" Insulation &
L
Geotextile Fabric
97.11 Drainfield Rock
97.1
93.1
93.1
86.9
50'Crrench Length)
10 0.1
2" Insulation &
L
reotextile Fabric
97.4 Drainfield Rock
97.1
93.0--/
50'(rrench Length)
93.0
. ...........
..... ..
49
... . ....... .. .... .. . .....
PROFILE AS -BUILT
...... ... . ...... .. .. ....... ..
M
No Scale
LE
% 0.
toiler,
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 16. BLOCK 3, SAMPSON ESTATES SUBDIVISION
PERFORMED FOR: WILLIAM DOUGHERTY
DATE: 8/25/2007 PROJECT No.:
PARCEL ID#: TECIINICIAN: S. GILBERT
DrTn I TEST HOLE # I-]
0w)
1
2
//
OB/OG
SLOPE
NET TIME
I (MINUTES)
3
NET DROP
I (INCHES)
8/1/07
-1
TEST HOLE PRESOAKED PRIOR TO TESTING:
4
8:33
4.25"
SILTY GRAVEL
5
1 2
GM
30
6.50'
GREEN/GRAY
6
3
9:04
4.38'
7
8
9:34
BOTTOM OF HOLE
9
2.13'
10
3
WAS GROUND WATER ENODUNTERED?
4.54
IF YES 0 Wl TAT DEPIT r
DEM I OF WATER AFTER MONITORING:
10:05
30
DATE OF MONITORING:—
I
I
I
I
I
SITE PLAN
SEE SITE PLAN
ISEE SITE PLAN
DATE
READING
G70SS TIME
MINUTES)
NET TIME
I (MINUTES)
DEPTH TO
WATER
I (INCHES)
NET DROP
I (INCHES)
8/1/07
-1
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
8:33
4.25"
1 2
9:03
30
6.50'
2.250
3
9:04
4.38'
4
9:34
30
6.50'
2.13'
3
9:35
4.54
4
10:05
30
6.63-
2.13 -
PERCOLATION RATE: 14 (MINANCH) PERCAIOLEDIA, 6 INCHES)
TEST RUN BETWEEN: 4. 0 FT. and 5. 0 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR To TEST. PERC. TEST ONLY TO VERIFY SOILS.
TEST PERFORMED BY ANDERSON ENGINEERING TECHNICIANS. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON
THIS DATE: 9/26/2007
MUNICIPALITY OFANCHORAGE
Development Services Department
On -Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW070213
Legal Description: SAMPSON ESTATES BLK 3 LT 16
Design Engineer: 0014 ANDERSON ENGINEERING
Owner Name: WILLIAM & KIM GREEN
Owner Address: 22435 SAMPSON DRIVE
CHUGIAK. AK 99567 -
p /-14
jq6D
116 Ita
Date Issued: Aug 22, 2007
Expiration Date: Aug 21, 2008
Parcel ID: 051-811-42
Site Address: 022435 SAMPSON DR
Lot Size: 40420 So. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit Is for the construction of.
M -e Disposal Field Z Septic Tank E3Holding Tank E] Privy El Private Well E] Water Storage
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 DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907)343-7904 (24 hours). (Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed. and heated to prevent freezing.
5. The following special provisions.
THE ENGINEER NEEDS TO DO AN ADDITIONAL PERCOLATION TEST PRIOR TO CONSTRUCTION OF THE
SEPTIC FIELD. THE PERCOLATION TEST PROCEDURE IS TO FOLLOW TABLE 3-8 OF THE EPA DESIGN
MANUAL. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE AS -BUILT INSPECTION REPORT. IF
THE RESULTS REQUIRE A DESIGN CHANGE. CONSTRUCTION OF THE SYSTEM WILL STOP PENDING
ON-SITE REVIEW AND APPROVAL.
Received
Issued By -
Date: 'R' I 4�wcn
Date: Z�07
/� I
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorame Alaska 99519-6650
www muni.org/onsite
(907) 343-7904
EF W
n ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-811-42
. If ;.,
S
t 1 $05:�,
�d
Property owner(s) William and Kim Green ay phone 688-6206
Mailing address 22435 Sampson Drive Chugiak, AK 99567 Zip Code
Site address 22435 Sampson Drive Chugiak. AK 99567 Zip Code
Legal description (Sub'd., Block & Lot) Lot 16, Block 3, Sampson Estates Subdivision
Legal description (rownship, Range & Section)
Lot Size 40,420 ____Sq. Ft.
THIS APPLICATION IS FOR (21 all that apply):
Absorption Field El
Septic Tank
El
Holding Tank
El
Privy
Private Well
Water Storage
Number of Bedrooms Four (4)
THIS APPLICATION IS AN:
Initial
11
Upgrade
Renewal
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(f a44�
(Signature of property owner or authorized agent)
Permit/Rush Fees: q&0 f lq�r Waiver Fees:
Date of Payment: /6 9� Date of Payment:
Receipt Number. Receipt Number.
(Rev. 11105)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
August 22, 2007
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 16, Block 3, Sampson Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The existing septic tank and absorption trench on Lot 16, Block 3, Sampson Estates
Subdivision are in a state of failure and must be replaced. We are therefore requesting
a permit be issued for the upgrade of the septic system to accommodate the four-
bedroom home on the lot. The attached Site Plan and backup documentation identify
the location and configuration of the upgrade to the proposed septic system. The
existing septic tank will be pumped, uncovered, crushed and removed. A new 1,250
gallon septic tank will be placed at the same location as the existing tank. A flow
diverter valve will be utilized to connect the existing absorption trench to the new
system for future use. Also identified on the plans are the locations of the existing well.
No conflicts exist between the existing septic system and the systems on adjacent lots.
Drainage arrows are shown indicating the current drainage patterns. The drainage
patterns will be maintained after construction.
The test hole placed an the lot indicated silty gravel with some sand (GM). The
application rate was determined to be .6 gallons per day per square foot. We are
proposing to construct 2-50' long by 5' wide absorption trenches with 4' of gravel
beneath the distribution pipe. The distribution pipe in the trench will be placed at 3'
below the surface with the total depth at 7'. No groundwater was encountered during
placement of the original test hole and none has been noted since.
The ground surface on the lot slopes slightly to the north at grades approaching 5%.
The trench will be constructed parallel to the contours of the ground as much as
possible and in conformance with design criteria. A minimum of 10' will be maintained
between all components of the septic system and the existing water service and 100'
Lot 16, Block 3, Sampson Estates Subdivision
August 22, 2007
Page Two
from any surface water and wells in the area.
If the system is constructed in accordance with our design the following statements
apply:
I The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact an reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
WW' --J' (f 04-4�
Michael E. Anderson, P.E.
Attachments
\L57
49:�
V �-A: � E. A%' JERS0%
No C�-4-181
.12 13
10
PSON 15
20
21
............
..... ...... ........ ..........
AREA MAP
SCALEI*=IOU # . % No. CE"I
. ............
s
SAMPSON
ESTATES SUBDIVISION
LOT
16, BLOCK 3
40,420 S.F.
Existing Well
N,
2-4!�0-EHL:,.p,.. 5' de
p
Absorption Tre h"
TH
(D
Four
Bedroom Flow Spritter
House Vat"
NOTE: Pump. Crush Remove
T,
cnd
It"
Existing Septic Tcnk.
Slipib9. nk
Fl" Mortar
vaive
vow EGO
OF 4
t
.........
R WE
A? C2 0,
49th * * *
SO
. .. ...... .
Oi.......... .
6
.. ...............
L ANDERS&T".
--6
,p% No. a4wi
SITE PLAN
................
Istilt SS%
N%lk
SCALE 11"= 41Y
LOT 16, BLOCK 3, SAMPSON
ESTATES SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom House 5'Wide Trench System
Perc. Rate: 16-30 Min./inch 1,250 Gallon Septic Tank
Application Rate: .6 GPD/SF 4'Drainfield Rock
4 Bedrooms X 150 GPD/.6 GPD/SF (Application Rate) = 1.000 SF Absorption Area
1.000 SF/5 SF/ LF -.5 (Red. Factor) = 100 LF Trench Length
THEREFORE: Construct 2 Trenches Each 50'Long x 5'VVide x 4'Effective Depth.
Flow Line to be 3' Below Existing Ground. Total Depth to be T Below Existing Ground.
Place Diverter Valve and Connect Existing Absorption Trench. Place Splitter Valve to Provide
Even Flow to Each New Trench. Provide Tof Cover Over Absorption Trenches and
4' Over Septic Tank.
— Natural
Backfill
2'6"
Geotextile
Fabric
6"" —4" Perforated
PVC (Holes Down)
4-0-1 1 ,>---t— Drainfield Rock
5.
TYPICAL 5'WIDE TRENCH SECTION
w CF
(NO SCALE) AA,��
...................
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6'Separabon From Bedrock.
Minimum 4'Separation From Groundwater.
Minimum 1 OO'Separation From Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.... No. CE�l
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICEs DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 16, BLOCK 3, SAMPSON ESTATES SUBDIVISION
PERFORMED FOR: WILLIAM DOUGHERTY
DATE: 8/1/2007 PROJECT No.:
PARCEL ID#: TECHMCIAN: S. GILBERT
Drm I TEST HOLE #7]
(11-0
2
.4
3
4
5
6
7
9
12- 4'
A.
I
I
I
COMMENTS:
[11111
SILTY GRAVEL
GM
GREEN/GRAY
WAS GROUND WATER ENCOUNTERED' No
IFYES@WILATDEFni'-
DEPT1 I OF WATER AMR MONITORING: NONE
DATE OF MONITORING: 8/150007
BOTTOM OF HOLE
SITE PLAN
SEE SITE PI -AN
ISEE SITE PLM
DATE
READING
G70SS TIME
MINUTES)
NET TIMEJ
I (MINUTES)
DIWEPTH To
ATER
(INCHES)
NET DROP
I (INCHES)
8/1/07
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
4:04
29'
2
4:34
30
30.75"
1.75*
3
5:04
30
32.50*
1.750
4
5:34
30
34.250
1.750
PERCOLATION RATE: 17 (MIN/INCII) PERC. HOLE DIA. 6 INCHES)
TEST RUN BETWEEN* 4. 0 FT. and 5 - 0 Fr.
HOLE PRE SOAKED PRIOR To TEST.
TEST PERFORMED BY ANDERSON ENGINEERING TECHNICIANS. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON
THIS DATE: 8/21/2007
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 16, BLOCK 3, SAMPSON ESTATES SUBDIVISION
GENERAL:
The scope of this project includes the pumping, crushing and removal of the
existing septic tank. It also includes the procurement and placement of a new
1,250 -gallon septic tank at the location shown on the Site Plan. Work also
includes placement of a Flow Diverter Valve and the connection of the
existing absorption trench into the new system. Work will then include the
construction of 2 new absorption trenches each 50' long X 5' wide X 4.0'
effective depth absorption trench at the location also shown on the Site Plan.
The distribution line in the trenches will be placed at 3' below the existing.
ground surface. Total depth of the trenches will be 7' below the existing
ground surface. The new absorption trenches and septic tank must be placed
a minimum of 100' from all private wells and any surface water in the area
and 10' from the water service line on the lot. A minimum of 3' of cover is
required over the absorption trench and 4' of cover over the septic tank. A
flow splitter valve must be placed to insure even flow to each trench.
2. Construction shall be in accordance with the approved site plan, design
drawings, Municipal Permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the location
of all lot lines. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
4. Unless specifically agreed otherwise, the contractor shall be responsible for
final grading areas subsequently depressed from soil settling. Property
owner shall be responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Department of Development Services, Building Safety Division for
system installations. Owners installing their own systems must receive prior
approval from the On -Site Water and Wastewater Program Section before
beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,250 -gallon septic tank must be procured from an approved source
and installed at the location shown.
Lot 16, Block 3, Sampson Estates
August 21, 2007
Page 2 of 3
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a level
bed of drainfield rock. Rock should then be placed over the pipe to provide a
minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield rock
and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations shown on
the design. The portion below the distribution pipe must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum 100' away
from any private water wells in the area, 150' from a Class "C" Well or 200'
from any community well.
6. Direct bury insulation must be placed over the distribution system if less than
3' of backfill depth is available. Finish grade over the trench must be
mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
Lot 16, Block 3, Sampson Estates
August 21, 2007
Page 3 of 3
8. A minimum 2' of accepting soil is required below the drainfield rock for an
absorption trench. All pockets of unacceptable materials must be removed
and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and
solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662
or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Co. Styrofoam Hl or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the
#200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These inspections
must be conducted under the supervision of a professional engineer registered
in the State of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled.
The second inspection must be conducted after the placement of the geotextile
fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction notes
for use in preparing the certified as -built of the completed system.
Parcel I.D. 015-811-42
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
C
0'
Expiration Date: r 10 —2j
1. GENERAL INFORMATION: 3 /
Complete legal description SAMPSON ESTATES; BLOCK LOT
Location (site address) 22435 Sampson Drive *Anchorage 99567
Current Property owner(s) Stephanie Hubbert Day phone 854-6188
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
PF_
®
Individual
Individual Water Storage
2
-
❑
Community Class Well
S A
E T Y
❑
Public Water System
Expiration Date: r 10 —2j
1. GENERAL INFORMATION: 3 /
Complete legal description SAMPSON ESTATES; BLOCK LOT
Location (site address) 22435 Sampson Drive *Anchorage 99567
Current Property owner(s) Stephanie Hubbert Day phone 854-6188
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5 5 (D Waiver Fee $
Date of Payment % 0,
1'O� Date of Payment
Receipt Number a99 5 �76 Receipt Number
COSA # 0 S CoZ2 1 3 6 Waiver #
ffr
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,
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: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179
Address: _ 3701 East Tudor Road Suite 101- Anchorage Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: `? 22 -
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the dates of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future perfonnance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. 7IGNATURE
System #1 Approved for bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the following
jJ�f � '�GCr•:e. s ..
crzss,ow
#AECC884
6\?NLITY p�.�/iii
�ti�Tila ioi� rFR iTF y�
< qS.T,. 4ND m
�o ROS FR =
j99I
Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist Nitrate Advisory_
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: SAMPSON ESTATES; BLOCK 16, LOT 3
Parcel ID: 015-811-42
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system _
A. WELL DATA
N
❑ Well log is filed with Onsite (or attached)
v
Date drilled 1112184
o�
Total depth 160 ft
Total measured depth from grade 7.5 ft (max)
Cased to 160 ft
0
❑ Sanitary seal is functioning correctly
Water added 650 gal
❑ Wires are properly protected
❑ N/A — pressurized field
Casing height (above ground) 12+ in.
Date of flow test for COSA 7/13/22
New depth in
p
120
Static water level at beginning of test 150.3
ft
Comments
B. TANK DATA
Age of tank(s) 15 years
Tank type/material '_"P4TT E'
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping I D1 q /21
D. ABSORPTION FIELD DATA
Well production at time of test 5.3+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes On Nc
[,Coliform bacteria is Negative
. , Nitrate 5, 2z mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L R Arsenic less than MRL (ND)
Collected by GEG, LTD.
Date of Sample 7/13/22
C. LIFT STATION
❑ Required maintenance completed
Age of lift station ye
Lift station material
t0
Which system tested (date installed) 8/29/07
Adequacy test date 7/13122
v
On ALL standpipes present per record drawing
Results R' Pass For 4 bedrooms
z a
Total measured depth from grade 7.5 ft (max)
Fluid depth prior to test 11 in
0
Measured depth to pipe invert from grade *2.17 ft (min)
Water added 650 gal
N v
❑ N/A — pressurized field
22
❑ Monitor tubes go to bottom of effective. If not, state
New depth in
p
120
depth into effective
Elapsed time min
❑ Code -required soil cover over field
Final fluid depth 18 in
❑ System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NIA
date of test)
Gallons introduced N/A gallons
If yes, enter date '
Comments/Deficiencies: 2007 DUAL TRENCH HAS 2 INCHES OF INSULATION -SEE EMAIL FROM OWNER REGARDING NO FREEZING ISSUES -TESTED SOUTH 2007 TRENCH ONLY.
SOUTH TRENCH WAS DRY UPON ARRIVAL AND STAYED DRY THROUGHOUT TEST
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
I- Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No ft
Absorption Field on Lot > 100'[M✓ Yes
if No
ft
Holding Tank > 100' Q✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' Yes
if No ft
M Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Q✓ Yes
if No
ft
Q Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' Yes if No ft
Property Line > 5' P,1 Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' Q Yes if No ft Private Wells > 100' ❑✓ Yes if No ft
Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft
Water Service Line > 10' n Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below
Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots:
Water Main > 10' 0 Yes if No ft Private Wells > 100' Q Yes if No * ft
Water Service Line > 10' R] Yes if No ft Community Wells > 200' 21 Yes if No ft
Surface Water > 100' E Yes if No ft
F. ENGINEER'S COMMENTS
*DISTANCE FROM WELL ON SAMPSON ESTATES; B4, L21 TO 1984 RESERVE TRENCH
IS UNABLE TO BE VERIFIED BECAUSE NO CLEANOUTS AND MTS ARE PRESENT.
**TANK TO BUILDING FOUNDATION IS 5'+ & MET CODE AT TIME OF INSTALLATION
***ASSUMED - MEASUREMENT IS FOR 2007 TRENCH. LOCATION OF 1984 TRENCH WAS
NOT VERIFIED - SUMP WAS DRY & NO INVERT MEASURED.
G. ENGINEER'S CERTIFICATION
I certify that i have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
Je fre A. Garness
Q° C 79
pr o f e s sio�°Q�
#AECC884
DEVELOPMENT SERVICES DEPARTMENT
On -Site water and wastewater Section
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 221386
Subdivision: Sampson Estates Block 3 Lot 16
907-343-7904
Fax: 343-7997
A water sample revealed a nitrate concentration of 5.22 milligrams per liter (mg/L).
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.
Mailirig Address P O Box 196650 *Anchorage; Alaska 99519 6650 *www muni org
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
Sonja Blewett
From: Abe Hubbert <Abe.Hubbert@technipfmc.com>
Sent: Thursday, July 21, 2022 9:49 AM
To: Sonja Blewett
Cc: Stephanie Hubbert; Heidi's Homes of Alaska
Subject: 22435 Sampson Dr drain field statement
Good morning Sonja,
We have experienced no issues what so ever with the leach field at our property (22435 Sampson Dr. Chugiak, Ak 99567)
freezing, backing up or working incorrectly. During the purchase of this property in 2019 we were also told the previous
buyers experienced no issues with the leach field as well. Please let me know if you have any other questions.
Thanks
Abe Hubbert
Operations Manager ( Surface Americas
P +1 907 563 3990 M +1 907 538 4892
abe.hubbert(cDtechnipfmc.com
TechnipFMC
700 IN International Airport Rd. Bldg A-1 Anchorage, Alaska 1 99518
TechnipFMC.com
1
• Municipality ®f Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
0SI
Parcel I.D. 811-42
1. GENERAL INFORMATION:
Snvery
Expiration Date: 3 r 0
Complete legal description SAMPSON ESTATES: BLOCK 3, LOT 16
Location (site address) 22435 SAMPSON DRIVE *CHUGIAK AK 99567
Current Property owner(s) WILLIAM & ETHEL DOUGHERTY Day phone 887-1607
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
19
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the
engineer.
COSA Fee $ 5-6-6
Date of Payment 4 1t11/9
Receipt Number t �qA-Ra"
COSA # DSC l9 /a3(_1
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
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,
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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 I
Engineer's Printed Name: Jeffrey A. Garness Date:--"iq/f
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system a
in accordance with the guidelines and regulations established by the. Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the Q4 P t l
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or I
H 7.encroachments may exist that were not identified during the evaluation. The operational life of all wells /� *' t 4
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,"'
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and I....., i. j '
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the (I `- ��J e . ey Ce ess.:
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of PQ ' CE 79 3 i
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in f �lir'
the future. The content of this report is for the sole benefit of the person/party that retained GEG to �o�esslo� o
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever. .,
#AECC884
6. DSD SIGNATURE j ON-SITE �G
/ � WATER AND
System #1 Approved for `7 bedrooms ;DWASTEWATER C:Z)
System #2 Approved for bedrooms PROGRAM
Disapproved 'O,p 50
Conditional approval for bedrooms, with the foi�ulatlons:
I M0
11 gwiill W,
z I ON wo 11 JIM,
0,
By'. Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist / Nitrate Advisory_
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc �U
/11 h-:1
Legal Description: SAMPSON ESTATES; BLOCK 16, LOT 3
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
A Well log is filed with Onsite (or attached)
Date drilled 1112/84
Total depth *160 ft
Cased to 160 ft
Q Sanitary seal is functioning correctly
,Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 1121/19
Static water level at beginning of test 151.2 ft
Comments
B. TANK DATA
Age of tank(s) 12 years
Tank type/material STEEL
Fil Standpipes/foundation cleanout per record drawing
Date of pumping A- v. 4 D 3. 3 o i ?)
D. ABSORPTION FIELD DATA
Parcel ID: 811-42
Structure served by this system 1
Well production at time of test 6.2+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes FillNo
[,Coliform bacteria is Negative
Nitrate 23 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L [,Arsenic less than MRL (ND)
Collected by GEG, Ltd.
Date of Sample 1/22/19
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material -
Comments: N/A
Which system tested (date installed) 8129/07
Adequacy test date 1/22/19
WALL standpipes present per record drawing
Results ✓❑ Pass For 4 bedrooms
Total measured depth from grade 7+ ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade *2.6+ ft (min)
Water added 720 gal
❑ N/A — pressurized field
New depth 5 in
A Monitor tubes go to bottom of drainfield. If not, state
Elapsed time 120 min
depth into effective
FE-1Code-requiredsoil cover over field
Final fluid depth 0 in
X System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NONE
date of test)
Gallons introduced 2065 gallons
If yes, enter date
Comments/Deficiencies: 2007 DUAL TRENCH HAS 2 INCHES OF INSULATION -TESTED AND PRESOAKED SOUTH TRENCH ONLY. PRE-SOAKED ON 1/21/19
COSA Checklist yellow sheet
ti
E SEPARATION DISTANCES
From Private Well onLot to: (Please enter distances if less than required nrifcommunity well)
Septic Tank/Lift Station onLot>107
Community Sewer Manhole/Cleanout >i07
Fv�Yes
ifNoft
F,71 Yes
ifNoft
Neighboring Tanb>1UU' ZYon
ifNoft
Private Sewer/Septic Line >25' FV-1YesifNoft
Absorption Field onLot >18O' [71 Yes
ifNoft
Holding Tank >1UO' ZYea
ifNoft
Neighboring Absorption Fields > 100'
Animal Containment > 50' [71 Yes
ifNoft
��Yoa
if
�
��
----
Manure/Animal Excreta Storage >1OU'
Community Sewer Main > 75' ��Yeo
ifNoft
F,71 Yes
ifNoft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
�
Building Foundations >1O' F-JYea if No ft Surface VVobsr>1O0' FV�Yeo ifNoft
�
Property Line >5' F,(�Yoe iyNoft Driveway/Parking >O' F71 Yes ifNo, comment
1^--
Absorption Field > 5' ��Ye s |fNoft VVe||a on Adjacent Lots:
Water Main >10' FV-] Yes if No ft Private Wells >100' [/�Yes if No ft
Water Service Line > 10' F,/� Yes if No ft Community Wells > 200' FV -1 Yes if No ft
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation >1O' �1Yeo ifNoft Driveway/Parking >[/ F71 Yes ifNo, comment
Property Line >1U' F,71 Yes ifNoft Wells onAdjacent Lots:
Water Main >1O' FVqYas ifNnft Private Wells >�1OU' Yoa if No ft
Water Service Line >1O' FV-qYeo |fNnft Community Wells >200' ��Yes ifNo#
Surface VVabar>1UO' [/�Yea ifNoft
?V-.3 L \Jo
F. ENGINEER'S COMMENTS
*DISTANCE FROM WELL ON SAMPSON ESTATES; B4, L21 TO 198,( RESERVE TRENCH'
iSUNABLE T[}BEVERIFIED BECAUSE Kj[>PIPES ARE PRESENT FOR 1984TRENCH.
TANK TO BUILDING F{]UN[}/\TI{)N IS 5'+ & MET C{][)E AT TIME OF INSTALLATION
Q. ENGINEER'S CERTIFICATION
/certify that / have determined through field inspections and review
ofMunicipal records that the above systems are /nconformance with
MOA C0SAguidelines ineffect onthis date.
r1A VA
10�01� �dt ffr y Gar ss..'
E—J9)3
CoaAChecklist yellow sheet -#Asccuu^'
��
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC191034
Subdivision: Sampson Estates, Block: 3, Lot: 16
A water sample revealed a nitrate concentration of 8.03 milligrams per liter (mg/L).
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. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. 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.
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
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