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Home My WebLink AboutSAMPSON ESTATES BLK 4 LT 16Sampson Estates Block 4 Lot 16 #051 �81 1 �21 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP251076 PID Number: 051-811-21 Dwelling: A Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Name ABSORPTION FIELD BRAD PLATT C/O ARM SEPTIC SERVICES 22410 PHAROAH CIRCLE, CHUGIAK, AK Phone Number of Bedrooms 907-688-9433 (ARM) 4 LEGAL DESCRIPTION Subdivision Block Lot SAMPSON ESTATES 4 16 Township Range Section ;EPARATION DISTANCES To Septic Absorption Holding Lift Station Yo m Tank Field Tank Well *50'+ *'5501+ *501+ - Surface Water *550'+ *501-1- *50+ - Lot Line 51+ *51+. 51+ - Foundation 110'+ � 101+ I 101+ I - Sewer Line 25'+ Project: ❑ New■❑ Upgrade ❑ Deep Trench ❑ Wide Trench N Bed ❑ Mound ❑ Other ail Rating Total depth from original grade *1.0 GPD/SF SEE DWG. Ft epth to pipe invert from original grade I Gravel depth beneath pipe SEE DWG. Ft. 0.50 Ft. II added above original grade I Gravel length SEE DWG. Ft. 40+ Ft. ravel width Beds: Number of Lines Distance between lines 15+ Ft, 3 5 Ft. )tai absorption area Number of trenches Dist. between trenches 600 Ft2 - - Ft. ANK ❑ Septic ® S.T.E.P. ❑ Holding ❑ Other D & S CONCRETE Material NA CONCRETE LIFT STATION Remarks *AWWTS - THIS IS A REBUILD OF THE EXISTING BED DRAINFIELD Installer ARM SEPTIC SERVICES Inspector GARNESS ENGINEERING GROUP, LTD. 1500 Gal Number of compartments 2 Aanufacturer Capacity D&S CONCRETE —500 (2ND COMP.)Gal, Uarm location Electrical installed by INDOOR S on PIPE MATERIAL House to tank EXIST. Tank to drainfield D17$5 Drainfield D3034 CO/MT D3034 3ENCH MARK (Assumed elevation) 100.00 It ption Sl @ SOUTHWEST CORNER OF HOUSE Engineers Stamp O q'C Q Date o * 4 -7* Ig Inspection Location and descri dates: � s'6/2/2025 2nd 6/5/2025 31' 6/5/2025 4'h BOTTOM OF S ON-SITE WATER AND WASTEWATER SECTION APPROVAL I Approval: Septic Sy Approved (Rev 0510211 f ey orness• this approval does not include well permit requ'-��'- #AECC884 PERMIT NUMBER: PARCEL ID NUMBER: OSP251076 RECORD DRAWING 051-811-21 FCO 26-2 20.2 1 MHl 34.0 30.4 MI -12 41.1 37T A VPI 42.5 39.5 MT1 100.4 96.0 COI 102.4 97.0 :A .. A ' 100' WELL RADII CO2 107.6 101.7 GENERAL '. I -A CO3 112.9 1106.7 LOCATIONS MT2 114.4 1108.8 7—i .-7 MT3 108.3 8&6 C04 109.9 88.8 "A C05 114.4 93.7 C06 119.3 988 MT4 121.4 U) NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN AUTOCAD. NEW 1500 -GALLON CONCRETE STEP TANK. EXISTING PUMP, CONTROLS, EFFLUENT. ETC. WERE REUSED: -- NOTE: OLD STEEL STEP TANK WAS FOUND TO HAVE HOLES IN IT. PER THE CONTRACTOR, THE TANK WAS REMOVED AND DISPOSED OFFSITE. EXISTING 4BEDROOM HOUSE ADDITIONAL FILL ADDED TO AREA DOWNGRADIENT OF DRAINFIELD 3:1 SLOPES ARE MET. AREA HAS TOPSOIL AND ALL DISTURBED AREAS HYDRO -SEEDED. OLD 15' WIDE BY 40' LONG BED DRAINFIELD.WAS REBUILT. WITH NEW PIPING AND ELEVATIONS. SEE RECORD DRAWING, PAGE 3 OF 3 .......... � .... . . . . . . . lNOUSF ze,x N X ol CL a. C L) SCALE: CO3 C I/ V 30' ATS -6 AEROCELL UNIT GEG TH#1 OF 4*� . .......... AV' co AV "ROUP 'ARNESS EN"INEERINIff kff Ltd :............................::.....0 ENGINEERING - SALES ,, CONSULTING 0 3701 E. TUDOR ROAD, SUITE 101 - ANCHORAGE, ALASKA PHONE (907) 337.6I79 * WEBSITE : www.gamenongineedng.com z..•. 0 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: j e arness $,Q v : AV 907-688-9433 2 OF 3 Cf -7973 .4 �- Air BRAD PLATT C/O ARM SEPTIC SERVICES I % 0• AV PROJECT/LEGAL DESCRIPTION: DRAWN BY: .. (o 2 3 zs->-"&, 10 - 4v SAMPSON ESTATES; BLOCK 4, LOT 16 J.L.M. ... ..... .4w TYPE OF WORK: DATE: 14 '�o LI ENSE RECORD DRAWING FOR NEW TANK AND REBUILT DRAINFIELD 1 6/23/2025 #AECC884 TOP OF r9ANHOLE (MH1) = 100.34— MH1 TOP OF TANK @ INLET = 96.57— TOP OF MANHOLE - FINAL GRADE (MH1) = 100.38- 100. 18-100.20 00.38- 100.18-100.20 PER CONTRACTOR, 2" OF INSULATION PLACED OVER THE TOP OF THE TANK (NOT SHOWN FOR CLARITY) a ` .. a HIGH WATER FLOAT--,,�] INVERT OF PIPE .� L _ — — OVERRIDE FLOAT \7 @ INLET = 95.60 =AL. — TIMER ENABLE FLOAT 35" MIN. LEVEL *NOTE: THE ENTIRE MOUNDED BED AREA WAS TOPSOILED AND HYDRO -SEEDED. 301 S� opE A 1500 -GALLON TWO-COMPARTMENT CONCRETE TANK TOP OF OLD FILTER SAND = 109.23 (AVG.) ORIGINAL GRADE = 106.39 PER 2005 RECORD DRAWING EXISTING FILTER SAND WAS FOUND HAVE NO BIOMAT. TOP OF OLD SAND FILTER WAS FOUND TO BE OUT OF LEVEL. SOME OLD SAND FILTER WAS REMOVED AND SOME NEW MOA FILTER SAND WAS ADDED AND DRAINFIELD REBUILT TO THE APPROVED DESIGN ELEVATIONS. BOTTOM OF 2005 EXCAVATIO AT LOWEST POINT = 105.39 NOTE: BENCHMARK FOR PROJECT IS THE BOTTOM OF SIDING AT SOUTHWEST CORNER OF HOUSE = 100.00 N MT CO MH2 PER CONTRACTOR, 2" OF INSULATION— FILTER FABRIC o I osP25�o76 � RECORD DRAWING TOP OF TANK OUTLET = 96.54 PER CONTRACTOR, 4" OF INSULATION INSTALLED OVER PIPE AREA THAT WAS EXPOSED DURING TANK INSTALL FEED LINE TO AEROCELE �— 80% RETURN LINE - INVERT OF PIPE OUTLET (RETURN) = 95.35 EXISTING PUMP —PER CONTRACTOR, CINDER BLOCKS INSTALLED AS PUMP PLATFORM CO CO MT INVERT OF OLD m n DISTRIBUTION LINES = 109.78 (AVG.)--\ r 00 60 �-_I:I_I=•_1=1=I_1=1.I_•_I.I_�_1.•=1-�_I_I=Y�1_I_1=1_1_I_1.1=•=•=1-1�•-1 -l-•-•-1�1=� �� INVERT OF NEW DISTRIBUTION LINES FOR REBUILT DRAINFIELD = 108.80 TOP OF FILTER SAND (BOTTOM OF DRAINROCK) FOR REBUILT DRAINFIELD = 108.30 15 -FEET WIDE PROFILE VIEW OF DRAINFIELD REBUILD SCALE: N.T.S. PARCEL ID NUMBER: 051-811-21 I W PROPOSED PUMP TANK FLOAT SETTINGS D & S CONCRETE TANK 1500 VOLUME AT INLET INVERT *1625 GALLONS MIN. OPERATING VOLUME *1264 GALLONS INLET INVERT 45" HIGH WATER ALARM 42.5" OVERRIDE FLOAT 40.5" TIMER ENABLE FLOAT 36.5" FLOAT LEVELS ARE FROM BOTTOM OF TANK. NOTE: MEASUREMENTS ARE WHERE THE FLOAT WIRE ATTACHES TO PIPING WITH A 3.5 INCH TETHER FROM PIPING TO FLOAT. ALL FLOATS MUST BE NARROW ANGLE FLOATS. LL W U)Lo cy) M �- VOLUME HIGH WATER FLOAT ON Q o�0-� LL rn m°0 oc) w M cl) o wp Q [if U 2 C w �` �� z 0 m� N N A WoO IL o0) a. WM w(0 o 38" *1,372 aa- cl *1,264 � �■.� R=co 0 Lux o Z� N d: W Z ZQ Ww 0 0 J O 0 LL *NOTE: LIQUID VOLUMES ARE APPROXIMATE. VOLUMES CALCULATED USING D & S CONCRETE INC DIMENSIONS FOR THEIR 1,500 GALLON SEPTIC TANK. E 0 -FINAL GRADE = 111.77-112.21 GEG TH#1 ,,.,—APPROX. LOCATION OF OLD 2005 DRAINFIELD 3 TO 1 g�opJE� -ORIGINAL GRADE = 108.23 PER 2005 RECORD DRAWING BOTTOM OF 2005 EXCAVATION AT HIGHEST POINT = 107.23 RELATIVE ELEVATION OF GROUNDWATER ON 6/20/05 = 104.23 RELATIVE ELEVATION OF BOTTOM OF TEST HOLE = 96.73 FROM BOTTOM OF TANK VOLUME HIGH WATER FLOAT ON 44" *1,589 HIGH WATER FLOAT OFF 41" *1,480 TIMER OVERRIDE ON 42" *1,516 TIMER OVERRIDE OFF 39" *1,408 TIMER ENABLE ON 38" *1,372 TIMER ENABLE OFF 35" 1 *1,264 -FINAL GRADE = 111.77-112.21 GEG TH#1 ,,.,—APPROX. LOCATION OF OLD 2005 DRAINFIELD 3 TO 1 g�opJE� -ORIGINAL GRADE = 108.23 PER 2005 RECORD DRAWING BOTTOM OF 2005 EXCAVATION AT HIGHEST POINT = 107.23 RELATIVE ELEVATION OF GROUNDWATER ON 6/20/05 = 104.23 RELATIVE ELEVATION OF BOTTOM OF TEST HOLE = 96.73 s o � C E W p v }- J W ,.m / Z� LL Z_ Q 0c') m c1r)� p Z w Q da C& co Z Q g Q w Z" � �■.� R=co 0 Lux o Z� N d: W Z ZQ Ww 0 0 J O 0 LL f0 l � m F- Z U) Q oW p 0 YNp LLV / L 7. L) n 0LW6. C/) 3 C 0 W o� Q(¢ ui 0 a w J W, OF �• ._:._ •. AN,4 .....:........ ....................:..... / 0eeeeee■rice■ a ■eeeeeeeeet.eeeeeeeeeeeee■ ■ee: 0, ey N. G.arnessAr �n_ ♦ �` '••.• 4,V -AV AW Z 3 `� .••' �• ROFESSO�" LICENSE ,1 0 1vi11t`�• #AECC884 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251076 Work Type: Septic Upgrade Tax Code Number: 05181121000 Site Legal Address: SAMPSON ESTATES BLK 4 LT 16 G:1560 Site Mailing Address: 22410 PHARAOH CIR, Chugiak Owner: PLATT BRADLEY R & CHRISTINE K Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: ggg S<, _� r. )(.i)art:t»ent 4/2/2025 4/2/2026 40891 Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By:� ( C Date: Issued By: Date: 2- Z 4 ON -SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 051-811-21 Property owner(s) BRAD PLATT C/O ARM SEPTIC SERVICES Day phone 907-688-9433 Mailing address 22410 PHAROAH CIRCLE, CHUGIAK, AK Site address 22410 PHAROAH CIRCLE, CHUGIAK, AK Legal description SAMPSON ESTATES; BLOCK 4, LOT 16 Number of Bedrooms 4 Engineering Firm GARNESS ENGINEERING GROUP Building Permit Number Not Applicable RN APPLICATION IS FOR: APPLICATION IS AN: (M all that apply) Absorption Field F-71 Initial El Septic Tank ❑ Upgrade D Holding Tank ❑ Renewal 171 Privy ❑ Well ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: Date of Payment- Z Permit No. 0C. Waiver Fees: Date of Payment: Waiver No. Distance: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251076, Curtis Townsend, 04/02/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251076, Curtis Townsend, 04/02/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251076, Curtis Townsend, 04/02/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251076, Curtis Townsend, 04/02/25 TREE RESIDENCE ELEC. PANEL CONTROL SEPTICGAS TWO STORY HOUSE LEGEND UTILITY PEDESTAL DECK CONCRETE PADMOUNTED TRANSFORMER EDGE OF ASPHALT RECORD DATA PER PLAT #84-10 SEPTIC PIPE WELL SEPTIC TANK LID TIMBERLINE SURVEYING AND MAPPING 17035 BARONOFF AVE EAGLE RIVER, AK 99577 907-242-5320 ryan@timberlinealaska.com FILE NO.: 25.043 SCALE: 1" = 30 FEET DATE: 3/19/2025 SHEET: 1 of 1 MOA GRID: NW1580 SCALE: 1" = 30 FEET(11"x17") 30'0' 60' AS-BUILT OF: ADDRESS: 22410 PHARAOH CIR, CHUGIAK, AK LOCATED IN: ANCHORAGE RECORDING DISTRICT LOT 16, BLOCK 4SAMPSON ESTATESPLAT #84-10 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program. 4700 South Bragaw St. -1 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 On -Site Wastewater Disposal System and/or Well Inspection Report Page 1 of Permit Number. SW050239 PID Number. 051-811-21 Name: BRAD PLATT Wastewater System: 0 New 0 Upgrade Address: P.O. BOX 670902 CHUGIAK, AK 99567 ABSORPTION FIELD Phone: No. of 8edrooWs___ — (907) 271-5359 4 ClDeep Trench ClShollow Trench 1111lied ClMound N Other* LEGAL DESCRIPTION Soli Rwwq: w4kW qf�: Block: Subdivision: 1.0 CPO/sq. rL **1.0 MAX rL 4 16 SAMPSON EST. DWh W pfpe W� tmm O'lenol qn�: SEE DWG. C10'el d.Mh bw�h pipr Township: Range: section: FL hall odded 0bwe "Inal gndw; - 0.5+ Z;� �WWh. SEE DWG. 40 Ft WELL: 0 New 0, Upgrade 15 of 16 oi� W. Cw"f�ti� (Priv,rtl. A.B.Cy. Tvio D�m- Tc(SM1000 TMW obawoe. FL 3 Mpe, 600+ SO. F1 D 3034/ F-810 \XA swt� safe, LevW: FL GEG, Ltd. Des vet~ 10/17-21/2005 C00-9 14"M � G�: 0 6 & to co -1 Jr. TANK SEPARATION DISTANCES 0 Septic 0 Holding 8 S.T.E.P. 0 Others Septic Tank Absorption Fwld Lift station Hold T. in k 1=1 16��urw,. GREER iZ_dy I. �9�_ — 1500 Well 100'+ 100'+ 25'+ wnpo�w' STEEL 2 Surface Water 10o*+ 100'+ LIFT STATION Lot Line 5'+ to*+ Size In 9� wonvfon�. 1500 CREER/ZABEL TECHNOLOGIES Foundation 5'+ 10'+ WvW 9L off ��; �qh wal�-� ft TIMER TIMER 45" Curtain Drain NONE KNOW pv� a `Z we" E� A k�� perr;;� �br I _N P-TE!30 Plut; RISING SUN Remarks: *THIS IS A SCAT BIOFILTER SYSTEM BENCH MARK *s2' TO 3.840 OF M.O.A. APPROVED SAND FITLER L� � 0�npl�: BOTTOM OF SIDING 0 SOUTHWEST ADDED TO TOTAL DEPTH. CORNER OF HOUSE A� E��; THE EXISTING SEPTIC TANK WAS COMPLETELY 100-00 n. �'ENGINEEPM SM - t ABANDONED IN PLACE BY FILLING WITH CONCRETE. THE EXISTING DRAIN'FIEUD WAS COMPLETELY ABANDONED IN PLACE. QF... GEG. Ltd. Inspections performed by: Dates: Ist 12LY2005 ....... .. ........ .......... 2nd J-0/1 8/2005 3rd 10/19/2005 ............ arness.- 'q� �p Development Services Department Approval A �5 0 Is CET79157P 0 2-0. , eviewed and approved by: I 1?'i lo -7 (Rev. 12/01) Dote: M PERMIT NUMBER; SWO50239 PARCEL ID N I AS -BUILT DRAWING 051-81 I A I R I LOT 15. BLOCK 4: SAMPSON ESTATES S/D SEPTIC % AREA EXISTING SEPTIC TANK I LS VAS COMPLETELY ABANDONED By v FILLING WITH CONCRETE - LOT 28. BLOCK 4: SAMPSON ESTATES S/D 4 tokr4SZ�,Vc /IOU 0004 W 1500 GALLON S.T.E.P. TANK - 1.25" FUD LINE AND 2" RECIRCULATION LINE (INSULATED WITH 2' OF RIGID INSULATION) LOT 27. BLOCK 4: SAMPSON ESTATES S/D GARNESS ENGINEERING GROUP, Ltd. � CONSULTANTS & GENERAL CONTRACTORS 3"' L � �A KM 101 M �7 ft� (90M"�Jft . F" tnr,�=" . — PREPARED FOR: PHONE NUMBER: PAGE R; BRAD PLATT 271-5359 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: SAMPSON ESTATES S/D; LOT 16. BLOCK 4, B. M./J.L.M. TYPE OF WORK: i AS—BUILT DRAWING FOR NEW SEPTIC SYSTEM 12 20/2005 (Rs,0lM5) DRAINFIELD EXISTING WELL LOT 26. BLOCK 4: SAMPSON ESTATES S/D . . ......... ........ y Car ss: . CE—�q 32.9S 44.82 ST2 38.72 49.96 MH1 40.73 51.76 C01 %STI 103.81108.93 CO2 108.38 112.92 CO3 111.20114.72 MT1 103.16 107.06 MT2 12.50 L15.111 L_ _ MT3 08 10 98 8 MT4 719-78 POD1 N10592 106.67 POD2 109.99 LOT 15. BLOCK 4: SAMPSON ESTATES S/D SEPTIC % AREA EXISTING SEPTIC TANK I LS VAS COMPLETELY ABANDONED By v FILLING WITH CONCRETE - LOT 28. BLOCK 4: SAMPSON ESTATES S/D 4 tokr4SZ�,Vc /IOU 0004 W 1500 GALLON S.T.E.P. TANK - 1.25" FUD LINE AND 2" RECIRCULATION LINE (INSULATED WITH 2' OF RIGID INSULATION) LOT 27. BLOCK 4: SAMPSON ESTATES S/D GARNESS ENGINEERING GROUP, Ltd. � CONSULTANTS & GENERAL CONTRACTORS 3"' L � �A KM 101 M �7 ft� (90M"�Jft . F" tnr,�=" . — PREPARED FOR: PHONE NUMBER: PAGE R; BRAD PLATT 271-5359 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: SAMPSON ESTATES S/D; LOT 16. BLOCK 4, B. M./J.L.M. TYPE OF WORK: i AS—BUILT DRAWING FOR NEW SEPTIC SYSTEM 12 20/2005 (Rs,0lM5) DRAINFIELD EXISTING WELL LOT 26. BLOCK 4: SAMPSON ESTATES S/D . . ......... ........ y Car ss: . CE—�q PERMIT NUMBER: PARCEL ID NUMBER: SW050239 AS -BUILT DRAWING 051-811-21 1 TOP OF TANK AT INLET - 96.42 INVERT OF BUNG AT INLET - 95.94 mNOTE: THE BED TO BE TOPSOILED AND SEEDED IN THE SPRING/SUMMER OF 2006.. mq TOP OF SAND FILTER - 109.23 (AVG.)— ORIGINAL GRADE 106.39---,, FINAL GRADE - 99.74-99.81 ST2 MH n r ---i NEW 1500 GALLON S.T.E.P. TANK —FINAL GRADE . 113.11-114.02 OF BED - 105.39 BOTTOM OF BED . I FABRIC GARNESS ENGINEERING GROUP, Ltd � CONSULTANTS & GENERAL CONTRACTO .. .... Ml L�F�� lot NUMBER: NUMBER: 71-5359 3 OF LEGAL DESCRIPTION: DRA N BY. SAMPSON ESTATES S/D; LOT 16, BLOCK. 4 B M./J . L.M. TYPE OF WORK: 06ATE: PROFILE AS -BUILT DRAWING 12/20/2005 (R..0IM5I —TOP OF TANK AT OUTLET - 96.42 ORIGINAL GRADE - 108.23 NVERT OF DISTRIBUTION LINE - 109.78 (AVG.) ........... arness.- CE— 7953 '0 Zsing 6on I-Lectric. Inc. 1A 14916 Voodand Prive [A-qLe River, AV, 99577 (907)622-6777 November 2, 2005 Gamess Engineering Group 3701 E. Tudor Road, Ste. #101 Anchorage, AK 99507 Re: Lot 16 Block 4 Samson Estates Dear Kelly: The lift station at the above referenced property has been wired In accordance with NEC and State/Local codes. Thank you. Sincerely, Kevin THornbuckle, Owner Administrator License Number 1284 Specialty Contractor License Number 27285 MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO50239 Date Issued: Jul 21, 2005 Expiration Date: Jul 21, 2006 Parcel ID: 051-811-21 Legal Description: SAMPSON ESTATES BLK 4 LT 16 Design Engineer: 0855 Garness Engineering Group, LTD Site Address: 022410 PHARAOH CIR Owner Name: BRAD PLATT Lot Size: 40891 SO. FT. Owner Address: PO BOX 670902 Total Bedrooms: 4 Permit Bedrooms: 4 CHUGIAK . AK 99567-0902 This permit Is for the construction of: M Disposal Field E Septic Tank E] Holding Tank E] Privy Private Well Water Storage AJI 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 ( 18AACBO ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. -THE UPPER SIX INCHES OF THE MOUND SYSTEM MUST CONSIST OF TOP SOIL AND THE MOUND MUST BE VEGETATED SUFFICIENTLY TO PREVENT EROSION. Received By. Date: 7 -9/ -c5 - Issued B Date: 712,11or Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 9951M650 www.cl.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0.5-1 - %I I - -.� / Permit Number Property owner(s) BRAD PLATI! Day phone 271-5359 Mailing address (1) P.O. BOX 670902 * CHUGIAK, AK. Mailing address (2) Legal description (Section, Township & Range) N/A Lot Size YL 4-/? / — ArrT!D THIS APPLICATION IS FOR: uml� �-- �� Number of Bedrooms 4 Sewer Only El Well Only El Sewer and Well El Water Storage El Sewer Upgrade N THIS PROPERTY CONTAINS: HotTub Jacuzz! El Swimming Pool Water Softening Unit Therapy Pool I certify that the above Information is correct. I further certify that this application is being made fora Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (6ignaltife eF pFepefty a Nner or aulherized egen!) Permit Fees: 14(to Date of Payment: -7- Ili-Q�' Waiver Fees* Date of Payment: Receipt Number: Receipt Number: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS June 29,2005 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Upgrade for Sampson Estates Subdivision; Lot 16, Block 4, To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic system is currently in the state of failure and needs to be upgraded. We are proposing thatl a new 1500 gallon septic tank, a M.O.A. approved recirculating trickling filter (sized for 4 bedrooms), and a bed type drainfield be installed. One test hole was excavated on the property. The drainficld will be designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE NVATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography in the area of the proposed drainfield is a 5 percent slope running approximately south to north. In short there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any . questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design packagefor this septic system. (Contact G.E. G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 0 Wcbsitc: gamessengincering.com LOT 13, BLOCK 4; SAMPSON -DRIVE T, 10 SAMPSON ESTATES S/D (NO CONCERN) 1D Zj LOT 14. BLOCK 4: LOT 19, BLOCK 4; SAMPSON ESTATES S/D SAMPSON ESTATES S/D (NO CONCERN) (NO CONCERN) cit 0 C;EPTIC ARE!D LOT 18. BLOCK 4' SAMPSON ESTATES i/D/ LOT 3. BLOCK 2: GLENN MEW NORTH S/D LOT 15. OL 4; (NO CONCERN) SAMPSON ESTA�/D J_ EXISTING �A 4 BEDROOM HOUSE EXISTING LOT 17. BLOCK 4; SEPTIC PIPES ROPOS SAMPSON ESTATES S/D EXISTING SEPTIC SEPTIC SYTEM SYSTEM LOT 2 BLOCK Z' GLENN VIEW NORTH S/D ---- (NO CONCERN) I --- LOT_::�LOCK 4'. SAMPSON ESTATES S/D LOT 1. BLOCK 2: GLENN VIEW NORTH S/D (NO CONCERN) LOT 27. BLOCK 4: SAMPSON ESTATES S/D (:;EPTIC AREA = / / 'e-116 .................... j LOT 27. BLOCK 4: SAMPSON ESTATES S/D LOT 26. BLOCK 4; SAMPSON ESTATES S/D LOT 25. BLOCK 4: SAMPSON ESTATES S/D (NO CONCERN) WEI t RADIUS j �G�c �e_\ GARNESS ENGINEERING GROUP, Ltd. - *L - CONSULTANTS & GENERAL CONTRACTOR �7,7;� ZZZrTr -1017 4 -CH -WAX M � (WrAV�1" - M Wr)33�=" - � . -REPARED FOR: PHONE NUMBER: PACE NUMBER:' BRAD PLATT (907) 271-5359 1 OF 3 ECAL DESCRIPTION: wN SAMPSON ESTATES SUBDIVISION: LOT 16, BLOCK 4; YPE OF WORK.' 11A SITE PLAN FOR PROPOSED SEPTIC SYSTEM UPGRADE 6/21/2005 ..qp�l !aim N T_ 'o N A. Comess! P NUMBER OF BEDROOMS: 4 GALLONS PER DAY (GPD): 600 PERCOLATION RATE/S: 60 MIN./INCH PROPOSED APPLICATION RATE. 1.0 MINIMUM DRAJNFIELD SO.Fr- 600 MAMMUM DEPTHA FOOT WIDTH: 13 FEET LENGTH:40 FEEr M.OJL APPROVED SAND FILTER: 2 FEET EFFECTNL*0.5 FEET REDUCTION FACTM- N/A ACTUAL SO.Fr.: 600 CONTACT CEO. BY PROCEEDING FORWARD WITH THIS INSTALLATION. THE ENGINEER. WELL DRILLERs CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY LOT 15. BLOCK 4; SAMPSON ESTATES S/D SEPTIC AREA .7 4,11 EXISTING DRAINFIELD TO BE USED AS RESERVE SITE. EXISTING SEPTIC TANK TO BE COMPLETELY ABANDONED — 14L 4 1�-Vc' --TR—OP5kF w � PROPOSED lCo APPROVED R;ECIUALAMG NO Ij TRICKLING FILTER (SIZED FOR 4 BEDROOMS) ir LOT 28. BLOCK 4: LOT 27. BLOCK 4; S4VT 26 .,BLT PSO ST TA 4 SAMPSON ESTATES S/D SAMPSON ESTATES S/D N 5 �D 0 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENEFtAL CONTFtACTORS ....... .. .. .. . .......... I L � 100A IM 101 - MADOWL M � 007)=�IM - M (WrA3D-X" - MEM tEPARED, FOR-' PHONE NUMBER' PACE NUM .. . . ....... .......... BRAD PLATT (907) 271-5359 2 OF 3 y . Go ness.' SAMPSON ESTATES SUBDIVISION. LOT 16, BLOCK 4; R.A.L � OF WORK: DATE' DESIGN FOR PROPOSED SEPTIC SYSTEM UPGRADE 1 6/21/2005 (Rw. 01005) 70 M—T Mr 0 1 2.5- 00() ()CO - IN FROM CO ('T— L SCAT ()co BIOFILTER --y-T F Lwr 0— Wro 2.5- W�" CONVERT FROM BRACING AND STAKING 2* TO 4' PIPE AS NEEDED F GRADE PROPOSED ZABEL 650 GPD SCAT 00FILTER REMOVE ORGANICS AND BUILD UNDER 0110FILTER SAND IN ORDER TO FLOW. AcHiEvE cRAvrry GARNESS ENGINEERING GROUP9 Ltd. CONSULTANTS & GENERAL CONTRACTORS =I L � MAX � "I - MMOWAL M 6� � MMW�IM - W (Wy)�n" - � PREPARED FOR.' PHONE NUMBER: PAGE NUMBER: BRAD PLATT (907) 271-5359 3 OF 3 LEGAL DESCRIPnON: DRAWN BY.' SAMPSON ESTATES SUBDIVISION, LOT 16, BLOCK 4; R.A.L TYPE OF WORK: DATE' DETAIL FOR PROPOSED DRAINFIELD I 6/21/2C pft.olms) �fABRIC FlLTER IVA OF .......... GARNESS ENGINEERING GROUP, Ltd. � CONSULTANTS& GENERAL CONTRACTORS — ISOIL LOG - PERCOLATION TE LEGAL DESCRIPTION: SAMPSON ESTATES SUUUM51UN; LUI lb, Ul PERFORMED FOR: BRAD PLATT DEP (feet EEE�i ORGANICS J!M ITEST HO�LE1 K 5 6 'D ' DPTH) 7 8. 9 10 11 12 13 14 15 16 17 18 -10L I 0 A A to DATE ffm 6/11/2005 4.0' 6/14/2005 4.0' 6/20/2005 31141 MZZ21 1 1 2 MM NUIR 5 1/2 MR. 111111111 2:40 6. - 1 1 4 3:10 -- 30 5 1/2- 1/20 1 1 5 DEPTH TO GROUNDWATER DATE SEEP 0 4.5' 6/11/2005 4.0' 6/14/2005 4.0' 6/20/2005 6- — Lar 15. BLOCK SAMPSON EStATES AR�A� A EXtSITNG eil DATE IREADING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 6/14/20051 1 2:10 6- — 1 1 2 2:40 30 5 1/2 1/20 1 1 3 2:40 6. - 1 1 4 3:10 -- 30 5 1/2- 1/20 1 1 5 3:10 — 6. - 1 6 3:40 30 5 1/2- 1/2 - PERCOLATION RATE 60 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 19 TEST RUN BETWEEN 3 FT. AND 3.5 FT. 2- A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES 0 NO SOILS LOGGED BY: JODY MAUS _ PERCOLATION TEST PERFORMED BY: CALEB GALL COMMENTS: PERFORMED BY GEG, Ltd. 1. JEFFREY A. GARNESS, CERTIFY THAT THIS E FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEM ENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITYOF ANCHORAGE AND a�P-AD PL-r'�T_7_ THIS MEMORANDUM OF LTNDERSTANDING made and entered into as of this 20 day of 2?-J01=j _ol`20�0 byandbetween RR&I 19t,47'7— herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater J?rc ;/Zc� I^ T * /V I Filien located Treatment System (AWWTS), described as at St)rp5.4 F' q Lv�- /1, Anchorage, Alaska. 2. Definitions. A. Alteration. Any change to the design or function of an AWNVTS that includes the installation or removal of any parts, components or pieces not included in the original construction pen -nit and design. Prior to performing any alterations to an AWNNrTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On -Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Dama.-c. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On -Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On -Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of 2?—e tz-o ($ 0 .00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. The term begins on the date of approval by the Municipality of the installed system and shall continue %-,-hile the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On -Site approval is issued to the new owner or transferee of the property. 5. Alterationq, Installation and Removal of Additionni Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AW%VTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or rcriewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustmcnt(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the ANNINNITS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWNVTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWVv7S Operating Permit is: I— Y JeAlz C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make an), necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. F. 0,,%-ner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Sitc Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWWTS is the governing professional guidelines for the construction, maintenance and repair of the 0,.vner's ANNINNITS. 7. Nonwaiver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a Nvaiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafler to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner: iol-IlTr- Anchorage: Purchasing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Memorandum of Understanding. 10. Severability. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. ONN'NFR: Date: MUNICIPALITY: By: Title: Date: STATE OF ALASKA )ss. THIRD JUDICIAL DISTRICT The foreg instrumwas acknowledged before me thi06Aay of 20C!��, by Z,+�- _,the (N-JGE 4L� 01f r\r on behalf of the Municipality of Anchorage. C" A 0 MnTAARY �PPURLIC FOR A A A ()T R):. a My Commission expires: PUBLIC Mr. Jeffrey Hickman Environmental Specialist Department of Health & Human Services Municipality of Anchorage 825 L Street Anchorage, Alaska 99519 June 24, 2005 Dear Mr. f lickman, This letter serves to bring you up to date with the actions taken since we last spoke. Our property's original Septic tank and leach field are 18 years old and near the end of their useful life. Last fall, in discussions with Mr. Jeff Urbanus of your office, I informed him that I was planning on replacing our septic system and leach field either this summer or next. Since last fall, I have been working with Gamess Engineering Group to design a new on - sight wastewater disposal system that will perform well in areas of known high groundwater such as Sampson Estates. We are planning on using a state of the art Zabel SCAT Biofilter septic system with a new leach f ield placed at the back of my property. The system is being designed and will be ordered to allow for a tentative construction date of late August. Part of the Zabel system will include the installation of a new septic tank. Once the new system is installed, my original septic tank and leach field will be decommissioned and taken out of service. According to Ms. Julie Makela with the Municipalities Development Services Department, On -Site Water and Wastewater Proeram, a waiver for my original leach field will not be required as it will be taken out of service. Consequently, I will not be applying for one. To discuss any aspect of my plans, I can be reached during business hours at 271-5359. Sincerely, Cc: Julie Makcla October 29, 2004 Bradley and Christine Platt PO Box 670902 Chugiak, AK 99567-0902 Re: Notice of Violation 15.65.020.A, Sampson Estates, Blk 4 Lt 16 Dear Mr. and Mrs. Platt On August 13, 2004, this department received a citizen complaint alleging that a subsurface drain originating on your property encroached onto their property. The complainants alleged that the drain originated in the vicinity of your septic drain field and terminated uphill of their well. An inspection of the complainants' property the same day documented a white PVC drainpipe and a flexible black plastic pipe exiting the ground, adjacent to the property line. A small amount of liquid was observed flowing from the PVC pipe. From the exposed pipe, a strip of grass, colored differently than I the surrounding lawn and suggesting recent disturbance, ran uphill, parallel to the property line for approximately 50 feet. At that point, the grass strip crossed onto your property near your septic drain field. I did not enter your property to take exact measurements but estimate that the grass strip passed within 10 feet of the visible drain field monitoring tubes. My second visit to your neighbor's property was on October 22, 2004 following excavation work they conducted. Where the grass strip had been previously, a trench was dug exposing and removing PVC pipe, drain rock, silt barrier, and insulation. Near the top of the excavation, a section of black flexible pipe was intersected. The pipe was set in a bed of drain rock and covered by a silt barrier and was of the same type observed, closer to the street, on my earlier visit. The pipe was clearly located beneath the grass strip described earlier and matched its orientation, pointing towards your drain field. I collected a sample of the liquid flowing from the pipe. Laboratory analysis of the sample indicated the presence of fecal coliform bacteria, a commonly used indicator of the presence of septic effluent. The Municipal Wastewater Code, Anchorage Municipal Code (AMC) Chapter 15.65, outlines public health standards for private wastewater systems within the Municipality of Anchorage. 15.65.020.A states that "No person may cause or permit any wastewater to be discharged or disposed of except into an on-site wastewater disposal system conforming to the standards of this chapter..." The sub surface drain improperly located too close to your drain field appears to be receiving wastewater from the drain field in violation of municipal code. AMC 15.65.60.A.I.c requires that septic drain fields are located: "Fifty feet upgradient or 20 feet downgradient from any portion of a subsurface drain " Item "c" of this same section requires that septic drain fields are located ten feet from property lines. My observations from the property line suggest that your system fails to meet the required setback distance. In order resolve this matter and in bring your property into compliance with AMC 15.65.60, DHHS requests that you take the following actions: 1 . Remove or relocate the sub surface drain you constructed on your property so that it meets the standards outlined in AMC 15.65.60.A.l.c. 2. Produce verifiable evidence demonstrating that your septic drain field meets the all required separation distances outlined in AMC 15.65.60.A. If it is determined that your drain field does not meet the required property line setbacks it will be necessary for you to obtain a waiver from the Municipal On Site Water and Wastewater Department. 3. Bring your property in compliance with AMC 15.65 as soon as possible but no later than 21 days from the receipt of this letter. Thank you for your prompt attention to this problem. For your information, departmental procedure in the event of non -response to a Notice of Violation is to pursue legal action. Therefore, please contact this department at 343-4759 with questions or concerns upon receipt of this notice, as we would like to assist you to the greatest extent possible. Sincerely, Jeffrey Urbanus Environmental Specialist cc. Dan Roth, Supervisor, On Site Water and Wastewater Program / I MUNICIPALITY OF ANCHORAGE �N Dl� RTMENT OF HEALTH AND HUMAN SERv,%;ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Ln4cuc'b'Dn �0- SEPTIC ABSORPTION WELL X -95-2—q kK q& TANK FIELD Phones) Perim No. of Bed WELL I I o' 715__Z�31 I 8_'I"0'00�1 1 7s�� LEGAL DFSCRIPTION LOT LINE lock Subdivision r) FOUNDATION Township, Range, Section I Or I -K lt\4 AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, TANKS driveway, ater bodies, etc.) VSEPTIC HOLDING Manufacturer Capacity in gallons -0 A ne-konn-o c I /�_6 0A I Material No. of TYPE OF SYSTEM []TRENCH [Li"BED [I W. DRAIN El OTHER Depth to pipe bottom from Total depth from original grade original grade FT Z -0' FT Fill added above original grade Gravel depth beneath pipe V2?InFT O -S FT Gravel length /-/3 FT Gravel width FT Total absorption area Distance between lines 17.01 So FTJ Number of lines _]�� I Pipe material FT I jqi-I SO FT I A-�)TM F 810 I nsJa I I e r I Date Installed WELLS EZ��RIVATE El OTHER (Identifv) Classification (A,B,C) Total Depth FTJ Cased to FT Installei I Date installed. REMARKS: I -L A U 0.1/kir Scale: ( N T_�> ) ENGIN - EER'S SEAL 't/y� ko rl�v Fill Inspec4QaLEgdorffied by: U IN LnAkAm caur I olaok� "lle fgi 6�5-riq _�wq 1 Date. _dbna E �4 U* -Q, ven-wA. Eq'd NB? cerlil that this inspection was performed according to all litic"liz Municipal and State guidelines in effect an this date: �7- '2-S 1-7 % J. C -'1v.';;1 Health Department Approval: Date. I pol 1-1 phi X [IF::., -.1"TE 11-- :1 , 1,11- �� V. �i 11-'.'3� / DEPARTMENT OF HEALTH AND E.VIRONMENTAL PROTECTI8N 825 L STREET, ANCHORAK 99501 264-4720 WN41_~40 11 -F-101 lot FEE Will BE-%. 11:::�Z 1F��1W1 X W PERMIT NO: 8700O7 DATE ISSUED: 01/02/87 APPLICANT: T&D CONST. CO. ADDRESS: BOX 2524 PALMER, AK 41. ' CONTACT PHONE: 745~2731 LEGAL DESCRIP: SU8DIVISIQN: SAMPSON ESTATES LOT: 16 BLOCK: 4 � SECTION: 3 TOWNSHIP: 15N RANGE: 1W " LOT SIZE: 40000 (SQ,FT. OR ACRES) MAX BEDROOMS: 4 Listed below are the options available to in designing septic you your system. Choose the option that best fits your site, .... .... .... ��..... ... ... ..... 13 R'DSAil/ �o1 ' DEPTH T13 PIPE BOTTOM (FIT. 1.5 ** �/��o� /"��'o,��u��alke-fl'e=^ GRAVEL DEPTH (FT.) 0.5 ��X �!^. �� _ . T[[[�AL DEP^!^H (FT ) 2 0 � � ' '/ ` GRAVEL WIDTH (FT,) 25,0 GRAVEL LENGTH (FT.> 48'0 GRAVEL VOLUME (CU"YDS,} 44.5 TANK SIZE 1.GALS>1 SOIL RATING (SQ.FT./BR) 250^ O ** ' ��/�4�^� ��eyr��m�� 197 '=- ° �� ** DEPTH TO PIPE BOTTOM < 2,8 FT. REQUIRES ADDITIONAL GROUND COVER W DEPTH TO PIPE BOTTOM < 3,5 FT, REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certi/y that: 1. I am 1amiliar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State o{ 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 - ot,understad u! 1 Stmulthat this permit is valid for a maximum of 4 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 BE OBTAINED; (2) AS`BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE 'ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. �..... .... � APPLICANT: T&D CONST CO ISSUED BY DATE: A January 10, 1986 TO: Permit Applicant P.O. BOX 6650 ANCHORAGE, ALASKA 0-9502-0650 (90711264-41111 T ONY K,% -C- WL E S. DEPARTMENT OF HEALTH & HUMAN SERVICES Subject: Permit #850198 Lot 16 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, gdt�-_� &L4.'V_t� Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit ,* ^^ .......... '1� 11 If DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET� ANCHO AGE, AK 99501 �/' D 264�4720 � �� PERMIT NO: 85O198 DATEISSUED: ` APPLICANT: SKAGGS CONSTRUCTI�N ADDRESS: P O BOX 67069O - CHU8IAK, AK 99567 CONTAC� PHONE: 688�2831 / LEGAL SUBDIVISION: SAMPSON Liz: r. ESTATES LOT: 16 BLOCK: 4 SECTION: 3 TOWNSHIP: 15N RANGE: 1W LOT SIZE: 40891 (SQ,FT. OR ACRES) .LOT LOCATION: PHAROAH CIRCLE ' MAX BEDROOMS: if ` Listed below are the options ays,ilable to you in designing your septic system" Choose the option that best �its site. your �..... ..... ... ��.... ..... ... ..... .... .....^��~��~ DEPTH TO PIPE BOTTOM GRAVEL DEPTH (FT.) 0.5 TOTAL DEPTH <FT,> 2.5 GRAVEL WIDTH GRAVEL LENGTH GRAVEL VOLUME (CU.YDS,) 40"O TANK SIZE (GALS) 1250,n ** ` SOIL RATING <SQ,FT,/BR) 177 ** DEPTH TO PIPE G0TTOM< REQUIRES INSULATI8N �* DEPTH.TD PIPE BOTTOM < 4"0 FT. MAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certi{y that: 1, I am {amiliar with the requirements {rr on-site sewers and wells as set �orth by the Municipality o{ Anchorage (MnA) a�d the State o� Alaska. 2. I will inst�all the system in acco�dance wi+h all MOA codes and re�ulations, and in compliance with the design criteria o� this permit, 3. I will adhere to all.MOA a�d State o� Alaska requirements {or the se�back distances �rom any existing well� wastewater disposal system or �blic seweragesystem on ��s or �ny ad�acent or nearby Iot. 4. I understand that this per�it is valid �or a maximum o| 4 bedrooms and any enlargem�ni will require an additional permit. IF A LIFT STATION IS INSTALLEI� I� AN AREA COVERED BY MOA BUILDING �mODES: THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS~BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL �INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN` SIGNED DATr. ...... ..... __............ -.... ... ' ...... wa APPLICANT: SKAGG��ONSTRU��N ISSUED �-��...... .... .... �- ----�`~...... Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "U'Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Al R (,16 DATE PER LEGAL OESCR(PTION: Township, Range, Section: SLOPE LO+ Wo block brown rqj<j. V ---d wp�ii- 2- BOIS, 31 bzft�--sA; W&4 q 6,j( �1 66"%J� qr6v-p-f to eo B e J. Convin 0. CE 8 T WOO/ ". Z --'t -F h - AD I-- -, r� I 1 11 1 1 1 1 1 1 WASGROUNDWATER ENCOUNTERED? L IF YES. AT WHAT 8t 0 DEPTH? P E Depth to Water After Monitoring? Cate: 4� A Reading Date Gross Time Net Time Depth to Water Net Drop NfiC%F. No ]:;V� /1:33 /QMtq 1�o . qg 1V 1,3:� I.q5 &0 . T1 .09 / Ll- / 1:5- 3 .60 .:5'1 .09 41 1.53/,7 o3 �'o .57 '01 5' 2:45 3 Az / 3 10c) .:5-1 .0q ;Z:/3/2.`*/q PERCOLATIONRATE (mmutes/mCh) PERC HOLE DIAMETER TEST RUN BETWEEN FT 0 FT 64 6640rw COMMENTS 3:-.nZ I I ) L�r I `!� �A Vr' Ll .1 A k0u. RPCO'A"I�JJ '!4A< PERFORMED BY. (4ttv'a ACCORDANCE W(TH ALL SI ATE AND MUNICIPAL GU(DEL(NE); I I/ 72-008 (Rev. 4,85) =— �CE I�y THAT TH�� TESTYVAS PERFORMED IN THISDATC. DATE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: �iw 0 Co W t;,T VU c -r t v �,l DATE PERFORMED: 5-4-95 LEGAL DESCRIPTION: T (3 4— SLOPE T) 2 3 4 6 8 9 10 11 12 13 - 14-1 15 4 16 - AW 17 18 io 19 20- .21,4- 1 67M LI(J& 9(2wW (4m-meo SRoM 6-7 pley - 1-4 3, Corwin 4Q F WAS GROUND WATER S ENCOUNTERED? L U P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop ge IL4 i ki e5b 's & 0 o(a PERCOLATION RATE TEST RL4,N BETWEEN -(minutes/inch) FTAND 0 FT I—. - . I - — COMMENTS V_,A�ttltl 0 /*7 2_ V-ecommalo oa) -tiy5vA PERFORMED BY: CERTIFIED BY: 72-008 (6/79) le TE: I �e < C,2 p - C0 =I 0 C%l 0 0 0 r. if, CD x 0 c; a: w LU U) w 0) CY) 05 00 CD W� LT. WA LT. W "A W �k W. L', MUN@CIPAEITY. OF ANCHORAI -1 a C) 0 0 0 0 DE�J, OF'HErH 4C --4 - EN �L TE F F� f F� EIMRO P 90� A I RLCIEIVEID ;.T. �T. fl: j on: a.) i u -I C) q: I 4J o Ln NI tc., Jd: Ali: P-1 klA z 0 Z 0 z c) z 9z Q u �4 W� LT. WA LT. W "A W �k W. L', MUN@CIPAEITY. OF ANCHORAI -1 a C) 0 0 0 0 DE�J, OF'HErH 4C --4 - EN �L TE F F� f F� EIMRO P 90� A I RLCIEIVEID ;.T. �T. fl: j on: a.) i q: I 4J o Ln NI tc., z Iz 0 Gn 0 Z rn Z �z w �:: m �z W� LT. WA LT. W "A W �k W. L', MUN@CIPAEITY. OF ANCHORAI -1 a C) 0 0 0 0 DE�J, OF'HErH 4C --4 - EN �L TE F F� f F� EIMRO P 90� A I RLCIEIVEID ;.T. �T. ILI QZ- Cl) z 4 0 fo a.) i 4J v): In: cni c):: (D . . . . . . . . . . . . 0 . . 0 . . 0 . . 0 . . 0 . . 0 E4 F� F4 F� F4 �4 F4 F4 F"' z 0 c): ("I vo: m: co: (-4: 0 0 0 0 0 0 0 0 0 0 0 W 94 9 W:9 9 9 z ILI QZ- Cl) z 4 0 fo MUNICIPALITY OF ANCHORAGE DEPARTM..,iT OF HEALTH AND ENVIRONMENTAL P,.jTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL kjq�_ go Ing OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date/,5- Fokhr 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 'Lot 1(0 T/f F Location Laddress or directions) Yv�ok _&re (b) Applicant Name aoft4rtAorl Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution 11 ;-Owner/builderl]21..:",BuyerEI OtherO (explain); (d) Lending Institution Telephone Address L: (e) Real Estate Company and Agent x 7 Address ........ �_; A telephone 's!h . . .... (f) Mail the HAA to the following addr ess: Call [,6_Uoa :04 �J� f 0 A . "�",i __0 'j'�i J" -ill' j A. 2. .;TYPE OF RESI DENPE :'Sindle-Family E?'mu-' e ...... Iti-Family El Oth' -Numberof Bedrooms % . gW&�,R XM 3. WATER SUPPLY Individual' Well jf Community Public g N rA ote: If comm unity well system, must have written conf irmation from the State Departrright.of Environmental Conso ation attesting to the leg tatus..,'- ality a nd s 'SEWAGE DISPOSAL' Onsite 61_�Fublic Community Holding Tan k Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE s� Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Parcel ID 051 -811-21 Certificate of On -Site Systems Approval OSC251306 Expiration Date: 6/17/2026 Legal description SAMPSON ESTATES BLK 4 LT 16 Site address 22410 PHARAOH CIR Current property owner(s) PLATT BRADLEY R& CHRISTINE K X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments By: Original Certificate Date: 8/15/2025 Thisfiertificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject sy em(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department 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. 051-811-21 Complete legal description SAMPSON ESTATES; BLOCK 4, LOT 16 Location (site address) 22410 PHAROAH CIRCLE, CHUGIAK, AK Current property owner(s) BRAD PLATT Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: FE Private Well serving #_ dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: � Private Septic [__1 Private Septic serving 2 dwelling units R Holding Tank El Community Septic or Public Sewer 5. SEPTIC TANK: R Steel EJ Plastic RE Concrete [I Fiberglass Age NEW - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: 1*0 AWWTS X Bed n Deep Trench n Wide Trench 0 Seepage Pit Waiver request for: Distance: Expedited review requested: D 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 $ Waiver Fee $ Date of Payment 712';I',;.f Date of Payment COSA # Waiver # COSA Applicalion_Apr2025.doc COSA Checklist Legal Description: SAMPSON ESTATES; BLOCK 4, LOT 16 Parcel ID: 051-811-21 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA FEI Well log is filed with Onsite (or attached) Well production at time of test 4.5 grim Date drilled 4/27/1985 Total depth 160 ft Water storage tank volume 0 gallons Cased to 160 ft Well disinfected for coliform test? ❑ Yes ON Nc M Sanitary seal is functioning correctly M Coliform bacteria is Negative FM Wires are properly protected Nitrate `~ 4Q mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) 18+ in. Arsenic ug/L 'Arsenic less than MRL (ND) Date of flow test for COSA 6/17/2025 Collected by GEG, LTD. Static water level at beginning of test 120.6 ft. Date 6/17/2025 Comments *WIRES IN CONDUIT TO®WELL ENCLOSURE. SEE ATTACHED PHOTOS. B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW n Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/5/2025 n ALL standpipes present per record drawing Total measured depth from grade 3.9 ft (max) Measured depth to pipe invert from grade 3.0 ft (min) ❑ N/A — pressurized field. n Per record drawings, field is insulated. 0 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) N/A If yes, enter date Comments/Deficiencies: DRAINFIELD WAS REBUILT. COSA Checklist June 2022 C. LIFT STATION H Required maintenance completed Age of lift station NEW years Lift station material CONCRETE Comments: Adequacy test date NEW Results 0 Pass Fluid depth prior to test NEW in Water added NEW gal New fluid depth NEW in Elapsed time NEW min Final fluid depth NEW in Absorption rate 600+ grid FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 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' Q Yes *50'+ Community Sewer Manhole/Cleanout > 100' -1 ❑Yes if No ft FE Yes if No ft Neighboring Tank > 100' ■❑ Yes if No ft Private Sewer/Septic Line > 25' E Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *50'+ ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft ❑i Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft ❑ 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' Q Yes if No ft Surface Water > 100' [:]Yes if No *50'+ ft Tank to Property Line > 5' ❑i Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No *51+ ft Private Wells > 100' ❑ Yes if No *50'+ ft Water Main > 10' ro-1 Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *FOR AWWTS. 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 Garness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 #ZE 8 84 -11 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Day of aCTUALYL of 20 S4 by and between lei A- ri-1 W -L— herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as _ 0L4CLr-)1G5 Nero CeM located at (legal description) TA 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) hrThroughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 P Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's A W WTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of .Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: (signature) Date: "10 Apliy4 -n m o4 ex— (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The forcgoing instruln nt was acknowledged before me this. day of Cr k4aer 20'd�'., 1 r NOTARY PUBLIC rOR LASKA C. M Commission expires: Notary Public State of -Alaska My Commisslon Expires Jul 18, 2026 (signature) Date: V ;print name) Title: (rev. 05/18/2018) Page 3 of 3 TREE RESIDENCE ELEC. PANEL CONTROL SEPTICGA S TWO STORY HOUSE LEGEND UTILITY PEDESTAL DECK CONCRETE PADMOUNTED TRANSFORMER EDGE OF ASPHALT RECORD DATA PER PLAT #84-10 SEPTIC PIPE WELL SEPTIC TANK LID TIMBERLINE SURVEYING AND MAPPING 17035 BARONOFF AVE EAGLE RIVER, AK 99577 907-242-5320 ryan@timberlinealaska.com FILE NO.: 25.043 SCALE: 1" = 30 FEET DATE: 7/14/2025 SHEET: 1 of 1 MOA GRID: NW1580 SCALE: 1" = 30 FEET(11"x17") 30'0' 60' AS-BUILT OF: ADDRESS: 22410 PHARAOH CIR, CHUGIAK, AK LOCATED IN: ANCHORAGE RECORDING DISTRICT LOT 16, BLOCK 4SAMPSON ESTATESPLAT #84-10 ENGINEERING FIRM PROVIDII 'INSPECTIONS, TESTS, FILE SEARCH, D AND INFORMATION As certified by myseal affixed hereto and as of thevalidation dateshown below, I verifythat my investigation of this Health Authority Approval shows thattheon-site watersupply and/or wastewater disposal system is safe, functional and adequate oms and type of structure indicated herein. I further verify that based on the information obtained for the number of bedro -site water supply and/or from the Municipality of Anchorage files and from my investigation and inspection, the on wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this �Mpection. (0 of Firm Telephone Name d. Ak 1 And I YZ, Address Date r LLn-r 11 1 q87 A Brt J. C0,11F n Engineer's Seal cz-5233 t fP i� , la Af, .�6_ DHEP APPROVAL Approved for bedrooms by Date zl� r _LR Approved 42s� Disapproved Conditional - A Terms of Conditional Approval JV2312 14d141irj?)P?d1 4.11 _rb L, I&Zlej 10LYA1 7-,',Okl .0ke0_ a -T- 77�-A e CIA CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations 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 requirements. 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. Page 2 of 2 514 4 jA 72-025 (11184) MUNICIPALITY OF ANCHOZAGE MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMEWAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 FE13 2 6 1987 264-4720 Legal Description: RECEIVED A. WELL DATA Well Classification Pr�xfa� If A, B, C, D.E.C. Approved (Y/N) /VA Well Log Present (Y/N) 4.0-5 Date completed - 4 - 4-7 - 6.5 *_ Yield Q PIVI Total Depth 1160 1 Cased to 1&01 k' Depth of Grouting NA. Static Water Level /090, + Pump Set At /620' I Casing Height Above Ground Sanitary Seal on Casing (Y/N) q P's Electrical Wiring in Conduit (Y/N) � IC6 — Depression Around Wellhead (Y/N) A Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line 1q /A To Nearest Public Sewer Cleanout/Man hole LA: To Nearest Sewer Service Line on Lot A /A Water Sample Collected by unt ahl_ Date _6)y )�a_b((ko I L I rq Water Sample Test Results or AV' '4& or Comments Fror', W I 1'a ff" f) Dc 1. rk B. SEPTIC/HOLDING TANK DATA Date I nstal led 10 Size 1ATQqa1Lo No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) --- "S Depression over Tank (Y/N) A Date Last Pumped _C�3_ 87L�_ Pumping/Maintenance Contract on File (Y/N) IV A, for Holding Tank High -Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Suppiy Well I I C), To Building Foundation To Property Line — .5:y 1 To Disposal Field — To Water Main/Service Line 14 n I To Stream, Pond, Lake, or Major Drainage C)6 Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1 /64 Type of System Design 6d Date Installed Q� 3 p7AO ruaE�4 9 B 2— Length of Field Width of Field cl� Depth of Field 10 Gravel Bed Thickness Square Feet of Absorption Area I;oq Standpipes Present (Y/N) V iz�c) Depression over Field (Y/N) J� 0 Date of Last Adequacy Test 4-A Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well ( G� I To Property Line To Building Foundation iu To Existing or Abandoned System on Lot A ; On Adjoining Lots No, To Water Main/Service Line A To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments nL �:T P -A n i n r (i q '7 D. LIFT STATION Date Atalled Size in Ga% �ns s L "Pump On Lev High Water Alarm Lev Tested for Electrical Codes (Y/N) Comments______� — Dimensions Manhole/Agc� �(YIN)_ 0 ff" Level at Vent (Y/N) Pumping Cycles duri Check P64itted Becftom Rating Against HAA Request Meets MOA I certify t�btj,;.,Yavoc.he�gVe/verified, or conformed to al I MOA and HAAguidelines in effect on the date of this inspection. Signed Date 6641uarv, Comp y I/A MOA No. FF86� —2-ve-n Receipt No. '-2 Or' 0 C2 0 Date of Payment 9 �2_ J- 7 C" Amount: $ .40 0 _� Page 2 of 2 72-026 (11/84) J. Cor, C-----283 Engineer's Sea]