No preview available
HomeMy WebLinkAboutSAMPSON ESTATES BLK 4 LT 20S CL N C14 pvGj 4 11 Nz- o 2: -0 "i Q) 0 0- z C' PA E C:)C 0 Q) Q) U) Odd' '�' �4444 �CiS. • ly• �ogLoap�O Q) C 0 CD E 04 0 c C C = - 0) 1 0 e, (U =5 0 0- > (D 0 0 > ei 0' 0 0 00_-- 0,(D a) U- LL m 0 -0 0 0 e < < c CK — c Q Q) O 0- (10)o c -J E :3 CL oa .2 ()0 < c o _0 .2:2 :3 0vi 0 0 U-) 0 a) :5 c 12 QO) Q) :3 C — 0 U) (L U) 0 LO 4- 0 0 (D D O -P 0 0 co om -2� 0 CV ei 4 t6 to 22 yaNi 0- N 0 rel Q N .... ...... ........ ...... co '0 , 0 C: 0, . 2: Z ED 0 c 5.9 3: CD 0 rn -.-0 0- -S: C14 0 Q) 'D- rx w 19.2� U) (1) -4 0 -0 toQ. -0 ED -6 C-4 rr) 6 E 1 o _0 :Asphalt -d- L.Li V) :d- to c 0, "o o ;—j 2 sp 00 E —,0 .03 - lo U0, -d o 0) 0,)— 0 0 CL CD u):s 4� E CO CD to U) o 00 C14 .2 N=3 0, 0, - 0 , 0 0 .,;d 'a C,4 C 0 0 CD C: o E cli 0 U) C) Q) 4 Q- x 0 0 V) CO Q) 0 C, z Q) Ol Q) x -co Go 4� �o 0 LLI (1) UO 0 a) o < L6 C) % 0 w C10 > C3, 0 0 -:02 [cc • 0* -v L C, C) - wI Z*ve E CY) 0 0 0 99. LN co N U) -i -CD 0 I 4-1 In 0 LO Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5W950511 A wR55-D05/l2 PID Number: 6j/-8//S Name. 1 Wastewater System: ❑ New )d Upgrade e M Address; 5. Sa p `195 ABSORPTION FIELD Phone:No. &8 - /0 70 B of Bedrooms: 3 ❑ Deep Trench ❑ Shallow Trench YBed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: _ Total Depth from original grade: O.5 GPD/Sq. Ft. Z f Lot: Block:Subdivision: 20 41 Depth to pipe bottom from original grade: Gravel depth beneath pipe _ Q5AmP W 6-rA t�S 115 FL . 5 Ft. Township: Range: Section: Fill added above original grade: Gravel length: 5 VARIE l - 0.5 Ft. 30` eO-C,h Ft. WELL:New El Upgrade wids. ��I> Number of lines: Distance been lines: a�Gravel n Ft. gee Ie Classification (Privat , A,B,C): Total Depth:sed To: Total absorption area: _,3 Pipe material, Ft. q00 SQ. Ft. F 9 10 IID 303 Driller: Date Drilled: Static Water Level: Installer: Date installed: FL WAc e_CvNS I(7 — rf B Yield: Pu p Set at: asing Height Above Ground: TANK GPM Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding P,S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines AMC.*0fZA4 E 7 c- izsci Well-/00'-J-r loo� /Qo + /� � STS - Material: � Number of Compartments: Z Surfac Water 200'.+ Zoo'+ zool+ / / LIFT STATION Lot Line /Q / + i. 7 /Q f + / / Size in gallons: /25 0 Manufacturer: �ENLI�o2 4G I to N lC Foundation Is is /a / ¢ /� 1� / / "Pump on" level at: "/Pump off" Level at: High water alarm at: // Curtain Drain /VQ ( /UO a M� �� Pump Make & Model ORE/JCo 20oSLo5 Electrical Inspections performed by: Na- 1-45Av5MoY L/6,qTs Remarks: I Fnc.l r b c.o e � BENCH MARK A s r/h Vi c✓ round aw5 Z %e 6� s�o a✓ Location and Description: r I - I 5 Corner fi iW s $e 45-� vt fi, ro er //'r)6 grealeI'M 61.4 aba,v.. neJ in o (d Assumed Elevation: 100 Ft �. �� �iu,�-ioh u,+•1 e� c,,ru � � I�o�c.(�.�'�(,le� n �,ac>�. ENGINEER'S SEAL �®�®®®®�� OF 41. ®� r °• 0 Inspections performed by: _ KKQ Dates: 1st Pf 7a'°•m ..Ift .....,..,•, 2nd /1/7 •,••• .;,,• d os• s•i •w o•• z� u ��N Department of Ht1th andServices a proval pp o°KennCE 1 *Oo. and approved byDate: —L� *.*@*aReviewed �1 p9�o;FE/SS10N®� 72-013 (Rev. 9/91) MOA 25 �`/ A -C = 16' +/- B -C = 64'+/- A -D = 22' +/- B -D = 67' +/- A-E = 154' +/- B-E = 174' +/- A -F = 181' +/- B -F = 207' +/- F -G = 13' +/- A -H = 179' +/- B-H = 199' +/- A -I = 207' +/- B -I = 232' +/- AS -BUILT P.I.D. if 051-811-25 WASTEWATER DISP❑SAL SYSTEM LOT 20, Block 4, Sampson Estat, �bdlvision CD CD M --------------------- T_ - LOT 19 LOT 18 OF � � _ ,4' 1 �* 49TH* *� / KENNETH M.°DU S: / ` CE -7116 1 \ `D?OBESSI013A� SEPTIC IVENT 9 G a CD S88°04'42 -E R220. 00, CS 100,00' (') L51 r..'. o WELL Jaz 47.29' I 68'6 �A'W j,71 S�2°5$ ARED FOR: DEAN & RAE MAXWELL 22506 SAMPSON DRIVE CHUGIAK, 688-67 08 AK 99567 a 42,29, N LOT 20 0 o a o N Z Q T.H. # Q T.H. #1 LOT 21 — 70.00' KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 (907)696-6111/Fax (907)696-8111 DATE-11-28-95/rev 6/7/96 DRAWING # SCALEr 1' = 50' 95031-S1 89.83 98.40 AS -BUILT DESIGN DETAILS WASTEWATER ABS❑RPTI❑N SYSTEM LOT 20, Block 4, Sampson Estates Subdivision PTLD. # 051-811-25 98.70 w WE SHED GRADE F 116.07 0 SEWER R❑CK Gngnnl Grd. I 117.39 Z D FINAL SLOPE 3d \ FILTER FABRIC AND INSUL 25 LF 1 1/4' PVC W/3/16' HOLES e 5' SPACING (TYP) SEWER R❑CK O MIN. '0,5' SAND ,F:ILL . .:. -. �_� L M� 112.06 E S.T. UHL� S,T.E,P, 116 Fi Lift Stntlon 89.82 Sand was added to level beds . System was installed in GM material. 2.5'(typ)— T 1 1/4' PVC FROM TANK TO[- FIELD 1 1/4' PVC FOR MANIFOLD M.T. Field Dimensions Ol Approx. 15' x 30' Trapizold Inside angles approx. 63 deg./117 deg. O2 Approx. 15' x 30' Trapizoid Inside angles approx. 81 deg./99 deg. 9 M,T. F112.07 I 114.22 9711WIDWO WATER MONITORED @ L00.75' 7 2.51(typ)—\, CAP FNT1S nF PTPF 0 25 LF 1 1/4' PVC W/3/16' HOLES e 5' SPACING (TYP) D O 30' 0 2.51(typ)-1 CAP FNT5S flF PTPF_ 0 25 LF 1 1/4' PVC W/3/16" HOLES 5' SPACING (TYP) D O M.T. T M.T. T 30' OF AL\ Lj 0 u s 1 ti Lo M D� � 4 0Note: 0 01. Drawing above is a schematic. 49TH * L' 2, Fields were constructed as trapezoids N in order to maximize separation distances. /KENNETH M. D S : / m 3. Piping and absorption are the same. `-. CE-7116,Wa PREPARED FOR: KND ENGINEERING 20441 PTARMIGAN BLVD \ D / �y' / DEAN & RAE MAXWELL EAGLE RIVER, AK, 99577 ARo FESSID' / 22506 SAMPSON DRIVE CHUGIAK, AK 99567 (907)696-6111/Fnx (907)696-8111 688-6708 DATE: 11-28-95 DRAWING # NTS 95031-S2 -4 Rick Mystrom, Mayor 11�Iunicipali-(y ofAnchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 October 13, 1995 Ken N. Duffus, P.E. KND Engineering 20441 Ptarmigan Boulevard Eagle River, Alaska 99577 Subject: Waiver Request for Lot 20 Block 4 Sampson Estates Waiver Request #WR950046, PID #051-811-25, SW950311 Revised Dear Mr. Duffus: Your request for a waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 1 foot to the west property line. Please be advised that the above referenced waiver is for a minimum setback distance of 1 foot between the septic system and the west lot line. The septic system includes all portions of the drainfield which includes the mounded area over the drainfield. For clarification purposes the toe of the slope of the mound must be no closer than 1 foot to the referenced property line. A Any future upgrade to the septic system will require all separations be met or another approval from this department. n 'Sincerelyi, r 1 ''v} JLnvl— James P. Williams •'Civil Engineer On-site Services JPW/ljm Con ur: f ames Cross, P.E. rogram Manager On-site Services MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet i PID# 051-811-25 HA# Permit # w"l� 03 WR#r.;�Q�ibm lla Date Received: Sept 12, 1995 Legal Description: Lot 20 Block 4 Sampson Estates Engineer: Ken N Duffus, P.E., KND Engineering 20441 Ptarmigan Boulevard, Eagle River, Alaska 99577 8736 Applicant: K. Dean Maxwell Waiver Requested: Lot line waiver requested of feet to the west property line Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOTAD115—e,�f— Rec rantted: A4 d-4 r� a nr Reasons for above: 0o #: #01291/2944 Amount: $ 115.00 Date Paid: 9-12--95 KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 1 /FAX (907)696-8111 December 28,1995 Jim Cross, P.E. On -Site Services Manager Dept. of Health & Human Services Municipality of Anchorage P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Lot 20, Block 4, Sampson Estates Subd., - Lot Line Wavier Modification Dear Jim: As a follow-up to our conversation on December 26th, I am requesting a modification of our lot line wavier to include both the south and the west lot lines of the subject property. Thank you for your consideration of this request. If there are any questions, please contact me at 696-6111. Sincerely, Kenneth M. Duffus, P.E. KND Engineering NOV-13-95 MON 10:00 PM,walkar contractinv 907 694 4858 P.01 MOV -13-95 MON 21:45 HEAVENLY LIGHTS ELECT 00 6a6 6061 P.01 22609 McManus • Chugiak, Alaska 99567 phone# (907) 688-6060 • FAX# 688-6061 dem a -I -�,-7u k0fi aaub� y -) R; PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950311 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:MAXWELL KERRY D & RAE J OWNER ADDRESS:22506 SAMPSON DR CHUGIAK, AK. 99567 PARCEL ID:05181125 LEGAL DESCRIPTION: SAMPSON ESTATES BLK 4 LT 20 LOT SIZE: 44276 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 lC) DATE ISSUED:10/05/95 EXPIRATION DATE:10/05/96 r Se7F !/,Si7 ! N ht/9 ci — lied 1lL CCe'7 wros 7 ilk Fc';t'g-dq Qpm 11-R-15�_ THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ABANDON EXISTING SEPTIC TANK AND LIFT STATION. MAINTAIN A MINIMUM 1 FT. SETBACK FROM WEST PROPERTY LINE PER ATTACHED WAIVER. RECEIVED BY: /44&> DATE • /a -- & ISSUED BY:W(Lt ca�DATE: 6 KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 1/FAX (907)696-8111 September 11, 1995 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Lot 20, Block 4, Sampson Estates Subd., - Sewer System Upgrade Gentlemen: Attached is our request for an on-site sewer permit for an upgrade on the above lot. The subdivision is served by on-site wells. As shown on the site plan, there are no conflicts with proposed wells, sewer systems or with potential reserve areas. In addition, there are no class "A" public wells within 200' of the property. This lot is gently sloping from south to north at a slope that varies from 1% to approximately 7%. There is adequate area directly north and south of the test hole location on the lot to install the replacement system. Minor encroachment into the property line setback is necessary and we are therefore requesting a wavier from property line in addition to the above request. The natural slope will provide positive drainage away from the proposed installation site. There is no surface water within 200 feet of any portion of the proposed installation. Several testholes were excavated on this property in an attempt to locate a suitable site for the installation. Testholes #1 & #2 were excavated just northeast of the proposed site; percolation and water monitoring results indicate that testhole #2 is inadequate. Testhole #1 has adequate soils but is lower and poses increased susceptibility to ground water. Testhole #3 has suitable soils and will not be impacted by ground water. Use of these site however will require your approval of a lot line wavier for the site. The design we are submitting is based on the existing three bedroom house and a worst case percolation rate of approximately (11 min./inch). Based on adjacent soils tests it is anticipated that the percolation rates for the area soils should be better than 11 min/in. Although Subject: Lot 20, Block 4, Sampson Estates Subd., - Sewer System Upgrade September 11, 1995 Page 2 of 2 water was monitored at only 12.5' we have chosen a shallow installation due to high water encountered in the area. Thank you for your consideration of this request. If there are any questions, please contact me at 696-6111. Sincerely, Kenneth M. Duffus, KND Engineering attachments: On -Site Well and Sewer Application Wastewater Absorption System Details Site Plan Soils Log/Percolation Test SITE PLAN WASTEWATER DISPOSAL SYSTEM LOT 20, Block 4, Sampson Estates Subdivision P.I.D. # 051-811-25 WELL �-ft `` OF AZ\ 1� 49 T -H* KENNETH M. DU / CE DU _ IN Al Ph30FESSI0I3P�, WELL - 100'+ PARED FOR: DEAN & RAE MAXWELL 22506 SAMPSON DRIVE CHUGIAK, AK 99567 688-6708 .4 , j4-�-b LOT SIZE 44,283+ LESS HOUSE FOOTPRINT: 2,263 LESS EXISTING SYSTEM 1,280 TOTAL AREA LEFT: 40,740 KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 (907)696-6111/Fax (907)696-8111 DATE, 9/tl/95 DRAWING # 1' Scute: = Oi; AM ! I 9531—SI WELL - 1001+ SAMP N DR. 0 225a�- - _ M SWOr•12•E IOUOV VELE LOT 19 "'MMMVVV 3129' �� � r229• WELL - 100'+ sunt v rts ccr TO Ex:snxs syslrR, LOT 20 LOT 21 x� 0 rH x2 WELL LOT 18� nc vsxr 0 H. tl WELL �-ft `` OF AZ\ 1� 49 T -H* KENNETH M. DU / CE DU _ IN Al Ph30FESSI0I3P�, WELL - 100'+ PARED FOR: DEAN & RAE MAXWELL 22506 SAMPSON DRIVE CHUGIAK, AK 99567 688-6708 .4 , j4-�-b LOT SIZE 44,283+ LESS HOUSE FOOTPRINT: 2,263 LESS EXISTING SYSTEM 1,280 TOTAL AREA LEFT: 40,740 KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 (907)696-6111/Fax (907)696-8111 DATE, 9/tl/95 DRAWING # 1' Scute: = Oi; AM ! I 9531—SI :Q P.I.D. # 051-811-25 DESIGN DETAILS WASTEWATER ABS❑RPTI❑N SYSTEM PERMIT # LOT 20, Block 4, Sampson Estates Subdivision 1,250 GALFMIM S.T.E.P. TANK FILTER FABRIC AND INSUL SEWER ROCK 2 - 30' x 15' BEDS PRESSURIZED DISTRIBUTION SYSTEM HOLE SPACING 1. RESIDUAL HEAD = 5' 2. HOLE SIZE = 3/16' = 1.00 GAL. PER HOLE @ 30 PSI 3. 30 GALS (PUMP DELIVERY)/1.00 GALS./HOLE = 30 HOLES 4. 150 LF LATERAL/30 HOLES = 5' SPACING PER HOLE 5. ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS. TO 2ND FIELD(SAME SIZE) 1 1/4' PVC FROM TANK TO FIELD 1 1/4' PVC FOR MANIFOLD 0 u 4' SOLID FROM HOUSE G, M r 0 r z O E ORG. GROUND I w 0 WATER MONITORED 12.5' BELOW GRADE DESIGN BON 14.0, 11 2.5 (typ)—\ rAP P-wwC nF PTPF(TYP) 2.5'(typ)--\ OF AZ4 'k *49TH *� I S / . KENNETH M. D S: / CE -711 : k7� 411 Awir \ d %PESS100 dw M.T. JNr`P G, E'1@75 LF 1 1/4" PVC W/3/16' H❑LES 5' SPACING (TYP) (PER EACH BED) r O K 0 r z z z 0 o z z Q z o £ w w w J J U V z w w Z J Q U £ 1,250 GALFMIM S.T.E.P. TANK FILTER FABRIC AND INSUL SEWER ROCK 2 - 30' x 15' BEDS PRESSURIZED DISTRIBUTION SYSTEM HOLE SPACING 1. RESIDUAL HEAD = 5' 2. HOLE SIZE = 3/16' = 1.00 GAL. PER HOLE @ 30 PSI 3. 30 GALS (PUMP DELIVERY)/1.00 GALS./HOLE = 30 HOLES 4. 150 LF LATERAL/30 HOLES = 5' SPACING PER HOLE 5. ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS. TO 2ND FIELD(SAME SIZE) 1 1/4' PVC FROM TANK TO FIELD 1 1/4' PVC FOR MANIFOLD 0 u 4' SOLID FROM HOUSE G, M r 0 r z O E ORG. GROUND I w 0 WATER MONITORED 12.5' BELOW GRADE DESIGN BON 14.0, 11 2.5 (typ)—\ rAP P-wwC nF PTPF(TYP) 2.5'(typ)--\ OF AZ4 'k *49TH *� I S / . KENNETH M. D S: / CE -711 : k7� 411 Awir \ d %PESS100 dw M.T. JNr`P 71 DESIGN CRITERIA M.T. in L 1. 3 BEDROOMS X 150 GAL✓DAY/BEDROOM = 450 GPD 2. SOILS RATING 9 MIN./INCH = 0.5 GPD/SF(BED) 3. 450 GPD/0.5 GPD PER SF = 900 SF 4. 900 SF /15' W = 60' L 5. MINIMUM DESIGN SIZE = 2- 15' W x 30' L BED (900 s•f.) 6. 2' HD INSULATION REQUIRED OVER FIELD <3' OF COVER 7, 2' HD INSULATION REQUIRED OVER TANK <4' OF COVER 8. CONTRACTOR TO PUMP TANK, REMOVE INTACT AND ABANDON IN PLACE. 9. ANY ASPHALT, CONCRETE OR APPERTANENCES DAMAGED OR DESTROYED BY THE CONTRACTOR DURING CONSTRUCTION SHALL BE REPLACED BY THE CONTRACTOR AT NO ADDITIONAL COST TO THE OWNER. 10. CONTRACTOR TO VERIFY AND INSURE 2Z GRADE FROM HOUSE. REPARED FOR: KND ENGINEERING DEAN & RAE MAXWELL 20441 PTARMIGAN BLVD 22506 SAMPSON DRIVE EAGLE RIVER, AK, 99577 CHUGIAK, AK 99567 (907)696-6111/Fax (907)696-8111 688-6708 Dater 9-11-95 DRAWING # SCQIe: NTS 9531-S2 O E'1@75 LF 1 1/4" PVC W/3/16' H❑LES 5' SPACING (TYP) (PER EACH BED) in O 71 DESIGN CRITERIA M.T. in L 1. 3 BEDROOMS X 150 GAL✓DAY/BEDROOM = 450 GPD 2. SOILS RATING 9 MIN./INCH = 0.5 GPD/SF(BED) 3. 450 GPD/0.5 GPD PER SF = 900 SF 4. 900 SF /15' W = 60' L 5. MINIMUM DESIGN SIZE = 2- 15' W x 30' L BED (900 s•f.) 6. 2' HD INSULATION REQUIRED OVER FIELD <3' OF COVER 7, 2' HD INSULATION REQUIRED OVER TANK <4' OF COVER 8. CONTRACTOR TO PUMP TANK, REMOVE INTACT AND ABANDON IN PLACE. 9. ANY ASPHALT, CONCRETE OR APPERTANENCES DAMAGED OR DESTROYED BY THE CONTRACTOR DURING CONSTRUCTION SHALL BE REPLACED BY THE CONTRACTOR AT NO ADDITIONAL COST TO THE OWNER. 10. CONTRACTOR TO VERIFY AND INSURE 2Z GRADE FROM HOUSE. REPARED FOR: KND ENGINEERING DEAN & RAE MAXWELL 20441 PTARMIGAN BLVD 22506 SAMPSON DRIVE EAGLE RIVER, AK, 99577 CHUGIAK, AK 99567 (907)696-6111/Fax (907)696-8111 688-6708 Dater 9-11-95 DRAWING # SCQIe: NTS 9531-S2 ."AV V" ,00 oe.oaooe J�. ; a ago Municipality of Anchorage tipa Y DEPARTMENT OF HEALTH & HUMAN SERVICES 0: 49TH*a g 8006 saeee3po..®a .e 825 "L" Street, Anchorage, Alaska 99502-0650 ,� �✓ SOILS LOG — PERCOLATION TEST �ge •vKenneth M•Duffus CE 711 �-�, / f�,/ooao _ aoo,C, PERFORMED FOR: �`^'(^� "r�YG{%EL.0-�/ IJ FQ •eoeoa•�� DATE PERFORMED:®111190Ea LEGAL DESCRIPTION: 4^' zo Township, Range, Section. DEPTH �� Sr. SLOPE SITE PLAN (FEET) 1 oz_ 2 N 3P .J fJIN�j ►� t_y.L./f'l��L 4 S U//I; 012 �- Ulj L I h I -H m 1w(I 5 E.D. �1%,/5,,� J) I d6 .r 7 1 8 1 10- WAS GROUND WATER , /O ENCOUNTERED? /IJ ��a ink s 11 L 11 IF YES, AT WHAT 12 01l9• DEPTH? P E 13 Depth to Water After r Monitoring? /o Date: `1 /� tt 14 15 16 17 18 19 Reading Date Gross Time Net Time Depth to Water Net Drop ;2 t�67 2�fl� S 3 S /.02z 5 z 54' 20 u !I % `VI& m 9 irP PERCOLATION RATE (mufevinch) PERC HOLE DIAMETER ��� /1� ,7 TEST RUN BETWEEN Zj FT AND 3' F'r COMMENTS Lel PLHI UIrtdLD t3Y._.�F-0�- (,I nlllY III/I IIt,%II 'J w/1" II IU(d'l611�Ifa / c ACr: (1110/.NGL WITH ALL STALL AND 6AUIJI(,IPA! (V III NI.I IN( -,114 1.11 ((, 1� !f! 1111', lih r DA I I /�`�� • 4 MUnicipalilY of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOLS LOG — PERCOLATION TEST ®tI 4l i� OF 4 6�j C�t�66! o °► 0.17s® ep��TN °pe ►e°u Kenneth M. v ;k. '►11"1110 • 40� PERFORMED FOR:_,( -,( 7P At 2.- DATE PEREORI S� •'p�, ' ^ <<'v 0 eeewe _♦ / .� OFE� SSW ®� LEGAL DESCRIPTION: w 70 49(r—,"f s Township. Range, Section: DEPTH CST. SLOPE SITE PLAN COMMENTS ;M > jq 64.fvew, vau n44er- '3m,11 SEEM■II■■� ■EE■RAQ owl EElI1E■ No MEMO ■■9—aIr� '1d WAS GROUND WATER ENCOUNTERED? &5 IF YES, AT WHAT SIs $ L P DEPTH? E Ikplh to Waler After ManiwrinII7 /D 1 Ove: Reading Date GrossMIet Timerop S' /o: Si3yS 23 15- 5 - PERCOLATION sPERCOLATION RATE e5o Im.nutevmchl FERC HOLE DIAMETER 41=�_ '(TEST RUN BETWEEN (//'' FT ANO a'S F'( '4 /1 4A. + Ll�� e tinC_ vGu C Ck' r,,, la — A u � ve6 -n ( 4 A . PE/n OI /1✓r0 RY IfY it I/- I I l fr, l f ' , I WA', hl ltl r rl •rl,f f� n: "-r,UI!I)AN(,(_ WI 111 AI I. S1A 1t ANO I.AUNI(,IW I (i(llfj( 1 II-!( IN I I I f (, I ! I l u', IJ If O/. 11 �� /% 001; N®�E'°�C • Municipality of Anchorage m' DEPARTMENT OF HEALTH & HUMAN SERVICES ° 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST p s'°°°° "" °" CKenneth M. Duff, ®so. % CE 7116 PERFORMED FOR: e!/�%.T/..% - T �/y: �j 4 °°°°/ /y 3va • � ( / � o? DATE PERFORME��:O,�pR °. •° LEGAL DESCRIPTION ?Er 1 1 1 1� 1E 1E 17 18 19 20 COMMENTS C"() 7- 6z Z ..6W Gig- t -'j 6m /ems Dtudl✓/ T, i n� �)A �®17-7�3 Township, Range, Section: a1-urt SITE PLAN WAS GROUND WATER ENCOUNTERED? PERCOLATION RATE /D• / (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 191-?- FT AND JY2 FT PERFORMED BY: cS()Illj CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: %zlL�5" 72-008(Rev.4/85) MUNICIPALITY OF ANCHORAGE DE �3TMENT OF HEALTH AND HUMAN SER 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 Address TO SEPTIC ABSORPTION DO X30?( G 7 /2Z� FROM TANK FIELD WELL Phones r(r/ l0 `�z23 Permit No. No. of Bedroom WELL I I O t I e!5 h ISD Lot Block' / Subdivision z� `_ SA J 0, QST. Township, Range, Section -Fis R I TANKS I A ❑ HOLDING Manufacturer Capacity in gallons G/Z I o0 Material No. of Compartments ST Eft— Z TYPE OF SYSTEM ❑ TRENCH X BED ❑ W. DRAIN ❑ OTHER Depth to pipe botto from original grad '7 Total depth from original grade FT y 5�. FT Fill added above original grade Gravel depth beneath pipe f _ FT FT Gravel length L� � �'_� Gravel width FT o�Li� FT Total absorption area Distance between lines l�8RSOFT yl 8d FT Number of lines S LA j&i"0 Pipe material FT PVG Installer Date Installed WELLS PRIVATE ❑ OTHER (Identify) alion (A,B,C) Total Depth Cased to Vlbuc(I t7jESIPt 1Jc 1620 FT II Date Installed: �.IIL!a MS .jU(LA Iq94z� REMARKS: h ,I. t FT LOT LINE - + 15I 3c�I FOUNDATION Z I I Opt+ �I AS -BUILT DIAGRAM (Show location of well, septic system, property lines, founds driveway, water bodies, etc.) scale: 1 "=1 D0 Inspections Perp W by: Date: �, i 9 as -8s i r 1 certify that this inspection was performed accordinqiq all Municipal and State guidelines in effect on this date: Health Department Approval: 72-013 (3/85) Date: S Iss °°°°° °. 9TH * 0 000000000000 o m00000 e$eee� aoo 000000 000eeoaeeo o.oegj ° Sm" L HmPen6urp ° A? i ze CE. 6739 'TJ PTJ '21 '71 'Tj 'Ti 'TJ 'TJ PV m Mutv7c. D) OP MTJ W4 oil lz XCh jWq 171 0 0 0 0 0; 6 VED '71 'TJ '21 -4 .4 43, m W m m rAl Cl) > > ro0 Oil ITI o K7 A 7d > > t7l t=j m W m m rAl Cl) > > ro0 Oil 0 o K7 A 7d > m W m m rAl Cl) — | t` Ji���� DEPARTMENT OF HEALTH AND ENV�RONMENTAL �R��ECTION � 825 L STREET� ANCHORAGE� AK 99-0� � �64-4720 � PERMIT NO: DATE ISSUED: APPL�CA�T: ADDRESS: eONTACT PH�NE: LEGAL DESCRIP: LOT SIZE: MAX BEDR�OMS: �� � � ������ 850264 ' 06/�6/85 LEIF ERICKSON� 3031 LO�S DRIVE #310 ANCHORAGE� AK 99503 753~2737 SUBDIVISION: SAMPSON ESTATES LOT: 20 44278 (SQ FTOTOWNSHIP: 15N RANGE: 1W 3 I certi{y that: 1, I am {amiliar with the requirements {� ' on~site.sewe's {orth by the Municipality and wells o� Anch o'age as set (MOA> 2^ I will install and the State o{ �laska the system i n acco'dance with all MOA and i li comp ance�with the design codes d an 'egulations; 3 I criteria or this ^ wiln all MOA and State permit dista�caoneremto �{ Alaska re�uirements^��� the existing well� wastewater set b k ac disposal sewer,g�=s/,oemany �t �=^ u'' ��'zs or any adjacent system or p�blic , 4 I und_ or nearby lot ` any e�rsran�ethatithis ..^c y�".additional permit is valid ~ �or, a maximum ^[ 3 bedrooms and permit. FEA LIFTASTATIONRIS^INSTALLED ` IN AN AREA COVERED B`� MOA BUILDINGCODES ��iy1��LIPERMIT AND INSPECTION J. L. �u w !�U;T AN MUST B� OBTAINED; <�) AS~B�ILTS ELECTRICAL INSPECTInm REPORT; LELW�rr:u DONE BY A LICENSED AND (�) T�E n ELECTRIC���N DATE: �!|~�� ' ^ ~~^`�``- [ ` __� \~` " " ��-------===�-�----------- DATE: X SOILS LOG MUNICIPALITY OF ANCHORAGE +\l DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION A PERCOLAT{o, IN � j 625 L. Street, Anchorage, Alaska 99501 264.4720 TEST SOILS LOG — PERCOLATION TEST 7�D�j PERFORMED FOR:X/,( 61j/7 z "4, 4j1,44 C� n/LpgTE PERFORMED: 1L2 cT,1t 9a� LEGAL DESCRIPTION: LOT ZQ BLOGK4 f�/`/�•J'Q/1/E,-S/�r��' �-"� /V /e?(tl /n1 r7L 0! SLOPE SITE PLAN 1 0ArCy /so" ML ¢a"t 15a?fJ -s.•%7 2 d a;wP 3 0 7 sGrit ylu�-f/*//Y —sanc?y rav2l 9 10 111 WAS GROUND WATER S ENCOUNTERED? /70 L O 12 P IF YES, AT WHAT _- E 13 DEE/PTH? /O T & Xoi� L,- /19 14 J.,110ra. 0 'r' fee' f 15 /t 0 /e _ �%Vawa� 16 • e 17 e• �Y61 % e o •ooeoa o0 oeoo� �eele000000e 18 � • ee`,Illatfq e e • uo BO� 19 � ar`� CE a 6739 Reading Date Gross Time Net Time Depth to - Water Net Drop rHzO �JUA0a� s3 z0 ,Yt,� 9. 7" G.S! I a / ! 0F:33 / - /0 G(l T/!/mac y. /9 tf/L 0 0 r: 31 q. iz 0 z :0 kc. 2.9z o.-79 ff/z0 V' -o X3 0 Mr 3.90 ° .80 fyLO ti 0�:�6 G 9: 0 3 0 /vLr`vL q. /Q -5 3 0. �y 0 S UY 0 3 a9•'� 30 4. -70 3. 9L 7SP 4 rol�sstu ®® i a� 2/ y l J. l0 9 PERCOLATION RATE_ (minutes/inch) TEST RUN BETWEEN FT AND 17'-5 FT COMMENTS Ov1�i/7/ /Z f a / ! Te / - /0 G(l T/!/mac 1 PERFORMED BY: CERTIFIED DATE:�� 72-008 (6/79) ZR s`/.BU.2 4-31/.3 Si /lJ Q,C. CGdt vs �ari�J r<e/ MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # L; \ - R � i - HAA # 1. GENERAL INFORMATION Complete legal description �o� � SSOC IL 4A Location (site address or directions) _ RR -6_10b -5�0,-M, 60,-7 Jar. Property owner Mailing address Lending agency Mailing address. 'asz co 'Se:, ay p one �7 OB: Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Y S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that -my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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. KND Engineering,/�/ Name of Firm 20441 Ptarmigan Blvd. Phone Eagle River, AK 99577-8735 Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. By: Conditional approval for Additional Comments bedrooms. Date , /96, OF CD a �- n � & CAt boa •ora M�aEaa a°e.a •aaa �.i u.• w cc Kenn,.; h1. sy CE 711 ,• a� t@ ��q0F oio' Qs bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-G25 (Rev. 1/91) Back MOA #21 M Municipality of Anchorage • DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-KEC E I V E D 14 Health Authority Approval Checklist MAY 28 1996 /l Municipality of Anchorage Legal Description: 4/zo ��,Y j yy �=-9ePty}iy"lth & ilman Services /�Sb�l Parcel I.D.: /)� r �/ Z A. WELL DATA Well type /zz If A, B, or C, attach ADEC letter. A�D�EC water system number Log present (Y/N) Date completed Total depth «Q Cased to �1G0 Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N)_ FROM WELL LOG AT INSPECTION Date of test Static water level �,?� / 135,71 Well production C e_n_m WATER SAMPLE RESULTS Coliform Nitrate /, T Other bacteria Date of sample: /9� Collected by:. /U B. SEPTIC/HOLDING TANK DATA / Date installed I/ Tank size 1250 Number of Compartments Z Cleanouts (Y/N) }I Foundation cleanout (Y/N) y — Depression (Y/N) N High water alarm (Y/N) Date of Pumping IVPQ C. ABSORPTION FIELD DATA Pumper IVA Date installed// Soil ratin (g.p.d./ft2 or-ft�z drm•) �,� System type Med Len h�heds � P_GL albeclS Lao,- 3"as / to Width J- QCT, Gravel thickness below pipe Total depth OLI �2. gas Effective absorption area 900 Srr Monitoring Tube present(Y/N)—L Depression over field (Y/N) /7eA�� Date of adequacy test /1 Results (Pass/Fail) — For bedrooms Fluid depth in absorption fiel fore test (in.); Immediately aft _ gal. water added (in.): Fluid depth (ins.) Minutes later: Ab tion rate = g.p.d, Peroxide atment (past 12 months) (Y/N) If yes, give date D. LIFT STATION Date installed ///%�j Size in gallons �ZS� Manhole/Access (YIN) "Pump ori' level at* "Pump off' level at* High water alarm level at* 7 7 *Datum Cycles tested .v E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic/holding tank on lot /fid + : On adjacent lots � Absorption field on lot //}Q , -f ; On adjacent lots /,96) -f Public sewer main /2q Public sewer manhole/cleanout /%Q Sewer /septic service line IM Lift station /DiQ / -k SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO Building foundation Property line /D 4 Absorption field /� f Water main/service line %O / Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation /0 '- Water main/service line / &0 -./-- Surface Surface water 200' '/ Driveway, parking/vehicle storage area 10D J ' - Curtain drain /� I / Wells on adjacent lots /4V ,'/ Property line 17, / -5ee , Gva/u>!✓W2 95'U0116&evesej) F. ENGINEER'S CERTIFICATION certify that have determined thru field inspections and review of Municipalrec ffegCJ{x+q(; � is are in conformance with ,LIOA HAA guidelines in effect on this date. . ; ' °•$o 6 `o® :49M •: Signature a as es *@..ease... $egos Engineer's Name Qy/�9 �/ /%l ��c > Ac :Eh&jpjya 00 m ®�.• CE 711 Date �'�o?5/�jL' ®� �<° °'•• � � °'s ®%O-ESSIO®®� HAA Fee $ .� . CADg Date of Payment tp �P dD q/ / Receipt Number Z (Z2 J Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number 3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 02�_E'Q8q OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application DateP"fT 7. /9 87 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) In ot 2G_ (3(ac(: �/, SgcmOSen Ccke1--J Location (address or directions) Susan b ri �z Fe- Aer-r C'rcc /T (b) Applicant Name ["ard- Re (cca/ton Cove Telephone: Home IV, A. Business Applicant Address 2w S. Branae /kue Su'fc (o/.� Gt-fnyt kny SIT 07039 Ti (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 1Z ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Fire Sn her.slal° San k Telephone 2 6K -S63S Address 3000 C" St. ¢n chdr ge /�� 99663 (e) Real Estate Company and Agent Dvnami c RecA M, 279 -?61/ Cc/ /e en Address bD1 W. KarAern 6,K4/> R/L' Apnc'herc,ye* /y -ft 99So3 Telephone 279 -7111 (f) Mail the HAA to the following address: / 2. TYPE OF RESIDENCE Single -Family ® Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well ® Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 91 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) A 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm F(a f oo TecAn ccuf S vsf Telephone 3 5 S- r 3 C:5,- Address ,,Address ('1530 Cctia S>` �Yn�hoicrgt, ,1} k 995 Date 5_1 Z 7 4 B 7 e ^? ��e.ee,a..,,..,..., •. e,,,,,,Al THEODORE F. MOORS .: Engineer's Seal t��4. ,•.. CE - 3589 •F,� t ��_ Araiess��= 3� �•m 6. DHEP APPROVAL r Approved for OL>&_]�,)bedrooms by Date 61/111-410— 6�, Approved Disapproved Conditional Terms of Conditional Approval �Jhep 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 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION MAY 2 9 1987 Legal Description: -Ina-L V, E �L m d so n Es irr. �E! A. WELL DATA Well Classification Priva.4t If A, B, C, D.E.C. Approved (Y/N) &A•. Well Log Present (Y/N) Y Date Completed 7 /15' /8,5- Yield >Y,8W." view 6'/Z01/8-7 Total Depth 16'0' Cased to 160 Depth of Grouting Ni A. Static Water Level 1'(o' Pump Set At 15'SI Casing Height Above Ground 110 Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot toe" ; On Adjoining Lots > too' To Nearest Edge of Absorption Field on Lot ^^ 200' ;On Adjoining Lots > too, To Nearest Public Sewer Line N, A. To Nearest Public Sewer Cleanout/Manhole N. . To Nearest Sewer Service Line on Lot N, A. Water Sample Collected by T. F. Nuore- ; Date 6l ZO / a 7 v Water Sample Test Results Sarlts�acfoj A O eu(rforn, / 100#19/J 0.60 V/,e Comments B. SEPTIC/HOLDING TANK DATA Date Installed 9/Zs/&S Size - f00� No. of Compartments 2 Standpipes (Y/N) I Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) i - Depression over Tank (Y/N) N Date Last Pumped 9/Z7/87 Spy J'j3's P��,�, y ✓ Pumping/Maintenance Contract on File (Y/N) ;for Al. Holding Tank High -Water Alarm (Y/N) N• A. Temporary Holding Tank Permit (Y/N) M. A. Separation Distances from Septic/Holding Tank: To Water -Supply Well (06I To Property Line > (0' To Water Main/Service Line N,A. Course > too, Comments SoMe "rrace cX ret rn ViC"nt,LV of rD)'!2c ktn(c. ance Page 1 of 2 72-026 (Rev. 8/86) Front To Building Foundation 19 1 To Disposal Field 136' ( To Stream, Pond, Lake, or Major Drainage M, ro( C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 26! 0' /Sotrm Type of System Design Date Installed 9/ as /as- Length of Field 6`/ ( . _ Width of Field -2o'--- Depth of Field Gravel Bed Thickness 0- S Square Feet of Absorption Area 1260— Standpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test S/ zo /g 7 ,,.. Results of Last Adequacy Test Ado uaAe ccyror op how ree Ae .ror 3 bealruormr v Separation Distance from Absorption Field: To Water -Supply Well 200To Property Line 10, To Building Foundation 1 SD To Existing or Abandoned System on Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course On Adjoining Lots To Cutbank (if present) N..4. To Driveway, Parking Area, or Vehicle Storage Area > too, Comments All jy/Qoe&r en beoC ,were oQry cr/ 741eS/Er✓f o/ l - Me Aerr D. LIFT STATION Date Installed Dimensions 114Irn6wo Size in Gallons 7.50 Manhole/Access (Y/N) "Pump On" Level at 3 30 cyu!!ooy "Pump Off' Level at ro a!(av ✓ High Water Alarm Level at 2 Ce 011f uV on /e0e/ Vent (Y/N) Y Tested for SGO h yallear on 5-1 ?0 /87 Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) N.A. Oufsrole code enler/emenf area goer 2/7/86 AE *gj Comments Znfor/'^gJioo on evct<r anaC extgrm �Srorn 217186 N/F,4 &PwAV " 20,0/s SAW 6 o • —C� 4/ " Check P rmitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 1� - 9 %1--~ Date 5-/ 27 /87 Company F� Tecti.o r c a( Si*u MOA No. 6r7 o,S2 Receipt No. �1 oni co Sc ®OF9®� Date of Payment F)-Q'c'`�1 ����`ee °et��®® e s ° Amount: $ I u(,°� 0 * .. 9TH* Engineer's Seal ®•e •oeeeeaeeeseoeeeeee •°seee�d - Aseeeeee •°o°eoe�ieee ��e• 9 ea THEODORE F. MOORE j AF Page 2 of 2 �� CE - 3589' �j ®'VIAJ •l •cavo°°e �` 72-026 (Rev. 8/86) Back ��TQI£SSiO`' ®� ®�W®.1AIN® 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) Lot 20 Block 4 Sampson Estates Subdivision (b) (c) Location (address or directions) Applicant Name Leif Erikson Telephone: Home 688-9223 Business 753-2737 Applicant Address PO Box 671224 Chugiak, Alaska Applicant is (check one): Lending institution ❑ ; Owner/builder ®� Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Alaska USA Federal Credit UniorFelephone 563-4567 Address 4000 Credit Union Drive Anchorage (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family E?c Multi -Family ❑ Other Number of Bedrooms three(3) 3. WATER SUPPLY Individual Well Mxx Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ®xx Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11184) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm LCMF Telephone Address Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of February 14, 1986. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. 6. DHEP APPROVAL Approved for three (3) bedrooms by Approved Terms of Conditional Approval Conditional dhep CAUTION June 17 1986 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 72-025 111/84) E Location (address or,directions) 'sampson�Drive Peter's (b) Applicant Name Leif Erickson Telephone: Home 688-9223 Business 753-2737 Applicant Address 'P0 Box 671224 Chugiak, AK 99567 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ; Buyer ❑ Other ❑ (explain); (d) Lending Institution` Alaska USA Fed.' Credit `U .Telephone 563-4567 Address 4000 Credit Union Drive (e) Real Estate Company and Agent — Address Telephone (f) Mail the HAA to the following address: Creek o GEOLAB None l 1131 E. 76th AVe.. #101 5. ENGINEERING, FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l further verify that based on the information obtained from the Municipality of Anchorage files and from my. investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm GEOLAB Telephone 344-8042 Address 1131 E. 76th Ave. #101 Anchorage, Alaska 99518 7 /7 /ftfi rate Recommend conditional approval pending final grac station and trench for 211 pressure line to bed; and pending final installation of electrical lines into conduit and underground; and pending installation of vent pipe in manhole cover of lift station. ft 6. DHEPAPPROVAL Approved for bedrooms by to ro Approved Disapproved Conditional Terms of Conditional Approval �?� C -d ✓ (2-) 43 77 dhep 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 (11/84) MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) ENVI ONMENTALEALTH PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984i19 1149 264-4720 Legal Description: Sampson Estgwf Sec 3 T15N R1 A. WELL DATA Well Classification Individual If A, B, C, D.E.C. Approved (Y/N) NA Well Log Present (Y/N) Y Date Completed 7/15/85 Yield 5 qpm Total Depth 160Cased to 160' Depth of Grouting NA Static Water Level 135' Pump Set At 155' Casing Height Above Ground 12" Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) N* Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot 110' * * ; On Adjoining Lots 1001+ To Nearest Edge of Absorption Field on Lot 216 1 ; On Adjoining Lots 1001+ To Nearest Public Sewer Line NA To Nearest Public Sewer Cleanout/Manhole NA To Nearest Sewer Service Line on Lot NA Water Sample Collected by DAStanleyGFGEOLAB ; Date 2/6/86 Water Sample Test Results J / �' Comments *Electrical wiring shorted out after freeze-up. New wiring to be buried and placed in conduit after spring thaw. **101' from well to lift station. B. SEPTIC/HOLDING TANK DATA Date Installed July 1985 Size 1000 No. of Compartments 2 Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) y Depression over Tank (Y/N) N * Date Last Pumped NA new system Pumping/Maintenance Contract on File (Y/N) NA ; for NA Holding Tank High -Water Alarm (Y/N) NA Temporary Holding Tank Permit (Y/N) NA Separation Distances from Septic/Holding Tank: To Water -Supply Well 110' To Building Foundation 171 ' To Disposal To Property Line 40 Field 133' To Water Main/Service Line NA To Stream, Pond, Lake, or Major Drainage Course NA Comments * No depression over septic tank, depression over lift station to be filled when final grading is done after spring thaw. Page 1 of 2 72-028(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 281sgft/BR Type of System Design Bed Date Installed July 1985 Length of Field 64' Width of Field 20' Depth of Field 4.01 to 6.0' Gravel Bed Thickness 0.51 Square Feet of Absorption Area 1280 sqft Standpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test NA new system Results of Last Adequacy Test NA Separation Distance from Absorption Field: To Water -Supply Well 216' To Property Line 15' To Building Foundation 159' To Existing or Abandoned System on Lot NA ; On Adjoining Lots 1001+ To Water Main/Service Line NA To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course NA To Driveway, Parking Area, or Vehicle Storage Area 1001+ Comments D. LIFT STATION Date Installed July 1985 Dimensions unknown NA Size in Gallons 750 gallons Manhole/Access (Y/N) Y "Pump On" Level at 330 gallons "Pump Off' Level at 150 gallons High Water Alarm Level at 211 above Pump on level Vent (Y/N) N * Tested for NA new system Pumping Cycles during Adequacy Test. Meets MOA Flortrinni rnrloc w/nh N - outside MOA code enforcement area Comments * Vent pipe missing from manhole cover. To be installed. ** Check Permitted Bedroom Rating Against HAA Request ** I certify that ave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date 2/7/86 Company GEOLAB MOA No. NA Receipt No. I- S/ Lo L Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal