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HomeMy WebLinkAboutSAMPSON ESTATES BLK 4 LT 18Sampson Estates Block 4 Lot 18 #051-811-23 Municipality of Anchorage ' '° ;• Development Services Department - �i Building Safety Division .. .. Onsite Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 2 www.cLanchorage.sk.us (907) 3437904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW070294 PID Number. 051-811-23 70B AND LETTIE DEVEREAUX Wastewater System: ❑ New ® Upgrade Aft"s 22421 PHARAOH CIR. ABSORPTION FIELD Peaty liumbar Of Bod p O DW Twrlh D Sn.no. T.wrh R Bad 0 Mesad 0 oaw LEGAL DESCRIPTION 804 R&rp Total Depth eom on" grade O.5 GPaFP 0 Ft. ll c Lel &66",m DoM N ppe boli m can orpno ana Greve) depm GxNalh ppe 4 18 SAMPSON ESTATES -0.5 Fl. 0.5 FI ToWWp Rm" •sawn Fe sand Wove org" pages Gray& Lerpm 15N 1W 3 3.3.5 Fl. 81 Fl. Well: ❑ New ❑ Upgrade or" Ha Qf toes aWnc. bx..W s.Ne 15 Fl. 3 3.8 FL CNe&M1cebon lPm&e, A B. CA Taal DOM Cod N Tour Wean love PaN mat" PUBLIC WATER Ft. FL 1215 Ff ASTM -3034 Da Date ON Si&w W&x Lev4 "loot "a MlW W FL GUARANTEED SERVICES 12R/2007 TNd Perry s& . ca•w HxptN Above Gro,ad TANK GPM Fl. FL SEPARATION DISTANCES ❑ septic ❑ Holding O S.T.E.P. ❑ Other. To Septic Absorption LM Holding lublWPrtvate 'a'•" b From Tank Field Station Tank Sewer Line ANCHORAGE TANK 1500 Gr "'e' - - - - - Metww STEEL raarder a Compal * 3 S'e.w&w +100' +100' - - LIFT STATION La La» +5' +10' - - Ke 250 c& ORENCO Fdad&wn +5' +10' — — 'Pury oW is,* & 46 'P. Off ver & 42 Hpl wnx &xm & 47 n In ti Culrn Dran +,ry��/f�f ' 4T — — Pare Make A Model EN h,pacbory tp a by OSI.05-20-HFF RISING SON ELECTRIC Ft~s FIELD PERCOLATION TEST CONDUCTED TO VERIFY SOIL BENCH MARK CONDITIONS DURING CONSTRUCTION. Lotalwn wd do p SLAB BY GARAGE SIDE DOOR TOPSOIL, AND SEEDING TO BE COMPLETED BY JUNE IST 2008. Nvawn 100.00 FL INTER CONDTIONS PREVENTED VEGETATION AT THE IME OF CONSTRUCTION. Inspections performed by: ERES Dates: 1" 1216/2007 2ere 121712007 Developmen Services Department Approval Conditional Approval Date: PZ - 13 -QR e CHRISTOPHER R W00 �' , p D/J poi( / r S %ne A 7 010 i �o �� G��t� u'f �iikCE:1038TC4i 0ESSiIJNP�OP Reviewed and approved by: Date: v or f v Eagle River Engineering Services Christopher R. Wood, P.E. PO box 773664 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax July 15, 2008 Jeff Poet MOA Development Services Department On -Site Water and Wastewater Program 4700 Elmore St. Dear Mr. Poet, Sampson Estates Block 4 Lot 18 has been top -soiled and seeded as required and is now complete. Thank you for choosing us to help you with your project, and feel free to call us with any questions at 694-5195. Sincerely, EAGLE RIV E 7;VICES Christopher R. Wood, P.E. Permit No. SW070294 Page 2 of 2 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT ON—SITE WATER & WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6650 On—Site Wastewater Disposal System and/or Well Inspection Report Legol Description: SAMPSON ESTATES LOT 18 BLOCK 4 051-811-23 LOT 18 o — CLEANOUT -� - WELL • - MONITOR TUBE \�Oc \�nqy ASA ARA R \ SUMED ELEVATION - 100' ELEVATIONS \ (NOT To SCALE) ORIGINAL GROUT MT -1 FILL MT -2 TANK - - - 1,SOOEGAL2' , SAND • •"• 111.9 BOTTOM OF T.H. SCALE V-40' LOT 20 71 SEAL ••. CHRIS CE-1038i CE-10 �,'••• 387 � �G TDO � PROFESS ��O�000�o EAGLE RIVER ENGINEERING 10421 VFW RD, SUITE 201 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 SOILS LOG - PERCOLATION TEST PERFORMED FOR: BOB DEVEREUAX DATE PERFORMED 12/6/2007 LEGAL DESCRIPTION: SAMPSON ESTATESB 0 K 4 LOT 18 DEPTH FIELD PERC SLOPE (FEET) r- 7�7 4 7 10 11 12 13 14 le 17 I$ 19 20 21 TOPSOIL/ORGANICS OF 4 h.'w E5SIG1 N: TOWNSHIP RANGE SECTION T15N, RlW, SEC.3 SEE SITE PLAN PERC TEST RESULTS READING • 1 2 3 4 5 6 7 GROSS TIME 10:00 10:30 11:01 11:31 W06/ 11:11 11:41 NETTIME 0:00 0:30 0:00 0:30 0:00 0:30 DEPTH TO WATER 2 6 318 2 9 3/16 2 6 3/8 2 9 1/4 2 6 316 2 9 1/4 NET DROP(IN) 0 3 3/4 0 311/16 p 311/18 tKCOLA 11ON RATE- 8 (MINNCH) PERC HOLE DIAMETER -6" COMMENTS: FIELD PERCOLATION TEST *PERC HQLE PRESOAKED 4 HOURS PRIOR TO TEST SOIL LC %�H STOPHER W00Q PERCOLATION TEST BY: CHRISTOPHER WOOD I �" " CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: )Z 9 MUNICIPALITY OF ANCHORAGE 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: SW070294 Legal Description: SAMPSON ESTATES BLK 4 LT 18 Design Engineer: 0848 EAGLE RIVER ENGINEERING SEI Owner Name: LETTIE & BOB DEVEREAUX Owner Address: P O BOX 670517 CHUGIAK . AK 99567-0517 Date Issued: Oct 26, 2007 Expiration Date: Oct 25, 2008 Parcel ID: 051-811-23 Site Address: 022421 PHARAOH CIR Lot Size: 40921 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: Q Disposal Field ❑,/ Septic Tank 0 Holding Tank E] 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 dosed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THE ENTIRE SUBSURFACE DISPOSAL FIELD IS NOT WITHIN A 30 FOOT RADIUS OF A PERCOLATION TEST. THE ENGINEER NEEDS TO DO AN ADDITIONAL PERCOLATION TEST PRIOR TO THE CONSTRUCTION OF THE SEPTIC FIELD. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE AS -BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE SYSTEM WILL STOP PENDING ONSITE REVIEW AND APPROVAL. Received By: 42� Date: fO /2 q A) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. n Si - B I I- A3 Property owner(s) 1 g-44 t- E Bob N%/-tr-eaLSlc Day phone f -J'0 Mailing address P0. f3ox (o'/0S/-1 CAS:40 k- . Ay— Zip Code9°5^T Site address P-ol- 4,P, I 10.'fiartr 0 C.i✓'GCc_ Zip Code qqs (n'1 Legal description (Sub'd, Block & Lot) mel*,-) cry CS-fn4c'& 1-19' Q Legal description (Township, Section & Range) T/5 n/ .mc- 3 R /vt1 Lot Size 901 9 A/ Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 'F THIS APPLICATION IS AN: Initial ❑ / Upgrade Q' Renewal ❑ certify that the above information is correct. I further certify that this application is being made for a Single Fames Dyaeliog and is In accordance with applicable Municipal Codes. (Signature of property owner dr authorized agent) Date of Payment: Date of Payment: Receipt Number: 0100/ Receipt Number: (Rev. 11/05) Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW RD. Suite 201(9o7) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax October 11, 2007 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Sampson Estates Lot 18 Block 4 Septic System Upgrade Narrative and Permit Application Dear Mr. Roth: Eagle River Engineering Services (ERES) was contracted to design a septic system upgrade at the above referenced property. The existing septic system backs up frequently and is in a surcharged state. A test hole and soils percolation test has revealed silty sand to a depth of 4' and tight silty GM to a depth of 10 feet, with no evidence of a water table. We propose to install a new bed system based on a soils percolation rate of 10 minutes per inch. We will elevate the bed with 2' of filter sand to keep the system as shallow as possible. We believe the installation of this new septic tank and leachfield will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are all large, so this lot and neighboring lots have room for septic systems and alternate sites. 2. Immediate neighboring septic systems are all +30' distance, and no private (or community) wells within 200' of the proposed septic system. 3. This permit is for a septic system only. 4. Drainage will not be affected and is not a major consideration in our design. 5. Slopes are less than 25% in the area of, and adjacent to the proposed septic site. Installation of the septic system upgrade on this lot will not adversely affect the septic systems or reserve areas on adjacent lots. If you have any questions please call our office at 694-5195. Sincerely, EAGLE RI • ENG C R G •RVICES Christopher R. Wood, P.E. Principal \2003%07-105 SEPTICNARRATI V ELETTER ,r I I II LOT 18 \ S 00, \\`,LOT 17 SEPTIC ARED �i- - TEST HOLE • - MONITOR TUBE C - SEWER CLEAN OUT + - WELL i �� I `\LOT 19 HbUSE /�'i 1 / I / I / 1.25 i i 1 , — — - EASEMENT 1. PROPOSED LEACH FIELD 2. EXISTING LEACH FIELD 43. o - DRNEWAY . CSEP71C AREA/ 280.76' 1 1 I I I I 1 1 0 0 ANAL• LOT 20 �sEPnc WELL SS C+200 S �25sp4"wI nT 24 NO KNOWN SURFACE WATER +100'. NO KNOWN CURTAIN DRAINS NO SEPTICS WITHIN 30' UNLESS NOTED NO WELLS WITHIN 200' UNLESS NOTED WELL/SEPTIC SITE PLAN LEGAL: SAMPSON ESTATES BLOCK 4 LOT 18 OWNER: ROB DEVEREAUX I CONTRACTOR: MARTIN CONSTRUCTION JOB# 07-105 1 DATE:10/4/2007 I SCALE 1 "=50' EACLE RIVER ENGINEERING SERVICES 10421 VFW RD. SUITE#201 EACLE RIVER, AK. 99577 (907) 694-5195 FAX. (907) 694-3297 F O �P s�-## i•. RISTOPHER R. CE -10387 \•:A ►:RC`ESSION � () I''Uw O (NW f�/ Z =] N 1 U-)(C(n \ O N °° Ooo ~ 0000 Z Q �Ooo 000 V Y 1°00 °°•�,'.:r;•` W LLJ 00 O °o w U ooo 000 O Q WO 4' W� U Q Q1W F- 104 oc om 04 U S� oo IJ'° N o t0 t0 �V JJ ,oOO '}'� '. O 000 % W 00 0 .i • , D L� W O F.. OO,W W WU O°Z �VI Z ;OOJ'•.!' 0 0 vl 1���` Z OU W OOZ .y.,. t `. • 2 Q 1 J op co m cc O a = CG W W KF- O 000 0 J m mN W o0 0 ?. ti }Z m Q4 zgz 000 0 :.. .. '• 4.' ' w�.. �U O 000 `,'•;':;:`'. \ Czi W 0 o •. / WHO) O0 O O o°o o IJ W 000 %' 000° .: ; o000-0 ,0°0°°0° :' �• •� !} 0000CL Ot0 I� O O Www z� W CLou Eagle River Engineering Services Christopher R. Wood, P.E. togzt VFW RD Suite tot (9o7) 694-5195 tel Eagle River, AK 99577-3294 (9o7) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM — MOA CERTIFIED INSTALLER LEGAL: Sampson Estates Lot 18 Block 4 October 11, 2007 A. GENERAL 1. The proposed septic upgrade plan is for a 4 bedroom single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Building Safety, On -Site Department, requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. A licensed surveyor should locate any utility easements and exact 100' radius from the existing and neighboring on-site wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test hole excavations shall be filled and monitor tube removed. B. SEPTIC TANK WITH LIFT STATION 1. The septic tank shall be an Anchorage Tank 1,500 gallon septic tank with integral OSI lift station pump model OSI -05-20411 IF 2. A receipt and statement from a LICENSED ELECTRICAL CONTRACTOR shall be provided to the engineer verifying lift station wiring to all applicable codes. C. BED . The bed is to follow the natural land contour to maintain uniform total depth of the bed bottom. 2. The bottom of the bed excavation shall be level, plus or minus 1.5". 3. The bed shall be constructed as follows: excavate approximately 2' to remove all organics and expose the free -draining sand & gravel layer beneath. Install 2' MOA approved filter sand. This sand layer shall remain loose and uncompacted. The top of this sand layer shall be at the original ground surface level. Install 9" of sewer rock above this leveled sand. Place 1" pressurized PVC lines detailed below 6" above the bottom of this gravel layer so that they are covered with 2" of gravel after installation. 4. The effluent lines (3) are to be 1" PVC lines with 1/8" holes drilled 48" OC within the leachfield, placed face down, or up with orifice shields placed over holes. Line from tank to field is to be 1-1/4" IIDPE. 5. The bed gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the bed. Mounded side slopes not to exceed 3:1. 7. The bed shall be covered with 6" topsoil and seed, and is a mandatory part of this design. This work shall be completed before the MOA will "sign off on the inspection documentation. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. \2003\07-105Bcd-lia- spec Continued: LEGAL: Sampson Estates Lot 18 Block 4 RECOMMENDED LEACHFIELD DIMENSIONS BOTTOM OF GRAVEL LAYER = At Grade as measured at monitor tube BOTTOM OF FILTER SAND LAYER= 2.0' Below Grade at monitor tube, or as required to remove all organic topsoil and expose Creodraining soil beneath GRAVEL THICKNESS = 6" under pipe, 2" over pipe (9" total) BED LENGTH= 80' BED WIDTH = 15' SOIL RATING = 0.5 GPD/ft5 BEDROOM CAPACITY = 4 SEPTIC TANK = 1,500 Gal S.T.E.P or Engineer approved equal EFFLUENT PIPE = I" PVC with 1/8" holes oriented down, or up with orifice shields spaced at 8" OC. Twenty-four (24) hours notice required for all inspections Additional Charges will be incurred for the 3 required inspections and preparation of septic system as-builts. Inspections on weekends and evenings after 5:00 PM are double normal rates. \2003W-105Bed-lift- spec EAGLE RIVER ENGINEERING 10421 VFW RD, SUITE 201 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 SOILS LOG - PERCOLATION TEST PERFORMED FOR: BOB DEVEREUAX DATE PERFORMED 10/1/2007 LEGAL DESCRIPTION: SAMPSON ESTATES BLOCK 4 LOT 18 TEST HOLE N 1 SLOPE 1 TOPSOIL/ORGANICS GRAY -TAN SOMEYGRAVEL •.o. CRAY GM TIGHTER WTH DEPTH 11 12 17 GROSS TIME NET TIME DEPTH TO WATER WATER TABLE DATA DATEWATER LEVEL 10/01/2007 NONE 10/11/2007 NONE 0:00 14 18 19 21 TOWNSHIP RANGE SECTION T15N, R1W, SEC.3 SITE PLAN NOT TO SCALE leo x• ®1 �g. �•C M PERC TEST RESULTS READING DATE GROSS TIME NET TIME DEPTH TO WATER NET DROP(IN) 1 10/02/2007 11:17 0:00 2' 4 0 2 10/02/2007 11:47 0:30 2' 7 1/8 3 1/8 3 10/0272007 11:48 700 2' 4 0 4 10/02/2007 12:18 030 2' 7 1/16 3 1/16 5 10/02/2007 12.19 000 2' 4 0 6 10/02/2007 12:49 0:30 2' 7 1/16 3 1/16 PERCOLATION RATE- 10 (MuTrA PERC HOLE DIAMETER -6" IEST RUN BETWEEN7 :N COMMENTSzhEERC HOLE•• OVERNIGHT•' TO TEST PERCOLATION TEST BY: CHRISTOPHER WOOD I &2' -' - CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:bI12 0� EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 07.105 Calculated By: CW Date: 10/112007 Legal: SAMPSON ESTATES B 4 L 18 TEST HOLE 1 3 bedroom single family residence Bed Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 600 gallons Percolation rate = 10 minutes per Inch Wastewater application rate = 0.5 gallons per day per square foot Required absorption area = 1200 square feet Bed width (1N) - 15 feet Gravel depth (D) = 0.5 feet Required length = Required absorption area / Bed width Required length - 1200 / 15 Required length = 80 feet Total Excavation Depth = 2.0 feet 07-105 Bed calc 6:10 PM10/112007 § 2 �■■■■ IS ! B 2(| § H■ § ® K | k « § ¢ k E | ISIS■■ISISMEMO■ �■■■■ IS ■■■ �`■■ t • ■■i■iiiu■i■■■ ■■q■ ■ ■ i H I i� IS ■ ■■ISIS■ ■■NNIS ■ i ■ ■ SME III ■■■�■■■ ■■�� ��i ■ ■■ �No ■WE ISIS ISIS■■ ■ ■MMM1 ME §I M ■■ �■ ■ � ■�■■ ■� ■■�■■■ ` ■ NM� �■ ■� ■� ■■� ■ ISIS■ ISIS■ � ISIS Z ■�_■ ■■� � ■ / ■. ■ ® ■NNIS ■���� ■/ !*ajL) a NoiwGt ! !II I! I !I! k!I s:t-2§■�§§®§&§©§J: k-l�Z�ls£ °]J`§t7�!!23{12��ƒ !°) ��{ ) E CL �� ! `k1 k Ix M R K k ,IIIIIIIII C; W;bi:_::::;; , E7 ■k E § 26� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: ERES Legal description: Sampson Estates, 134 L18 ®Permit ❑C.O.SJL []Inspection Report The attached paperwork has been reviewed and is being returned for the following reasons: 1. How will the sides of the bed be supported? 2. The entire subsurface disposal field Is not within a 30 foot radius of a percolation test. The Engineer needs to do an additional percolation test prior to the construction of the septic field. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. Name of reviewer. Deb Date: 10117/07 LSED�D Please supply the necessary information and re -submit your request LEAVE THIS FORM ATTACHED TO THE PAPERWORK \ \ I 100 VIE• 1 ♦♦ I `, LOT 19 1 / ♦♦ i CIRCLFy� - / ed I ♦ 11 LOT 18 \\\ \ 1LONS HbusE \ s 10C 1 \ 1 \♦ I 3F ♦\ 1 ♦♦ - H - 00, ♦♦ I /' ♦♦.♦LOT 17 1�11Ha C sud SEPTIC ARE - TEST HOLE — — - EASEMENT • - MONITOR TUBE - PROPOSED LEACH FIELD o - SEWER CLEAN OUT _ EXISTING LEACH FIELD + - WELL © _ DRNEWAY WELL/SEPTIC SITE SAMPSO 4 LOT 18 SEPTIC ARES 280.76' t )A TALL Y 1 CAL TANK 1.25 HD / TALL N s'xeo' WELL +200' \\ ` SEPTIC ----- 100 0 1 I I I I 1 1 LOT 20 00 �sEPnc 5-j258�0'"*LOT 24 1. NO KNOWN SURFACE WATER +100'. 2. NO KNOWN CURTAIN DRAINS 3. NO SEPTICS WITHIN 30' UNLESS NOTED 4. NO WELLS WITHIN 200' UNLESS NOTED PLAN OWNER: ROB DEVEREAUX CONTRACTOR: MARTIN CONSTRUCTION JOB 07-105 1 DATE:10/4 2007 I SCALE 1"=50' EAGLE RIVER ENGINEERING SERVICES 10421 VFW RD. SUITE#201 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX.(907) 694-3297 0* :4 %CHRISTOPHER R. WOOD.' O 41 ,p CE -10387 \ 'i 14I �`'ESSION►\' 1w �Ikik �� O J Z U LLJ J O v / O O ct CL O W L1., > w F- LLJ C) N1 Z w a -J�o o LL _ 3- N W J O n O I - I nm V w � Wq�kc) ko C4 r4 � V �• V O �Ow� 0 i_., MUNICIPALITY OF ANCHORAGE , DE iTMENT OF HEALTH AND HUMAN SER\ ES II Environmental Health Division D s 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON—SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES SEPTIC ABSORPTION Address FROM TANK FIELD WELL ao /v< Phone(s) Permit No. No. of Bedrooms WELL /oo ft /Ur p�f-f Lot Block Subdivision Township, Range, Section /sN RIP -V 3 TANKS SEPTIC -le ❑ HOLDING Manufacturer C- r'c e/ Capacity in gallons 1.2.5'o Material No. of Compartments 2. - TYPE OF SYSTEM TYPE ❑ TRENCH BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade 5 FT Total depth from original grade /,$� FT Fill added above original grade 2,0 FT Gravel depth beneath pipe O,$ FT Gravelngth le 60 FTL` Gravel width FT Total absorption area /4W SQ FTJ Distance between lines 6: 0 FT Number of lines Soil rating SQ FT Pipe material Installer CCG Cops rra��r 1 Date Installed ti/�/ z 3 z4 1?8 WELLS PRIVATE ❑ OTHER (Identiliv) Classification (A,B,C) Total Depth FT Cased [o FT Installer Date Installed: REMARKS: / f-%/ f /.S !m2 [ird�rY e_ d z7/ 07/.5 7/ LOT LINE FOUNDATION AS -BUILT DIS driveway, water JI (Show location of well, septic system, property lines, foundation, etc.) n - 0 z Scale: 6%.S SEAL d" -"7r1 we"s Ifo'-? t (vs^tlle07 Inspections Performed by: ! O A ` ®i /1/%N. CO✓C/O/e/ "/fl/S�/a�io� '3,® i Date: r C? ' • I' a%*V o1e`o4A ri7�vt. 3.5'-*, Z/4 A241sr,( 2,7,r' TH $c __,h �.-.6 _j rm..,�.:� /.-:.e ��jy /ot,�r / •se ooyax • to so.r•a.. Municipal and State guidelines in elle 1 on this date: �s Health Department Approval: 72-013 (3/85) .'Zw� . �fJ[�P�-OI�N/' �%XC�f' �• ��3�. 0 04 • "Yd•s . Ti _ certify that this inspection was performed according to all Q� � ;� Dale R. M rrell 30 !`/� Jam• No. 2055-E Foo•,••••..•.... •,f C Date: u c7,. OFEGSS� r fi MUNICIPALITY OF ANCHORAGE Department o{ Health & Human Services 825L Street� Anchorage, Alaska 99501 343-4720 ON~SITE SEWER PERMIT Permit Number: 870183 Upgrade 11dw4P-1,77eK4 Date lssued: 07/24/87 Engineer Designed Owner Name: ROBERT DEVEROUX Day Phone: Owner Address: PO BOX 670517 688A9170 CHUGIAK, AK 99567 Parcel Id: 051-811-23 Lot Legal: Subdivision: SAMPSON EST" Lot: 18 Block: 4 Section: 3 Townshifs: 15N Range: 1W Lot Size 1.75 A (sq.{t. or acres) Max Bedrooms: This Permit: 4 Total Capacity: 4 I CERTIFY THAT: 1. I am {amiliar with sewers and wells as set �orth by the Municipality of Anchorage (MOA) and the State of Alaska, 2. I will install the system in accordance with all MOA codes and re�ulations� and in compliance with the design criteria o[ this Permit^ 3. I will adhere to all MOA and State oi laska requirements for the seL back distances Him any exisring well, wastewater disposal system or public sewerage system on this or any adjacenor nearby lot. 4. 1 understand that this permit is valid for a maximum of 4 bedrooms. I a1so understand that the capacity oi the total system is 4 bedrooms and any enlargement will require an ad�itional permit. ��� --------- - .. .... - ..`������-� (Owner> R08ERT DEVLot OUX Issued By: DATE: -... ..... .... -~-- ___ rMUNICIPALITY OF ANCHORAGE Department = Health and Environmenta- rotection Pouch 6-650, Anchorage, AK 99502 264- 4744 On-site Sewer/ Permit 4�Y_A_�_ HANDWRITTEN �� Permit No: Date Issued: 7 9_�/(9/ Applicant: Y_049&&T r4,1CV4P"V, Address: 4A 670.-07 j!fA&o41 mak o,� �lCcrli% Legal Description: S/D 10/V7i9�8.S Lot: f8 Block: Section: 3 Township:. l�N Range: Lot Size: �, "4 ae_, (Sq. Ft. or Acres) Lot Location: 16e,44OAtJy�QC�G Max Bedrooms: 4— Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. ------------------------------------------------- --------------------------- TRENCH BED,(' W. DRAIN Depth to pipe bottom (f t.) Gravel depth (ft.) 4C 14 �. 7`lk/C a�7/aCsliC / Total depth (ft.) -eov w"A__ clex; ygwe,,'l Gravel width (ft.) Gv Gravel length (ft.) Tank size (gal.) Soil rating (sq. ft./br) ** Gravel length 75 feet requires multiple runs (not exceeding 75 feet each) ** Tank must have at least two compartments ---------------------------------------------------------------------------- I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage(MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for the maximum number of bedrooms stated above, and any enlargement or modification 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 ELECTRICALRK MUST BE DONE BY A ICENSED ELECTRICIAN. SIGNED: DATE: `y Applica t ISSUED BY• DATE: 02 SWP/024 rev.1/85 N N N N N N .o a f a 10-v 00 0 e 17 � Am ✓r / /` r`a. �f'%O P/ed117 dl�rff i G fro;,-e--ea-LIsAr� Gf-Aenp-e �oi�S GvyG/ lPon, ?-� f z ZS sy 1pGr &G. 'Pvoru r� Ate, www ow www 000 �N w N � 17 N N N N N N RVrD r g� OV!gfplea 6-00N0 < 7 moi- -RA^-P 1,14 61-2 /AU5- -H vooj �i--. is ri% /.. „�/ ii ,i. /�J ii !r !-,'�✓, r-- �_�I set � __•�� 7Zf e-1 vwfroa� 1'7, 2r/-,- fva s is o�� �1 0/ /u �le-�%c- �? • c5�! %G-rr��- a -55, /-/eq ` OF 4k � Ae4 °°sw.•°e ``T • Irk f 14 i C^ Dale P. errell ✓'a awe a � I 61I w W�m I ! ► i moo i I Ci -a Q PP I° ° C4N C4 tiN I � E � 0 � I I 1 C7- L I 6 r� irj i I w n, y? °O+en $a aaxaxae 0>c y�CD� �1 r 0 e ��saa a eas>a onesa• s �� `1 C c eo >oe e > c • �� � '{� 71Vi� /.� E? �� o> Dale ^.e PftFFSSIOhF i r-� Municipality of Anchorage 101. K DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 0 D SOILS LOG — PERCOLATION TEST c,F •' PERFORMED FOR: 1`d�U 3� « 7� PERFORMED: DATE PERFORMED: LEGAL DESCRIPTION: ���14 6�a/� ��Rtil7SOit U Township, Range, Section: DEPTH (FEET)v:t�*'....1�'A',f.J 1 2 4— 5 F D, Is Net Drop �At 0 ■■■■..■NMEMENEENI 7 l ' t 8 n 9 D v 10'- 12 13 14 15 16 17 18 19 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED?�i S IF YES, AT WHATL DEPTH? O PP E Depth to Water Atter o / ryry��,, Monitoring? /� Date: /b7 Reading Date Gross Time Net Time Depth to Water Net Drop �At 0 ■■■■..■NMEMENEENI MEMEMEMMIME 61 Ile ImoommommomN ze OMEN M■MMISM■■■. MEMEMEMENE ■■■■■.■■®® ■■■■■■■■■■ WAS GROUND WATER ENCOUNTERED?�i S IF YES, AT WHATL DEPTH? O PP E Depth to Water Atter o / ryry��,, Monitoring? /� Date: /b7 Reading Date Gross Time Net Time Depth to Water Net Drop �At 0 61 Ile ze 20 PERCOLATION RATE ',- (minutes/inch) PERC HOLE DIAMETER '//�Piri MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME . f�.LU. S l.-(!/GVJ/GiClrvrV PHONE jQjj�) NEW ❑UPGRADE MAILING ADD E��*+S��S �` 171`6 j_^-7 LEGAL DESCRIPTION 5 S 5- 2ifW LOCATION NO. OF BEDROOMS ``�` F.- Well t Absorption area n I Dwelling n PERMIT NO ��0/ O� Uy DISTANCE TO: !� Z [s , a~ Q Manufacturer Material f No. of compartments wF Y`e�ilr U I y Liq. capacity i allons -I IF HOMEMADE: Inside length Width Liquid depth y JUZ DISTANCE TO: Well Dwelling PERMIT NO. = z Manufacturer Material Liquid capacity in gallons FQ„ DISTANCE TO: Well - f�. Foundation 210 P Nearest lot line r�P PERMIT NO eS� t m y w z No. of lines Length of each line Total length of lines P Trench width Distance between lines / Z w9 F - inches tC/ S h Top of the to finish grade P Material beneath the Total effective absorption area fl � pinches so Length Width Depth PERMIT N0. LU 0 Q I- Type of crib Crib diameter Crib depth Total effective absorption area LU LU Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W 3: Building foundati n Sewer line Septic tank Absorption area(s) DISTANCE TO: oPE� 2ND OTHER 0 1VL PIPE MATERIALS 03034- 4 (2-2627— SOIL TEST RATING '0P/� 1-7'7 INSTALLER .. c G 21yy REMARKS 115-x A I mWe 11 -n P 6 R L.5 ,n m. F At 2 S° .WT 6t5 LO 1 17 .. . .e c J Corwin , APP �' . �E-5253 4 �� DATE LEGAL /J///(////.(�� (,lf, 84f 53,' i ism! l °pA/� -44ysenE6+,6, FA A'l ` c . ( /\ c���. ��HARTMENT OF HFKALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 ���.... �1 '-r"[E 1---3�:.:7 W EH: V -C 2!� ��L- L- F-:0 FE FR 1-1 1 '1 - PERM I -T 1- PERMIT NO.- DATE O:DATE ISSUED: AF9L.ICANT: ADDRESS: CONTACT PHONE: 850188 05/14/85 SKAGGS CONSTRUCTION P.O. BOX 670690 CHUGIAK, AK 99567 688-2831 LEGAL DESCRIP: SUBDIVISION: SAMPSON LOT: 18 BLOC[.-"'- 4 SE�TIONo 3 TOWNSHIP: 15N RANGE: 1W LOT SIZE: 40000 (SQ.FT. OR ACRES) MAX BEDROOMS- 4 Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. n F;� F-�][1%J DEPTH TO PIPE BOTTOM (FT.) 3"0 ** 3.0 ** GRAVEL DEPTH (FT.) 0.5 1.8 TOTAL DEPTH (FT.) 3.5 4"0 GRAVEL WIDTH (FT") 24.0 5.0 GRAVEL LENGTH (FT.45.0 124.0 ** GRAVEL VOLUME (CL). YDS. 40^0 34,5 TANK SIZE (GALS) 1,250.0 ** 1,25O.0 ** SDIL RATING (SQ.FT"/BR) 177 177 ' ** DEPTH TO PIPE BOTTOM < Z.5 FT. REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4.0 F7. MAY REQUIRE A LIFT STATION ** GRAVEL LENGTH > 75 FT" REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ` . I certify that: 1. I am familiar with the.requirements for cm --site sewers and wells as set forth by the Municipality of' Anchorage (MOA) and the State of' Alaska" 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere toall MOA and State of Alaska requirements for the' set back distances from any existing well, wastewatep disposal system or public sewerage system on this or any adjacent or, nearby lot. 4. I understand that this per/mit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit. " IF A LIFT STATION IS INSTAL -LED IN AN AREA COVERED BY MOA B.I'DING CODES, THEN (1) AN ELECTRICAL PERMIT AND^INSPECTION MUST BE OBTAINED; (2) AS -BUIL -TS WILL NOT BE APPROVED WITI-fOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" SIGNED DATE: APPLICANT: SKAGGS CONSTRUCTION ' ' ISSUED BY DATE: ������ - ~~�_~ ������...� . ..... ......���� x/ ° ' - ` `1-1 tj !%A j: li�j 11 §O� Sn; R_ X: 71- "y" 1:3 W got 141 U 1-1 M TA eol W k , DEPARTMENT OF HEALTH AND ENVIRONMENTAL �ROTECTION , 825 L STREET, ANCHORAGE, AK 99501` 264 20 � 171 X11 --- sh 1: -W- THE THI EYE Wj WE TOZ AN Ali 11� PERMIT NO: 850188 DATE ISSUED: 05/14/85 ' ^ APPLICANT: SKAGGS CONSTRUCTION ADDRESS: P. 0. BOX 670690 CHUGIAK, AK 99567 CONTACT PHONE: 688~2831 LEGAL DESCRIP: SUBDIVISION: SAMPSON LOT: 113 BLOCK: 4 SECTION: 3 TOWNSHIP: 15NC RANGE: 1W , LOT SIZE: 40800 (SQ,FT, OR ACRES) MAX BEDROOMS: 4 Listed below are the pptions available to you in designing your septic ` system. Chpose the opt. ion thatbest f i Lon your,i ... ..... ..... ... ����������� ^���THE ������ �� = 11117:1% :1 N".! DEPTH TO FT.) 3.0 ** 3.0 ** GRAVEL DEPT| -1 (FT.) 2.0 5 .0 TOTAL DEPTH (FT.) 5.0 4,0 GRAVEL WIDTH <FT`) 1.-2- 21., 15. X) GRAVEL LENGTH (FT.) 177. 44 GRAVEL VOLUME (CU.YDS,) 41.0 34,5 TANK SIZE (GALS) 1,250.0 **1 250. A SOIL RATING FIT 1: 177 177 ` ** DEPTH TO PIPE BOTTOM < 3.5 FT. FEQUIRES 11013ULASION ** DEPTH TO PIPE BOTTOM < 4"0 FT. MAY REQUIRE A LIFT STATION ** GRAVEL LENGTH > 75 FT" REQUI11ES MULTIPLE RUNS (NOT EXCEEDING 75 FT` EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I c�rti�y that: 1. I am Wad liar with the requirements for on^site sewers and wells as set Forth by the Munibipality of Anchorage <MOA> and the State oi Alaska, 2. I will install th� system in accordance with all MOA codes and regulations, and in compliance with the design criteria o{ this permit` 3. I will adhere to all MOA and rements For the set back distances From any existing well; wastewater disposal syMem or .public- j2 ublic sewerage system on this or any adjacDntor nearby lot. 4. I understand that this permit is valid for a maximum o� 4bedrooms and / any en�arge�ent will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA INC, rODES� 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, DATE: SOILS LOG MUNICIPALITY OF ANCHORAGE ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Z .1t D C01VS IZUC- 10A tDATEEPERFORMED: 3 - 4 V e5 LEGAL DESCRIPTION: 4,07-/,53\ OL(Dc 4- 1519MP=J«1v sUaD i y��1 SLOPE 71 SITE PLAN I ', I N I I 1 1 ' Gross Time O Depth to Water P E IF YES, AT WHAT A m>,4 DEPTH? -- z /:z- 4 -6b ,aS 5 f r, f 0 --6 Go) cfz61- a) 4 '7 f EbA �0Zc7W ice! 7 T1 &HT s 9 10 11 12 13- 14 eND 15- 5 OF 17 ,-°° r°is/ 9 •• a.°° °°.°ane s'- 1-P s p J. Corwin 19 •° �� d�F CE -5283 •, g8` 3 �r� 20 ROFESS����" COMME WAS GROUND WATER S AJC) L Gross Time O Depth to Water P E IF YES, AT WHAT A m>,4 DEPTH? -- Reading Date Gross Time Net Time Depth to Water Net Drop 1: z4 A m>,4 eco -- z /:z- 5 -6b ,aS f r, f 0 4 / � cfz61- a) 4 '7 o7 i PERCOLATION RATE �Z ✓ (minutes/inch) TEST RUN BETWEEN '�� - FT,\ID FT > 7 3 Zy 11A1b fZM J3 PERFORMED BY: )Q2 CA-FEEE CERTIFIED 72-008 (6/79) DATE: S".- /¢ 6 S 99 t Anchoraoe Z5 July 1, 1985 POUCH 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Laura Seeley Corwin and Associates 1549 East Tudor Road Anchorage, Alaska 99507 Subject: Lot 18 Block 4 Sampson Estates Subdivision Permit #850118 - As-builts During the review of the as-builts for the above referenced property, it was noted a few items were incorrect or not filled in. Listed below are those items needed for correction(copy of as -built attached). (1) The well information under "well": is marked N/A, howev ,tr, it%�s noted the well is in on the drawing. Therefore, the pertin information needs to be filled in. (2) The distance measurements from the well tog�pt� 'Jank under "septic tank" and well to "absorption area" are re ek11� L-d�of the drawing of the property. See attached copy. (3) Sidewall information is not given(o t�� �et�acks). Please submit a corrected original as -built so this office can review and approve the subject property. If there are any further questions, please call this office at 264-4720. Sincerely, Laura J. Ward Acting Engineering Tech II enc: copy of as-builts cc: File: Holding f r = w w w w w w w w w w f_-ii 'MUNICIPAL•ITY QF AhjCH01l C DEPT; OF HEALTH &Ed-ION: 'pR0'pENL PRTo O �0 O H E- H w w I�G��a ° 1.zID " 3> z x ig ° a 03 w U Qr �, •- 3 v) 0 0 0 0 0 0 0, 0 0 0 0 0 ,H a Q A a a x a a x a a a a a a z w w w w w w w w w w w w v A v� A C7 x a � •j c� o { �i C%l i • J ' i w wLLI w w w 1E cc W W A r ;,< : i O o O O O O o O O O O O )'; :':i E 0" • F E-F (H F+ F+ F-F F+ F F-F F-F F-F H ' 1 Q� d a w a Y w H z w w a c'9O rn rn w C)6 a k„ O O O O O o 0-0 O O O O z c� w i i 0 x a a x x x x x a a a a CD z Aa F H A w w w w w w w w w w w w U 0 d 3 A A Municipality of Anchorage On -Site Water and Wastewater Program^ (907) 343-7904.. \111�� Certificate of On -Site Systems Approval Parcel I.D. 051-811-23 1. GENERAL INFORMATION: Expiration Date: —t q — Z Complete legal description SAMPSON ESTATES; BLOCK 4, LOT 18 Location (site address) 22421 PHARAOH CIRCLE, CHUGIAK, AK 99567 Current Property owner(s) BRANDON & BRANDY KARSCHNIK Day phone 580-2321-5040 Mailing address 22421 PHARAOH CIRCLE, CHUGIAK AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $_550 Waiver Fee $ Date of Payment—V/ 7AL Date of Payment Receipt Number 823 cs7 G y Receipt Number COSA # S C q 0 Waiver # `A 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 0 )161 Z' 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. 6. DSD SIGNATURE / System #1 Approved for t bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the fo ��JY OFA(, !�AEcc884 ON-SITE WATER AND rn m WAST'_y"1ATER z1 G � PROGRAM c�� owb stipulations: S By: vim— Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph S by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc Legal Description: SAMPSON ESTATES; BLOCK 4, LOT 18 Parcel ID: 051-811-23 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/21/85 Total depth 160 ft Cased to 160 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/29/21 Static water level at beginning of test 137.0 ft. Comments B. TANK DATA Age of tank(s) 13.5 years Tank type/material STEEL Measured operating fluid level in septic tank 42.75° ❑ Standpipes/foundation cleanout per record drawing Date of pumping /�A D. ABSORPTION FIELD DATA PRESSURIZED BED Which system tested (date installed) 1216-7107 Al ALL standpipes present per record drawing Total measured depth from grade 3.2 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field Well production at time of test 6.8+ gpm Water storage tank volume NIA gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 3.28 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L RJArsenic less than MRL (ND) Collected by GEG,LTD. Date of Sample 7/1/21 C. LIFT STATION [Required maintenance completed Age of lift station 13.5 years Lift station material STEEL Comments: Adequacy test date 6/29/21 Results Q Pass For 4 bedrooms Fluid depth prior to test **0'0 in Water added 737 gal New depth "016.25 In * ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time 2 min ❑ Code -required soil cover over field Final fluid depth **0 10 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: 'BASED UPON ELEVATION SHOTS, THEY ARE SET WITHIN 0.09 FEET (ELEVATION) OF EACH OTHER **WEST MT / EAST MT. WATER ADDED TO EAST MT. COSA Checklist yellow sheet I E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No *51+ Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' 7 Yes if No ft Private Sewer/Septic Line > 25' C]✓ Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' P71 Yes if No ft Neighboring Absorption Fields > 100' Water Main > 10'✓0 if No Animal Containment? 50' 7 Yes if No ft ❑✓ Yes if No ft . Water Service Line > 10' F✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft r,/] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *51+ ft Surface Water > 100' IZI Yes if No ft Property Line > 5' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Absorption Field > 5' M✓ Yes if No ft Private Wells > 100' F7 Yes if No ft Water Main > 10'✓0 if No Yes if No ft Community Wells > 200' 0✓ Yes if No ft Water Service Line > 10' F✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' F✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 121 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' R� Yes if No ft Community Wells > 200' R� Yes if No ft Surface Water > 100' ❑✓ Yes if No ft F. ENGINEER'S COMMENTS 'MET CODE AT TIME OF INSTALLATION G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet •J//��ffey A':�x ess. G� CE_ -795 ` �4�-"pro f essio0-11oQ #AECC884 OF ANCHORAGE Develo-,p ! Ien9 ServicEs Departn,ient Phone: 907-343-7904 On -Site V,,`rJ:er 8, '1..?Vastre�.Aiater SeciAOVI Fax: 907-343-7997, Lift Station/Pump Vault MaMtenance Log Owner�v—.-\Y-\ Street Address Septic Tank: -Sludge level inches -Pumping: required yesQno -Pumping completed es no I 7 1i Lift station: -Pump basket cleaned es n o -Effluent filter cleaned es no -Control floats cleaned e no -Proper float settings confirmed es 110 I -Operation satisfactory es no Alarm System: -Dedicated electrical alarm circ<geOno -Audible and visual alarm inside dwellio ui n o �e no -Alarm system :%not satisfactory i Manhole Riser -Ground water intrusion at riser to tank connection es no -Ground water intrusion around pipe penetrations e no -Weep hole functions esl no -Manhole lid: Function es) no Insulate es) no Properly Secure v�es no Other All manufacturer required inspections and maintenance co mplete< es no Comments: Qualified Maintenance Provider: o Technician Date of maintenance Company v Signature ofV�Date Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 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 Parcel I.D. 05-1- 8 I Imo_ COSA 1. GENERAL INFORMATION Expiration Date: Complete legal description S/}wtp50a) ESj_ 9L L I S Location (site address) ZZ1421 Pjd jLOH GT 2 L l Current Propertyowner(s) goK 4 L4 MS- beJ-QEhLnX Dayphone_685-`)/770 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Po For, 670517 69K rA•r— A 7955? Day phone W64RA- i r6ffi&!-Sa/AJ Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: q 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: , Individual Well Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -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 S. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm EAQ6' VLOF-2 Phone 6i�1-S/9 S Address PO t3oX 7736Aq AIc 99S 77 Engineer's Printed Name CN2157z)PfP, L P,_0001> Date Zho%7- bedrooms, with the following 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: 2 % 3' OR (Rev 77N5) Municipality of Anchorage '! Development Services Department Building Safety Division ' On -Site Water & Wastewater Program' ----. 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: _SAM 9FbA j parcel ID: A. WELL DATA Well type f j EL/ArE If A. B, or C provide PWSID # _ Well Log ON) - /ES Date completed 1/1718S Sanitary seal properly protected ON) `/� �) Wires Total depth / 6 ofL Cased to/ LO ft. Casing height (above ground) 30 in. FROM WELL LOG AT INSPECTION Date of test _ y /2 7 /Q,S Static water level ISO ft• � 3 5 g_ Well production 9 -P.M. { 6• s g.p.m. WATER SAMPLE RESULTS: Coliform_colonies/100 ml NitrateH,5 m aN .— g/L Other bacteria _colonies/100 mL Arsenic:4r mg/l Date of sample: I /�/O$ Collected by: C#Pj S Woo I> B. SEPTIC/HALt"" TANK DATA Tank Type/Material _46,20f - TiAlK S1 -66L Date installed % Z ZZ/07 Tank size 1.500 gal. Number of Compartments Cleanouts &/N) Foundation cleanout ON) `�E 5 Depression over tank (Y)& _ti LO High water alarm61N 5 ) Date of pumping Pumper NLt,J CoA) C. ABSORPTION FIELD DATA Date installed 1210710f Soil rating (g.p.d./ft' or 0bdrrti) System ys type Length -_ zb it. Width _11— $ ft. Gravel below pipe _ f7. S ft. Total depth _Y__ ft. Eff. absorption area 1215 fe Monitoring tube Depression over field A/ Date of adequacy test Results (Pass/Fail)p s f 4 For IL bedrooms Fluid depth in absorption field before test _jam in. Water added_6f¢gal. New depth t)/Ain Elapsed Time: NIA- min. Final fluid depth NfA-r in. Absorption rate Any rejuvenation treatment (past 12 mo.) (YM & type) 1U /A- If yes, give date _,v /A i D. LIFT STATION Dale•installed IZ/0'7/07 Size in gallons 2 'Pump on' level at � in. 'Pump off level at L42- in. Manhole/Access eY N) High water alarm level at in. Datum TOP OF YrSTlj Cycles tested �_— Meets alarm t;, circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: I Septic tank/lift station on lot _::L1(70 Absorption field on lot 4- 100 Public sewer main •I"" 100 / Sewer /septic service line r Z S Animal containment areas —±A20-L— f f / 20 ` On adjacent lots f f00 On adjacent lots 4' Public sewer manhole/cleanout Holding tank -+ 7 S Manure/animal excrete storage areas -f /00 SEPARATION DISTANCES FROM SEPTIC/HetfJtNG TANK ON LOT TO: `+ field + S Building foundation 1 s Property line S Absorption Water main •i" t0 ' Water service line +10 Surface water r Wells on adjacent lots t I00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: `r Property line �1 p Building foundation 210 Water main +//9 Water Service line t-�— Surface water t 100 Driveway, parking/vehicle storage r y0 Curtain drain fi SOr Wells on adjacent lots t 1c�:7 1 I F. COMMENTS New -Pirr5 Pyo' •F- 5E2 TO KE cok 5PZnvA6 2v0� G. ENGINEER'S CERTIFICATION Q�E''''ii•F• ^ �qsL 1 certify that I have determined through field Inspections and Jr^ T review of Municipal records that the above systems are in *••/ `Y conformance with MOA COSA guidelines in effect on this date. W. rw�Y• Engineer's Printed Name �IIRl$ToPHER l�- I�rJUD �'; CNRMiTOPHERF.WOOD �,. cE•�o�a� Date OL 1101 Ddo COSA Fee $ (o D Date of Payment 2-- / / J D - Receipt Number/ Q'/ G (2 (Rev. 11/05) Y' ,(t t N d �essia� Vii'/ — at" ee$ ' p Date of Payment > � 5 6 Receipt Number SCS Ret# 1080220001 Client Name Eagle River Engineering Services Project Name/# Sampson Est. B 14 Client Sample ID Sampson Est B14 Lot 18 h1stria Drinking Water PWSID 0 All Dales/Times are Alaska Standard Time Printed Date/Fime 01/30/2008 16:00 Collected DateMme 01/18/2008 9:00 Received DateMme 01/18/2008 15:00 Technical Director Stephen C. Ede Sample Remarks: 4500-NO3 - Total Nitrate/Nitrite - The matrix spike recovered below the QC criteria. The batch LCS is within QC limits. Parameter ResultsAllowable Prep Analysis PQL Units Method ContainerlD Limits Date Date Init Metals by ICP/M9 Arsenic ND 5.00 Waters Department Total Nitmte/Nitrite-N 2.48 0.100 m8/L SM204500NO3-P D (<10) Microbiology Laboratory Colony Count 0 Total Coliform COUIOOmL SM20 922213 A ( Fecal Coliform 0 coV100mL SM2092220 A (<p<I) 0 coVI00mL SM209222D A (<I) 01/23/08 01/29/08 TK 01/28/08 1DS 01/18/08 SDP 01/18/08 SDP 01/18/08 SDP ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO FNCROACHi(E TS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THS EXISTENCE OF ANY WHI CH T OR RESTRICTIONS H DONOT APPEAR ON I THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HOF FENCE LINES,NOR FORBE USDESTABLIISH NG SOFOR U D- ARY LINES. SCALEt OATS/��P� OF aC�S�01 GRID: 0. 7 A3 + *J.'4 ••rH"'/:• +. yw/S6o FB: Duen• Me'k „• oral DRAWN: .G/11f , * A •mow �� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Locat1io, n (address or directions) ALASKA (b) Applicant Name COVIRh64 Telephone: Home — _ Business Applicant Address P.D. (c) Applicant is (check one): Lending Institution ®; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain;; _— (� (e) K Lending Institution Address Real Estate Company and Agent Address Telephone Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family E!r Multi -Family ❑ Other Number of Bedrooms -4 Telephone 3. WATER SUPPLY Individual Well Iff Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Departmentof Environmental Con✓ rravLni attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 0"� Public ❑ Community CI Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Consemrafrsrb attesting to the legality and status. Page 1 of 2 72<zs,:.r 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMAIrION a � 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 regulations in effect on the date of this inspection. /j.r �,� Name of Firm f,�i� A�1 l / "� ��K`�� �s� Telephone 560� " Address Date I irez IOF i O rll j/�j 0{J' -d p50 LOP OOCnn2'+ Engineer's Seal Gruc ! Cory/in 4 9 %\ hi r/[-5213 o %,,P ESS\ 6. DHEP APPR0 A Approved for . 3, bedrooms b� r�' � � t. ��-� !��. pP % Y Date Approved Disapproved Conditional Terms of Conditional Approval 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 72-025 (77/84) mumcIPAUTY OF ANCHORA DEr� OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: W I 10, i3 4' ;MMR5W SOB. SUL'ANNe-A'tL tJto.me 1s° JAmP �K�CS t�kCS Well Classification 19i/ak If A, B, C, D.E.C. Approved (Y/N) N{� Well Log Present (Y/N) Date Completed 4--27-L IFS Yield ' I pk esy Total Depth _�. __ Cased to _ Inv�* Depth of Grouting _ (9NKN Static Water Level i7� Pump Set At t Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) . I Depression Around Wellhead (Y/N) 7U Separation Distances from Well: To Septic/Holding Tank on Lot )®F On Adjoining Lots s To Nearest Edge of Absorption Field on Lot 100 On Adjoining Lots + To Nearest Public Sewer Line NIA To Nearest Public Sewer Cleanout/Manhole ��I� q To Nearest Sewer Service Line Jon Lot �1A A, t Water Sample Collected by . C;, Meq ; Date 7/ tj105 A"� Water Sampl Comments B. SEPTIC/HOLDING TANK DATA Date Installed 9-71I-95 Size 1155 No. of Compartments 2 Standpipes (Y/N) Air, -tight Caps (Y/N) —y Foundation Clean/osut,(Y/N) Depression over Tank (Y/N) IV Date Last Pumped L Pumping/Maintenance Contract on File (Y/N) �� ; for N Holding Tank High -Water Alarm (Y/N) N Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: t 1 To Water -Supply Well ! to "� To Building Foundation ! To Property Line If -30 To Disposal Field To Water Main/Service Line +50 To Stream, Pond, Lake, or Major Drainage Course g1A Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA To Water Main/Service Line��r To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Akry, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Cutbank (if present) N [ Dimensions Manhole/Access (Y/N) "Pump Off" Level at - Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA q "` Checivg; g Against HAA Request " ¢ rmyns 1 certify or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed4, to /®Z� Compa (iA No. S- 235"2IS Receipt No. Date of Payment Amount: $ 45 D� Page 2 of 2 72-028 (71184) OFA` IA$ Soils Rating in Absorption Strata 1-7-7 f OP94 Type of System Design Date Installed '"%)'05 Length of Field Width of Field Depth of Field [� Gravel Bed Thickness Square Feet of Absorption Area /OB2 Standpipes Present (Y/N) Depression over Field (Y/N) A /f V Date of Last Adequacy Test /" 4 n y N/14 Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 1f9� To Property Line !G-` To Building Foundation To Existing or Abandoned System on NlA CO) Lot : On Adjoining Lots l To Water Main/Service Line��r To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Akry, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Cutbank (if present) N [ Dimensions Manhole/Access (Y/N) "Pump Off" Level at - Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA q "` Checivg; g Against HAA Request " ¢ rmyns 1 certify or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed4, to /®Z� Compa (iA No. S- 235"2IS Receipt No. Date of Payment Amount: $ 45 D� Page 2 of 2 72-028 (71184) OFA` IA$ • r /r T /e sa -am ®�r's Seal • a • ao .••,.i.. io ip s s 0•s •u•e••w•nn:.® Er 6ruc Corwin ; . 6. k ��tP s 65283 �