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Home My WebLink AboutSAMPSON ESTATES BLK 4 LT 9Sampson Estates Block 4 Lot 9 #051-811-14 e Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program, 4700 South Bragaw Street P.O. Boz 196650 Anchorage, AK 99519-6650 Page 1 of 3 www.ci.anchorage.ak.us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number SWSW060146 PID Number 051-811-14 Nana Wastewater System: ❑ New ® Upgrade Aoaae. toAup Anrh AKQ9501 ABSORPTION FIELD Prone- Nmdw of Bseloome ®Deop Trani o shollo. Tlw-cl o Bed o MwW o onw LEGAL DESCRIPTION Sod RaWq TOW Dpth km a" pool. Block Lot Bubdmwl Depth lo ppe botlon eam MV -W pods Geral depth Damm"o Towalp Rage Salic" Fa oddod Nwra Oda^" pato 4 Ft Grnol Laglrt 58 Fl - Well: New Upgrade r'e "w4h NM ofkae DwK.bot~ lnes claooffi hon (PmMe, A B. C): TOW Depth Called b I Total eboapban aea Poo Mol" Exist'g Private Ft. Ft 580 Fe 3034 PVC Dmer Dole WIN! swc WON Lar" Ft YINOAar JR Purnl2ing DNB aM1aIWl. 612912006 n.w wros.l,l CanaH89MAeovoGwi ld. TANK GPM fl. f1 SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption LIR Holding ubllUPrtvate a"'"d'ph'•r capoaly From Tank Field Station Tank Sewer Lbro Anch Tank 1000 Gel w« 132.5 126.3 130+ M.IwWI. Steel moowof +n e 1 2 BMroce wNer 100+ 100+ LIFT STATION Lot Lina 50+ 67 e¢. GN ManANa 8 21 PulpW W. a 'Pump of k.N a. Nph Mar Nam" FauMNan 1 1 1 M N N 50+ 50+ PWV"a a Moo"Ftwnwks EWtrnNIn.p.awne pa/amWM Dean Dan Abandoned old tank & old field per code. BENCH MARK LocN,on aq DeeOnptwn Back Deck Mounrd EWN 100.0 FL Engineer's Stamp lk- raaa11 Ilk- � 41 ........ `P\. ............... ♦ Inspections performed by: PES. LLC Dates: 1"6128/2006g9 rH `♦♦ *..0 i Development Services Department approval o f :•Steven R. Pannone: i Conditional Approval by: Date: ♦� S'q 0E 8149.. Reviewed and approved by: Date: —/ 3' o ♦♦ea,ta .• PERMIT NO:SW060146 RECORD DRAWING P•I.D.NO: 051-811.14 ' WASTEWATER DISPOSAL SYSTEM LOT 9 BLOCK 4 SAMPSON EST. EXISTG SAS -ABA PLACE. PIPE C HIGHER 2 40 z �Am m 09p yyyy m inNO Ka STG 11000g L PTIC TANK ,ONED IAW — THE CODE 10% DONED IN ADE WAS HAN PIPE M HOUSE 68.7 EXISTG SEPTIC AREA ! ! / EXISTG / WELL EXISTG WELL EXISTG 3 OR INSTALLED HOUSE I NEW 1000g i SEPTIC TANK b I DOUBLE CLEANOUTS � T,1 t 132.5 T2 126.3 / III III \ E1M,UPGRADESAS ! I III III •58 L 5' FxED,9'TD III III \' III M2 II' C 10% 67.8 // �� ./"•—.—.—. �•��'�\ , accordance with AMC15.65. EXISTG WELL \ accordance with those specified In AMC15.65. Wastewater Disposal. CO A B \ FC 8.1 19.3 pSi�Y OR / T7 9.7 T2 16.1 27.0 31.1 O( QEi , / \ \ DC 18.5 Ct 33.0 21.0 38.q2 1 O' M1 23.3 C2 77.0 39.6 83. �;'• 49 tH �GCV7 Steven R. Pannone EXISTG SEPTIC \\ M2 74.8 81.6 / AREA \ / \ / \ DESIGN Mark and Billie Truskett 1426 W. 15th Ave. Anchorage, AK 99501 3) Maintain 10' separation to all APPLICATION RATE:188 SF/BR lot lines and proposed water 0.8 GPD/SF lines. 3 SR HOUSE 4) Lots served by private water 4508 GPD DESIGN FLOW system. No wells within 100' of REO'D AREA S64 SF proposed system. 5' ED DEEP TRENCH 57 LF x 5.0 ED. 2J' WIDE, 9' TO 1000 GAL. SEPTIC TANK PANNONE ENG. SVC, LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P. 272-8218 Fax PLAN NOTES: 1) All work shag be performed In accordance with AMC15.65. 2) Materials used shag be In accordance with those specified In AMC15.65. Wastewater Disposal. Mark and Billie Truskett 1426 W. 15th Ave. Anchorage, AK 99501 3) Maintain 10' separation to all APPLICATION RATE:188 SF/BR lot lines and proposed water 0.8 GPD/SF lines. 3 SR HOUSE 4) Lots served by private water 4508 GPD DESIGN FLOW system. No wells within 100' of REO'D AREA S64 SF proposed system. 5' ED DEEP TRENCH 57 LF x 5.0 ED. 2J' WIDE, 9' TO 1000 GAL. SEPTIC TANK PANNONE ENG. SVC, LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P. 272-8218 Fax PLAN S1N :31VOS SlItl130 900£-9 :31vO '.��1��•• • xe3 829-ZLZ'd ZZS£-LZZ .. OLS66 VHSb1V'3Jtl2iOHONV • •• 10966NV'B6ejOLPUV �• . ,. . .{ . ' 41SL'M9Z4L � �;� 6V18 3'J . �{{ 4S6Z0 L X09 'O •d pa,lsTul 8111M pue Wery J auouued Uana3S {{ 011 OAS'0N3 3NONNVd :2103 03HAVd38d 0 .................. •• •• `• r /{.....T .................... ....� FOUNDA {{ CLEM OUT Tn z •.�� MCLEM OUT 0� co D7 CLEM OUT i U, CLEM OUT CLEANOUT DO oO o � nn Of U� � R U1 q 4 w CO L. (n b 6 X CLEM OUT m 0 Do MONITOR TUBE c :r�.t.�.�. Cf T r�'� AT EACH END F= 4, m 7"c, c in o ; M T v 4 a < m m CL Cr IT Ge 1 MONITOR TUBE AT EACH END 1• 1 '✓ 'r CLEM OUT •1S3 uosdweS 4 X3018 6101 W31SAS 1VSOdSiO U31VM31SVM :ON'0'1'd SlIV130 ONIMbMG CIU003M 9>1090MS:0NlIWa3d MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 08, 2006 Expiration Date: Jun 08, 2007 Permit Number: SW060146 Parcel ID: 051-811-14 Legal Description: SAMPSON ESTATES BLK 4 LT 9 Design Engineer: 0062 PANNONE ENGINEERING SERVI( Site Address: 022652 GABRIEL CIR Owner Name: MARK TRUSKETT Lot Size: 40461 SQ. FT. Owner Address: 1426 W 15TH AVENUE UNIT A Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 995014906 This permit is for the construction of: ❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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. Received Issued By: Date: o6obLa Date: tL 5 -05 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. o51- A I I- 14 Property owner(s) Mark Truskett Day phone 273.8313 Mailing address1426 East 159, Ave. Anchorage, AK Zip Code 99501 Holding Tank Site address 22652 Gabriel Circle . C -vic> I C,\A Zip Code 99567 Legal description (Sub'd., Block & Lot) Lot 9. Block 4 Sampson Estates Legal description (Township, Range & Section) Lot Size 40,461 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 3 THIS APPLICATION IS AN: Initial ❑ Upgrade 19 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. Pannone Enqineerinq Services (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: I Z `� Date of Payment: Receipt Number: v Receipt Number: (Rev. 11/05) Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 )907) 272-8218 (907) 272-8211 Fax May 21, 2006 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 9, Block 4 Sampson Estates Septic System Upgrade Permit Request Gentlemen: I am writing to request a permit to construct an upgraded septic system be issued for this property. The proposed systems will serve an existing three-bedroom house. The existing well is located in the northeast corner of the lot, over 100 feet from the proposed septic system location. The surrounding lots are served by private water systems and are over 100 feet from the proposed soil absorption system. 1. Soils. See the attached soils log. Ground water was monitored for seven days through the May high ground water period. Ground water was not encountered in the test holes nor found in the monitor tube during the water -monitoring period. Bedrock was not encountered in the test hole. A percolation test was performed. It is my opinion that the overall soils appearance of the soils, an application rate of 0.8 gallons/day/square feet should be used using a conventional treatment system. 2. Trench Design. a. Percolation Rate: b. Application Rate: c. Number of Bedrooms: d. Design Flow: e. Min. Absorption Area: f. Total depth: g. Effective Depth: h. Width: i. Reduction Factor: j. Minimum Length: k. Design Length: 1. Effective Absorption Area: m. Septic Tank Size: 5-15 Min Per Inch 0.8 gpdpsf 3 450 gallons per day 562 sf 8 feet 5 feet 2-3 feet 0.0 57 feet 57 feet 570 sf 1000 gallon, if required after verification. Page 2 of 2 3. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The average topography in the area of the proposed septic system is approximately 1 percent. The eastern portion of the lot drops off at approximately 10-20 percent. The proposed and existing SAS is located greater than 50 feet from this slope. The proposed system will be installed on the central portion of the lot. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. The existing septic tank will be verified for integrity and will be replaced if found to be leaking or excessively corroded. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, Steven R. Pannone, P.E. Civil Engineer Attachments: C:\Work\Letters\9-4 Sampson Est.001.doc PERMIT NO:SW06 DESIGN DRAWING P•I•D.NO: 051.811-14 WASTEWATER DISPOSAL SYSTEM LOT 9 BLOCK 4 SAMPSON EST. •\ EXISTG SEPTIC / ./ •� •` •` •\ AREA /•/ •\•\ /EXISTG •\ i WELL \ EXIST' G \ ` WELL \ EXISTG 3 BRZA �/1 10% HOUSE INSTALL DOUBLE / ) L I CLEANOUTS E IS-TG 1000gr/t 138.8 i PTIC TANK —t 125.1 I , VERIF INTEGRITY °6 °10TH \ / III III� PROP SEb.UPGRADE SAS III III % I INSTALL DIVERTSE LTYPE •57L'£z5'ED,9'TD i _ 1 i VALVE III III — — —' \•\ nl III `•\ ,�� k: "' /� % III •, '. , - / . V%• EXISTG SAS Ill IN FAILURE •\ / / 9.7—.k,•i �• / -69.7-�i /�` •i -10% % :\ / mss_._.—•�' � i �� /� 10% �•%` -. �• �!\• 67.0 _ i �. �. Om/ 1/ ��EXISTGWELL \\ bbbb �i� i R �\ Urn Nm i o�nho pgE�gP'` o� v?pPSE� \ 1\\ �n� �� RpPO \\\ �i� iii/ OT EXISTG SEPTIC `\ i AREA \ \ DESIGN: NOTES:3) Maintain 10' separation to all PERC RATE: 5.15 MPI APPLICATIONPRATE: 188 SF18R ♦♦♦♦��\t,�, 1 1) All work shall be performed In lot lines and proposed water AMC15.65. lines. ♦ 460 ♦'`Q��„.,,,,,,� G.•'•'�• �� • �� ••.•'s accordance with 3 BR HOUSE 450g GPD DESIGN FLOW 2) Materials used shall be In 4) Lots served by private water REO'D AREA: 564 SF accordance with those In No 100' �A[7 >} ♦ specified system. wells within of 5' ED DEEP TRENCH • — /�� / ,,,,,' : TM ,,, .... ti,,,,,� �� r 0 AMC15.65,Wastewater Disposal. proposed system. 57 LF x 5.0 ED, 23' WIDE, 9' TO 1000 GAL. SEPTIC TANK PREPARED FOR: "' """"""""} ": ra':” PANNONE ENG. SVC, LLC • Ste venR. Pannone .� �� . P.O. BOX 102954 814r • ♦ i �• Mark and Billie Truskett 1426 W. 15th Ave. ANCHORAGE, ALASKA 99510 4444ilt) �u.... ♦♦• Anchorage, AK 99501 227-3522 P, 272-8218 Fax DATE: 05.18-06 PLAN ��,"",••♦ SCALE: 1'=50' PERMiTNO: DESIGN DRAWING DETAILS P.I.D. NO: WASTEWATER DISPOSAL SYSTEM Lot 9 Block 4 Sampson Est. tno NY3TJ r; eN3 N7Y31V 38n1 tlO11N 125 v 8 Epp o li 0 V L �a?''r H 2 LIJ 0. Gj �''1 1. • per.. e o ON3 N7Y31V "•°. 'q agrl NOLMM LL c TTT•T:f:T:T: ri w Lb NY3c] 'Y'.' , ; O fn LDL. o r I h ul o ^ io 00 C y 00 TC O z°E inouvm r Z�Z 0U• 2 1w NY3n Q �U LW NY31a N 1 W U J ♦1 = 49 3N ♦♦♦ IVOnO NY3n %...... _ _1. ............3..... ; ^^^ •••• ••• PREPARED FOR: St ♦'-. PANNONE ENG. SVC, LLC ♦ eanrane Steen R. PMark and Billie Truskett ♦ if P. O. BOX 102954 ♦°• gtgg tgzs W. tsm ANCHORAGE, ALASKA 99510 ♦♦e•��jy'�: Anchorage, AK ascot 227-3522 P. 272.8218 Fax ��0��,' ;;��• DATE: 0518-06 DETAILS SCALE: NTS SOILS LOG -PERCOLATION TEST♦♦♦♦ PANNONE ENGINEERING SERVICES .......... :Oj�P'' ♦♦♦. OS-OB-06 2:21 P.O. BOX 1029549 TN �1 i ♦� 2 ANCHORAGE, AK 99510 I" "� 10 MIN 76'3 2111 3 (907) 272-8218 ••• • ••• • • Steven R. Pannone Mark Billie Truskett CE 8149 PERFORMED FOR: and DATE PERFORMED: OS -08-06 ♦-OD.'G��_Z•_1`.•�•y'�� ♦♦♦c 00,,' LEGAL DESCRIPTION: Lot 9 Block 4 Sampson Est. 2111 TEST HOLE 1 SLOPE 417E RAW �/'�._— •-- •� OR i•�/ �•� 2:31 10 MIN 713 2- 3 3 Poorly Graded it _ Gravel 1. i 4 GP/ and Sandy Gravel (j • SP Some Sifts ( /i S ) MSA -8.0 8 TEST ;ATN ( HOLE lTM \\ I'm r111' / a- el7— \ 10 ,1 ,2 , I 13 Unir«m Over WAS GROUND WATER SLOPE 14 Depth ENCOUNTERED? No Easy Digging 15 BOH IF YES. AT WHAT TEST HOLE DEPTH? -0- x 18 DEPTH TO WATER AFTER 17 MONITORING? -Dry- 18 DATE: 05-15-06 19 CLOCK READING DATE TIME WATER NET TIME LEVEL NET DROP READING 20 PEROLATION RATE 4 (minAnch) PERC HOLE DIAMETER 6Inches TEST RUN BETWEEN 5 FT AND 6 FT COMMENTS: Test hole excavated by Flinstone Services. Test Hole was presoaked before perc test. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. OS-OB-06 2:21 613 - 2 2:N 10 MIN 76'3 2111 3 2:31 S - { 2:11 10 MIN 7111 2111 S 2:U 61A - 6 2:31 10 MIN 713 2111 1- Top of til g t finish grade ivia erial beneath the h incnes / 4 Total ctive abs rption are MUNICIPALITY OF ANCHORAGE I/ ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Depth ev^ inchesWA ENVIRONMENTAL ENGINEERING DIVISION LU 0 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 PERMeffeIT NO. ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Type of crib NAME Crib diameter iv Total effective absorption area w PHONE vv `fes ° _ P ❑ UPGRADE MAILING ADDRESS w DISTANCE TO: Well ` Nearest lot line LEGAL DESCRIPTION wClass - I/Cr—" ��/ r Imo\ / K LOCATION PERMIT NO. Q NO. OF BEDROOMS / Y DISTANCE TO: WellU Absorption area Dwelling PERMJT NO, �' Building foundation F- Z CL F Manufacturer Septic tank I Material No. of�Ompartments Lic. capacity in gallons Inside length IF HOMEMADE: Width Liquid depth Y J Z DISTANCE TO: Well Dwelling PERMIT NO. OTHER = z F Manufacturer Material Liquid capacity in gallons w = DISTANCE TO: Well _ Foundatiory Nearest lot ne PERM 0. .. J w Z - Z w No. of line ' Length of ach Iing Tot �l length of Ines Trenc th lgss /Picea �r•s A� W 40440/ Distance hetween linac 1- Top of til g t finish grade ivia erial beneath the h incnes / 4 Total ctive abs rption are Lenth Width Depth ev^ inchesWA LU 0 PERMeffeIT NO. wa Type of crib Crib diameter Cri dept Total effective absorption area w w DISTANCE TO: Well uilding f undation Nearest lot line wClass Dept Driller 3 islance to lot line PERMIT NO. / it DISTANCE TO: Building foundation Sewer line Septic tank I Absorption area(s) OTHER PIPE MATERIALS /q� 'to �r SOIL STRAYING !® M4 S 6 l t7�a INSTALLER REMARKS Ix t QAd a IfO f r a � _ Ir JAWa o • James .: ey - y CE - 6036 APPROVED Alp e-.QATE� LEGAL 72-013 (Rev. 3/78) U) Y ^ 3 �^ O J m O nQ Y v J cc: Z W W W z W Q W Ya ::� W J a J v _ a N C7ocWx o � m WLU J a M2 Q J Q N ine M W N M FE M W J ' Q W ai H Cd: -H Cd w ' oOrGUdd�b.cOFza 0]w >0 0q :N rrd n(n rs 0w wOw0rsO0w0 0000 www0w9w99 rd(1) rFr . Lu44onPo4� (13 Cd: b: rQ bdd fq 0 O00w o ab.0 -1o O >n C'- o o • °aWa°°z CR xx Cd r a ; U L-T NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 DF 2 H: CdCd O; CJ o a: w U: Ca : E 0 0: t S t U: 0: O: O a O: Cr) E E o: CO O z a° �4;, m O y vFi o00 V2 a, w p -� F C w w w w rl H: N f� 0C q: H 3 oti o : H: LT, rn: a ° z w C aG v F p Q Z w w w W ^1 Q p f/1 p C7 aC H Cd: -H Cd w ' oOrGUdd�b.cOFza 0]w >0 0q :N rrd n(n rs 0w wOw0rsO0w0 0000 www0w9w99 rd(1) rFr . Lu44onPo4� (13 Cd: b: rQ bdd fq 0 O00w o ab.0 -1o O >n C'- o o • °aWa°°z CR xx Cd r a ; U L-T NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 H: CdCd O; CJ a: U: : E 0 t S t U: 0: O: O a c1: Cr) E O z a° m O y vFi p -� F F Z H Cd: -H Cd w ' oOrGUdd�b.cOFza 0]w >0 0q :N rrd n(n rs 0w wOw0rsO0w0 0000 www0w9w99 rd(1) rFr . Lu44onPo4� (13 Cd: b: rQ bdd fq 0 O00w o ab.0 -1o O >n C'- o o • °aWa°°z CR xx Cd r a ; U L-T NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 POI -ri 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840401 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 9 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 Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 i M.U1N�C IP.ALTTY OF ANCHORA 9_ D,-_PAFMM!-cNT Of }:' ALT,+ .AND ENVIRONN nNT?L PROT :CTI^N 5 L S T R E T� ANCHOPA. Er AK 95101 ON -SITE. 3E4ER ?- d E L L P,ER-1IT ___ __ •� P DMIIT N0 340,401 - DATE ISSU D: 05/29/•;4 APPLICANT; AND TI`%MERMAN VENT. FENT3N CCNSTRUCT101 ADDRC:SS: 208' CAMPS -LL PLACE ArlCH.R&GEr Ay, 9950'7 COVTACT PH, 3N7 .563-:23 LEjAL DESCRIP: SU=DIVISION: SMIPSCh ESTATES LOT» 9 FLOCK: 4 SECT ION: � TOAN-SHIP: 15N RAIN` G 1W fJ LCT 51Z _: 4 C.FT.-GR ACRES).._ MAX ' it: DR00 44S» 'I LIST E CE.EL`CW ARE THE flP7I `iS 1V ILA LF TO: YOt! __1N Df:SIU, NIN G Y0U'R. SEPTIC - -- --- . `YSTEM. CHOOSE THT OPT JN THAT �� ST FTTS YOUR S1.'T: TRENCH >3£0 r.',DRAIN 7EPTrt TO P.FE a"OTTJiM (FT.), 4.0 4.0 4 GRAVEL DEPTH (FT.) 5.0 34 5 TOTAL PwPT_H (fT.) 101 . ". J_- GRAVc-L IAIDTH (FT..) G.i 44? -.5 2 5.'7 rO GRAVeL LENTH {FT,) 52,'1) 7r.0 _�y 'rg-c - - GnAV_L__VULUME (L'J,_Y0S., 71_.2_ � _ — TANK SIZE ((,ALS) 1,000. ** 1 JCOe.0 ** 1"000.0 *# (boo SOIL RATINa (Sa.FT./AR) 20-) T'NK `L5T „AV At _EAST W CJ. AR. .c QTS l� 0 -- - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -- I CERTIFY THAT. 1. I A� FAMILIAR 'r;ITH TH R `�UIFc_,MCNT fOR C�1-5?TE Swkci?:S .4 IviD-s4CLt'S AS SET F3YTh 8Y Th= `IUMICIPALITY GF ANCHOFAGE (YOA) AN IH." STAT_E.OF ALASKA. %. I 'n ILL IN'TALITH. SYSTEP' IN ACCCRDAN,-;: WITH ALL MCA rODES AND RFGULATION3 AND iN C0^PLIANCE WITH TH-T DESIGN CRITERIA. 3F THIS PE?±?IT. 5e I WILL ADHE?E TO ALL TiCA Aviv ;TATE 3f ALASKA -tF LIRr, ={JTZ FvR..-1, S T ±Cv DISTANL=S-FRCi 1 'ANY EXISTING WELL. WASTEWATER DISPOSAL SYSTEM 3R PUPLIC SZ:WiERAGE SYSTEM CN THIS Ca ANY ?DJAC_NT OP 'JEAP�Y LOT. 4. I1. UNDERSTAND THAT THIS --E. MTT IS VA:LI_Di FOR A MIAXIMU`l OF z ?f_DROC`^S AND ANY ENLARGE'lE 1T WILL REdLIFP. AN ADDITIONAL `'FRiyi;T. If A L-.F.T STATI+ON IS INSTALLED 1N, AN, AREA. CC; VF^zs ;Y MOA PUILDING CODE `3, TH_N {1) "AN ELECTRICAL P E 9 M I T AND 1NSPs£T10N PuST :4E O'GTAIMl D: C2) AS-:UILTS ldlLt tivT P �PPaOVED"'r.'IT'LUT A`v r CiRICAL Itis°%CTICty �LPOPT: AND t3) THE 'Lc CTR IC Al b,ORK_:^.UST "E:= DONE FY_ AL7CrcNSED ELFC:TRI:CIAN,. SIGNED nYi / �v P .� _----D� �_6I APPLICANT. ANJ TIfi':F.R""Pi VENT. T_,�TDN fDNSTRU£ 1J ISSUED Sy ___ �� ru T tea\ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST ❑ SOILS LOG Wo (-IUi PERCOLATION TEST PERFORMED FOR: Ie�e/ zL q (�n'DATE PERFORMED:_ LEGAL DESCRIPTION: 'Zo / �pC �� `�ar�/J ' Z�!1'S. DEPT—T +/ / SLOPE rcccT�H SITE PLAN cif 2 OF At 4 i t 0eA i��9TH �+ � (�...• •e eeee.e eee eoeeeoeeo® R. Kinn 5 �Inly 6VpJaCE 6036 �Qa �dprofessic'��'�®� ®fie sit ( 9 l 10 MEN ■■MENEM IIIIIII,�_'.�■■■�■" FAI No 72-008 (6/79) ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION I I 825 L. Street, Anchorage, Alaska 99501 264-4720 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: ✓ ' ��dST/if� f�iJ DATE PERFORMED: 5`27-9z1 LEGAL DESCRIPTION: DEPTH F SLOPE (FEET) SITE PLAN 1 2 3 4_ 5 6 7 a ( - 9 10 11 12 13 14 15 16 17 18 19 20 -:OMMENTS Zaa � x s a ti// Jam F Y 4/ Cc 6036 s /12J.A 57go—o1;� (?OGL(?`r7 ®7e WAS GROUND WATER /� / S Tesf11OZ6 � ENCOUNTERED? / v� L / O P IF YES, AT WHAT E DEPTH? A/0Ze - Tesf // Z /j1 ;02— ■■■■■■. Date Gross Time ■MONS ■■■ ■■��W� �■ MMON Q ZO ■moon ■■■■■■ Z/ mom■■■MEMO MMOM 30 „ L/ ■■.■■■■■■ 4a MEMEMEM 0 EMEMEMEEMIN 7 �R Reading Date Gross Time Net Time Depth to Net Water Drop SZ7 Q ZO !� Z/ 30 „ L/ 4a ,0 3% 7 �R PERCOLATION ATE TEST RUN BET NE 2-e� �6•)/h 5�d ' FT AND PERFORMED BY: J kl/'-) lel CERTIFIED BY: 72.008 (6/79) l3S u 7T_ (minutes/inc(,) / ,r L2 DATE: Certificate of On -Site Systems Approval Parcel I.D. 051-811-14 Legal description SAMPSON ESTATES BLK 4 LT 9 Site address 22652 GABRIEL CIR Current property owner(s) PITCHFORD KEVIN R Expiration Date: 8/20/2025 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: L9 Original Certificate Date: 9/10/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE• U—eve lopment 6rvices Uepartment Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 05181114000 Complete legal description SAMPSON ESTATES BLK 4 LT 9 Location (site address) 22652 GABRIEL CIR Current property owner(s) PITCHFORD KEVIN 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 250-5919 3. TYPE OF WATER SUPPLY: 0 Private Well F1 Private Well serving 2 dwelling units El Private Well serving 3+ dwelling units R Community Well or Public R Water Storage 4. TYPE OF WASTEWATER DISPOSAL: FN Private Septic E] Private Septic serving 2 dwelling units n Holding Tank n Community Septic or Public Sewer 5. SEPTIC TANK: f-01 Steel E] Plastic E] Concrete R Fiberglass Age 18 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: F-1 AWWTS n Bed X Deep Trench n Wide Trench El Seepage Pit Waiver request for: Expedited review requested: F Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Date of Payment COSA # C Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 COSA Checklist Legal Description: SAMPSON ESTATES BLK 4 LT 9 Parcel ID: 05181114000 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled 5/30/84 Total depth 121 ft Cased to 121 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 8/22/24 Static water level at beginning of test 54 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 50 Date of pumping 8/20/24 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/29/06 ❑■ ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 3 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficienci COSA Checklist June 2022 Well production at time of test 5 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑■ Coliform bacteria is Negative Nitrate 3.74 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by NRim Eng. Date 8/22/24 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 8/22/24 Results g Pass Fluid depth prior to test 39 in Water added 450 gal New fluid depth 45 in Elapsed time 30 min Final fluid depth 42 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 60 Effective depth used 42 in Effective depth remaining 18 in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No 8* Community Sewer Manhole/Cleanout > 100' M Yes if No ft■❑ Yes if No ft Neighboring Tank > 100' ■❑ Yes if No ft Private Sewer/Septic Line > 25' ❑■ Yes if No ft Absorption Field on Lot > 100'■❑ Yes if No ft Holding Tank > 100'■❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50'■❑ Yes if No ft ❑■ Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ■❑ Yes if No ft ■l Yes if No ft L N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 8* ft Surface Water > 100' *]Yes if No ft Tank to Property Line > 5` ❑■ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ■❑ Yes if No ft Private Wells > 100'■❑ Yes if No ft Water Main > 10' ❑■ Yes if No ft Community Wells > 200' ■❑ Yes if No ft Water Service Line > 10' ■❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS * Tank @ 8', trench @ 10'+ G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm NorthRim Engineering Phone Engineer's Printcd Namc Steve Eng I)atc _ COSA Checklist June 2022 694-7028 8/30/24 OF 1W rA� �* .�91H cn Steve Eng tv GE -6256 3 0 -1'2 10' TELE. & EL EC. ESM'T. OF q jq�;4p CO '49 r SHANE A. HOLT...' p LS -6914 0` Q�a o �Arofessiona� foJ o O�� THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE. FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON AS -BUILT SURVEY I" =30Y NO CORNERS SET THIS DATE CD, l HEREBY CERTIFY THA T l HA VE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT9 BLOCK 4 SAMPSON ESTATES A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUA TED THEREON ARE WITHIN THEPROPERTYLINESANDNO VISIBLEENCROACHMENTS EXIST OTHER THAN NOTED. DATED ATANCHORAGE,ALASKA THIS 6TH DAYOF SEPTEMBER , 2024 NOL T LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 4091 238-61 223-8615 Municipality of Anchorage • Development Services Department�,f"';e, Building Safety Division Onsite Water and Wastewater Program S. < 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. COSA# D�D�gS Expiration Date: l O—/ 3- O 6 1. GENERAL INFORMATION Complete legal description Lot 9 Block 4 Sampson Estates Location (site address) _22652 Gabriel Circle, Chugiak AK 99567 Current Property owner(s) Mark b Billie Truskett Day phone 273-8313 Mailing address 1426 W. 151Ave.. Anchorage AK 99501 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 19 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of bn-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of Onsite 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 Phone 272-8218 Address P.O. Box 102954 Anchorage AK 99510 Engineer's Printed Name Steven R. Pannone P.E. Date Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines &. Regulations. The reported results describe the performance of the system under the conditions encountered at the time orthe test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water ,**��" QF levels that may fluctuate during the year, and the water usage of the family being served by the system. " ♦�� Thcse conditions arc outside the control of the evaluator orchis system. All systems eventually fail and , �q �# satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational i requirements of the MOA DSD. The content of this report is for the sole benefit or the owner listed ee c Steven R. onnone above. Any reliance upon or use of this report by any other person or party is not authorized nor will it ��' N c[ 14 pp confer any legal right whatsoever. ��•••' `'S.� ti. DSD SIGNATURE �444,, 1.::•' Approved for *1 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: :7— 1S. -Or. (Rw.. LADS) Municipality of Anchorage •., • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Boa 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST �'t •� ?RA .i .a 1 A. WELL DATA Well type P If A. B, or C provide PWSID # _ Date completed 513011984 Sanitary seal (Y/N) Y Total depth Jj_fL Cased to eft. FROM WELL LOG Data of test 5=984 Static water level 30 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Coliform `�oolonies/100 mL Nitrate 51 6oo' mg/L Arsenic: r) mgt, Date of sample: GWM B. SEPTICIHOLDING TANK DATA Tank Type/Material Anchorage Tank Steel Tank size J000 gal. Number of Compartments 2 Foundation cleanout (Y/N) I Depression over tank (YM) N Date of pumping C. ABSORPTION FIELD DATA Pumper NEW Well Log (Y/N) Y Wires properly protected (Y/N)V Casing height (above ground) _tin. AT INSPECTION 512401808 98 ft. 4.7 g.p.m. Other bacteria `g colonies/100 mL Collected by: Steve Pannone Cleanouts (Y/N) Y High water alarm (Y/N) WA Data installed 612901005 Soil rating (g.p.d.M' or ft'/bdrm) 0.8 System type Deso Trench Length 58 ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth ¢ ft. Eft. absorption area §Rft2 Monitoring tube Y Depression over field N Date of adequacy test%\� s ► �R_es�ults (Pass/Fail) Pass For 2 bedrooms Fluid depth in absorption field before test /�`� in. Water added= gal. Ll depth . Elapsed Time: = min. Final fluid depth _ in. Absorption rate >= `C C50 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. Data installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES 'Pump ofr level tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 132.5 Absorption field on lot 126.3 Public sewer main 100+ Sewer /septic service line 25+ Animal containment areas 100+ alarm level at in. Meets alarm b On adjacent kris 100+ On adjacent kris 100+ Public sewer manhole/cleanout 100+ Holding tank WA Manurelanimal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 8 Property line'f+ Absorption field 5+ Water main 100+ Water service line 25+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 67 Building foundation 21 Water main 100+ Water Service line 25+ Surface water 100+ Driveway, perkingNeNds storage 10+ Curtain drain None Observed Wells on adjacent kris 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 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 IL Pannone RE COSA Fee $ v Waiver Fee S _ Date of Payment!10(o Date of Payment Receipt Number Receipt Number, (Rev. 11/05) El 0! r'MM)O M9{D M1O(M nAv. IAAL,lIIm7 ' al,a.04n wwoAm <Nsq w lwxwa) ia.m oLTAwT �SGQ e 6 ioL ALALam l+AACA gB •_41 0� I • 4!1: r 5 SURVEY CERT111CAMON ♦syyysnne�e� ?rl>IT OFed by PLOT PLAN .n P-�� O, ..N/ Robert E. Jahns, Jr. & Assoc. www<..,«a..narr C � F fCf^.ir;l')r;('I I.f1.'1:i C17r�Iny^F-. Iaawmm wa mi w ma r w• «, 'r wr ! •t ! 11 1700 BRNK DR. NaP m aomama naw a.a, ! {I ,•••• , 1. "7 •: %i' Ip ANCdORACk', ALASKA 99501 ! FlPlnawFwFOUNDATIONe,°A..w.rrwaNM.axa'OmI mAA«a'r.^.rTFOUNDATIONN'm•«�PraAS-BUILT S-BUILT.a gSUrvvepeAt:o WR'e.n.c .. Plot �al.� Fr e No. L KLt m .ror 5Uwa w«, '•.•.. ••••• ...............!!!.r,,,, by CNecke.l by Uale Urawn: WAL STRUCTURE AS -BUILT Trr�12. .1MI .( m..mawa « alwr,4 m r,s, Na %f (1 a,w«wm.mumm.a wa, maw '1,� oTesslon'A L''e�' LOT 9 IILOQC S L1 Lor suRvr S< son Estates Subdivision ❑ FWNDAnoN As -BUILT �1RVEY TYPE SYMBOLS ❑ NUL SIRUCIUK AS -BUILT • SET RE, '-AR�Tn bmji-P (.""".1 ❑ PLOT PLAN ... AS-IRALT ... Wt SVB�[r .. , lwMitAYHr o FO,)N•1 r rFAri DRAINAGE "-1 ASPHALT _Q A^ -elm, Nn fro.�ee •r �' 4CATlpI AS MIT NO CfYNTPS SrT 094 ASSUMCO EI C•r. �_-A._.A. WOCN F�L•'Nq: -/T CUNCRL'tC 1 , • _. acro, .ua- IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PPIOR TO NSTRUCTION, TO VERIFY PROPOSED BUILDING CHA.UE NELATIVE ONLY THOSE IMPRCVC.MI Nc;: ABOVE GROUND AND VISIBLE WILL BE FINISHED GRADE AND UTILITY CONNECTIONS ANU TO UEICRM'HE ET,SHOWN. CSiON^(WC S. r .0 C'CMAUTS' SIDEWALKS, DRIVEWAYS, H DO NOSTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPwivi: GEP:T� FR0. OE NC TE LOCATION. AND LO ATOO. ICH DO NOT APPEAR ON TVi� RFCORDrO SU4:.IVIti ON PLAT, A!J.. DIGTAN^r^ AR_-_Rr Cr`Rd,t lRO F^a hTH�4 UNDER NO CIRCUMSTANCES Sa^I:LD ADI A5..9, BLT RE USED FOR CCN'I;RIIC'.ICN • P^1^ T ^ THE SURVEYOR TAKES RESPONSIBILITY FOR THE IKI'rIAL TRANSACTION ONLY AND ASSUMES FI:AIR iAI,,L'i,WyU ONLY UFOR THE CCSTNDArtY ()R COF PCS SUR`rY. LISTED DISTANCES PREVAIL OVER SCALING. RCPROOUCTION MAY CAUSE Ek,&RS IN SCALE 5. 91 By: STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 995577 Engineer's signature DHHS SIGNATURE _ Approved for A&65�% bedrooms. Date 4-2i _eA 2 per!.„ d a �4 415 �p* ne...MITfE.Y..G.. No. 9215 Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 1uTlr Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev.1/91) Back MOA#21 . Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 16 Legal Description: �o 'k &L -t/- Parcel I.D. sip A. WELL DATA Well type If A, B, or C, attach ADEC letter Log present'N) �4 Date completed _ Total depth I Sanitary seal LqN) Date of test Static water level Well flow Pump level Cased to FROM WELL LOG 1 ADEC water system number a11�1 Driller SDS t s:�.a�owrsrat Casing height \z -%I Wires properly protected (VN) l5, n g.p.m. AT INSPECTION I. -- Z.rp - °12 `w L LJ L LJ Cie SEPARATION DISTANCES FROM WELL TO: Z z Septic/holding tank on lot UJ On adjacent lots i (;D �k /'17 �_ n Absorption field on lot uL� )+ rn ; On adjacent lots }: m D - z _ Public sewer main M Public sewer manhole/cleanout 14 A• no Sewer service line2S �� Petroleum tank 2S) M y = o WATER SAMPLE RESULTS: Coliform 0 �v'/oo.vt.2 Nitrate C)•SE to Z Other bacteria IkL11 Date of sample: j Zo - 9 2- Collected by: 5 & 5 ENGINEERING 17u;34 Eagle Riven t-eop Road No- '204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed 5-,&4 '0114(l Tank size i bDD �+- Compartments Z Cleanouts &N)- V _� Foundation cleanout4%N) V Depression (Yiq High water alarm (Y,ky �( Alarm tested (Y/N) j/A Date of pumping , - 22 st y Pumper x\2 - C mss PooC SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells 1k () on lot l �D On adjacent lots iob i} Foundation a t To property line 1� `� Absorption field Water main/service line 10 Surface water/drainage too 72-026 (Rev. 7/91) Front - CONTINUEDONBACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access Meets MOA electrical,c (Y/N) SEPAR DISTANCE FROM LIFT STATION TO: on lot On adjacent lots "Pump off" level at Cycles tested Surface water _ D. ABSORPTION FIELD DATA tIy Date installed 5� S la Soil rating 201.0 4A I?, System type Length 1Ci l t g Width 3 Gravel thickness 4'•S Total depth Total absorption area LP1 S Cleanouts present &N) Depression over field (Y& Date of adequacy test Results fail) Pass for�3i bedrooms Peroxide treatment (past 12 months) (YA dO^IF� 12 i6 uJA.( If yes, give date ' 14 - SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ) `+�+ On adjacent lots 1 ao ` � Property line � To building foundation l b tk To existing or abandoned system on lot On adjacent lots -2 t I Cutbank �1I�,_ Water main/service line lo'+ Surface water 00 Drivewa3aD y, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in M 5 & 5 ENGINEERING Signature 97014 Eagle Riuer I eee Road No 204 Eagle River, Alaska 99977 R °Engineer's Nametil 0kAN qg OA 0 ;e! Date-2�—��A��s Q a(;21 t� no a tb Afi0Fj.. dV HAA Fee $ 170 / Waiver Fee: $ Date of Payment 7-7— 2Z Date of Payment Receipt Number - 0 Receipt Number 72-026 (Rev. 3/91) Back MOA 21 of this inspection. y�6 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 50526 Chemlab Ref.# 92.0242 Sample # 3 Matrix: WATER Client Sample ID : L9 34 SAMPSON EST. S/D PWSID UA Collected JAN 20 92 @ 16:30 his. Received JAN 21 92 @ 15:00 hrs. Preserved with AS REQUIRED Analysis Completed JAN 22 92 Laboratory Supe vis r STEPHEN C. EDE Released By �� V4-- Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO# Req# Ordered By Send Reports to: 1)S & S ENGINEERING 2) PO# :NONE RECEIVED ...................................................................................................................... Parameter ---------------------------------------------------------------------------------------------------------------------- Results Units Method Allowable Limits NITRATE-N 0.58 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: .................................................................................................................................... 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected " See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than 11162%a`3S Member of the SGS Group (Societe Gdndrale de Surveillance) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) 4Z)745, S'L �C� � ,vsa. Lrs/ l�'J - _l 3 . 7/4SI.' • P/ ti/ Location (address or directions) (b) Applicants Name _ j -q{4 Telephone - Home Business Applicants Address Z0613 /A '2�6 /_ PL - (c) Applicant is (check one) Lending Institution = ; Owner/builder Buyer ; Other E:::l (explain); (d) Lending Institution --�� (e) Real Estate Co. u Agent Address ri UA►YI'" _ Telephone L (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Number of Bedrooms 3. Water Supply Individual Well Community Tel esu'" Acaj Other (describe) Public M Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite � Public Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. (Page 1 of 2] 01 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein.- I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Address Telephone ZZLO 12 Date Fi (ENGINEER SEAL) lie 0 oxer s.+ l 6. DHEP Approval L J Jl ;? Ci 6 Approved for � �.e� bedrooms By �_�� 2=i a 2! L>*3 Approved Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE. A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER`S WORK. RR4/ej/D18 [Page 2 of 21 01 (DHEP SEAL) 7-19-84 A. [ALL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 2 51986 Legal Description ? Well Classification If A, B, or C. D.E.C. Approved(Y/N) Well Log Present (Y/N) Date Completed 530 -6 Yield Total Depth ^-12l Cased to -IZ'Depth of Grouting /VA Static Water Level 30 Pump Set At i/� Casing Height Above GroundSanitary Seal on Casing (Y/N) OL Electrical Wiring in Conduit (Y/N) L Depression Around Wellhead (Y/N) A/ Separation Distances from Well: To Septic/Holding Tank on Lot /�� On Adjoining Lots Ale To Nearest Edge of Absorption Field on Lot /I ; On Adjoining Lots,y To Nearest Public Sewer Line N To Nearest Public Sewer Cleanout./Manhole%,¢ To Nearest Sewer Service Line on Lot Water Sample Collected By Date /y%c/r4 Water Sample Test Results &42�% kM CaULL nts B. SEPTIC/HOLDING TANK DATA Date Installed Size 000 No. of Compartments Standpipes N) ;V Air -tight Caps ) Foundation Cleanout N) Depression over Tank (Y/N)Date Last Pumped /l/�u� Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Alld Temporary Holdirxj Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply 4b11 M</ To Building Foundation To Property Linerlj� To Disposal Field 1�0/ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Receipt # 'a-7-7q-7LQ Date Paid: Amount: [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA - , Soils Rating in Absorption Strata a2dl; Type of System Design Date Installed e 4V-4 Length of Field 7.51 Width of Field A� It Depth of Field 91 S''1 Gravel Bed Thickness5'� Square Feet of Absorption Area 4 %� Standpipes Present (Y/[J)��. Depression over Field (Y/N) A Date of Last Adequacy Test es /LX•rJ Results of Last Adequacy 'lest I® Separation Distance from Absorption Field: i To Water -Supply Wall /J� To Property Line �-Clw 7 To Building Foundation 00/ To Existing or Abandoned System on Lot-/�,�j pOn Adjoining Lots To Water Main/Service Line /t -//A To Cutbank(if resent)If / �- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, cr confcrmd to all MOA HPA .,%U�gjos in effect on the date of this inspection.N Signed Date Z Z3� a��a - ° °• @�8 /940 - Company A,Y,eJ � MOA No. _ f T� KB1/d5/s ®° .........°...... James R. Kinney S1�('Pr� 6f, %%nEPr1 CE 6036 011(9,6 All (Page 2 of 21 -�y�a6 -+ 2-15-84