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Home My WebLink AboutSAMPSON ESTATES BLK 4 LT 1ampson Estates Block 4 Lot 1 #051-811-06 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 930 qQL PID Number: 05/— F/% — A� Name: vorl.4c 5 Wastewater System: ❑ New ®' Upgrade Address: P, D, ox �,4 99577 ABSORPTION FIELD Phone: No. of Bed r oms: ❑ Deep Trench ❑ Shallow Trench O(Bed ❑ Mound ❑ Other LEGAL DESCRIPTION s°Il Rating: 0 b Total Dept from lgrade: GPD/S . Ft. Lot: Bleck: Subdivision: Depth to pipe bottom from original grade: Ft. Gravel depth beneath pipe O.6 Ft. Township: / G - / Range: �W 1 Section: 3 Fill added above original grade: Z /% Gravel length: 4 z , Ft. Ft. WELL• ❑New N�,q ❑ Upgrade :r.r Gravel depth: J✓/Dr�� Number, of lines: `/l Distance between lines: 1 (P L-- Ft Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area:: /,0o Pipe material: PVC 5C,HeL) 40 Ft. Ft. SQ. Ft. Driller: Date Drilled: Static Water Level: Installer: �9e 1,)5 Date installe : Ft. 6V1jl/��.r�• Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Xseptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Pa4fie/Private Manufacturer: Capacity inlions: 15 From Tank Field Station Tank Sewer Lines Z D Well 102'' (PO' r //(p73' N/A Material: Number of Compartments: Surface NA Nle N�/ N /� %�14 LIFT STATION Water Lot Line % r l0 r (DS NIA i .0 Size in gallons: 500 Manufacturer: /INCH TANK 10961VW Foundation 7 r/ / 00 / ` r `�/ /ylA IVIA Pump on" level at: "Pump offer el at: High w-3/ farm at: fl Curtain A d I7� A� /A NIA Pump Make & Model Electrical InspeefioVns performed by: Drain N!// JY 4 !' ,/ d�Z-05- -HHG No Tdir �✓/tir.� w -n[. i N BENCH MARK Remarks: GxiSTiu a# Location and Description: 'r/cl-/I OM /N L 1 /VCW I -ILL S27J01V 41,0106d llrifZp LklSrllV" Tod Olt�_ COM12CLG 06)N D <' ria r / k , L�ACL Assumed Elevation: o -o ENGINES SEAL ,a 6q oaf®leges Fa Voneq 4 � tp _ a ®e . Inspections performed by: Dates: 1st r. 2nd // /lJ 9 �, ,...... .... ° C K` Department of Health and Human Services approval (t Louis A. L+utera t% ''-, CE -6736,€ �� u °°agoe J Reviewed and approved by �`' Date: 72-013 (1/91) MOA 26 Permit No. SW93-0467 Page 9 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 9 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SaWson Estates Lot 1 Blk 4 Z CD 320,.28 ww Q N 33' SECTION LINE EASEMENT A v —— _—_— --- —!ING EXISTING /SEPTIC i1ANK ELEVATI[INS (NOT TO SCALE) +95.2 EXIST. SEPTIC TANK LIFT STATION PID No.: 051-81 1-06 i N V) 'o I o I A /W NO SEPTIC SYSTEM +100' TOP OF CONCRETE FOUNDATION ASSUMED ELEV = 100.00' m /2" 35PPSI INSULATION =O 2.5' ADDED FILL AROUND F- - LEVEL @ 95.9 m I�J : \94.1-972 970 NO GWT 2' SAND FILTER LAYER 86.6 94.1 FIELD - ENGINEER'S SEAL LEACHFIELD PIPING IS 1.25' LATERALS WITH 1/D' HOLES SPACED AT 8C ON CENTER WITH CAPPED CLEANOUT ON END OF EACH LATERAL. MANIFOLD IS 2' PVC PIPING _ 72-013 A (2191) MOA 25 • - MONITOR TUBE o - SEWER CLEANOUT - :WELL — — -EASEMENT . SCALE 1" = 60' �F �P .* 4 �y TH ... c LOUIS A. BUTERA s CE -6736 V \ b • t NEW f UFT T[ES AWING 39.0 B - C = 165.6 B - D = -71.3 C - D = 14.2 fy B - E = i70.8 C - E = 15.4 - B - E _ _103.4 B - G = -135.3 C - G = -93.0 ELEVATI[INS (NOT TO SCALE) +95.2 EXIST. SEPTIC TANK LIFT STATION PID No.: 051-81 1-06 i N V) 'o I o I A /W NO SEPTIC SYSTEM +100' TOP OF CONCRETE FOUNDATION ASSUMED ELEV = 100.00' m /2" 35PPSI INSULATION =O 2.5' ADDED FILL AROUND F- - LEVEL @ 95.9 m I�J : \94.1-972 970 NO GWT 2' SAND FILTER LAYER 86.6 94.1 FIELD - ENGINEER'S SEAL LEACHFIELD PIPING IS 1.25' LATERALS WITH 1/D' HOLES SPACED AT 8C ON CENTER WITH CAPPED CLEANOUT ON END OF EACH LATERAL. MANIFOLD IS 2' PVC PIPING _ 72-013 A (2191) MOA 25 • - MONITOR TUBE o - SEWER CLEANOUT - :WELL — — -EASEMENT . SCALE 1" = 60' �F �P .* 4 �y TH ... c LOUIS A. BUTERA s CE -6736 V a Is DEC -01-93 WED 11:04 QUALITVfSAND<-AND+GRAVEL 3737979 P.01 QUALITY 14)w SAND & GRAVEL P.Q. Box 1430 Pnjmcr, AIC. 9qf145 Cit: (907) 373-5211 1 RMI 478-:213 Evenjogs* (007) 74t1 02.35 LQ :1 Xm, 37:fi PARKS JINVY- T Ile 16127 ICE No. . Tn •PHIO "C' IV PERCRtFTION OF WORK Apou- T-._ T. "OURS RATE AMOUNT TOTAL_ MATF TOTAL LA SOR TAX PAY THIS AMOUN APF 27-94 WED 11:4 f, UI InnEL- GVWSIKUuIaury Coro-rv+oTt. April 2z, 1994 MAY 51994 Municipality of anchorage gept. Health & Human Serwoee Eagle River Engineering Services 11940 Bunineas Blvd Eagle River AK 99577 TO WHOM IT MAY GMNOFRN:. I Arthur B.'Stemen, a journeyman far Raven Electrie-Inc., wired a sewage lift statiod for a Mr. Donald Williams. I tested the system after making the electrical connections and everything seemed to work . properly. All the wiring had been to state and munleipa1 Code: Sincerely, Arthur R. $temen #105625 12/12/94 AS/hr: 6015 Schoen Street, Anchorage, Alaska 9951,9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT NUMBER:SW930467 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:WILLIAMS DONALD OTIS & OWNER ADDRESS:P.O. BOX 771972 ANCHORAGE AK 99577 PARCEL ID:05181106 LEGAL DESCRIPTION: SAMPSON ESTATES BLK 4 LT 1 LOT SIZE: 40012 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 39fn Ceg0-) L1'Is a3 (UPGRADE) PERMIT 1 J_q-�l DATE ISSUED: EXPIRATION DATE I 1-q-`-4 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 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: ///`--;_4.l ISSUED BY: �� rn� DATE: r PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920342 DATE ISSUED:10/09/92 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE:10/09/93 OWNER NAME:WILLIAMS DONALD OTIS & OWNER ADDRESS:P.O. BOX 771972 EAGLE RIVER AK 99577 PARCEL ID:05181106 LEGAL DESCRIPTION: SAMPSON ESTATES BLK 4 LT 1 LOT SIZE: 40012 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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: ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. THIS IS A PRESSURIZED DISTRIBUTION SYSTYEM. RECEIVED BY: DATE:- 1o113Ly Z ISSUED BY: JOfft, - 0M7H DATE: ZR/61 �qZ Male RIlvQr HUSA'De alus sarTACM Louis Butera, P.E. Registered Civil Engineer September 3, 1992 John Smith, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Sampson Estates, Lot 1, Block 4 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 as there is no developable land to the west. 4. Drainage will not be effected 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 VACANT LOT 7- _p, r - Fo _p'Fo 33' SECTION LINE EASEMENT n� N—--------- e�------- EXIS Ale') IAIG SEPTIC G fR US Gere TANK Fd D so' NEW LI T LEACHFIELD PIPING TO BE STATIO 1.25' LATERALS WITH 1/8' HOL Ito.s SPACED AT 2,1' ON CENTER WITH N S� P�2 CAPPED CLEANOUT ON END OF EAC e LATERAL. MANIFOLD OFF OF 2' PVC PIPING, 1%lez °SEPTIC TANK XICSEP +30' OR'S WELL +100' LOT 2 HOUSE SF'ZF,�9 F WELL -4 4 _ � A; �J (v NO SEPTIC / h SYSTEM +100' 0 - TEST HOLE • - MONITOR TUBE o - SEWER CLEANOUT NO SURFACE WATER COURSES 4 — WELL i+HIIIFH+ — PROPOSED LEACHFIELD NO KNOWN CURTAIN DRAINS — — – EASEMENT SEPTIC SITE PLAN LEGAL: LOT 4, BLOCK 1 SAMPSON ESTATES a�-_r a OWNER: DON & MARIANNE WILLIAMSio mo Tl CONTRACTOR: N/A`�" 0 000 �m�, noameom�ma me mmm Q• JOB # 92-141 DATE: 10/02/92 SCALE 1" = 50' B c4e ho l n. eusera°`' ® iP °® CE -6735 EAGLE RIVER ENGINEERING SERVICES �® P.O. Box 773294 �3c�P80FESS1'�`�� EAGLE RIVER, AK. 99577 TGNK Sa�4 4t4N ✓G f"� (907) 694-5195 FAX: (907) 694-3297 5� �a��r ane<r•.r�s t SAMPSON EST. L1/B4 PUMP Flow (GPM) ELEV. Head (ft) PIPE Head ORIFICE FITTING Total Loss *(FT) HEAD (FT) LOSS (FT) HEAD LOSS ORIFICE FLOW F1ATE** NUMBER ORIFICE OF SPACING ORIFICES 29.0 9.5 3.93 5 5 23.43 0.42 69 2.09 Constants: Pipe Length (ft) 40 PIPE SIZE IN. 1.25 Pipe ID (inch) SDR 160 1.38 Pipe Friction Coeff. (m) 155 ORIFICE SIZE IN. 0.13 TOTAL LATERAL LENGTH IN BED 144 *HAZEN AND WILLIAMS FORMULA ((452*(914-I.85)/(E23-1.85)/(E22-4.86)tE20)/100)/0.433 ,**ORIFICE EQUATION OF Ai g0"vo9 o4 "@" . �014 �o Louis A. [Butes [Butes CG613E• <` e nR OFESti W ..; 350.00 it it J.i EFFLUENT .......... .. .. 4... 4..: ... ... 1/2 Hp to 11/2 H PHASE, 60AZ 20 ... it ...... .. ... .. .. .. ... SINGLE 115/230 VOLT ..it ... • OSI 15 HHF - 9 stage PC#2 4 lit -j- 44.. ... ... ... .. .. ... .. ... 05192 300.00-- .......... it ... .. .. .. ...... .. ... .. .. .. ....... .. ... ... .... . .......... J. .4 ... ... ...... ... -44- ... ... ........... i.. 4 .. ..4 .. .. . .. ... .. ...... t.. .... .. ...... . ....... . .. t ............. .. .. . .. ... 0 •20 OSI F- 10 HH rstage rVV. 250.00- 4-4- it it i i .. ...... .. .. 44-4--.. ...... . ... .. .. .. .. ... ... .......... .............. .. ... ..... . ... 14-4 .... ... ... .. . ...... ........ ... ... ... .. .. Lil ..i .... ... ... .. ..... ..... . ... ... ....... ... lz ..... .. . . .. ........ 200.00 .. .. ... ... -4- . < -4 .. . ....... . ... .. .... ...... ... ....... ... .. . . . . . . ...... ... ....... ...... ... ... .. ............. . .. ... 44 .. ... ... .. . .. t U... ............... it t.. ... 0 OS 05 HH - 5 staged OSI 07 HH - 5 stage@ 150.00 - it .... . ... -4 ..... -4-4 .. .............. .. .. .. it . ... ... .. ...... i V. VT .. .. ... . ... =L .. .. .. .. .. ... !it .. . ............. ... .. ... ... O .......... .......... .. .............. .. .. .. I : i : V. ... v -1-t ... .. .. .. ... ... .. .. .. .. ... ;4.4 ...... 100.00 .. . .......... .......... 4-4 ........... ... ... it 4 . .............. 4--............... ...... . ...... .......... ... ........... .. .. ................. .. . .. .. .............. .LJ ... ... .4- ... ... +1 it it OSI 05 HH 2 stage* 50.00- .4 .. ........... .. 4-4 .. ...... .. .. ... ................. ... ... .. ................. ... ... ..... .. ... ... ... i .. .. ... ....... it Ali U10V .... 23 200SIOSI iHF - 5 stage .. ... ....... ky.. -9.1 4 w 1/4 "flow controller JIA 0.00 0.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00 40.00 45.00 50-00 NET DISCHARGE, GPM [CO—RENCO SYSTEMS, INC 2826 COLONIALD ROSEBU OR 97470 (503)673-0165 20 • [CO—RENCO SYSTEMS, INC 2826 COLONIALD ROSEBU OR 97470 (503)673-0165 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM Revised 09/10/92 LEGAL: LOT 1, BLOCK 4, 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 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 per 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. BED 1. Excavate all topsoil material to 1.5' depth and replace with sandy pit run material, <5% fines. Contractor must provide current certified sieve analysis of soil utilized. 2. The elevation of the imported sand layer is to be +0.5' above ground surface. 3. The finished bottom of the bed shall be level, plus or minus 1.5". 4. The effluent line is to replace the existing effluent line that leads to the existing field. 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 4' or equivalent is to be placed over the leachfield. Side slopes of bed mound are to 3:1 grade. 7. The area over the bed is to be finish graded to prevent ponding of surface water runoff, and 4" topsoil with seed are to be placed. 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 = +0.5' GRAVEL DEPTH = 6" under pipe BED LENGTH = 42' BED WIDTH = 24' SOIL RATING = 0.6 GPD/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK SIZE = Existing tank + 500 gallon Orenco lift sation NOTE: Wire lift station to code and provide receipt from licensed electrician Twenty-four (24) hours notice required for all inspections. PROOIY,t 2041 � I, Cldm, Mas 01471 Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L•• Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: ��/4✓"'r TicsTP/ocE *1 02 LEGAL DESCRIPTION: —10��/�`! Su"rnfe^' /=ft Date E rT Net Time Depth to Water ENCOUNTERED? sunK 1 11 2 S N Fl r a L ON O 12 3- 2, E �. :Uv 13 4-- 44 Depth to Water After f7� ,;�Monitoring? Date: ✓� /= f ■■0 42 ' `O . AND MUNICIPAL 6 DATE: &A 1 —k 7 9 (ENGINEER'S SEAL) DATE PERFORMED: 25 /?/9z Township, Range, Section: Tis^ is /w Tcc 3 SLOPE SITE PLAN ■■MEN Date .■ Net Time Depth to Water ENCOUNTERED? sunK S�/9 11 PERC HOLE DIAMETER S N Fl r a L ON IF YES, AT WHAT O DEPTH? P �7 12 q 2, E �. :Uv 13 Depth to Water After f7� ,;�Monitoring? Date: ✓� /= f ■■0 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: &A 1 —k 72-008 (Rev. 4/85) ■■■. ■■■. 10 Date WAS GROUND WATER ',• -- - /N/ Z) Net Time Depth to Water ENCOUNTERED? sunK S�/9 11 PERC HOLE DIAMETER S N Fl r a L 'rye IF YES, AT WHAT O DEPTH? P �7 12 q 2, E �. :Uv 13 Depth to Water After f7� ,;�Monitoring? Date: 14 15 16 17 18 19 TH Reading Date Gross Time Net Time Depth to Water Net Drop sunK S�/9 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 3? COMMENTS (,/a�-er q yfi/iz/..ter Pxi✓f>.✓i �. :Uv PERFORMED BY: /� ✓� /= f I ` CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: &A 1 —k 72-008 (Rev. 4/85) 30 20 b' l' t__] PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 3 FT COMMENTS (,/a�-er lC/✓el xy� .-.-�'a e� yfi/iz/..ter Pxi✓f>.✓i r1—�d.�ifvr fug 70 Ag UPrth PERFORMED BY: /� ✓� /= f I ` CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: &A 1 —k 72-008 (Rev. 4/85) (ENGINEER'S SEAL) eP Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 1/l�//c�" t DATE PERFORMED: TEST HocE ;tr/ LEGAL DESCRIPTION: LOrI Township, Range, Section: T/f-/✓/i,,, Sec, 3 SLOPE SITE PLAN 1 2 ` _�2 3 4 v 5� d 6 7 )V� Sr i / '50 O/5 t i ' c /h , , (Gm) S re y 0- ,'V med cQC Vc 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth to Water After Monitoring? /o Dale: 7 9 z� U 11 Reading Date Gross Time Net Time Depth to Water Net Drop S oaK 8// 3 3 ;/0 /0 R'ly 20 -{ S 111 PERCOLATION RATE / D (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN a FT AND 3 FT COMMENTS Wft'tc /e/ e / rno J, fr e_a( Gr f // a . v3 £x J f 1 mo i1r ,Nf 74 Se /i /o /]PPS PERFORMED BY: /� 7 J ~� y CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) EAGLE RIVER ENGINEERING SERVICES M(T,)Ma(w P.O. Box 773294 EAGLE RIVER, ALASKA 99577 �� "E C i� I i � LETTER R a � a,. Phone 694.5195 j a Date of Anchoraga To -Dept. Health "Human Services Subject /��_. rs��/s✓fr _�+i" �z�. ��i Cc_l !�s'� _._cl'aG�z alb Gs.l.. /�-�.__.. ___... d'l>I:' j2 �✓��• JJ _.... _f��... `?� v"£ sv�/ �.di.j Cdj�/e�_. � ��=s iTr /�s�L� lli✓e� ❑ Please reply ❑ No reply necessary SIGNED �✓ z AUG 1 9199,3 i<<Y 0i Anchorage 000, Health & Human Services J Municipality of Anchorage Page o -2— DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT 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 Numb r: S PID Number: �r I - 8t � -eDb Name: � tri S Wastewater System:71-New ❑ Upgrade Address: P. a 'l -11— ABSORPTION FIELD Phone: No. of Bedrooms: ❑ Deep Trench ❑ Shallow Trench Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: O ^ Total Dep[h f� rr4original grade: GPD/Sq. . Ft Lot: Bloc -k2 S diivviisionn: Depth to pipe bottom from original grade: Ft. Gravel depth beneath pipe Ft. Township: 1 Range Section: ^7._ Fill added above original grade Gravel length: S� csG.. J G7, — I Ft. Ft. WELL: ANew ❑Upgrade Gravelrle)3f4i:"'tiAtl,, t �- Number,of lines: - Distance between lines: (o Ft. Ft. Classifi do A,B,C : Total DepFh: Qil Cased To: Total absorption area: S 12•SQ. Pipe material: I tJ Ft. Ft. 1 Ft. &1 Drill : �� Date Drilled: Static Water Level: Installer: Dat en'os_tailed: Ft. Yield: I Pump Setat: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding PubliPri ie anuf cturer: Capacity in gallons: From Tank Field Station Ta k Sewer Lines Well t Io� tom' Ik I 2ti A- Material: S i Number of Compartments: tea- LIFT STATION Watere Lot (4— Size in gallons: Manu Line h �I� Foundation I f _f / "Pump on" level at: "Pump off" level at: I er alarm at: Curtain II rj ,� `` nL I f��. Pump Make & Model Electrical Inspections performed by: Drain rv�N� NOuL N I�i'j Remarks: BENCH MARK - Location and Description: Assumed Elevation: ENGINEER'S SEAL a"� ��s•n' �a .. y.( Inspections performed by: Dates: 1st 3 S SENGINEERING 3 I 17034 Eagle River Loop Road Na, 204 2nd z ....., .,,.,`.._ r ouF rt A Shia a91ver, Al s 99577 Department of Heallm ana Wman Services approval :, ;y ' "Fr• t u _t7 4— Reviewed and approved by: - u' Date: 72-013 (1/91) MOA 25 Permit No. ' Page Z of Z 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 Legal Description: L,<--rC k 4 E� 'E�- PID No.: CE5k -22'\� - c2> 72-013 A (2/91) MOA 25 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN / ROBERT SHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694.2979 FAX 694.1211 June 8, 1991 `Ps�r Municipatt..ty aU Anchorage DEPARTMENT`OF HEALTH AND HUMAN SERVICES 825 L I S.txeet P.O. Box 196650 Anchorage, Atka 99519=6650 REFERENCE: Lot 1 Btock. 4; Sampson E.6ta,tes Subdivision; "Thi, 4.ikm receritey submitted a septic system .inspeeti.on/as-built repojrt to your, o64iee under permit #910002. On May 2, 1991 we persormed a site vi.6 t and bound the septi,c,4ys.tem .to be .inundated with groundwater. The groundwater tevee on -t4e'. property was bound .to, be approx-imatety 3 6t. betow .the:.ground surUace. Due ,.to - .th.i6 groundwater. separation d .6tance encroachment we wish to w.ithd2aw our prev.iousty I submitted .inspection report unt tx ,Steps ane .taken,to recti.gy .the situation. Possibte sotuti=6 .ine2udes`e2evat%on of the teach4.ie2d or a dewateAi.ng/drainage -system .to tower seasonty high watex tevets. S.inc et ; . V ERT A. SHAFER, :P. E. d-UN.1 Q 1yA S/gm. acge DOPl, Ha .alf h 0"t d—;u—i pan Services SOILTEST . PERCOLATION TEST STRUCTURAL& MECHANICAL - - - INSPECTIONS - ON SITE WASTE WATER DISPOSALSYSTEM - DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 rj p HEALTH AUTHORITY APPROVALS p y u Mu{7i{.L' % a-(il. o./ g Anchal[a e Novembers 2, 1990 ROBERT SHAFER, P. E. ROGERSHAFER CIVIL ENGINEERS (907) 694.2979 FAX 694-1211 DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.U. Box 196650 SEWER &WATER Anchorage, Ata6ha. 99519-6650 MAIN EXTENSIONS REFERENCE: Lot 1; Block 4; Samp4on E4tate6 Subdivision; PERMIT REQUEST NARRATIVE SEWER& WATER INSPECTION Reque6t you ti46ue a pe an.it to in-6tat2 a septic 4y4tem on the kegenenced pito petty. On th,i4 pnopenty exist6 a we P,2 and the houze 4oundatc:on. There was a ENGINEERING STUDIES 6oit6 Log pet4o)med by Tobben SpuWand in 1984 and we have pengokmed AND REPORTS two add%ti.onat 4o.it test6. Due to the urge dot 6ize and m.inimat development in the area, we do not 5o&uee any impacts on the nei-ghboking pnopentiez by the WELLINSPECTION -(nstattation og the 6epti.c 6ystem. & FLOW TEST Since y, SITE PLANS R RT A. SHAFER, P.E. JS/gm ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744 HAND WRITTEN PERMIT Permit Number: SW9*\/tiV Permit Type: .S'a"we►4 ��w��no/ Date Issued: 0/f/q/ Expiration Date: �l8/9Z Design Engineer: SfSe��f .GSG� Owner Name: Day Phone: 1046 Owner Address: &K 77/`i9Z 4r41"E /?iY6R� fl�G q4s� Parcel ID: oS/-BN-0A Lot Legal: 'Subdivision'!: Ar*?&$ Lot: Block: '¢ Section: 3 Township: I.FW Range: / W Lot Size: *9! OiL sq. t. or acres) Max Bedrooms: This Permit: 4 Total Capacity: 4 - SEPTIC SEPTIC TANK: Minimum septic tank capacity: 1-25'0 gallons. Each septic tank must have at least 2 compartments, insulation is required if depth to top of septic tank(s) is less than 4.0'. Lift stations require an appropriate electrical inspection. WELL LOG: A copy of the well log must be sent to DHHS within 30 days of the well's completion. / / .rVlee. tf..rs/.R•,a HroNt,� �G �/Jj7�s!/.ra X01 .ec�cO•+do a4C-? w.aLii yy,� ,e:✓X,-•�cer1' C��'t�l!yv� o/a,r�eq/ ��Z/�J. �xc4iraT/0+1�' .y,,,.rT�✓ /'�Jirr^t V`Z� dr /� iJ ,4i -t4 4 �daei0 7 sinfl � ieti eG Aocr 6 eGJised eYj ��BIpZ - C' C� I CERTIFY THAT: 1. I will install the on-site sewer system and/or well in accordance with all codes and regulations of the Municipality of Anchorage (MOA) and State of Alaska , and in compliance with the design criteria of this permit. 2. I will adhere to all MOA and State of Alaska requirements for separation distances from any existing well, septic system, or surface water on this or any adjacent or nearby lot. 3. I understand that this permit is valid for a single family dwelling with a maximum of 4 bedrooms. I also understand that any enlargement will require an additional permit. .4. I understand this permit is issued for the cale/d)rr year and expires on Q A w a r-3 € 1 etlre-�ea�-- ems 5. I will notify DHHS prior to all inspections by the engineer or well driller. SIGNED: ISSUED db/115 DATE: DATE: Municipality of Anchoraggc / Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 January 10, 1991 Don Williams Box 771972 Eagle River, Alaska 99577 a Subject: Lot 1 Block 4 Sampson Estates Subdivision Permit #900363, PID #051-811-06 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1990. A new permit must be obtained from this office for a well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as -built inspection report (three-part form) must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, Sin re y, Jo Smith Pr gram Ma ager on-site Services JW/1jm:200 enc: Copy of Permit please call this office at 343-4744. "Kids Are Our Future" �ssued Dy: DATE: OF ANCHORAGE 11UN1CI10ALITY Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-4720 ON-SITE SEWER & SEPTIC TANK PERMIT i`ermit Number: 900363 lu-\ \L�L'� {}�te Is;suedx 11/06/90 Engineer Uesigned MAY Phonm.: Owner Name: DON WILLlAMS Gwner Address: 8OX 77i9/2 696-0567 EAGLE RIVER� AK 99577 Parcel ld: 05�^811-06 Lot LogaJ: Wind ivisi SAMPSON EST Lot: 1 Block: 4 Ssction: � �ownship: 15N Range: 1W Lot Size 40C1� (sq.ft" or acres) Max �edrooms: This Permit: 4 Total Capacity: 4 �EPlIC 7ANK: M1nimum total septic tank capacity: 1,250 llcm! s, Each sept.ic tank have at least 2 compartments" Depth to top of septic tank (s> < 4.O must /oet re'!uirails insulotion over WIN (5) INSTALLED AS SHOWN ON THE ENGlNEER'S DESIGN THIS SYSTEM MUST BE EXCAVATIONS MUST BF OPENED/CLOSED THE 0E41ISEb) DAiED 11/2/90" FREEZING DVERNIGHT. NOTIFY DHHS �AME DAY O1 i: 8E PROTECTED A8AINST /�EFURE ALL lNG�EClI Lot S. THIS PERMIT IS FOR A 4 BEDROOM SINGLE FAMILY RESIDENCE ONLY, AND EXPIRES ON 12/31/90" �ssued Dy: DATE: S�5� �f. • SCALE 6— a v v' U �f. � � Y •J �` Veye .i � °Af•'e� ,� �r;�fY� �• �� ;. `'� is ' J�}.•tA it ._•�A �, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:T2V �L jl.'Vi'N s- 5 i"` DATE PERFORMED: \Z LEGAL DESCRIPTION: L✓` L� "� t5;,N"fl5pr�Township, Range, Section:�r�a � DEPTH 4659/ SLOPE SITE PLAN 1 rt ffi!� 2 �ia�fL'"ate+i>•L'�- 3 A� P� 5 "! 6 k 7 O 8 `o 0 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT t L DEPTH? P E Depth to Water Afte t Monitoring? ; _ �� Oale: mmmmm� ., �ia�fL'"ate+i>•L'�- N ch PERCOLATION RATE 7i0 (minutes/incch/) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS s & Z-� ENGINEtnPING 17034 Egjla River Loop koad NO. 20.4 PERFORMED BYE elle River, la 5rn 99577 I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG v PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: I t7 LEGAL DESCRIPTION: �`y� !� i� 1�3i Township, Range, Section: ��Y-� �.j t,% 1j145c, '3 SLOPE SITE P111AN DEPTH ��-- N 2 �t 3 r 4-' rh 5 op w r7 6 7 e - .'Cr R �p 9 r !( ,1 WAS GROUND WATER �\ 10 ENCOUNTERED? 11 12 13 14- 15 16- 17 81920 18- 19- 20 COMMENTS NEERING IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? �Pf—A-4 Bate: it�-3A Reading Date Gross Time Net - Time Depth to Water Net Drop t V� 40 25 a'.2p lP3 f33 It k to .' L' A' Lo v PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN _0 FT AND 7 FT '17034 kagle Fiver Locp'€Qad WC), 204 PERFORMED BYFa : i_ Ala2ifq 995;17 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: . 0 0 MUNICIPALITY OF ANCHORAGE ".PARTWMTOP HEALTH AND ENVIRONMENTAL PROTECTION 1[24 4 ""4, A■. 000% Alb" 4 801 2"4rd0 tolls Wo ` 13 M ITOL^roa t✓Y s.. AS BU LT SURVEY 9 1, P. C. 3U' 6C50 ,L .-IORACE, ALASKA 99502-0650 (907) '?f-4-4111 DEPARTMENT OF HEALTH 8 HUMAN SERVICES January 10, 1986 TO: Permit Applicant Subject: Permit # 850299 Lot 1 Block 4 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, 1985. 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 needs 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(three part form) 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, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit � ��.1 1 -T V Cj 1F-*' Ir -N P4 U H C—� f -"D 43 Er DEPARTMENT OF, jEALTH AND ENVIRONMENTAL Pk- rECTION � 825 L STREET, ANCHORAGE, AK 99501 a^ ` 264-4720 ` L-) P4~ -E-3 T 7FS3 E-�.--'W EE F�e F- 1`F:;C M I?F PERMIT NO: 850299 ' 'ATE ISSUED- 06/14/85 APPLICANT: ADDRE 6S: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS. RAY PELLITIER SHASTA CONST, INC" 2MWEST 34TH SUITE 556 ` ANCHORAGE' AK 99503 274-0156 SUBDIVISION: SAMPSON ESTATES ' LOT: l SECTION: 3 TOWNSHIP: 151\1 RANGE: f*t \L��i 43560 (SQ.FT" OR ACRES) ' BLOCK: 4 Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. � + � ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ` I certify that: 1. I am familiar, with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or, public sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid for a maximum of' 3 bedrooms and any enlargement will require an additional permit" ' F A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2)? AS-BUILT8 WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. ' SIGNE DATE: APPLICANT: RAY PELLITIER SHASTA CONST, INC. ISSUED BY DATE- -41 ATE: &� ~��1~�� . =K� , "y/��)� �~ J� � -T-V-C E--* F%J4�- 1-1 E --'n W" IC� FR o:%][1%J DEPTH'113PIPE BOTTOM (FT.} 4.0 4.5 4"0 GRAVEL DEPTH (FT,) 3^0 0.5 3.0 TOTAL DEPTH (FT.) 7°0 5,0 7�O GRAVEL WIDTH (FT.) 2.5 19.0 5.0 ` GRAVEL LENGTH (FT.) 7:�.0 36, 0 531.0 GRAVEL VOLUME (CU. YDS. 23.7 25.4 34^4 TA*SIZE (GALS) 1,000,0 ** 1�000"0 1,000"0 ** SOIL RATING (SQ.Fl[°/BR) 146 150 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ` I certify that: 1. I am familiar, with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or, public sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid for a maximum of' 3 bedrooms and any enlargement will require an additional permit" ' F A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2)? AS-BUILT8 WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. ' SIGNE DATE: APPLICANT: RAY PELLITIER SHASTA CONST, INC. ISSUED BY DATE- -41 ATE: &� ~��1~�� . =K� , "y/��)� �~ J� � Municipalaty ®� POL '6-650 ANCHORAGE, ALASKA 99502-0650 (907)264-4111 TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840944 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 1 Block 4 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 needs 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, Keith E. Bandt Supe�`visor P Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 | / � ` , # ' �"111: EE,�: 11: L-. :1 1, C-11 �Rr 1q. !E],l�� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 CD 11 �4 :1 11- 3 111E,,.`�,�,�, U0 . ��11 111 E: 0 PERMIT NO: 840944 DATE IqSUED: 11/13/84 ` APPLICAN�: STEVEN SKAGGS ADDRESS: P O BOX 670690 [HUGIAKr AK 99567 CONTACT PHONE: �8R---- 2831 LEGAL DESCRIP: SUBDIVISION: SAMPSON ESTATES LOT: 1 BLOCK: 4 SECTION: 3 TOWMSHIP: 151\1 RANGE: 1W LOT -SIZE., "993A (SQ.FT. OR ACRES) MAX BEDROOMS: ' Listed below are the options available to you n idesigning your sep ti c:, system. Choose the option'that best {its jite, _..... ..... ..... ... ..... �..... .... ..... ... _~___~ PE -E: 011 EEO 11-1 13 FAZ eN Z HN11 DEPTH TO PIPE BOTTOM (FT.) 4.0 4"5 4.0 GRAVEL DEPTH (F -T. ) 3"0 0"5 3"0 TOTAL DEPTH (FT") 7^0 5.0 7.0 GRAVEL WIDTH (FT.) 2"5 19^0 5"0 GRAVEL LENGTH (FT.) 73.0 36.0 53"0 GRAVEL'VOLUME (CU.YDS.) 23"7 25"4 34.4 TANK SIZE (GALS1,000.O ** 1,000,0 ** 1,000.0 X- S 0 1 L. SOIL RATING (SQ,FT./BR) 146 150 150 ** TANKMUST HAVE AT LEAST TWO COMPARTMENTS I ceptif,y that: 1" I am familiar with the requirements for on --site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska, 2, I w111 install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3^ I will adhere to all MOA and State of Alaska requirements �or the set back distances from any e�xisting well; wastewater disposal systemor public sewerage system on this or any adjacent or nearby lot. 4, I 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 MOA BUILDING CODES� THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST RE OBTAINED; (2) AS~BU�LTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND THE ` ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN^ SIGNED DATE: ' �� '~~__�_~.~_ __//[��.__� APP�IC�NT: STEVEN S� ~ ISSUED BY DATE: ~.-�_�~�_~�-�~_�_~�� ~~_�___.~��~_ ` V SOILS LOG MUNICIPALITY OF ANCHORAGE ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION El PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Sh 6 S t'4 /Sii�$'S S DATE PERFORMED: 1011dilk"I LEGAL DESCRIPTION: L'S�'�r7`efSec �_.. SLOPE SITE PLAN 11 WAS GROUND WATER ��T'fo+� ENCOUNTERED? o� 12 (+n) e IF YES, AT WHAT 13 DEPTH? Date Gross Time 2 Depth to Water �® o 16r z'r �m 3 D o e 4 G•v. .. i ILI -v 5 yb v o �GM C - P) 7 8 lu �a 9 Q 10 v 11 WAS GROUND WATER ��T'fo+� ENCOUNTERED? o� 12 (+n) e IF YES, AT WHAT 13 DEPTH? NO L O P E 11A / vz Reading Date Gross Time Net Time Depth to Water tl• 16r z'r Py ^, T H +: , 4' e 17v�...li. .. i � -1 Ian .2225-E; JUNE 25, 1971 18 yb 19 NO L O P E 11A / vz Reading Date Gross Time Net Time Depth to Water Net Drop 20 -{ I 9&6A �x Iul PC-I�G9tA."G9iV RATE (minutes/inch) TEST RUN BETWEEN 3 � FT AND yea FT COMMENTS 4 t 3'�a � aldp lof'A Ll S74;/ PERFORMED BY: A', .7TH r* CERTIFIED BY: rS 72-008 (6/79) RE g,44 71- �/. 0.4:z e 34 I, Richard P. Hankins, hereby certify that I_hove surveyed the following described property: LpT /, BGvGK 4-1 S.��I��so.� Es TA7ES Anchorage Recording District, Alaska, and that no encroachments exist �'��•��1except as indicated hereon. i *; 49L '• Richard P. Hankins i1 • ' J' 0/) '' •i 'y `ROFESiIUN A�-�P,� It is the responsibility of the ownbr to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Date: Drawn by: Praparad by RICHARD P. RHANKINS REGISTERED PROFESSIONAL LAND SURVEYOR Scale: Plat filing no:l P0, BOX 1105 -EAGLE RIVER,ALASKA 40 v4. -!n PH. 694.2371 99577 • Municipality of Anchorage On -Site Water and Wastewater Program�� (907)343-7904 cry Certificate of On -Site Systems Approval Parcel 1. D. 051-811-06 Expiration Date: -� - 1. GENERAL INFORMATION Complete legal description Sampson Est. Block 4, Lot 1 Location (site address) 22748 Sampson Drive Current Property owner(s) Donald & Marianne Williams Day phone Mailing address PO BOX 1087 Real Estate Agent Day phone 2. TYPE OF DWELLING: Fxj Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 DEC 2 3 2013 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual FXI Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public VVater Sysiein ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment li �a 313 Receipt Number C); 35 Ci COSA# 0-51_-H31b55' Date 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 Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE 1/SSystem #1 Approved for bedrooms System #2 Approved for _ bedrooms Disapproved Phone (907)272-8218 Date 7/19113 Conditional approval for bedrooms, with the following stipulations: By: f/(✓� Original Certificate Date: rt — ! `14 Th4 u ' p ofnchorage 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory X Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheet t c If more than 1 septic system is on the lot: COSA Checklist # 1 of + Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Sampson Est. Block 4, Lot 1 A. WELL DATA Well type Private Date completed _ Total depth ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (YIN) Y Cased to ft. FROM WELL LOG Parcel ID: 051-811-06 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 42 in. AT INSPECTION 7/16/13 ft. 114 ft g.p.m. 4.1+ g.p.m. WATER SAMPLE RESULTS: ColiformLAJ es colonies/100 mL Nitrate S. 19 mg/L ( C Arsenic 10 � ug/L Date of sample: j arin / I � Collected by: � > B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 11/16/93 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) Y Date of pumping 12/12/13 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 11/16/93 Soil rating (g.p.d./ft2 or ftz/bdrm) 0.6 GPD/SF System type Bed Length 42 ft. Width 24 ft. Gravel below pipe 0.6 ft Total depth +0.5 ft. Eff. absorption area 1,008 If Monitoring tube Y Depression over field N Date of adequacy test 7/16/13 Results (Pass/Fail) PBSS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 687 gal. New depth 0 in. Elapsed Time: 180 min. Final fluid depth 0 in. Absorption rate , 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed 11/16/93 Size in gallons 500 "Pump on" level at 30 in. "Pump off' level at 26 in. Datum Bottom of Tank Cycles tested 4 E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ Manhole/Access (YIN) Yes High water alarm level at 31 Meets alarm & circuit requirements? Yes On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS 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. Engineer's Printed Name Steven R. Pannone Date COSA brown sheet 10-10-12.doc 7/23/13 Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ in. Municipality of Anchorage Community Development Department o r Development Services Division M S A E, On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 131655 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 4, Lot 1 of Sampson subdivision. This inspection revealed a nitrate concentration of 5.19 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. EAST 300. ze N • UI 33 �SECTi*�.f/ G/yr ES�Y/l/T p/,oES /vi t_ er.��r, ..aa. ASBUILT-NO CORNERS SET THIS DATE, I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SA)?I FOLLOWING DESCRIBED PROPERTY SCAT=E j-=�Ya Sh'''°'RS�i•/ ES7A= ESQ !a7 ,p{.f- y ANDTHAT NO ENCROACHMENTS EXIST EXCEPT AS DATE INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: " EASEMENTS, COVENANTS, OR RESTRICTIONSWHICH tics ir6o DO NOT APPEAR PLAT. DER NO CIRCUMSTHE TANCES SDED HOULD VISION UNDER FB& ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN, .oyr L' OF A� ° Duana Mork Snwerd ( ��r'•, LS. 918 �wf A 09/12/2013 02:20 907 INVOICE DATE WELL DEPTH SWL CHLORINATED PUMP DEPTH SALESPERSON S-ri'-'' DESCRIPTION..PRICE' ''.'.AMOUNT-. .'. rr r C o r' e ita7S o� LABOR HOURS RATE AMOUNT TOTAL MATERIAL TOTAL LABOR WORK ORDERED BV TOTAL LABOR PAY THIS AMOUNT Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow.Aarow Pump & Well Service, L.L.C. the right to remove unpaid for equipment and charge for labor already Performed & labor to remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.6% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.