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HomeMy WebLinkAboutSAMPSON ESTATES BLK 4 LT 28Sampson Estates Block 4 Lot 28 #051-822-18 -� Municipality of Anchorage Development Services Department ;' :_� Building Safety Division e l _ On -Site Water 8 Wastewater Program, 4700 Bragaw St. - P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SWO80175 PID Number: 051-822-18 Name: CATHERINE CLAWSON Wastewater System: ❑ New ■ Upgrade Address: 23613 GOLIATH DRIVE * CHUGIAK, AK 99567 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 350-5132 4 O Deep Trench Q Shallow Trench er Bed ❑ Mound 0Other LEGAL DESCRIPTION SoN Rating 1.0 Tata °'°'h a c °' Gn/S' rL SEE n Block: Lot: Subdivision: 4 28 SAMPSON ESTATES Depth to Pipe bottom from arks grade: SEE DWG. CrarW depth beneath plW: rt. 0.52 Ft Township: — Range: — Section: — FIN odded obave crgH,ol grode: Grovel kenth: SEE DWG. rt. 40 rt. WELL: ❑ New ❑ Upgrade Grovel slain: 15 Number of IL»e: Oetonce bet~ Sr'"; 3 5 Closrl.cct,on Private. A.S.0 :Told Dep Cooed TQ:(KD" G FL Total ob"tion urea: rt Pipe moterfol: +�\ �. rL \� 600 so. L D 3034/ F-810/SCH 40 r Date DKK: Static water L": Walw- Ltd. Date Installed:: st 8/28-29/2008 F1GEG, Ywla: Pump Set Q. Cc" Height Abo" Ground: CPU I rL I Ft. TANK SEPARATION DISTANCES oSeptic p Holding ■ S.T.E.P. tr Other* To From Septic Tank Absorption F Lift Holding ubric/Private « Lure Mon`ifaaturef. GREER Capably M gala^: 1500 Well 100'+ 100'+ too'+ — 25'+ Materwi. STEEL dumbw of comportment: 2 Surface Water 100'+ 100'+ 100'+ - - LIFT STATION Lot Line 5'+ 10'+ 5'+ — _ Si1e in goliom: MonVocturer' 1500 GREER QUANICS Foundation 5'+ 10'+ 5'+ — — an bvel et: Pump ol) level at: li.gh soler oiorm a TIMER TIMER 44 Curtain groin NONE KNOWN Pump Woe k Model Arkal b.epectkne perfom.ed by: IS p—TE-30-1 RISING SON Remarks: OLD SEPTIC TANKS WERE ABANDONED BENCH MARK Location one oeecriptwn: PER UPC. OLD LIFT STATION WAS REMOVED FROM TOP OF MANHOLE LID THE SITE #QUANICS AEROCELL TREATMENT SYSTEM Assume: Vevat,a,: 97.98 F., /� GEG Ltd. Inspections performed by: Dates: 1st ENGINEER's3EAl _8/28/2008 2nd 8/29/2008 3rd 8/29/2008 a Development Services Department Approval p 09 ' �..... ... ...::y.. Conditional approval: Date: .............. O f y A. rness.: QQ C —753 Reviewed and approved by: ate: 4/00d P�ofessto� 44 ��Q4�000'�a Uj Nf)v) i D -n 61-10 h'i d 7 L_T_`!� 4-o (A 39 T Quante GARNESS ENGINEERENG GROUP, Ltd AeroCell'. -------- — ---- -- ENGINEERING SALES CONSULTING Alaska Authorized Dealer January 24, 2020 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650 Anchorage, AK 99519-6650 (907) 343-7904 Ref: Sampson Estates S/D; Block 4, Lot 28 (23613 Goliath Drive, Chugiak, AK) Memo concerning converting CAT III AWWTS to CAT II AWWTS septic system To whom it may concern: The permitted septic system was installed on the referenced property and started up in 2008. ARM Septic Services, LLC has checked the monitoring tubes in the drainfield in June of 2019 and found them to be dry. In order to simplify the operation and maintenance of the system, we are proposing that this unit be permanently configured as a CAT II system. Our justifications are as follows: The receiving soil has a percolation rate of 40 minutes per inch. Given this percolation rate, a 1.0 gpd/sq.ft. application rate is required for a Cat II system. The home has 4 bedrooms, so 600 sq./ft. of absorption area is -required for a CAT II effluent (600 gpd / 1.0). The existing 2008 drainfield has 600 sq./ft, of absorption area. The approved On-site Wastewater Inspection Report stamped and signed on 9/9/2008 already shows the soil rating to be 1.0 gpd/sq.ft., so it does not need to be amended. At this time, we request that your department approve a CAT II configuration to be used at the referenced property. Upon your concurrence, we will have ARM Septic Service, LLC., go to the propertylevel the Jandy valve basin, remove the actuator from the ball valve, leave the valve in the o � position, and have them place a CAT II sticker on the control panel. Sinlrelt, . P. E., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179' Fax: (907) 338-3246 * Website: www.garnessengineering.com Jody Maus From: ARM Septic Services LLC <armservicesak@outlook.com> Sent: Monday, June 24, 2019 9:16 AM To: Jody Maus Cc: Jeff Garness Subject: 23613 Goliath - Sampson Est. B4 L28 CAT H approval Jody, The new owners of the Quanics system located on 23613 Goliath Drive (Sampson Estates; Block 4, Lot 28) gave ARM and Garness verbal approval to convert the currently CAT III Quanics system to CAT 11, negating the need of the Jandy valve actuator. We completed a site visit on Saturday, when the jandy valve had a hiccup, and the owner again confirmed they want to get this rolling. As far as we can tell, the documentation shows a sand filter, and the djainfield is dry. Let me know if you have any questions. If this is one that you've already taken care of, we apologize as it may have gotten lost in the earthquake shuffle. Respectfully, Rob Campbell Managing Member ARM Septic Services, LLC Ph: (907) 688-9433 Cell: (907) 317-9433 Email: ARMServicesAK@outlook.com Website: www.ARMServicesAK.com Facebook: www.facebook.com/ARMServicesAK/ PERMIT NUMBER: SW080175 A B ST1 80.70 64.40 MH 87.81 73.34 JV 102.04 86.96 C01 105.54 91.08 MTI 104.15 91.18 CO2 89.12 98.09 CO3 93.91 102.84 C04 98.80 107.52 MT2 99.90 109.11 AS -BUILT DRAWING 4` NEW DRIANFIELD� MT2 IC04 CO3 .jCO2 H 650 AEROCELL POD PARCEL ID NUMBER: 051-822-18 NEW 1500 CALLO S.T.E.P. TANK SCALE: GLENN VIEW NORTH. LOT 1. BLOCK 2 1'- 40' • • • • • • • GARNESS ENGINEERING GROUP, Ltd. . ••• •---_--. CONSULTANTS & GENERAL CONTRACTORS MI 1. ROW C. (UI( 101 • Noa.0(. M 10107 • Noe (eoi)337-4171 • (M (YOY)sa-,iN • YOLt elm .,e y -e, PREPARED FOR: CATHERINE CLAWSON PHONE NUMBER: 350-5132 LEGAL DESCRIPTION: SAMPSON ESTATES, BLOCK 4, LOT 28 TYPE OF WORK: AS -BUILT DRAWING (Rev UMM) PACE NUMBER: 2 OF 3 DRAWN BY: K.D.M. DATE: 9/9/2008 PERMIT NUMBER: SW080175 AS -BUILT DRAWING PARCEL ID NUMBER: 051-822-18 TOP OF TANK INLET - 92.44 FINAL GRADE 97.61+ TOP OF MAN — ,(ANDY VALVE HOLE 97.98 650 OUANICS AEROCELE UNIT INVERT OF BUNG INLET •• 91.83 1500 CALLON S.T.E.P TANK 10 GA. RATED FOR 10' BURIAL DEPTH OP OF TANK OUTLET .• 92.39 TO DRAINFIELD BOTTOM OF THE ORIGINAL BED VARIED FROM 93.40 TO 94.90.REMOVED CONTAMINATED MATERIAL. UP TO 1 FOOT OF MATERW.. AND REPLACED WITH MOA APPROVED SAND TO ELEVATION HIGHER THAN BOTTOM OF OLD BED. FINAL GRADE 98.75-98.78 INSULATION FILTER FABRIC ? f^i JJ ti4�'Gn i,'s`YK} 1 ♦4bl -:l JJ• �.• xr T .tt. rr�Ki', +.Y ett 1 .�• 'ley. �.� .ii K i •.ne•!- .4 rLK 4'}.r-r�i: r`. �''�. r� t'T,'.,Jj i `r i•Iftie_r�v J iih�tl5•t�/1 .~. r�n�i TOP OF SAND ' r}� �+�•.+y4Ai'A „ � : h CCS�. ,.i \.N -.•l Y 4 a} r'�4X <...•Y h...tiffs •. 94.92 trht.<4 f rhe 1/4:; �......v Jk+yr,% 1•\S4rll•.�h t rY M �yl.,.:!i "r Nrt T 5.11 • foie+ C tN � fres 4. r' +Vlir"i/r'^••`; r�\rltil •V smt 1 15' WIDE �..*%%`........._ MOUND WAS TOPSOILED AND SEEDED SLOP GARNLSS ENGINEERING GROUP, Ltd. •v-- •�••^••�•---_�••»•- CONSULTANTS 6 GENERAL CONTRACTORS....—.. 1701 1. e.W eoA sun 101 • rmciutt. M Se507 • PICK (01)33+-e17e • eM (107)33.4244 • scone w..,a,�rpwww,ee•, PREPARED FOR: CATHERINE CLAWSON PHONE NUMBER: 350-5132 PAGE NUMBER: 30F3 LEGAL DESCRIPTION: SAMPSON ESTATES, LOT 28 BLOCK 4 DRAWN BY: K.D.M. TYPE OF WORK: PROFILE DRAWING DATE: 9/9/2008 INVERT OF' DISTRIBUTION UNE - 95.44 BOTTOM OF BED 93.52 0 o�4p� OF,A A -ss E-7 g.l�. 4, Profession 400000 (Rev. 01kO5) i■�Sep 10 2008 10:348M Rising Son Electric, Inc. 907-622-6777 i■ ■i September 10, 2008 Gamess Engineering Group Attn: Rob 3701 E. Tudor Road, Ste. #101 Anchorage, AK 99507 Re: Lot 28 Block 4 Samson Estates Dear Rob: Rising Son -Electric, Inc. 14916 WoocJIanci Drive -Eagle River, AK 99577 (907) 622.6777 p.1 The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes. Thank you. Sincerely, /?ea - ,a iia n-a�f • ?�L Kevi S. Hornbuckle, Owner Administrator Ucense Number 1284 Specialty Contractor Ucense Number 27285 cc: file 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: SW080175 Legal Description: SAMPSON ESTATES BLK 4 LT 28 Design Engineer: 0855 GARNESS ENGINEERING GROUF Owner Name: CATHERINE CLAWSON Owner Address: 23613 GoOLIATH DRIVE CHUGIAK , AK 99567 - --z-8-0 g e S: uo Date Issued: Aug 19, 2008 Expiration Date: Aug 19, 2009 Parcel ID: 051-822-18 Site Address: 023613 GOLIATH DR Lot Size: 40531 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. A. Permit includes waiver WR080057 allowing: 1. Zero (0) feet separation from the existing drain field and the proposed drainfield, 2. The proposed drain field in Option 1 to be 36 feet wide. B. Option 2 requires a signed maintenance agreement to be on file with MOA prior to construction. /�� Received By: � ya Date: Issued By Cl,vit9 Gt Date: Municipality of Anchor Mayor Mark /legich August 19, 2008 P.O. lire I!%450 •,tnchnmgc.Alaska) 99519.f1450.4700 Elmore 12. ( nee: (907):i7:481111 • I'ac: 1007) 343.82I0 htlp://www.mml 11.nrg I)evclopnrcnt Services Department Jeffrey Garness, P.E. Garness Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Subject: Waiver Request for Sampson Estates; Block 4, Lot 28 Waiver Request WR#: 080057 Parcel ID # 051-822.18 Permit #SW080175 Dear Jeffrey Garness, P.E.: Ili_1_I SIA Department Your request for the two waivers shown below has been approved. 1. The required ten (10) feet horizontal separation from the proposed absorption field to the existing absorption field is approved to be zero (0) feet. 2. The required maximum absorption bed width of fifteen (15) feet is approved to be thirty six (36) feet. These waivers apply to the current proposed construction/improvements only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, J6p(ies "Jay" Crewdson Civil Engineer On -Site Water & Wastewater Program Commultity, Security, Prosperity Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 05142- "-/ Property owner(s) CATHERINE CLAWSON Mailing address 23613 GOLIATH DR. "CHUGIAK. AK Day phone 350-5132 Site address a. it> &)DIIAfl4 ISM& Zip Code 99567 Legal description (Sub'd, Block & Lot) SAMPSON ESTATES: BLOCK 4. LOT 28 Legal description (Township, Section & Range) N/A Lot Size .53 ( Sq.Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR ( ® all that apply): THIS APPLICATION IS AN: Absorption Field ® Initial 0 Septic Tank ® Upgrade Ell Holding Tank 0 Renewal 0 Privy 0 Private Well 0 Water Storage 0 I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit/Rush Fees: [ b o • 0 0 Waiver Fees: Date of Payment: ) I , o 3 Date of Payment: Receipt Number: q31/t1/9 Receipt Number: (Rev. 11/05) Ian! �a�Dh N i a,6 -f GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS r- . -:; June 2, 2008 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic System Upgrade for Sampson Estates; Lot 28, Block 4, To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic system is in a state of failure and needs to be upgraded. We have two options that we are proposing. For option #1 we are proposing to rebuild the existing bed. For option #2 we are proposing to partialy rebuild the existing bed and install an Aerocell treatment system. Comments regarding the design are summarized as follows: 1. SOILS: We are rebuilding over the existing drianfield site. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPIIY: As can be seen on the attached design drawing the average topography within 50 feet of the drainfield is relatively flat. We are unawar of any adverse impacts this installation would have on adjacent wells or septic systems. If you have an questions, please contact us at 337-6179. Thank you for your assistance. rely, Presi E., M.S. NOT ttached is a site plan drawing. a design drawing, one soil log, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: www.gamessenginecring.com GARNESS ENGINEERING GROUP, Ltd. 0.,.1...._sa mvoirl mma CONSULTANTS & GENERAL CONTRACTORS rn+'rxrf r.0 `n...nr rcnmcri August 14, 2008 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sampson Estates, Block 4, Lot 28. Waiver for separation distance between drainfields & waiver for absorption fields width, 1. We are requesting a waiver for the required 10' separation distance needed between a proposed and existing drainfield. For both design options (I & II) we are proposing to rebuild all, or a portion of, the existing bed, thus it will have a zero foot separation distance to the old bed. All of the contaminated soil will be removed and replaced with MOA filter sand. In short, once the contaminated material is removed it will be the equivalent of constructing a system on insitu soil. We have successfully rebuilt numerous drainfields over the last 18 years. We are requesting that you grant a 0' separation from the existing and proposed drainfields. 2. For design Option I we are proposing to rebuild the existing bed, which is 36 feet wide and 56 feet long. Given that the bed width will be greater than 15 feet a waiver will be required. The existing 36 foot wide bed functioned adequately for 17 years, so there is no reason to believe that reconstructing it to its current dimensions will be problematic; therefore, we arc requesting that your department grant us a waiver to allow for the bed's width to be 36 feet wide. 3. Satisfied 4. As we have always done in the past, the contaminated soil will be used as the first layer of backfill over the new drainfield. If you have any qu ions, please contact us at 337-6179. Thank you for your assistance. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337.6179' Fax: (907) 338-3246 • Website: www.gamesscngineering.com SAMPSON ESTATES; 1 BLOCK 4, LOT 15 I EXISTING SEPTIC PIPES SAMPSON ESTATES; BLOCK 4, LOT 16 GLENN VIEW NORTH S/D, LOT 2, BLOCK 2 (PUBUC WATER) SAMPSON ESTATES; BLOCK 4, LOT 16 SAMPSON ESTATES; SAMPSON ESTATES; BLOCK 4, LOT 26 BLOCK 4, LOT 27 it__ DRIVE \ 14, GLENN VIEW NORTH SP: LOT 13. BLOCK 1. SAMPSON ESTATES; BLOCK 1. LOT 1 SAMPSON ESTATES; BLOCK 1. LOT 2 SAMPSON ESTATES; BLOCK 1, LOT 3 SAMPSON ESTATES BLOCK 1, LOT 4 SCALE: 1 • .• 100' i L _ GARNESS ENGINEERING GROUP, Ltd. •.. CONSULTANTS & GENERAL CONTRACTORS "•- — — 701 L TUDOR SUR 101 • NOCRIGC. M( 90507 • MONY (8011131M119 • FAX (907)3.36-3246 112891[. falsn9Ineseln4 PREPARED FOR: CATHY CLAWSON PHONE NUMBER: 350-5132 LEGAL DESCRIPTION: SAMPSON ESTATES: BLOCK 4, LOT 28 PAGE NUMBER: 1 OF 3 TYPE OF WORK: SITE PLAN FOR PROPOSED SEPTIC SYSTEM UP -GRADE DRAWN 8Y: K.D.M. DATE: 6/2/08 (Rev 01/05) DESIGN CRITERIA: NUMBER OF BEDROOMS: 4 GALLONS PER DAY (GPD): 600 PERCOLATION RATE/S: 40 PROPOSED APPUCATION RATE: 0.3 MINIMUM DRAINFIELD SQ.FT.: 2000 DRAINFIELD DESIGN: MAXIMUM DEPTH: REMOVAL OF ALL CONTAMINATED SOIL WIDTH: 36 FEET LENGTH: 56 FEET IMPORT M.OA SAND FILTER AND REBUILD THE BOTTOM OF THE BED TO THE SAME ELEVATION A5 THE EXISTING BED. OR HIGHER. EFFECTIVE: 0.5 FEET REDUCTION FACTOR: N/A ACTUAL SQ.FT.: 2106 GEC, Ltd. HAS A 7 PACE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEC. BY PROCEEDING FORWARD WITH THIS INSTALLATION. THE ENGINEER. WELL DRILLER. CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. NOTE: BOTH TANKS & UFT STATION ARE TO BE INSPECTED FOR STRUCTURAL NTECRITY. UNITS THAT DO NOT MEET THE REQUIREMENTS ME TO BE REPLACED. IF ALL TANKS ARE FAILED A 1500 GALLON S.T.E.P. TANK SHALL BE INSTALLED. NOTE: THE CONTRACTOR SHALL HAVE THE NORTH LOT LINE FLAGGED BY A REGISTERED LAND SURVEYOR RIO'_, CONSTRUCTION. CO vrto‘wcqukAt.1 Soils re.tAn(vea {mon ISA eArthil cd)Sorp1:dv, bind shall Qlo1Le r i�. AL Av's lotthr 0,/ backe'11 over 4e vmty pe8% 9& ribs1 50 FEET LONG LATERALS 0 6 OOT ON CENTER OPTION 1 THE DISTRIBUTION UNES ARE TO BE 1.50 INCH PVC WITH 3/16 INCH HOLES SPACED 6 FEET ON CENTER (8 HOLES PER LATERAL/48 HOLES TOTAL) 5E: 609 L PROPOSED LOCATION OF 1500 GALLON S.TE.P. TANK IF REQUIRED DUSTING E6' x 56 BED TO TO BE REBUILT C\9 EXISTING DOUBLE CLEANOUTS EXISTING 500 GALLON UFT STATION (INSTALLED 1991) DOSING 500 GALLON SEPTIC TANK (INSTALLED 1985) C9 MING 1000 GALLON SEPTIC TANK (INSTALLED 1985) EXISTING 4 BEDROOM HOUSE SLS I GARNESS ENGINEERING GROUP, Ltd. .. •• CONSULTANTS 8. GENERAL CONTRACTORS --_•-- -..• POI L TUDOR ROOD. suns 101 • FIICMGIN.L AK 11301 • ACK (07)337-4171 • FAX (1013336-324 • nSRL AnAponremarseln44414 PREPARED FOR: CATHERINE CLAWSON PHONE NUMBER: 350-5132 LEGAL DESCRIPTION: SAMPSON; BLOCK 4, LOT 28 TYPE OF WORK: SEPTIC DESIGN UPGRADE - OPTION 1 (Rev. 01105) PAGE NUMBER: 2 OF 3 DRAWN BY: K.D.M. DATE: 6/2/08 DESIGN CRITERIA: NUMBER OF BEDROOMS: 4 GALLONS PER DAY (GPD): 600 PERCOLATION RATE/S: 40 PROPOSED APPUCATION RATE: 1.0 MINIMUM DRAINFIELD SO.FT.: 600 DRAINFIEI D DESIGN' MAXIMUM DEPTH: REMOVAL OF ALL CONTAMINATED SOIL WIDTH: 15 FEET LENGTH: 40 FEET IMPORT M.OA SAND FILTER AND REBUILD THE BOTTOM OF THE BED TO THE SAME ELEVATION AS THE EXISTING BED. OR HIGHER. EFFECTNE: 0.5 FEET REDUCTION FACTOR: N/A ACTUAL SO.FT.: 600 CEG. Ltd. HAS A 7 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEC. BY PROCEEDING FORWARD WITH THIS INSTALLATION. THE ENGINEER WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. NOTE: THE CONTRACTOR SHALL HAVE THE NORTH LOT LINE FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. NOTE: BOTH EXISTING SEPTIC TANKS & LIFT STATION ARE TO BE PUMPED, CRUSHED, AND COMPLETELY ABANDONED. 1 \— II '' COt�`iaw11K4tt0 s1>U Moot. 4w w1 42.e eachi..: otbso pthq, bed s&tl14 pl&ee`a \Lsive Pa' 6deatig 8/11 SCALE: 1• - 40' C9 PROPOSED REBUILT PORTION BED PROPOSED 650 AEROCELL RECIRCULATING TRICKUNC POD AND JANDY VALVE :s: OPTION 2 EXISTING 500 GALLON UFT STATION EXISTING DOUBLE CLEANOUTS / 60 As" tee O1 , 0i 5. ntd wAoa tttt414 A stlir EXISTING BED PERIMETER PROPOSED 1500 GALLON S.TE.P. TANK DOSING 500 GALLON SEPTIC TANK EXISTNG 1000 GALLON SEPTIC TANK EXISDNG 4 BEDROOM HOUSE GARNESS ENGINEERING GROUP, Ltd. - -.• -•• + CONSULTANTS & GENERAL CONTRACTORS 3701 L 1'1011 P310. Silt 101 • AKIOMR. M 99301 • PHONE (907)337-9179 • FAX (9013335-3341 • W1171511L •negs,wy__µ•M, PREPARED FOR: CATHERINE CLAWSON PHONE NUMBER: 350-5132 LEGAL DESCRIPTION: SAMPSON; BLOCK 4, LOT 28 PAGE NUMBER: 3 OF 3 DRAWN BY: K.D.M. of :r A. CEr79� •' t" ed 712> QE�ov 't4.‘‘..50 Pfass\oP e TYPE OF WORK: SEPTIC DESIGN UPGRADE — OPTION 2 DATE: 6/2/08 1 1 On 0 r (Rev. 01/05) GARN E SS ENGINEERING GROUP, Ltd. - 1 CONSULTANTS B GENERAL CONTRACTORS r July 24, 2008 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Response on Submittal comment sheet for Sampson Estates; Lot 28, Block 4, To whom it may concern: The following are the responses to the three items needed to be addressed per the design for Sampson Estates; Block 4, Lot 28: 1. There is no code that prohibits rebuilding an existing bed. We have never been charged a waiver fee for rebuilding a drainfield in the 17 years we have been in business. 2. There is no limitation on the maximum size of a drainfield; code only requires a drainfield to meet the minimum requirements set by the MOA. We have never been charged a waiver fee for building a drainfield larger than the minimum requirements in the 17 years we have been in business. 3. The changes h ve been made on the option 2 design. Please note that only a small portion of the bed will be rebuil (1; 40'). Jeffr Pres i• ent N07�E: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246' Website: www.garnessengineering.com Municipality of Anchorage Page of -2---' —1 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: _ i&lcl 16j- 40 PID Number D1ig25 2-2If) Na e: q '' A/,Wastewater System: ❑ New Upgrade ,tABSORPTION Address: FIELD Phone: f 1441r_ �./ No. of Bedrooms: it �T . 0 Deep Trench 0 Shallow Trench Bed Mound 0 Other LEGAL DESCRIPTION Soil Rating: � /� (%•GPD/Sq. Ft. Total Depth from original grade: 7j/ Lot: 2.0 Block:Subdivision: ifS.pa60,4P� Depth to pipe bottom from original grate: • r .S FL Gravel depth beneath pipe l0 Ft. Township:Section: I Range: Fill added above original grade: 61---0./ Ft. Gravel length: �(jy :/(J Ft. WELL: ❑ New D Upgrade Gravel depth:Wspro /� �Ft. Number of lines: (a Distance between lines: l(� Ft. �Cl�a�.S/�ficationA(,Private, A, B,C): l� t )i�G7 Yj Total Depth: Ft. Cased To: Ft. Total absorption area: (i[/ . Ft. Pipe materia t0 g_e�, il'e n-1 ..rJ�j(J "e-- Driller: Date Drilled: Static Water Level: Installer: �� pc.1-(� /p Date installed: i 1 - I 1 1 Yield: GPM Pump Set at: Ft. Casing Height Above Ground: Ft. TANK SEPARATION DISTANCES ( e.Mci sr,4olding 0 S.T.E.P. (tel To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Manufacturer: / Capacity in gallons: 1 OOO 4 ,lo'O/ Well /2014� I(iiis'_i_ No r„. _, iJl�. (J—r✓ Material: Number of Compartments: WaterSurface I a) `-S-' (OVA- [064- — LIFT STATION Lot Line LU,1 ID' -4-Ib C-1- Sizgans: nauer GtrSL Foundation VA- 10t -i- f Ot-4- "Pump on" level at: 'Pump off' level at: �0" f 1 High water alarm at: _!/" 2)(0" Jl�I],9��i CurtainDrain � IC VR' J &J Ppmp MakeModel � Ele'ri4caInspJ'e o;sl it "V rWl •Yilw� Remarks: BENCHp - `` /� �, '11T� c`Jlt 'kJ %OiD N `�f /A 1c D Locati n andq Description: rx,i -- -4 4f 5 t i'oee..-A�t AM�,ARK� �7�� `,- .l rAc 4-I � � S � J.6 40.11. ->.4e sJ7YR`te.(rC�� /' 01A-1 i ►�1Ca - 4,7U--Rx.--c--- ' 11...V4 Assumed Elevation: /')yD Ft. ZC7C, Sit N/P . r (- - 1.1---1- S—r r c rJ g107 „, a . , ° o.., �At` Inspections performed by: `0 = J Dates: 1st ii 6 • / ! ..11 I I 4 9 . 1e0 •0o WIPP'• r • - .. • • _ .. ,� 2nd 11 - 110- //jjl) ••11,,� • ® 9 •, R07 RJ.'AFER, P.E. a Department of Heal and Human Services approval Reviewed and approved by: "I%41 Date. //-2‘--1/ tB�T�®°•.•...... ,,, 0 41PROFESS'°' ®b®®®� 72-013 (1/91) MOA 25 Permit No J1,0-(61 11.)C) Page j of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: 'j)�' L0 2' IJ:W rt -1 bU �XlsTii- A Gbd-S.T 0X(111.14 tax, PID No• 0-162)7--'1 ••••=re -4 %OW ax+.3 13� 5t kx5? P)3-- z )} L waw: 72-013 A (2/91) MOA 25 TO Roder RODNEY P. =NNW ASSOCIATES, rim. CONSULTING ENGINNMSS 16600 Centerfield Drive, Suite 202 Eagle River, Alaska 99577 PHONE (907) 694-2332 FAX (907) 694-1807 RE Sieve Analysis Test sul FROM Clark Kinney DATE _November 26, 1991 COMMENTS Enclosed is te esu or Estates an Lift Statxo Ee� dd�ga.Mater� FAX 694-1211 • k 4 11 . 6D THIS COVER SHEET PLUS 2 PAGES PLEASE PHONE CONTACT IF NOT RECEIVED PROPERLY GRAIN d i SIZE i d • - - DISTRIBUTION TEST REPORT 20 ! i : hi. 80 70 _. M LU 2 ; 1.1. i-- W u M w 40 u SIM 0.. 30 . . . , ' . . • • "MI 20 ' IIIIIIMMIll 10 I . . • 0 . ' 11 200 100 10.0 1.0 0.1 GRAIN SIZE - mm 0.01 0.001 Test %+75md % GRAVEL % SAND % SILT % CLAY • 1 0.0 19.9 79.8 0.3 LL PI 085 DEO D50 pao 015 010 , 4-c Cu 0 NP NP 7.08 2.14 1.55 1.013 0.5695 0.4370 1.10 4.9 MATERIAL DESCRIPTION USCS AASHTO • SAND WITH SOME GRAVEL SP A-1-b Project No.: 1170A Project: SAMPSON ESTATES (5$S ENGINEERING) 0 Location: LOT 20, SLK 4 • Date: 11-25-91 Remarks: LIFT STATION BEDDING MATERIAL FROST CLASS. F8 Figure No. 1 _ GRAIN SIZE DISTRIBUTION TEST REPORT RODNEY P. KINNEY ASSOCIATES GRAIN SIZE DISTRIBUTION TEST DATA Test No.: 1 Date: Project No.: Project: 11-26-91 1170A SAMPSON ESTATES (S$S ENGINEERING) ==mi=---.-r._.r=ax =M = Sample Data Laoation of Sample: Sample Description: USCS Class: AASHTO Class: LOT 281 BLK 4 SAND WITH SOME GRAVEL SP Liquid limit: A -1-b Plasticity index: NP NP Notes Remarks: LIFT STATION BEDDING MATERIAL FROST CLASS. F2 Fig, No.: 1 Mechanical Analysis Data Initial Dry sample and tare= 447.20 Tare = 164.40 Dry sample weight = 282.80 Tare for cumulative weight retained= 164.4 Sieve Cumul. Wt. Percent 2 1 0.5 0.375 # 4 # 10 # 20 # 40 # 100 # 200 inches inches inches inches retained finer 164.40 100.0 190.40 90.8 200.00 201.80 220.70 284.40 380.80 420.60 444.40 446.30 87.4 86.8 80.1 57.6 23.5 9.4 1.0 0.3 Fractional Components % 75mm. = 0.0 % GRAVEL = 19.9 % FINES = 0.3 D85= D30= Cc = % SAND = 79.8 7.08 D60= 2.138 D50= 1.650 1.0127 D15= 0.58952 D10= 0.43702 1.0977 Cu = 4.8922 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:SW910330 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:DEXTER MICHAEL T & OWNER ADDRESS:23613 GOLIATH DR CHUGIAK, AK 99567 PARCEL ID:05182218 LEGAL DESCRIPTION: SAMPSON ESTATES BLK 4 LT 28 LOT SIZE: 40531 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:10/14/91 EXPIRATION DATE:10/14/92 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY' DATE: COP -5/ DATE: /6//W ///7/,f �i �ry.i:`�c>•,7.p�%�LG�,(' T- Ci'L'c ) fr-C4-76:Q G!/r"i L, /-4 /4-/L f/e'C//� [.� • s'fLi4ta/.r f, �• ci (�J %� a ‘:„ 1, S c ',4c/ /L/L// ,,,c/ 41.4' L 14 `( x,„ 7,4 _ //64i 1 � /40- /a / / HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. Octobers 10, 1991 Municipatity o4 Anchonage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L S.t e.et P.O. Box 196650 Anchonage, Akasfza 99519-6650 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 REFERENCE: Lot 28; &oafz 4; Sampson Estates Request you .issue a pewit .to upgnade the septic system senv.ing .the ne4e4enced property. An adequacy test was penbonmed on .the existing system. We bound .the absorption capacity o6 .the system to be less than accep-ta.b&e bon a 4 bednaom house. A -test hake was excavated on .the pnapevt-ty in .the anew ob a proposed upgnade. Enam .the groundwater monitoting we {round .the existing system to be encroaching gnoundwatek. We have proposed the .insta tatLon o4 an elevated keach6.ie2d bed. There ane neka Lve2y kange tots in .this area and we do not anticipate any adverse Wects on neighbani-ng pnopekties by the insta Cation ob the proposed upgnade. IS you have any questions on negwire addLtiana2-Lngonma.tion {yon your nev,iew, pkease contact us. S.ineereky, ROGER J. SHAFER, P.E. RJS/gm MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION OCT 1 1 1991 RECEIVED 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 . 11 SCALE JnC j v D Z n 7 v x 1 \\\ SCALE • • tt s •• • • . • \ s e I . , Fc • seo!M 9 LHL.ii)H `^;{ '-:'.• C5WOL{Cu\, IC61 9 AON a]1\iJJ 1/4/4 r�> v\ 0 v 0 D --m 1 TUE 19 A CR EAGE SYr TEMS 0 - CI a , • (1) 17) r L"--" E V NOV 6 191 1 Of Anchorage l• 1.)opt. Health 8. Human Servicee, l4 FET S smor mmys nommumm A M mmusingog mm Am migrumi ummumAni imoms mimparl monAmrmrsampulms nuommolor RN initaiiiMMIMin iniMM NUMMMIMMII A gl Mil 11111111401 A AI nom mmarammumn AN um mmannimmamman sum OMUSOMPROMIM MEM 1 EMP=ONOMMNIM mum REMMOMMENXIM IMRE. UMNIENNIMMEM MEM BENEUMBINNEMOMMIMM UMMENUMMINIMMIN EIMMIUMNIMMMINNXI OMMEMEMEMMINOMM MINIMMXWMEEMMUMMI MOMMOMMEMMMONIMM IMMIIMMERMUNIMMI 1 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Iv 1, t/t."ix1 2 LEGAL DESCRIPTION: VZ 54- 1 '4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 AE PTH (R.6E17. 't,( NOINEE Q 16 A�9114 • .. •.. .0 . •.•. 0• • R+SER J.C • NAFER16, ▪ P. •• E' 61 :co...., /s • �k R��• ROFESSt0P��� , re DATE PERFORMED�®I�'-��'4 Township, Range, Section: 4 SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After .�/ 1 Monitoring? / Date to S L 0 P E SITE PLAN 4 N — 1 1 Reading Date Gross Time Net Time Depth to Water Net Drop 1� 5 z- --- 7 I t.7- I-411 2', tS z 2:25 I rimJ• -'7/e" `��" 'Z.'.35 " .5 .'/y a 1 z 4 2'.`('S u yr$/e" 3/a" S Zt.s5- p s`'/sr -3 NO 7 •- is tr 5`61e," 3 (e" e -i:2s t, c� j I /�I " '31 --)s."-is" v" 1/4r" PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER iot" FT AND 3 FT COMMENTS S & S ENGINEERING PERFORMED BY. 17034 Eagle River Loop Road No. 204- 'a?!e I, ska 99577 ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC CERTIFY THAT) THIS TESToWAS PERFORMED IN ACCORDANCE WITHON HIS DATE. DATE ! 0— ! !I 72-008 (Rev. 4/85) p / \ 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 SA -6615 eon/5T2ucnon1 K PHONE 'q,3I (p�'U/J LINEN UPGRADE f�,/� A�'�//j�'�!!. ` ,�`'�,^ /��/„--7 MAILING ADDRESS Po. 88k (9rt7,042g0 Ii'lV�/l 4 4LAs 7 q% 5(v LEGAL DESCRIPTION LOT 28, Beck 4, S414P5oni L%1Y T5 LOCATION &O1!4171 5T. NO. OF BEDROOMS as I Sys SEPTIC TANK DISTANCE TO: Well IW* Absorption area 15, Dwelling lof PERMIT NO. '.�"i eso337 Manufacturer G e I' K, Material Slef- .L r Gt�i No. of compaxtme , Liq. capacity in gallons I000 # WO IF HOMEMADE: Inside length Width Liquid depth 0 JAZ Z h DISTANCE TO: Well t11 Dwelling PERMIT NO. Manufacturer A= Material Liquid capacity in gallons TI LE DRAINFIELI) TRENCH DISTANCE TO: Well J40' Foundation w' Nearest lot line`� r PERMIT NO.�a33e7 No. of lines / 2 IQ Le th of epch line ci l 34 - 2G ]-/ Total length of lin1es 1 174 Trench widt� d 2 Ji inches Distance between lines i 6 Top of tile to finish gradeMaterial 41 beneath tile ep inches Total effective absorption area 17a SEEPAGE PIT Length Width Depth PE MIT NO.�S-! /}'L -G -H -,-it / Type of crib Crib diameter N 1A Crib depth Total effective absorption area 4.-00 , , 3 h O 0 DISTANCE TO: Well Building foundation Nearest lot line '70 r74--[--- 0 , /2.-6 6 p _ J J W � Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption areals) OTHER a PIPE MATERIALS W/'94' o Z77. 10:0-"J)' 2' "'.a e vizi, SOILPVC. RATING ®`eu'4 zoq fi3dvvn 01, � 1 1,000,1t Ion S' INSTALLER eVils4 �ct-L 7c f< $ t G 99s 0 REMARKS -7'3 5 MM EX- es- ice+ b p, iii !I r R ;,0> ? :', , •war lIa 4E RL=4 70 . an. V 0 ; , r ' i LI d , ° aer —'11./ ��n1 N • T4- `3y %$4�\. i� ` C. 0 IAtsvre -n 13( v SE i EY o . , a`e pad � .. c �/�” eaa.0 0 J 9� Al i. , gig '� _ gg e.f 5" 6.i 1 Y O r 2 ..• r.4 6 , _ Bruc. .. Corwin A Ai I `i a,a APP 0 ED 4. (f 'ee N. CE -5243 ,, ..:'DATE LEGAL I4� . FDA eweeaa�e'`\''' 6 .a S! 41 Ear fr i a� 4, �/+--'I I ��IV sop.,-�i 7 -(1 :i fRav t/7R✓ e r-ro Li ND., F.- L.. 7" V C3 F=7 �IND Pk 10 ELI.; DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264~4720 DEN !F--31E-ApJFEEZ, PERMIT NO: 850337 DATE ISSUED: 06/29/85 APPLICANT: SKAGGS CONSTRUCTION ADDRESS: P.P. BOX 670690 CHUGIAK, AK 99567 CONTACT PHONE: 688^2831 LEGAL DESCRIP: SUBDIVISION: SAMPSON ESTATES SECTION: 3 TOWNSHIP: 15N LOT SIZE: 40531 (SQ.FT. OR ACRES) MAX BEDROOMS: 1 c,(L - \~r LOT: 28 RANGE: 1W BLOCK: 4 Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. - - - - - - - - - - - .-� -117-FZEDINJCA-i EE:E.-I W. rilFiMfAi ".1 NI DEPTH TO PIPE BOTTOM (FT.), 4.0 5.0,\.4.0 GRAVEL DEPTH (FT.) 2.0 0.5 \ 2.0 TOTAL DEPTH (FT.) 6.0 5.5 6.0 GRAVEL WIDTH (FT.) 2°5 13.0 5,0 GRAVEL LENGTH (FT.) 55.0 25"0 f 31^0 GRAVEL VOLUME (CU.YDS") 12.3 11.6 13°9 TANK SIZE (GALS) —1,000.0 ** 1,000.0 * 1,000.0 ** SOIL RATING (SQ.FT°/BR) 212 \ 205 / 212 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS \ I certify that: 1. I am familiar with therequirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. J will install the system in accordance with all MOA codes and regulations, and in -compliance with thedesign criteria of this permit. 3. I will adhere to all MOA and State ofAlaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 1 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS~BUILTS WILL- NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK- MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED ` . DATE: Q16 APPLICANT: SKAGU ISSUED.BY 9TRUCT DATE: MUNICIPALITY OF ANCHORAGE , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION (1 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME "Ti' ,%, Cons i",c» .on PHONE JRNEW El UPGRADE MAILING ADDRESS P1p) 052-'/ Pa/,.,�, �4-K 996 Y.5 - DESCRIPTION , / 29 `7 sa-,�san $$ d: v. s /a") LOCATION Pe--ie---Gr-p% NO. OF BEDROOMS 3 SEPTIC TANK DISTANCE TO: Well /0-0 Absorption area Dwelling j/, PERMIT NO. 9,5—.06,5 Manufacturer �r Material 5� / / No. of compartments Liq. capacity in gallons /001) IF HOMEMADE:Inside length ' Width Liquid depth 6 Y JO2 O z < DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons a ( NY F DISTANCE TO: Well ( �� Foundation , r Nearest lot line ., /0 PERMIT NO. R5-603 No. of lines Length of each line 3y f linos- (� /,'„es ea tr width [j�1 ,. _zv,. isEaasalaeYwweR-Frrles .I e Ie.,yys4•, - YC3, Top of the to finish grade t��g„ Material beneath tile Wer' roe{t� �p inches Total effectl e absorption a��((ea gotO S.Y'. SEEPAGE PIT Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J J w Class I'r'.yQ Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER o WI'/14 PIPE MATERIALS r �� f°VC. ' d,„„,_ SOIL TEST RATING z09 s../b. r, Q 1 INSTALLER J tl REMARKS �� /VUS-a— i j OF i L �t1 p: {�•! ®!vs? / �, o q 111 1 1 gd :!t-.4j�Gd c' L-- JV e, 0 //,fir /.....aes..les.. .c 19,4 1 �3 ./(iaa ..�•,.� a J. Corwin �' W " a � c e • + pvc# u 3 K n �tiv Gv 11 `6 `l14iti 5'a+ { ,t, 1 y •NT T_I (i 1 1 41 14 4- t . 1 . . t . . , 1 16 1 11 b 11 1 l 1 4 APPR V ■ DATE LEGAL - ,.. �-� L._ 7'ir5 ..5a-nys.,) Sada.) LUf z et ,B /,Le_k. 72-436(Rev.3/78) r/ MI IJ ." .17 I C„01. OM���� DEPARTMENT.O. )EALTH AND ENVIRONMENTAL F '7ECTION • 825 L STREET, ANCHORAGE, AK 99501 264-4720 ��-1:1 I "I- IE.7. • E3 K"EE dR:1N1 7ff- �� �� ..� '���� * ������9�� PERMIT NO: , 850003 ��r~��*�^7^~�"~�� '' °' '�- APPLICANT:: SKAGGS CONSTRUCTION ADDRESS: PO BOX 670690 CHUGIAK, AK 99567 CON|ACT PHONE: 688~2831 LEGAL DESCRIP: SUBDIVISION: SAMPSON ESTATES LOT: 28 SECTION: 3 • . TOWNSHIP: 15N •RANGE: 1W LOT SIZE: 40531 (SQ.FT^ OR ACRES) MAX BEDROOMS: 3 * (yNDE;2 PEMm/7~ F4o9ca3 7~1,0F412 LoG, BLLICK: 4 'Listed below are the options.available to you in designing your septic system" Choose the option that best fits your site. -1~IR: EE frh.,I1C::: II -II ���:"IF-"Ii. 11/;:g - :1113 F:Ii:!1E!'t][Ir'',11 DEPTH TO PIPE BOTTOM (FT.) 4^0 5"0 4^0 GRAVEL DEPTH (FT.) � 2.0 0.5 2,0 TOTAL DEPTH (FT") 6"0 5,5 6.0 GRAVEL WIDTH (FT") 2"5 22,0` 5^0 GRAVEL LENGTT (FT") 165,0 43.0 93"0 GRAVEL VOLUME (CU"YDS^) 38.2 35.1 43"1 TANK SIZE (GALS) . 1,000^0 1r000"0 ** 1,000.0 ** SOIL RATING (SQ.FT./BR) 220 209 220 ** 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 on-site sewcrs and wells as set forth -by the Municipality of Anchorage (MOA) and the State of Alaska, 2. I will install thc 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 o{ Alaska requirements for the set back distances from any existing wellwastewater disposal system or public sewerageu// this or any adjaccnt or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES; THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED.,; (2) AS~BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTIONREPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" SIGNED ___,__ HN ' ISSUED BY DATE: DATE: MunicipalAy ®d Anchorage POUF 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840963 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 28 Block 4 Sampson Estates Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Keith E. Bandt, Supe visor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 .r ElLJP4 1HG P"Ptil..z.:1: 7- -,1,7 C3F7 1-(2111NEC.71.-CENFR!Pft��� ' • DEPARTMENT OF'«ALTH AND ENVIRONMENTAL p'—'TECTJ N 825 L STREET, ANCHORAGLE, AK 995.^ 264-4720 11-311-4,41���-1f- �_. PERMIT NO: 840963 DATE ISSUED: 11/28/84 APPLICANT: SKAGGS CONSTRUCTION ADDRESS: P.OBOX 670690 CHU8IAK, AK 99567 CONTACT PHONE: 688 2831 LEGAL DESCRIP: SUBDIVISION: SAMPSON SECTION: 3 TOWNSHIP: 15N LOT SIZE: 40000 (SQ^FT^ OR ACRES) MAX BEDROOMS: 3 LOT: 28 RANGE: 1W BLOCK: 4 Listed below are the options available to you in designing your Septic system. Choose the option that best jits•youc site. --17REEENEC71-41 E3BEEI) 4.4~ ID, F.4! er!ft :E Eq DEPTH TO PIPE BOTTOM (FT.) 4"{) 5"0 ` 4"0 GRAVEL DEPTH (FT.) 2"0 I. 2^0 TOTAL DEPTH (FT.) 6.0 5,5 6"0 GRAVEL WIDTH (FT.) 2.5 19^0 5.0 GRAVEL LENGTH (FT.) 113"0 ** 36.0 63.0 GRAVEL VOLUME (CU,YDS.) 26,7 25.4 • 29"2 |ANK SIZE (GALS) 1,000.0 ** 1,000.0 ** 1;000"0 ** SOIL RATJNG (SQ.FT"/BR) 150 150 150 ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: I. 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 egulations/and in compliance with the design criteria of this permit" I will adhere to all MOA and State of Alaska •requirements for the set back distances from`any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is .valid for a maximum of' 3 bedrooms and any• enlargement will require an additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE.OBTAINED; (2) AS ..... BUILTS WILL -NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE. ELECTRICAL WORK MUST BE DONE13Y A LICENSED E/ECTRICIAN" SIGNED Nk APPLICANT: SKAG2.9 COI' RUCTION ISSUED• BY � DATE: DATE: c~ g cl PERFORMED FOR: LEGAL DESCRIPTION: DEPTH (FEET) i 3- 10 ' 11 - 12 - 13 - 14 - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST Slcail 5 Cons-1-7---“<C+i D 7 5a SOILS LOG [SPERCOLATION TEST DATE PERFORMED: //- 7 so rl SLubcj lv_ /ock L0-1- 08 / SLOPE O-/. or: Pea f •o -f,0': S/v1/� 4(.0-/o.o1; app.earS f�hl�r iv✓vliva°s ba*'' [N i iT ti'• .. /:41:•N1A®1 16 ti OF A44%e r�P'.•!••°.... •••:P4-1 _:Y ....r "1 1t1� , i . 9TH '' * : it 0 lip: le r� ; Brr�au/i a �. Corwin c 1 '. No. CE -5283 ,..4.46° � S'<‘;5'... '- �� 20 - d4F rl?0FESS0O ®�' A WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? No S L O P E SITE PLAN 11)0 use_ Z5i --4 �r— N 0 Reading Date Gross Time Net Time Depth to Water Net Drop /-1-.1,_0 /7_00_43/ r/: 2i4.› Y 30 /O min, .5"..- .'j 0//Jzc7 .yo . /a 1-11z Uy' y: 30 Yo /o /11///, S° , V/ , 07 1-/1fz 0 5,... 5-o /a m,ir. • y/ . o7 PERCOLATION RATE TEST RUN BETWEEN COMMENTS -Sot• /S rpt4r-ei of ZOS VV/ido-on bfiw (o ir.eele !-,' 1 rn PERFORMED BY: /}') . DKt=e 72-008 (6/79) X b /. /}3,S' (minutes/inch) / /Or FT AND S / CERTIFIED BY. FT DATE : `l—Z6 eq-- ALL ALASKA P.O. BOX 670042 - CHUGIAK, ALASKA 99567 r r1 www a w w C:) C•) STATIC LEVEL OF WATER FT 0 0 0 0 E.4 (.4 0 0 0 / www www DRAW DOWN FT. GALS. PER HR KIND OF CASING G3A1.1J3'l wt:4 Na1031 7M fhtlitINNC IANK H11V3H dO 'ldn4 30V21OHDNV dO A111VdDINf1W r -i •.i a a x a w 4.4 4-: (lJ S., *C.) 2i 1: ni G (tl C V) C3 (n IT] www p 1 C^ (f C' i rS (S c r. ' l CI bl d--?` O) (; ¢cn Xco 00 0 a U� o ¢ 3 DATE - STARTED DATE - ENDED KIND OF FORMATION: 0 FF 0 0 0 0 0 0 0 wwwwwww w w a V.) �Y 'C ca CIi: 8 ("4 C'1 wawaa a a a w 0 L. INFORMATION: C DRILLER'S NAME 5P114 S MUNICIPALITY OF ANCHORAGE Ave Development Services Department \ `s R Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 051 822 18 Expiration Date: c7 1. GENERAL INFORMATION Complete legal description SAMPSON ESTATES BLOCK 4 LOT 28 Location (site address) 23613 Goliath Current property owner(s) DORSEY Day phone Mailing address 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: Private Well Private Septic 0 Water Storage ❑ Holding Tank Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment a/(-11/9 Date of Payment Receipt Number 01339.0 Receipt Number COSA# Q 5 dq 1O33 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 2/1/2019 o�• '41:'g' k 6. DSD SIGNATURE j //. fi System #1 Approved for L( bedrooms �6 CHARLES G BALZARINI System #2 Approved for bedrooms #� • F��•. CE•13854 •,��/ pp 'i1;F- Disaroved PROFESSION"-er- Conditional approval for bedrooms, with the following stipulations: L d�qF S�rE I- '114s7-;,!AND ; S VICES°' _ .� / Original Certificate Date: 2--1 I I The Municipality of Anchorage Development Services Division (D 9) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: SAMPSON ESTATES BLOCK 4 LOT 28 Parcel ID: 051 822 18 If more than 1 septic system on lot: COSA Checklist# 1 of 1 Structure served by this system 1 A. WELL DATA 0 Well log is filed with Onsite (or attached) Well production at time of test +4 _gpm Date drilled 12/3/84 Water storage tank volume NA gallons Total depth 240 ft Well disinfected for coliform test? ❑ Yes 0 No Cased to 240 ft • Coliform bacteria is Negative ■❑ Sanitary seal is functioning correctly Nitrate ND mg/L • Nitrate less than MRL (ND) ❑■ Wires are properly protected Arsenic ND ug/L • Arsenic less than MRL(ND) Casing height (above ground) 30 in. Collected by C&M ENGINEERING Date of flow test for COSA 1/30/19 Date of Sample 1/23/19 Static water level at beginning of test 165 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) 10.5 years • Required maintenance completed Tank type/material STEEL Age of lift station 10.5 years ❑ Standpipes/foundation cleanout per record drawing Lift station material PLASTIC Date of pumping AWWTS MAINTENANCE CONTRACT Comments: AWWTS MAINTENANCE CONTRACT D. ABSORPTION FIELD DATA BED SYSTEM Which system tested (date installed) 2008 Adequacy test date 1/31/19 ❑� ALL standpipes present per record drawing Results ['Pass For 4 bedrooms Total measured depth from grade 4 ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 3.5 ft(min) Water added 600 gal ❑ N/A—pressurized field New depth 1 in El Monitor tubes go to bottom of drainfield. If not, state Elapsed time <1440 min depth into effective 0 Code-required soil cover over field Final fluid depth 0 in ■❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) NO date of test) Gallons introduced 950 gallons If yes, enter date NA Comments/Deficiencies:AWWTS SYSTEM COSA Checklist yellow sheet 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' Community Sewer Manhole/Cleanout> 100' Q Yes if No ft ['Yes if No ft Neighboring Tank > 100' EYes if No ft Private Sewer/Septic Line >25' QYes if No ft Absorption Field on Lot > 100' Q✓ Yes if No ft Holding Tank > 100' ✓❑Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' Q✓ Yes if No ft Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft E✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water> 100' ['Yes if No ft Property Line > 5' 2Yes if No ft Driveway/Parking > 0' ✓EYes if No, comment Absorption Field > 5' ['Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' [Nes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells >200' ✓❑Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q✓ Yes if No ft Driveway/Parking >0' Z Yes if No, comment Property Line > 10' Q✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' Q✓ Yes if No ft Water Service Line > 10' Q✓ Yes if No ft Community Wells > 200' ['Yes if No ft Surface Water> 100' ✓Q Yes if No ft F. ENGINEER'S COMMENTS QUANICS AWWTS SYSTEM SYSTEM PRESOAKED PER 15.65.060 a ii. 0.4*15140'*0.51* 7.5(GAL/CFT)=940GAL G. ENGINEER'S CERTIFICATION �� 9 qgsllo I certify that 1 have determined through field inspections and review je. *1—:9°00, of Municipal records that the above systems are in conformance with j*: 49TH • * MOA COSA guidelines in effect on this date. 2/2/2019 ......,...L!: r' . / CHARLES G BALZARIN1 rt f<s.. CE-13854 •.�ie �, JlF�•., .••c`�G?.i �1l\PROFESS10*\. COSA Checklist yellow sheet \\»1� ARM Septic Services, LLC February 14th, 2019 Quanics 23613 Goliath Drive Enatnooring Water Solutions Chugiak AK, 99567 Advanced TreCeatiifiedt Systems Maintenance a "der Subject: Quanics Aerocell - Maintenance Report To Whom It May Concern, We appreciate the opportunity to provide a quality inspection and maintenance for your Aerocell system. Overall, your system appears to now be in acceptable working condition. The system appears to be operating as it was designed (after several items were repaired, which will be addressed later in this letter), and the drainfield was found to be dry. The pump and return functions were tested, along with the floats and alarm functions. While onsite, ARM cleaned the pressure filter, the nozzles in the aerocell, and serviced the media. In addition, we visibly inspected the effluent quality and found it to be clear in color and free of major odors. The following deficiencies were noted during our inspection and then repaired: 1. The aerocell media appears that it had not been serviced in some time. The media was anaerobic, containing large amounts of black biomat sludge and ponding of effluent (meaning that the effluent is not draining as it should). This media was near or at the end of its useful lifespan (10-years old). ARM replaced all of the media with brand new media. 2. The tank contained almost 50% solids in the first compartment, and 8" of sludge in the second (over state minimums). The tank was properly pumped and emptied of the contents. 3. The unit contained the older style collection piping, and required an upgrade/replacement. ARM replaced this collection piping and added clean outs for future cleaning. 4. The return and discharge piping appeared to contain large amounts of growth and was not draining properly. Per Garness Engineerings' direction, we treated these tines over night to clear them out. ARM was authorized to complete repairs to all of the above items. The aerocell was emptied of the biomatted media, and an extensive cleaning was performed inside the tank. The unit now contains the newer style collection system, and brand new aerocell media. ARM (and Garness Engineering) always recommends that a quality tank pumping/cleaning is completed annually on systems serving more than two people. In addition, all advanced wastewater treatment systems (AWWTS) are required (by Municipal code) to maintain a working remote monitoring system. Please provide ARM notification when you have provided a working phone line for your monitoring system, or if you wish to switch out your unit with a wifi compatible monitoring device. The system now appears to be in acceptable condition and working properly. Please feel free to contact me via phone or email with any questions. Sincerely, Rob Campbell Managing Member ARM Septic Services, LLC (907) 688-9433 24738 Chugiak Drive *Chugiak, AK 99567 Ph: (907) 317-9433 office/fax: (907) 688-9433 Email: ARMServicesAKCoutlook.com MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the"AGREEMENT" made and entered into as of this 5 tit Day of F f b ru4c of 20 1c1 , by and between Thorna_s i, L l l i lW\S , herein the"OWNER,"and the Municipality of Anchorage,herein the"MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Quanics Aerocell located at(legal description) Sampson Estates Block 4 Lot 28 2. Maintenance,Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. C w' It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s),replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). T`•-/ Owner•agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. t\J Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system,which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. T t✓ Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. I t" Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. T v✓ Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. t Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. ‘`J Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions,nor in any way affect the validity of the Agreement or any part hereof,or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 ti. OWNER: By: (signature) Date: 5 FIZL /' Tvvi itu> B . w i W«GIM6 (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) � The foregoing instrument was acknowledged before me this`�day of 2.p( U 20/9., by �J..t t..L r' � . • i tteu tcrrrrgr �� GESS f�ii, NOTARY PUB C FOR ALAS e*- 2'/4 , • . My Commission expires: My commission expires • ; ;�v• • 20 May 2022 ▪ QJ • .: 8TAt�.•• MUNICIPALITY: By (signature) Date: Z `! I"" (print name) Title: (rev. 05/18/2018) Page 3 of 3 RUSH! , Parcel I.D. 05/" & Qhd Municipality of Anchorage Development Services Department �• 11; l'; 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 FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address COSA# 0 015 Expiration Date: l -AM SAMPSON ESTATES, LOT 28, BLOCK 4 23613 GOLIATH DRIVE • CHUGIAK, AK 99567 CATHERINE CLAWSON Day phone 350-5132 23613 GOLIATH DRIVE • CHUGIAK, AK 99567 Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ 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 COSA5 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by I affixed hereto and as of the validation date shown below, l verify that my investi tiff on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shoe% on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for then tuber 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. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there am no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE �/ Approved for —f bedrooms. Disapproved. Conditional approval for 114 ex t Phone 337-6179 Date bedrooms, With the fl !Ming std u1 f f ioF i i , ` • le P�eqIV \4' • • • Cep t•• ON-SITE t.c WA WASTEWATER ; uRAM Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By' /.7/// GC%rrt" I/ Yti (Rom liIK, jiff, vicNT SEN,,\ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: C1A/AS 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' SAMPSON ESTATES, LOT 28, BLOCK 4 Parcel ID: 051 •S 2219 A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N/A Date completed 12/8/1984 Sanitary seal (Y/N) YES Total depth 240 ft Cased to 240 ft Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 24 In. FROM WELL LOG AT INSPECTION Date of test 12/8/1984 5/14/2008 Static water level 30 ft, 160 ft, Well production 20 g.p.m. '6.5 g.p.m, WATER SAMPLE RESULTS: 'ARCTERRA ENGINEERING AND SURVEYING Coliform 0 colonies/100 ml. Nitrate et • 1 fmg./L. Other bacteria. 0 ,colonies/100 ml. Arsenic: N/D ug./L.Date of sample. 8/28/2008 Collected by GEC Ltd. B. SEPTIC/HOLDING TANK DATA OUANICS AEROCELL TREATMENT SYSTEM Tank Type/Material S.T.E.P./STEEL Date Installed 8/28-29/2008 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YIN) YES Date of pumping NEW Pumper - C. ABSORPTION FIELD DATA Date installed8/28-29/2008 Soil rating Length 40 ft. Width •BELOW FINAL GRADE r ft'/bdrm) 1_0 System type BED 15 ft. Gravel below pipe 0.52 ft. Total depth '3.86 ft. Eff. absorption area 600 ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS Fluid depth In absorption field before test= in. Water added =gal. For 4 bedrooms New depth =in. Elapsed Time: = min. Final fluid depth= in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - - D. LIFT STATION Date installed 8/28-29/08 Size in gallons 1500 Manhole/Access (Y/N) YES "Pump on" level at TIMER in "Pump off" level atTIMER in. High water alarm level at 44 in Datum BOTTOM OF TANK Cycles tested NEW Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Curtain drain F. COMMENTS Surface water 100'+ Driveway, parking/vehicle storage 10'+ NONE KNOWN Wells on adjacent lots 100'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Print d Name JEFFREY A. GARNESS Date are Fee $ COSA Fee / Date of Payment �r�1f I nate of Payment Receipt Number 53 n '! (1 'Rebeipt Number (Rev. 11/05) ss CT&E Ref. #: Client Name: Project Name: Client Sample ID: Matrix: PWSID 1084575 GES Sampson Est L28. B4 Sampson Est L28. B4 Drinking Water n/a SGS Environmental Services 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 Client PO#: Printed Date/Time: Collected Date/Time: Received Date/Time: Technical Director: n/a 09/11/08 11:35 08/28/08 8:30 08/28/08 11:10 Stephen Ede Released By: Deanna crump Sample Remarks: Arsenic, Nitrate, Total Coliform data Parameter Arsenic (As) Nitrate/Nitrite Total Coliform Results ND 2.18 ND Allowable Prep POL Units Method Limits Date ug/L mg/L col/100m1 EPA200.8 EPA 353 SM209222B 10 10.0 0.0 Analysis Date Init 09/11/08 SCL 09/11/08 08/28/08 DLC N 84-10 SAMPSON ESTATES SUBDIVISION LOT 28, BLOCK 4 40,531 S.F. 01.0 pa' Nimcr- ace,QJr� / N 89.57.27"E 150.05' 47.3' 49.3' SEPTIC SYSTEM .. • • • . • v 22.7' 0 22.0' 123 4 •, 7.7+ EXISTING BUILDING 22.2' cOJ. ENTRY o 22.7' WELL 44.8' 42.5' A.C. DRIVE 10' T. & E. ESMT. N 89.58'04"E 150.16' O M GOLIATH DRIVE AS -BUILT GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI, R.LS. 2000 E. DOWUNG RD., SUITE 8 ANCHORAGE, ALASKA 99507 PHONE 248-5454 GRID NW1560 DATE 9/5/2008 F.B. JOB NO. 5E264 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. R IS THE RESPONSIBILITY OF THE OWNER 'ID DETERMINE THE EXISTENCE OF' ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT. ALASKA NOTE NO CORNERS SET THIS DATE 0 N 00°03'58"W Ruses yes779KH ttZ x -Vs 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.ak.us (907) 343-7904 ERTIFICATE OF. HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING • Parcell.D. 051-822-18 HAA # Oeoo9c Expiration Date: 1. GENERAL INFORMATION Completelegaldescription Lot 28; Block 4; Sampson Estates Location (site address or directions) 23613 Golia th Dr. Chugiak.•AK 99567 Current Property owner(s) Kathleen Patrick Day phone 688-7017 Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. .2. NUMBER OF BEDROOMS: 4 3: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: 0 0 0 Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority 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. 1 further verify that based on the information obtained from the Municipaiity:;gf /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 S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert 4 Shnfer Date 2 - Z 5. DSD SIGNATURE Approved for T bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments : WATFR AND • m WASTEWATER . • nnnnne�� tttttUfffr,,,„,��/ tA�t,,OFAN�, • ON-SITE • ;o• 111/))1)7• Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: / QA'/ Original Certificate Date: 2-3 — 06— (R.v.0V02) Legal Description: A. WELL DATA Well type Mr- If A, B,orCprovide PWSID>s= Date completed jal!Weill Sanitary seal 0) Ves Total depth 249f ft. Cased to R4Or ft. FROM WELL LOG Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST 1 -sr S; LOC -k 4; SsnrAc lf5i t Parcel It): 05 I–�ZZ– IB Date of test Static water level Well production f Z/s/8q 30" w µQct 20 WATER SAMPLE RESULTS: Coliform colonies/100 ml. Arsenic: — mg./1. B. SEPTIC/HOLDING TANK DATA Tank Type/Material S&Pr/ c 1 C Number of Compartments 2 i 1 ft. g.p.m. Well Log a) "165 Wires properly protectedeN) tet n Casing height (above ground) fit/ '1- in. AT INSPECTION . q (G3 ft. 6e 6 ►- g.p.m. * Loma -cm By Purer 2 doombl os Nitrate 2.f5mg./I. Other bacteria © colonies/100 ml. Date of sample: g 5 Tank size /off al. Foundation cleanout&N) Y&t Depression over tank (Ye 00 High water alarm N) 114 '-tFT STIAT7o t,) �Zr RI-Mewt 1� 6A Pumper s 17o,nrrA) , Collected by: cI /.6111,.)...t,0 Date installed lig /I bb3S Cleanoutse'J) y65 Date of pumping 2/2-Voc, C. ABSORPTION FIELD DATA Date installed Itiit /91 Soil rating ig.p.dft orft2/bdrm) a5 System type 31`b r Length GO 5 ft. Width 36• 6 r ft. Gravel below pipe 0. 5 ft. Total depth - ii. ft. Eff. absorption areaao71. ft2 Monitoring tube `ICS Depression over field Alb Date of adequacy lest 441810t/ Results Pas ail) MSS For 4 bedrooms Z4., Fluid depth in absorption field before test 2 6- in. Water addedOD gal. New depth in. Elapsed Time: min. Final fluid depth 3 /Zin. Absorption rate >= 1::> 00 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 1000C KAV&i If yes, give date D. LIFT STATION Date installed 11/111, `/ Size in gallons Manhole/Access ON)i & S "Pump on" level at &Lin. "Pump off" level at (3 i in. High water alarm level at 7 9, in. Datum TOP of- rr1/44 Mtl Cycles tested 2) Meets alarm & circuit requirements? 'It S E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 10011/0014- On adjacent lots / 00 if - Absorption field on lot /001+ On adjacent lots /00 ' f- . Public sewer main N14 Public sewer manhole/cleanout N/4 Sewer /septic service line g.5i -h Holding tank /on SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation toil- Property line 10) t } Absorption field /0/ 1- Water main N 1`i Water service line /r7m -!- Surface water /0014 - Wells Gbr+-Wells on adjacent lots /00 f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1� Property line 10 Building foundation 1014 - ,Water main N4 1 Water Service line 101+" Surface water /R") /4- Driveway, parking/vehicle storage S(j I4_ Curtain drain Nc L*- lefi aa)1Wells on adjacent lots /a) 12/ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records thane above systems are in conformance with MOA HAAg�uid�rline;? in,gffperrjn th' ate. Engineer's Printed Name Date 2 — Z. 8"-05e— e' ....... ,,, es i t17 4 4 N.N{.Y• 5 eA Witht- • 1457.E ice.: HAA Fee $ 930 'ct 4 /t d?i 6eusk) Date of Payment 3/b 1 /r76 Receipt Number (1C/a £4 (Rev. 12/01) _r► Waiver Fee $ Date of Payment Receipt Number 02/23/05 WED 08:36 FAX 807 364 7146 som I Z' PACIFIC CPOC 1 i7 PC i J. ;Jr' Fre. T` M. VA'. v LY 'caC. n,'Rc.ri,v$ t-ernt irurn antro .d Earnf, wiI \l l 1570.11. r A 1110u2 .r �o Efa. c. i�..� C AS -BUILT E s,.•L�-. 1 hereby certify that 1 have surveyed the following described •propem.. Loi LS, /cc k 4- • 4Q r, , r,90.1. ErF-.e.+_a 5 sv. de, Anchorage Recording Precinct, Alaska, and that the improve mens situated thereon ate within the property lines and du no overlap of encroach on the property lying adjacent thereto. tha no Improvements -on property lying adjacent thereto encroacl on the premises In question and that there are no roadways transm.1131= lines or other visible easements on said proven++ except as indicated hereon. Dated at Eagle River, Alaska y 193it this 7' da of o c ROBERT C. JOHNSON 1..F.. • SCALE: Registered Land Surveyor No. 61,0 -LI I" - {r p , Boa 77-0456, Eagle River, Alaska 9957 Phone (907) 6942543 MAR -01-2005 11:34 SG$ SGS RetD Client Name Project Name/ Client Sample ID Mavis 1050898001 S & S Engineering Samson Est LOT 28191k4 Drinking Water 583 ENGINEER 1NG 907 694 1211 P.02/02 All Dataillak+are Alaska Standard Time Printed Datelilae 02/282005 16:25 Collected Datelflme 02/232005 17:15 Revived Date/Time 02/242005 1202 Tublike' Director Stephen C. Ede Rekased By Sumple Remarks. Pa to Resifts PQL omibleUniv Method ConnGner1D All ntint DDe e tADow r Ind Waters Department Nitrate -N Microbiology Laboratory 2.13 0.100 mg/L. EPA 300.0 8 (c510) 02/24/05 XM1 Total Calirotm 0 co1/)00m1. St420 9222.8 A (c=1) 02/24/05 DKC TOTAL P.02 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.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-822-18 1. GENERAL INFORMATION Complete legal description Lot28; Block 4; Sampson Estates Location (site address or directions) 23613 Goliath Dr. Current Property owner(s) Gary Defreese Day phone 688-1005 Mailing address PO Box 670962 Chugiak, AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address HAA # 09-0/3 L f - Expiration Date: 7— Unless — Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: • ' Individual Well Individual Water Storage 'Community Class Well Public Water System 4 4p,_ TYPE OF WASTEWATER DISPOSAL: X❑.0 0 0 0 Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation; based on procedures outlined in the Health Authority 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 S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date id/ /0 f f1.i ...••••.••.•.,.. l] .••• • ,s,4_,- .,...-.• fi.. �;G N ER (J+ i• M. ...- ..w. " , .J•. ,n • ROBERT C. COWAN i N , 5. DSD SIGNATURE Vj `�' • CE - 8801 I 4.-= A Approved for 14- bedrooms. ?• +$fFjcc? °................... ..,...•° .k.t♦ ;<' Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ttttiYtpFliqri c1' • .F : • ON-SITE G� WATER AND :R' : WASTFWATER- : • '•• PROGRAM •� ••• el\ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report_ Other (Rev. 01)02) Original Certificate Date: i -2.2— (U Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY. APPROVAL CHECKLIST Legal Description: L O r 3- g GI- 0 c.cc y Sf} ' So,v EntITESpaircel ID: O S/ 1; A. WELL DATA Well type ('RAN i,rE ; ' -If A, B, or Cprovide PWSID y � # Well Log�N) yE� Date completed/ )/ _ Sanitary seal (9 N) YES Wires properly 'protected 6%) YES Total depth d ¥ 0 ft. Cased to a /0 ft. i Date of test FROM WELL LOG Static i water level 3 0 j ry Well I oduction a -O P g.p.m: WATER SAMPLE RESULTS: Coliform 0, colonies/100 ml. Nitrate )• mg./I. Arseur 1 mg./I. Date of sample: Y B. SEPTIC/HOLDING TANK DATA ,., S PT 1 c t S TS L Tank Type/Material ft. i' Casing height (above ground) AT INSPECTION lgloy, 163 ft. g.p.m. Other bacteria O colonies/100 mi. Collected by. S & S ENGINEERING 17034 Eagle River Loop Road No. 404 Eagle River, Alaska 99577 yt in. Date installed 1 � ; Cieanouts dl) Y' High water alarm Oy/N) 1„, 1 i/-.L.}R,-, 1N Tank size/ 000. Soogal. Number of Compartments. ; Foundation cleanout y N) • YC S Depression over tank (Y Date of pumping • B f' / 0 3 Pumper C. ABSORPTION FIELD DATA Date installed '1/ /1/ / q / Soil rating Length 3-r-5- ft. Width I i, Total depth a' ;1't ft. : Eff. absorption areao- 0-7 6 ft2 Date of adequacy test 1// /'' 1/ Results 1 , Fluid depth in absorption field before testa 6 in. Water addedG/0 gal. Elapsed Time: 60 mina Final fluid depth 3 VI- in. ry Any rejuvenation treatment (past 12 mo.) (YIN & type) N o r/ 4- ,1 s2 s or ft2/bdrm)"" O - L / FT 57,471gw m. Syste'type ' 6.0 Gravel below pipe • ©- S ft. ;Monitoring tube YE -5 Depression over field °' 0 ail) . Absorption rate >_ A/ w r✓ For bedrooms New depth ' in. G 0 O g.p.d. If yes; give date "" D. LIFT STATION Date installed // /11 19 / Size in gallons S-00 "Pump on" level at g_ in. "Pump off" level at 9) in. DatumTdP 0A I M.fA/ Itcc-t Cycles tested 3 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: / O 0 1 -f -4O0 Septic tank/lift station on lot Absorption field on lot 1 0 0 -t- Public sewer main /✓ /4 Sewer /septic service line ' ?•S /� Manhole/Accessi 9N) 1 s. , High water alarm level at S in. Meets alarm & circuit requirements? YDS On adjacent Tots On adjacent lots l 0 0 -f-; / Oo • Public sewer manhole/cleanout Holding tank It/ ti G • • SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r _ Building foundation 10 Property line JO f Absorption field Water main N �A Water service line / O f Surface water Wells on adjacent lots / 0 0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 r Property line % o -t- Building foundation ) O Water main r Water Service line / ° - Surface water / OO -f- Curtain drain Ni PC 14- owr-i Wells on adjacent lots X00 F. COMMENTS l 0. /''.0 Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name PO 2 est T C CD l,14"' Date 117/6 /or OF A a11,':' ?i •` 11 - i ROESERT C. COWAN '� 4��% 'CE=8801 Leer.?:. • HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Li 30_ la/ to /o V So S'7 Waiver Fee $ Date of Payment Receipt Number ti� SGS Ref.# Client Name Protect Name/# Client Sample ID Matrix Sample Remarks: 1041692001 S & S Engineering Lot 28, Block 4, Sampson Lot 28, Block 4, Sampson Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time Collected Date/Time Received Date/Time Technical Director Released 04/13/2004 12:09 04/08/2004 19:00 04/09/2004 10:30 Step C. Ede Parameter Results PQL Waters Department Nitrate -N Microbiology Laboratory Total Coliform 1.60 0 0.100 Units Method Container ID Allowable Prep Analysis limits Date Date Init mg/L EPA 300.0 B (<=10) 04/09/04 JIB col/100mL SM18 9222B A (<=1) 04/09/04 DKC Municipality lof Anchorage Development Services Department p P To: Bob Cowan Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT, SHEET Legal description: Sampson Estates Block 4 Lot 28 ij The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on l ❑ Calculation error in design. ❑ Additional soils information needed. ❑ Water monitoring results inadequate ❑ Discrepancy in information submitted'_: r ; ❑ Topographic information missing or inadequte. ' ® Incomplete; missing Lift station alarm must bregister both visually and audibly inside the dwelling ❑ Incomplete; missing 4 ' I. ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. ❑ Measured/proposed distances/dimensions'missing. ❑ Locations of all soils, percolation and water monitoring tests not shown 0 ❑ i ❑ Omission in narrative. Proposed system too deep for soils informat on submitted. I Well log 'required. 0 ❑ Other. Insufficient fill over tank or field. Name of reviewer: Jeff Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK Date: 4-22-04 MUNICIPALITY OF ANCHORAGE DEPARTMENT OFHEALTH& 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 I D # U - 1. GENERAL INFORMATION Complete legal description HAA # r)14 -LA Lot 28; Block 4; Sampson Estates Location (site address or directions) 23613 Goliath Drive Chugiak, AK Property owner Alan Beckett Day phone 688-6482 Mailing address P.O. Box 671757 Chugiak, AK 99567 Lending agency Northland Mortgage Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 V xxx MUNICIPALITY OF ANCHQ. 9Gp ENVIRONMENTAL SERVICES DIViSJON OCT 09 1996 RECEIVED 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 XXX 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 STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 6 'ill' } `I 7 9 17034 Eagle River Loop Road No. 204 Eagle River, AJRaka eoa77 Address Engineer's signature Date / a s /' L Ayr', �::, Psi T % ROBERT C. COWAN i ,C •.t CE - 3301 6. DHHS SIGNATURE a %` X- Approved for bedrooms. _`' Disapproved. Conditional approval for bedrooms, with the following stipulati�ons: By. Additional Comments Date — CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 MUNICIPALITY OF ANC Municipality of Anchorage ENVIRONMENTALSERVIC DEPARTMENT OF HEALTH & HUMAN SERVICES OCT 09 1 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343- 4c Health Authority Approval Checklist Legal Description: Lot' 28 , 13ioc.te: 4 : SAMP5.0rJ Parcel I.D.: C55.518 Z z A. WELL DATA Well type eftwerc If A, B, or C, attach ADEC letter. ADEC water system number Log presen >1) Ni OS Date completed 12- 8 811 Total depth Z'f(i Cased to Doo t Casing height (above ground) ..Zt Sanitary seal ON) ES Wires properly protected ON) Yes FROM WELL LOG AT INSPECTION Date of test 1'Z` "8(f 10-'7-q Static water level 30 161 Well production 20 (tE T) g.p.m. • 7 g.p.m. WATER SAMPLE RESULTS: Coliform (d Nitrate 1 a 17 Other bacteria 0 Date of sample: lc I - ifs Collected by: v- &a C.,11113crz 11.1G EIVED B. SEPTIC/HOLDING TANK DATA I . ir35 I e, a 64•-a... Zii `� Date installed 6--1<- Tank size .moo &AI Number of Compartments 1 Cleanouts ON) writ 6 -co 6A1.-CL1f-r srr lo;e) I coo laE;i, Foundation cleanout/N) ii 5 Depression (Y j t v High water alarm (j N) `ii=5 C LIFT S-rar' Date of.Purnping lchic.t Pumper 3e. eusoeigG C. ABSORPTION FIELD DATA. Date installed II -U-14. Soil rating (g.p.d./ft2 or ft2/bdrm) GIT/System type QRESsiR%zeo kr Length 58. Width 35: 6- Gravel thickness below pipe 0.5 Total depth Z,'a Effective absorption area Zolta Monitoring Tube present (JN) lei Depression over field (Y/ Date of adequacy test i o 1-'11, Results ail) ei.t S For bedrooms Fluid depth in absorption field before test (in.); 0 Immediately after7(.O gal. water added (in.): Ifz 9j Fluid depth ,3 (ins) Minutes later: Absorption rate = LCA g.p.d. Peroxide treatment (past 12 months) (Y/N) eta k40.-.14 If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed I 1 — 1 i -11 Size in gallons 500 Manhole/Access ON) 'f a S "Pump on" level at* Boit "Pump off" level at* i i► High water alarm level at* 3 *Datum ao %rav, Cycles tested 3 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septi holding tank on lot i2.01+ On adjacent lots /00 $ Absorption field on lot 19 G 14 On adjacent lots 1 v c 1+ Public sewer main iJ )1k Public sewer manhole/cleanout Sewer /septic service line 2.6k Lift station 12oti f SEPARATION DISTANCES FROM SE HOLDING TANK ON LOT TO: Foundation j c ► f Property line ► 01't Absorption field Z0 o f Water main/service line t o t Surface water/drainage i oo 1 Wells on adjacent lots 1001-r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 10 a Building foundation Sol f Surface water o�i Curtain drain t'1 J(1/4 F. ENGINEER'S CERTIFICATION Water main/service line lcIf Driveway, parking/vehicle storage area 1004. Wells on adjacent Tots IO o 1 t I certify that I have determined thru field inspections and review of Municipal records in conformance with 0 H guidefes in effect on this date. Signature Engineer's Name 'v 3vtier C_ Co k/44) Date to /5'/9 G HAA Fee $ Date of Payment Receipt Number 70/9/9-6 s are s O Eit7';-,C.UCOWAN,:y.1 Q CE -£3801 •rc �„ _.4; 72-026 (Rev. 3/96)* Cc4-/—d-1 Waiver Fee $ Date of Payment Receipt Number 10/08/96 10:34 CT&E ESI ANCHORAGE 4 9076941211 N0.640 P08 AielL CT&E Environmental Services Inc. u Laboratory Division rsi CT&E Ref.# Client Name Project Name/# Client Sennple JD Matrix Ordered By PWSID Laboratory Analysis Report 965243002 S & S Engineering Outside Faucet Lt 28 Bk 4 Sampson Rst. Drinking Water 0 Client NV Printed Date/Time 10/08/96 08;10 Collected Date/Time 10/01/96 14:00 Received Date/Time 10/02/96 14:45 Technical Director: Stephen C. Ede Released By Sample Remarks: Parameter Nitrate -N Total Coliform Resulte PQL Units Method Allowable Prop Limits Date 1.17 D.100 mg/L SM18 4500-803F 0 0 col/100mL SM18 92228 Analysis Date Init 10/04/96 EMB 10/02/96 TAV 200 W. Potter Drive, Anchorage. AK 99518.1605 - Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 — Tel: (907) 474.8656 Fax: (907) 474.9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA 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 I D # �.a\-�iaa-\x 1. GENERAL INFORMATION Complete legal description HAA # -q t r) -vut9 Lot 28; Bock 4; Sampson Estates Location (site address or directions) 23613 Go2,iath Property owner Mike g Rox ie Dex-ten Day phone 688-4095 Mailing address 23613 Go.Pi.ath, Chug.ialz. Alz. 99567 Lending agency G.M.A.C. MORTGAGE Day phone Mailing address AgentAudney Mahon RE/MAX OF EAGLE RIVER Day phone 694-4200 Address 16600 Center{,te2d Vnive #201 Eagle Riven. Afz. 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 ' 3. TYPE OF WATER SUPPLY: Individual well Community well Public water xx 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 xx 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 x21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage.files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone 5 & 5 ENGINEERING Address 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 II-1�_� Engineer's signature Date 6. DHHS SIGNATURE 4 XApproved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments BY b79414e, 4(it Date//— 2-Y� CAUTION 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 order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �lj4 ^-CJ J & 16. -IL arcel I D 6SIS1--Z l A. WELL DATA Well type t'TAe_t\%b&T• If A, B, or C, attach ADEC letter. ADEC water system number I Gt �1 —..1D.'! >„l I r✓i. t b cats Date completed 1i-0 4 Driller �•��►�ly-\ l'� Log presen Total depth Cased to Date of test Static water level Well flow Pump level FROM WELL LOG 7--6 - '4 14i(.UOk j II SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot lib I Absorption field on lot Public sewer main 1 -to 0. a Sewer service line `-(- WATER SAMPLE RESULS: VCO Casing height 12-" -4- Date- Wires properly protecte gpm AT INSPECTION I64' ; On adjacent lots ; On adjacent Tots gpm ENVIRONMENTAL SER Public sewer manhole/cleanout i o*I 6, Go9 Coliform Nitrate Date of sample: T-23-11 B. SEPTIC/HOLDING TANK DATA Date installed Petroleum tank Ij Diel K-1,-101.4.1 /10 Cleanouts/(YJ/N) Tank size Other bacteria Collected by' S 4' 1000 G6z-- e -e0 (,I D-4- Compartments Foundation cleanou High water alarm (Y/N) IA, Date of pumping q �" -1 1 Depression (Y/ Alarm tested (Y/N) LU L...1 LU Pumper.4 Vi 1f,1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I7,0 I 0 r -r -- To property line Surface water/drainage 72-026 (Rev. 7/91) Front On adjacent lots Absorption field 107) 156 `± Foundation �Jr+ Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons y'(31 U Manhole/Access/N) kr Manufacturer . C -frc,,t ' 1G->- t {s Vent 19'/N) High water alarm level "Pump on" level at (,0u 2n" "Pump off" level at I Meets MOA electrical codes&N) ( - Cycles tested L SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot I() f On adjacent lots 40014- Surface water D. ABSORPTION FIELD DATA Date installed 1`-11-qi Soil rating 0•'7 System type Length Width � Gravel thickness iI2 Total depth / Total absorption area 1,01-(P Cleanouts present (y?N O Depression over field (YN) I1/4- Date of adequacy test 14f p Results (pass/fail) 6k/G-r -( Peroxide treatment (past 12 months) (Y 0.1 for 4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation l() (`I' On adjacent lots bedrooms If yes, give date r 10") + Property line `o To existing or abandoned system on lot {i) On adjacent lots � Cutbank LI D t• -i& Water main/service line 1 () I+ Surface water t00 i+ Driveway, parking/vehicle storage area "ft/ Curtain drain VA ki5141. E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect kr UJ%d e�of this inspection. ® �e°° m e S&S ENGINEERING °°° •pp 0 17034 Eagle River Loop Road N0. 204 �S ' 0� Signature ° eagle Sliver, Alaska 99517 d 9TH °° Engineer's Name /{C1 _' , , l 0 bb • fae Date 1 -9- ) de Roy RJ.3 Ann, P.E. *ff‘Of i�1ela 4,y1"... tea. HAA Fee $ 170, v7) Waiver Fee• $ Date of Payment P----17 ` 9/ Date of Payment Receipt Number o2'0 aa3 2 (tel / 7Lf) Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. Ai:IL— — 5633 9 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 LABORATORY ANALYSIS REPORT BY SAMPLE for WORKordert 40261 Date Report Printed: NOV 15 91 @ 16:31 Client Sample ID:SAMPSON EST B4 L28 PWSID :UA Collected NOV 12 91 @ hrs. Received NOV 13 91 @ 13:50 hrs. Preserved with :AS REQUIRED Analysis Completed :NOV 15 91 Laboratory Superviso : "'NEN C. EDE Released By : Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO # PO t NONE RECEIVED Req t Ordered By :R. SNAFER Send Reports to: 1)S & S ENGINEERING 2) Chemlab Ref 1: 916119 Lab Smpl ID: 1 Matrix: WATER Parameter Tested Allowable Result Units Method Limits NITRATE -N Sample ROUTINE SAMPLE COLLECTED BY: LYNDA USHER. Remarks: 0.97 mg/1 EPA 353.2 10 1 Tests Performed ND= None Detected NA= Not Analyzed See Special Instructions Above " See Sample Remarks Above LT -Less Than, GT -Greater Than UA -Unavailable ecASG7 Member of the SGS Group (Societe Generale de Surveillance) 0 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE fox WOREorder# 38512 Date Report Printed: SEP 24 91 @ 09:57 Client Sample ID:L28 B4 SAMPSON EST PWSID :UA Collected SEP 19 91 @ 16:00 hrs. Received SEP 20 91 @ 12:10 hrs. Preserved with :AS REQUIRED Analysis Completed :SEP 23 91 Laboratory Supero sox :STEPHEN C. EDE Released By : e Chemlab Ref #: 914960 Lab Smpl ID: 3 Matrix: WATER Parameter Tested Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO # PO # NONE RECEIVED Req # Ordered By :BOB SHAFER Send Reports to: 1)S & S ENGINEERING 2) Allowable Result Units Method Limits NITRATE -N 1.0 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: 1 Tests Performed • See Special Instructions Above UA -Unavailable ND= None Detected " See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than SGS Member of the SGS Group (Societe Generale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WOREorderf 39811 Date Report Printed: NOV 7 91 a 13:49 Client Sample ID:DRINKING WATER L28 B4 SAMPSON EST. PWSID :UA Collected OCT 29 91 1 16:00 hrs. Received OCT 30 91 1 12:30 hrs. Preserved with :AS REQUIRED Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO f PO 1 NONE RECEIVED Req 1 Ordered By :ROGER Analysis Completed :NOV 4 91 Send Reports to: Laboratory Supe ie or ST HEN C. ?„(4....„.._ 1)S & S ENGINEERING Released By2) Chemlab Ref 1: 915831 Lab Smpl ID: 1 Matrix: WATER Parameter Tested Allowable Result Units Method Limits VOL AROMATIC/UNSAT ORGANICS n/a n/a EPA 503.1 BENZENE ND(1.0) ppb EPA5D3.1 BROMOBENZENE ND(1.0) ppb EPA5D3.1 n-BUTYLBENZENE ND(1.0) ppb EPA503.1 sec-BUTYLBENZENE ND(1.0) ppb EPA503.1 tart-BUTYLBENZENE ND(1.0) ppb EPA503.1 CHLOROBENZENE ND(1.0) ppb EPA503.1 2-CHLOROTOLUENE ND(1.0) ppb EPA503.1 4-CHLOROTOLUENE ND(1.0) ppb EPA503.1 1,2 -DICHLOROBENZENE ND(1.0) ppb EPA503.1 1,3 -DICHLOROBENZENE ND(1.0) ppb EPA503.1 1,4 -DICHLOROBENZENE ND(1.0) ppb EPA503.1 ETHYLBENZENE ND(1.0) ppb EPA503.1 HEXACHLOROBUTADIENE ND(1.0) ppb EPA503.1 ISOPROPYLBENZENE ND(1.0) ppb EPA5D3.1 4-ISOPROPYLTOLUENE ND(1.0) ppb EPA503.1 NAPHTHALENE ND(1.0) ppb EPA503.1 n-PROPYLBENZENE ND(1.0) ppb EPA503.1 STYRENE ND(1.0) ppb EPA503.1 TETRACHLOROETHYLENE ND(1.0) ppb EPA503.1 TOLUENE ND(1.0) ppb EPA503.1 1,2,3-TRICHLOROBENZENE ND(1.0) ppb EPA503.1 1,2,4-TRICHLOROBENZENE ND(1.0) ppb EPA503.1 TRICHLOROETHYLENE ND(1.0) ppb EPA503.1 1,2,4-TRIMETHYLBENZENE ND(1.0) ppb EPA503.1 1,3,5-TRIMETHYLBENZENE ND(1.0) ppb EPA503.1 o -XYLENE ND(1.0) ppb EPA503.1 m & p XYLENE ND(1.0) ppb EPA503.1 SAS Member of the SGS Group (Socidt4 Generale de Surveillance) n/a MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND. ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH MUMCIPAur( Or ANCHORAGE CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY qp p VAL°F HEALTH 8, eNVIK NMENTAI PROTECTION OF ON-SITE SEWER AND WATER FACILITY 264-4720 JUS Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot- 2e, 6Jat el -7 r a, Location (address or directions) Pr?Ger /3cV1y ,, (b) Applicant Name I -Am e D jd'elephone: Home Applicant Address (c) Applicant is (check one): Lending Institution 0 ; Owner/builder X; Buyer 0 ; Other 0 (explain); RECEIVED Business (d) Lending Institution — Telephone Address (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: ./+L IA P ©,Vin,, 2524- garner; 52 - garne ; ,U R1&4;- 2. TYPE OF RESIDENCE Single -Family YS! Multi -Family 0 Other Number of Bedrooms 4 3. WATER SUPPLY Individual Well 129 Community 0 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' Public 0 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. 72-(25 {11,24) Pane 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ation of lth As certified by my seal affixed hereto and as of the validaatiidd/o wastewater e shown belo disposal system is safe, funcify that my tional onal and this adequate Authority Approval shows that the on-site water supply 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. Address Date 6. DHEP APPROVAL Approved for r-:2 (49 bedrooms by Approved /\ Disapproved Terms of Conditional Approval `y T O ip a 015 • . G •° Bru . Conv:n • 6-, % N ' E-5283 �: �� Conditional Date Engineer's Seal 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. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: 5 3 A. WELL DATA t:i01 iEif, N01103101� �I 1N3WNO i1AN If A, B, C, D.E.C. Approved (Y/N)'8*^�_� Well Classification If Yield Well Log Present (Y/N) — 1--- Date Completed Total Depth � Cased to Depth of Grouting7 .� Static Water Level Pump Set At Casing Height Above Ground 1 Sanitary Seal on Casing (Y/N) — Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments 46 / NA 14 LGol 17,E 1,00r - ; On Adjoining Lots on Lot On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date --1 Z r,Ili t'4 WO di /•1 B. SEPTIC/HOLDING TANK DATA WO al 1-90 al Anel l Date Installed C-1'$ Size ---- No. of Compartments Y Foundation Cleanout (Y/N) Standpipes (Y/N) _____Y---Air-tight Caps (Y/N) ----- Date Last Pumped x`14 ;for N %n Depression over Tank (Y/N)A Pumping/Maintenance Contract on File (Y/N) Temporary Holding Tank Permit (Y/N) �` Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: Well 12 0/ To Building Foundation To Water -Supply j�+ To Property Line 10 To Disposal Field To Water Main/Service Line 1.0' To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 C.. ABSORPTION FIELD DATA Soils Rating in Absorption Strata zzi s-/br Type of System Design Date Installed 1-7-95' Length of Field ,,Lo' Width of Field ZLi' Square Feet of Absorption Area 11.0 Depth of Field 6"(,, 4p4mP Gravel Bed Thickness 1' Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well ISS To Property Line ' O. To Building Foundation To Existing or Abandoned System cn Lot n one ; On Adjoining Lots To Water Main/Service Line - To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course n o r c To Driveway, Parking Area, or Vehicle Storage Area Co rents D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check rmitted Bedroom Rating Against HAA Request ** I certify/ at I h ye, checked, verified, or conformed to all MOA HAA-G4AtikatWee in effect on the dat of th,s/iinspection. Signed '`/ Date !-234S Compan ', f s' ' ��'11C.- ��(!� , MOA No. 5/-84-z/5 KB1/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE Application Date 1. General Information (a) Legal Description (include lot, block, subdivision, section, township, range) LcfZ'C%IIIc C-�c 7`.. /2So c. Gis / io Location (address or directions) C,�-c /C (b) Applicants Name 5I77) (-6,r) /7'L(<4.0 "1 Applicants Address P1? Telephone - Home Business (c) Applicant is (check one) Lending Institution Buyer ; Other` I (explain); (d) Lending Institution Address (e) Real Estate Co. & Agent Address Telephone E-� Owner/builder Tel--s Telephone (f) Mail the HAA to the following address: td 3 ' V4-, %- ;E 17) 2. Type of Residence Single -Family 17.-t Multi -Family f Other (describe) Number of Bedrooms 3. Water Supply Individual Well Community I= Public Note: If community well system, must't'have"written confirmation from the State Department of Environmental Conservationiftesting to the legality and status. ftl- 4. Sewage Disposal (1 1) Community Holding Tank Onsite Public yrt Note: If community well system, must have written confirmation from athe sState e• Department of Environmental Conservation attesting to the legality [Page 1 of 2] 5. Engineering Firm Providing Ins ections, 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 wafer supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Address 6 Date /-22-8; W,i S.Sacr�c��c,s Telephone S-6.•,/-6, /57 6. DHEP Approval Approved for bedrooms 9314 vu ggil 0 Y. �eddGINBEie°<sE•A )„. rule J. Corwin s,4 0�4 c•-,-. rule Rb. CE -5283 A v � iBQFE Y Approved Disapproved Conditional Date f / Terms of Con-' ional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. WI/ RR4/ej/D18 (Page 2 of 21 (DHEP SEAL)', ( 11 Ii \ I t 1 1' 7-19-84 A. WELL DATA Well Classification Well Log PresentTotal Depth Z,401 44 Cased to Static Water Level Zlb' Casing Height Above Ground _ Electrical Wiring in Conduit (Y/N) Separation Distanoas frau Well: To Septic/Holding.Tank on Lot To Nearest Edge of Absorption Field To Nearest Public Sewer Line MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: P vale. 2' MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH a ENVIRONMENTAL PROTECTION JA'I 2 3 1985 r2s�n 5(A -bet y /%5 r o If A, B, or C, D.E.C. Approved(Y/N) Date Completed Yield 2�Fb g Depth of Grouting Sanitary Seal on Casing (Y/N) Y Y Depression Around Wellhead (Y/N) N On Adjoining Lots , loo ` — _; On Adjoining Lots 1otic__ To Nearest Public Sever Pump Set At I on Lot 55-' Cleanout/Manhole To Nearest Sewer Sery Water Sample Collected By Water Sample Test Results cin') Comments ice Line on Lot Date 1--21-r35 B. SEPTIC/HOLDING TANK DATA Date Installed 1--1- 05- Size 1 0 004 21 No. of Compartments z Standpipes (Y/t`j) Y Air -tight Caps (Y/N) i' Foundation Cleanout (Y/N) �L Date Last Pumped Depression over Tank (Y/lV) _ Pumping/Maintenance Contract on File (Y/�`1 �; for---- Holding Tank Permit (Y/N)_ Holding Tank High -Water Alarm (Y/1`I) Temporary Separation Distances from Septic/Holding Tank: To Water -Supply Wall 1-Z0' To Building Foundation 1I' To Disposal Field 7 h L To Property Line 7 Id or Drainage To Water Main/Service Line To Stream, Pond, Lake, or Maj Course Comments [Page 1of2] n Receipt # Date Paid: Amount: 1. (0- -r v, _ 2-15-84 C. ABSORPTION FIELD DATA / Soils Rating in Absorption Strata .2.0q //Q, Type of System Design Bed Date Installed 1-7 -65 Width of Field 25 A - put /Z ' Length of Field 4 @ 34'1, 2 (3l9 Depth of Field 5 Gravel Bed Thickness /7. s Square Feet of Absorption Area /2(0O Standpipes Present (Y/N) Depression over Field (Y/N) %\i Date of Last Adequacy Test N IA Results of Last Adequacy Test u�/k Separation Distance from Absorption Field: To Water -Supply Well 140 / To Property Line >10 To Building Foundation Got. To Existing or Abandoned System on Lot iA To Water Main/Service Line + f0' ; On Adjoining Lots To Stream/Pond/Lake/or Major Drainage Course NiA To Driveway, Parking Area, or Vehicle Storage Area > 5o Comments > To Cutbank (if present) ni IA D. LIFT STATION lu IA Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request **. 4. el/OD11?S I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ��// � _ ,y Date Company (.r7YNJvj2 a(r+.Gt . MOA No .S% -85' -Z -i Receipt No Date of Payment d R, Amount. $ 4-1S. Page 2 of 2 72-026 (11/84) �E OFA 41 ,,•....... •4�, , v °• 17 LuPPrce(a rrt f_QJ?J// Y ne�0 k Cirzr 11 7a ry 0P1A.6LOJ . Corwin ." rid CE -5283 : • ((id ineer's Seal