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HomeMy WebLinkAboutSAMPSON ESTATES BLK 4 LT 24Sampson Estates Block 4 Lot 24 #051-822-14 V `"N" 1 e mL Municipality of Anchorage SEP H On -Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT //���j r V Permit Number: � "15 PID Number: 054– 622— 1 T Dwelling: [Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Upgrade N r ABSORPTION FIELD ❑ Deep Trench ❑Shallow Trench El Bed ❑Mound Address IAV ❑ Other P ne Number of Bedrooms Soil Rating Total depth from original grade f 2 1 4 GPD/SF Ft. LEGAL DESCRIPTION - Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Sub ' ' ion Block Lot b��O �s Fill added above original grade Ft_ Gravel length Ft. t Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES TO Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FIS Ft. Well / - 10 C �' TANK Septic ❑ S.T.E.P. E] Holding ❑ Other r C� Maacturer Capacity nn Surface Water / Gal. MaterialN of compartments Lot Line �� �p 2 ✓umbeer NA Foundation LIFT STATION Manufacturer Capacity Curtain Drain Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer S `( PIPE MATERIAL Housetotank i Tankto 0 drainfield LL F- DrainfieldV�j�CO/MT Inspector BENCHMARK (Assumed elevation) ft Inspection Vt dates: GJ L 2"d Location and description ,� 3� 4'" �20t�iZ �1 COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin �S amp Conditional Approval: Date t .. a, ..BRUCE -P't ICE Approve h,V. Date r1v ispecnon Reporr_a-i-i2.coc - SAMPSON ESTATES BLOCK 4, LOT 18 PROPERTY UNE - 1 1 1 1 Vk PROPERTY UNENEW SEPTIC TANK, EXISTING DRASEE ENLARGED VIEWF==` _ — — -y/p ` NG EXISTING WELL E . EXISTING WELL /— EXISTING FCO ___! 100' RADIUS i 100' RADIUS SAMPSON ESTATES \ \ BLOCK 4, LOT 24 I - 1 SAMPSON ESTATES BLOCK 4, LOT 23 WE I II 11 � I I r WELL® SAMPSON ESTATES BLOCK 4, LOT 25 ------ AS—BUILT Prepared for w�A BRUCE & ROBIN HOPPER SAMPSON ESTATES, BLOCK 4, LOT 24'' PID NUMBER: 051-822-14 4�°h Eagle River Alaska Bruce E HoppeP BRUCE E. N PER • r /E DATE: 9/01/2015 +� " �" CE- 7745 P.O. Box 670549 Chu lak Alaska 99567 DRAWN: BEH g r SCALE: 1"=50' (907) 688-2032 / FAX: (907) 258-4653 /�� 1 1 1 1 1 1 •�t��•'`•••"••••'••`•••••'• 111111 111111 ..��� ♦t� UNE TO 1992 FIELD 1� 1 1 1 ` EXISTING 1984 CLEANOUT TOWARD FIELD 1 DRAINAGE FIELD `..•..`*ease 1111 CLEANOUT TOWARD FIELD VALVE 0600606soa '•• a 1111 11 EXISTING OWARIDNTANK --_.- c CLEANOUT TOWARD FIELD ti t 8OUTLET INVERT ELEVATION 94.93' TOP OF TANK ELEVATION 95.6' TDP OF GRADE ELEVATION =99.6' P FILL OVER TANK - 4' \ 1,250 GALLON, 2 -COMPARTMENT TANK ` DIA. = 4.7', L = 10.0', MFR = GREER 53 2" RIGID FOAM INSULATION OUTLINE OF HOUSE 7•$ �1' ABOVE TANK ASSUMED ELEVATION OF FF = 100.0' TOP OF TANK ELEVATION 95.63' INLET INVERT ELEVATION 95.23' 5.8 N -- h - --EXISTING WELL ( 100' RADIUS fT W 1 6: -!�'1� NEW CLEANOUT 0 o TOWARD HOUSE EXISTING CLEANOUT TOWARD TANK o IVl' 441111 AS—BUILT Prepared for BRUCE & ROBIN HOPPER SAMPSON ESTATES, BLOCK 4, LOT 24 PID NUMBER: 051-822-14 Eagle River Alaska Bruce E. Hopper, P.E. P.O. Box 670549 Chugiak, Alaska 99567 (907) 688-2032 / FAX: (907) 2584653 4<Ah DATE: 9/01/2015 x p. sauce e. DRAWN: BEH SCALE: 1 "=5' _--"'"- ttttatttattttattttattta r '�;��aaataaaaattttaaat � t � R4jS,t lta at 1'�l ttltattttllllattt l EXISTING DRAINAGE�1 lttttattttttaltttttalllltai FIELD TO REMAIN ttllalttttlolltaa �1 ptatt t taatat, EXISTING LATERAL �\\ R.B' tttataatat Vol, ��1 rattttaa EXISTING STANDPIPE _- L N / / Qs• BCKG4 1S'ATES EXISTING HOUSE O i AS -BUILT Prepared for BRUCE & ROBIN HOPPER SAMPSON ESTATES, BLOCK 4, LOT 24 Y' ' , _ PID NUMBER: 051-822-14 49%N Eagle River Alaska BRUCE E. OPPER Bruce E. Hopper, P.E. DATE: 9/01/2015 CE -7745 .Y P.O. Box 670549 DRAWN: BEH hep •• ^ x ) 68 Alaska 99567 4� _ � (907 5 (907) 688-2032 /FAX: (907) 258653 SCALE: On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151271 Tax Code Number: 05182214000 Work Type: SepticTank Upgrade Permit Effective Dates: August 24, 2015 to August 23, 2016 Design Engineer: Subdivision: ISAMPSON ESTATES Site Legal Address: SAMPSON ESTATES BLK 4 LT 24 G:1560 Owner/Address: HOPPER BRUCE E & ROBIN J PO BOX 670549 CHUGIAK AK 995670549 Site Mailing Address: 23807 GOLIATH DR, Chugiak This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 41716 Total Bedrooms: 4 N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. ,, rf Special Provisions: Absorption bed may be under the addition foundation. Excavation to determine the location shall be done at the time of tank installation. Please contact the Onsite department after the bed is located. Received Issued By: �(/D,�,. ,_ Date: lql' COO— Municipality of Anchorage 0 inenr S 1 P J� L y n a m epartment **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV151111 COSA#: Permit#:OSP161271 P1 D#: 051.822-14 Legal Description: Sampson Estates Block 4 Lot 24 Engineer: Bruce Hopper -343-5231 Applicant: Bruce Hopper Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the foundation has been approved. The approved separation distance is 3.3 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. •................................. a...... ........ a.f... �..� Waiver is Granted: X Waiver is not Granted: Date: 174112f- Approved by: Name of Reviewe **** VARIANCEMAIVER REVIEW **** MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program Parcel I.D. 5182214 ANCHORAGE ON-SITE SEWER/WELL PERMIT APPLICATION ti AUG Property owner(s) Bruce & Robin Hopper Mailing address P.O. Box 670549, Chugiak, AK 99567 Day phone Site address 23807 Goliath Drive, Chugiak, AK Legal description (Sub'd., Block & Lot) Sampson Estates, Block 4, LT 24 Legal description (Township, Range & Section) Lot Size 41716 Sq. Ft. APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank Single Family (SF) ❑X Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 4 APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) ❑X ADU) ( Upgrade RXw/wo Duplex (D) ❑ Renewal ❑ Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: SIA 40 ioWIA .4-'O" Distance: 3,3' I certify that the above information is correct. I further certify that this is in accordance with appligable Municipal Cgide�. nature authorized Permit/Rush Fees: G215 Waiver Fees: '0215 Date of Payment: J ��1� Date of Payment: ` _q A/ Receipt Number: ©0!3 I6 Z Receipt Number: Permit No. osf I�51a11 1 Waiver No. OPV 1 51 i 1 Permit App_'.:. PROPERTY LINE EXISTING DRAINAGE FIELD TO REMAIN SAMPSON ESTATES BLOCK 4, LOT 18 EXISTING EXISTING WELL RADIUS i LINE i r'� 1 ti 1 EXISTING CO ` EXISTING DIVERSION VALVE NEW CO TOWARD FIELD NEW CO TOWARD TANK EXISTING SEPTIC TANK TO BE REMOVED AND DISPOSED OF PER CODE. INSTALL NEW 1,250 GALLON, i` rn 2 -COMPARTMENT TANK. INSTALL PER o - - 4! 15.65.050 ` 115S1NG NOOSE , `.\ EXISTING WELL 100' RADIUS SAMPSONSTATES BLOCKLOCK 4. 4, LOT 24 SAMPSON ESTATES BLOCK 4, LOT 23 ` WELL®_L — - — — WELIT / WELL® SAMPSON ESTATES BLOCK 4, LOT 25 Septic Design Prepared for BRUCE & ROBIN HOPPER SAMPSON ESTATES, BLOCK 4, LOT 24 Eagle River Alaska Bruce E. Hopper, P.E. P.O, Box 670549 Chugiak, Alaska 99567 (907) 688-2032 / FAX: (907) 258-4653 7_ BRUCE E. MOP DATE: 8/22/2015 rk.CE - 7745`� DRAWN: BEH ' ,a...._..... ���nFre' rE55;G SCALE: 1"=50'=„ August 24, 2015 Deb Wockenfuss Municipality of Anchorage, Onsite Water and Wastewater P.O. Box 196550 Anchorage, AK 99519-6650 Re: Sampson Estates, Blk 4, Lt 24 Ms. Wockenfuss: This letter is an application for a waiver for 15.65.060 (f), separation between the existing subsurface disposal field and the existing building foundation. The code section requires 10 feet separation, the existing field is approximately 3.3 feet from the existing building foundation. I believe the waiver is justified for the following reasons: The building structure that encroaches on the subsurface disposal field is a slab -on -grade construction with no void beneath the floor. Further, the slab is placed over a continuous 10 -mil polyethylene sheet which is sealed to the concrete stem wall. No sewer gases are able to migrate from the disposal field up in to the habitable space. The separation distance is large enough that the influence area beneath the wall footing does not pass through the disposal field section. The bottom of the existing disposal field is 1'-10" below the bottom of the footing. If a conservative 1:1 estimate of the slope of the influence area below the footing is used, the structural load from the footing passes beneath the bottom of the disposal field. The condition has existed for 17 years and there is no evidence of structural subsidence, or gases within the structure. If you have any questions regarding this waiver request, please feel free to call me at 862-2032. Sincer ly, Bruce E. Hopper, P.E. Bruce Hopper, P.E., P.O. Box 670549, Chugiak, AK 99567 Phone (907) 688-2032 Municipality of Anchorage Page of 2 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: _SG✓ 920//f9 PID Number: 0:51- K7 -2 _11A Name. -,2126 Q HA vE Wastewater System: ❑ New Upgrade Address: Po Coy, (P?04 eHWgh41 ABSORPTION FIELD Phone: Ply S No. of Bed ooms: ❑ Deep Trench ❑ Shallow Trench )�ted ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: ) Total Depth from original grade: 0,4 GPD/Sq. Ft. 3— Lot: Block: Subdivision: Z� AMPSoN EST. Depth to pipe bottom fro m� Q/riginal grade: Gravel depth beneath pipe 0,5 / / Ft. Ft. Township: /,5,V 'v Range: Section: Fill added above original grade: /10 Ft. Gravel length: - l� z 5 Ft. WELL: ❑ New (,)(15f1#6;o Upgrade Gravel depth;.JVIDp %7l Ft. Numb1oflines: Distance between lines: � T & Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Ft. Pipe material: Ft Ft. 41S SQ. Ft. 034 STM Driller: - � A D ed: Static Water Level: Ft. Installer: R.ler: 40 /k/ E�1T Date install d: O(o d 2 Yield: _ Pump Set at: . - - Casing Height Above Ground: / 6x 1 sv/w, TANK - GPM Ft. Ft. SEPARATION DISTANCES Xseptic ❑ Holding ❑ S.T.E.P. To From Septic Tank Absorption Field Lift Station Holding Tank PebHe/Private Sewer Lines Manufacturer:n 6rG Capacit In gallons 250 well Al 14 N/4 1-71 Material: E � L Number of Compartments: Surface1 Water NSA N A N A k114 111A LIFT STATION LotSize Line 6o J� P/A IVI,4 SO in gallons: Manufacturer: Q FOundetion6 r /S / �1 ^ ` , A ,�V N/A "Pump on" level at: "Pu level at: High water alarm at: Curtain Drain �l NSA //� /!A'r `7 IV/ ^ Pump Make & M Electrical Inspections performed by: /`r �`t Remarks: BENCH MARK Location and Description: - - - D ees U V%JLVE Tp F oineq 4-10W 5 I .t3 f oc 4,AIZ) IVdJ iELAS- Elevation: /04.0 1' ouNDCP Spic- 0-0 vc,� . ENGINEER'S SEAL OF A ` ry ea Aa /� e Inspections performed b 15116 �16a Din 29 92 P P Y�. Dates: is 2nd 12 �e AlegggO Cvg enaoovaeonce,mnn•t. r Department of Health a uman S es approval §x. o vosa i� CSE Louis A. Eutera iv ` g .^ C[4736 e Reviewed and approved by: �- Date:¢ Permit No. SW 920149 Page 2 of 2 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: Sampson Estates, Lot 24, Block 4 PID No.: 051-822-14 i F _ 24 ELEVATIONS (NOT TO SCALE) E15U1 tµK 72-013 A (2/91) MOA 25 VALVE EXISTING SEPTIC T E A rn �E p0 100,0' l A- G _ 99 -B-- G =7951.. SCALE 1"` = 60' 7�2 MONITOR TUBE o - SEWER CLEANOUT ¢ - WELL HH -FIN -H+- LEACHFIELD — — - EASEMENT TOP DE REAR DECK ASSUMED ELEV = 100.00' 4OUNDED GROUND :OVEfl 1' AVG i x 7RIGINAL yk a 5ROUND N .EVEL E 84.51 CWT BOT 80 .7' BOTTOM SIX 81J' BOT ENG1NF,E8',$,SEAL cT tT� ilaeoo t A >5,�! p06e� ' i Vo e Louis A PUMraD ','I;; ..' %aD P4POF PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 JO �UC1%Y� ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT i� 3LU_g PERMIT NUMBER:SW920149 DATE ISSUED: 6/23/92 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 6/23/93 OWNER NAME:SCHAVE JAMES H & OWNER ADDRESS:P.O. BOX 670228 CHUGIAK, ALASKA 99567 PARCEL ID:05182214 LEGAL DESCRIPTION: SAMPSON ESTATES BLK 4 LT 24 LOT SIZE: 41716 (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: 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: DATE:4��� �/ 2 Louis Butera, P.E. Registered Civil Engineer June 17, 1992 John Smith, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Sampson Estates, Lot 24, Block 4 Narrative Dear Mr. Smith: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The area has large lots allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. This is the second septic field, and a diversion valve will allow alternating the leachfields to lengthen lifespan. 4. Drainage will not be effected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, o 6Gdua Louis Butera, P.E. P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Pax (907) 694-3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 24, BLOCK 4, SAMPSON ESTATES A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. BED 1. The bed is to follow the natural land contour to maintain uniform total depth of the bed bottom. 2. The bottom of the bed shall be level, plus or minus 1.5". 3. The total depth of the bed excavation is not to exceed 4' at any point. 4. The sewer line is to be connected into the existing leach line to allow effluent switching, utilizing a diversion valve, to the upgrade leachfield. 5. The bed gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the bed is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 4' GRAVEL DEPTH = 6" under pipe BED LENGTH = 62.5' BED WIDTH = 24' SOIL RATING = 0.4 GPD/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK SIZE = 1,250 existing NOTE: Fill and compact over existing test holes located in the leachbed area. Twenty-four (24) hours notice required for all inspections. EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK 99577 694.5195 Finam uo-1(upk Sneers) 2W-1(PaMe4)U®Ino, Grolonjhm 01471. to Order MONE IOLL FREE 1-800-pp&8880 JOBSampson Est. Lot 24, Blk 4 92-091 SHEETNO. ng CALCULATED BY L. B. DATE 06/16/92 CHECKED BY scni c DATE n W W Oj NOD 20 In O z LES }+30, z N 84°34' 18 RIVA�Es SZEMS 155.( AEE SEPjIC AEE u � goo S 2<58 4 +30 0 1�p91 �s E APPROX. WELL LOCATION 49,p3 4" W PA D ® - TEST HOLE / • - MONITOR TUBE o - SEWER CLEANOUT N❑ SURFACE WATER COURSES + - WELL i r - PROPOSED LEACHFIELD NO KNOWN CURTAIN DRAINS — — - EASEMENT SEPTIC SYSTEM SITE PLAN #2 LEGAL: LOT 24 BLK 4 SAMPSON ESTATES OWNER: SCHAVE CONTRACTOR: N/A JOB # 92-091 DATE: 06/17/92 SCALE 1" = 60' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5995 FAX: (907) 694-3297 OF A<lSt�i .'49 TH Of...... ...... ..... LOUIS A. BUTERA CE -6736 = 11i��'?OF'ESSJO"P- '• 0 S T.H.#1 625, T.H.# �• n o 1 R E' 1 O %' DIVERSION VALVE J SA 10 ZI,X43' EXISTING N o SEPTIC TANK 23 -C O � HOUSE n 100.0' APPROX. -0 WELL 2 4 LOCATION APPROX. WELL LOCATION 49,p3 4" W PA D ® - TEST HOLE / • - MONITOR TUBE o - SEWER CLEANOUT N❑ SURFACE WATER COURSES + - WELL i r - PROPOSED LEACHFIELD NO KNOWN CURTAIN DRAINS — — - EASEMENT SEPTIC SYSTEM SITE PLAN #2 LEGAL: LOT 24 BLK 4 SAMPSON ESTATES OWNER: SCHAVE CONTRACTOR: N/A JOB # 92-091 DATE: 06/17/92 SCALE 1" = 60' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5995 FAX: (907) 694-3297 OF A<lSt�i .'49 TH Of...... ...... ..... LOUIS A. BUTERA CE -6736 = 11i��'?OF'ESSJO"P- '• I W W 0o (U 20 In yz wE��s x+3o' Z N 64°34'30' E 4sa 18 PRZ�PCEs�scEMs 155,00 PLL SEgj1G "O. PLL • W � }goo 1 7 PSE W SEMS +3o PP LPSEPjiC S(S 1�p,91 0 625/• N s P ® i T.H,#1 T.H.#2 �r Z SEPTI o Lc .CFiFiELD DIVERSION ° N I M VALVE IDtV 2� X43' EXISTING SEPTIC TANK 23 ScPTI £ LE9CHFIE.D N ° O\ HOUSE -co LA m n 25 d 100,0' APPROX, 2 4 ¢ WELL LOCATION WELL 106.54 APPROX.S 85°58'4' W WELL i 48,54 LOCATION �' g9•p3 ' N �29L,00 TEST HOLE / /` • _ MONITOR TUBE o SEWER CLEANOUT NO SURFACE WATER COURSES -0 — WELL NO KNOWN CURTAIN DRAINS PROPOSED LEACHFIELD — — EASEMENT SEPTIC SYSTEM SITE PLAN #1 LEGAL: LOT 24 BLK 4 SAMPSON ESTATES ,�'t�••OF.41C %%v OWNER: SCHAVE •°• •• CONTRACTOR: N/A or `"! '•;y�9� 9 IN - JOB # 92-091 DATE: 06/17/921 SCALE 1" = 60'"'�"' - •••�•••o EAGLE RIVER ENGINEERING SERVICES Vm•; 1/elouti A•Butem• *a j P_O_ Box 773294 d��v�.••• CE 6736 •: �.'''/ EAGLE RIVER, AK. 99577A`�'Fo�•.,,,,,,..••'���� (907) 694-5195 FAX: (907 s 694-3297 ��� �� 9 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L•• Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �uye- DATE PERFORMED:.9� LEGAL DESCRIPTION: /ot -,,2Y &lArV .S* -;erc j Township, Range, Section: 7-/-,5'-AJ/2 I w S•eC_, C`s r SLOPE SITE PLAN �1f7f 7ZSo 1i� f Orfcc .c mE I I I I I I 1= 2- 3- 4- 5- 6- 7 34567 .y 8- C>. O. 9- to - 12 to12 13- 14- 15- 16- 17 1314151617 18- 19 (&AI-) '5 ✓tom .ii %> .it.r�( r^/y i4 ✓G� /hGd, k ;-- Y WAS GROUND WATER ENCOUNTERED? Yc S s IF YES, AT WHAT 8 2 / LO G S DEPTH? P E Depth to Water Aller i Monitoring? Dale: CIO i Reading Date Gross Time Net Time Depth to Water Net Drop ° rs p���180�L000f' isx �. euoR'JCiTT:..>:nrf JA PERFORMED FOR: �uye- DATE PERFORMED:.9� LEGAL DESCRIPTION: /ot -,,2Y &lArV .S* -;erc j Township, Range, Section: 7-/-,5'-AJ/2 I w S•eC_, C`s r SLOPE SITE PLAN �1f7f 7ZSo 1i� f Orfcc .c mE I I I I I I 1= 2- 3- 4- 5- 6- 7 34567 .y 8- C>. O. 9- to - 12 to12 13- 14- 15- 16- 17 1314151617 18- 19 (&AI-) '5 ✓tom .ii %> .it.r�( r^/y i4 ✓G� /hGd, k ;-- Y WAS GROUND WATER ENCOUNTERED? Yc S s IF YES, AT WHAT 8 2 / LO G S DEPTH? P E Depth to Water Aller i Monitoring? Dale: CIO i Reading Date Gross Time Net Time Depth to Water Net Drop Svq 6 /.o 3 6�• f/8 9!3o 7 20 -I Imo_ JI PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER � y TEST RUN BETWEEN FT AND"-, FT COMMENTS / if rr Eagle River Engineering services PERFORMED BY: P rt Gnr 70294 1 -5f PERFORMED CERTIFY THAT THIS TEST WAS PERFORMED IN Ea11te River, A 919 ACCORDANCE WITH ALL STA E AL GUIDELINES IN EFFECT ON THIS DATE. DATE: - 72-008 (Rev. 4/85) 1 e Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: S'e/lu ve F��."(ENGINEEf1SSEAL� ' ,., r , fi DATEPERFORMED:�/ 9�9� LEGAL DESCRIPTION:_,�of' .'2Y &lAr- 4' .SU^trrvj Township, Range, Section: 7'/ 5-t-1 /2 I w Se C-, Es r- SLOPE SITE PLAN 7U .f' / // is4r rc 2- 3- 4- 6- 7 3 46 r 8- 9- 10- 11 910 11 12 13 14 15 16 17 18 19 CG�) om WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Y<s S L �r 6 0 P E Depth to Water Aller Monitoring? 9• ? Dale: Reading Date Gross Time Net Time Depth to Water Net Drop SvA 6 /o -71/ zo y PERCOLATION RATE 0'•3 (minutes/inch) PERC HOLE DIAMETER � TEST RUN BETWEEN i` FT AND FT COMMENTS rGLG �v Z Will River Engineering Services PERFORMED BY: a n a,„, 7"294577 1 l�e� CERTIFY THAT THIS TEST WAS PERFORMED IN Eapl9River, ACCORDANCE WITH ALL STATE wilw CIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE i 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 PHONE ®NEW '-S kve� ❑ UPGRADE MAI LING ADDRESS PO. 8ax & 0(9D (5ti rak /9K MW LEGAL DESCRIPTION -Setmpsn) Seib, Lot 2� LOCATION NO. OF BEDROOMS DISTANCE TO: Well i BOO Absorption area A)/ Dwelling 3.7' PERMIT NO. n I�07O`7 U _ Y .IWf �J F Z w Manufacturer �%� Material No. of compartments 2- Stee / N Liq. capacity in gallons IF HOMEMADE: Inside length Width _ Liquid depth O Z DISTANCE TO: Well (�j� Dwelling PERMIT NO. _ Oz Manufacturer A'//4- Material Liquid capacity in gallons 0 w= DISTANCE TO: Well / //O Foundation �(� Nearest lot line i I(jf PERMIT NO. E?gD70�7 J w Z No. of lines tt Length of each Ij ne I Total length of lines T -F n width / Distance between lines 6 / ~ F Top of tile to finish grade_. / - / Material beneath the wsFies f Total effective absorption area 0 J') a.s .�•,.,?::�>r. 1 to inches 46 Lu Length Width Depth PERMIT NO. a a F LU LU Type of crib — Crib diameter Crib depth -- Total effective absorption area — y DISTANCE TO: Well Building foundation _ Nearest lot line J w Class PriYQte Depth Driller - Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line �` Septic tank Absorption area(s) OTHER Jo e1 PIPE MATERIALS l�ST/�9 �D3� SOIL TEST RATING /SO INSTALLER S kQ S C045trt'.C-F7 o n RE RKS C." Se G t l p r APPROVJ*D DATE LEGAL 5a.., pS o, Sub- 131, ck y tof z q 72-013 (Rev. 3/78) � P1 1%4 1 C:, I V-" ir-N JL.. I -r-�r L -p F= ���f— F-1 E3 � Ir4 �F.- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET. AN[*nP��F A[. -'- 264-4720 x STREET , �,`~��.�.^.�� . 264-4720 C»" �E3 1: FE IS E- W�7-- IF� ff:P' E������-� PERMIT NO: 840707 DATE ISSUED: 08/20/84 ' � APPLICANT: SKAGGS CDNSTRUCTIInS ADDRESS: P.O. BOX 670690 ' CHUGIAK, All. 99567 CONTACT PHONE: 688 2831 LEGAL DESCRIP: SUBDIVISION:SON ' �*rr LOT: 24 BLOCK: 4 SEC17I0N: 3 TOWNSHIP: 15N RANGE: 1W LOT SIZE: 41716 (30 -FT. OR ACRES) MAX BEDROOMS. 3 Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. ~~ �r � DEPTH TO PIPE BOTTOM (FT.) GRAVEL DEPTH (FT.) m67TOTAL DEPTH »' ' ') "~'-� GRAVEL WIDTH (FT.) GRAVEL LENGTH (FT ^ ) ` � SOIL RATING (SQ.FT./BR) ����^14� �= � � ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1" I am familiar with the requir'ements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska 2. I will install the system in accordance with all MOA codes and regulations, and. in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid for 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 DONE BY A LICENS�D ELECTRICIAN. 1^=.E" DATE: APPLICOCANT: G ISSUED BY QATE: �~ SOILS LOG a MUNICIPALITY OF ANCHORAGE • +� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: -i n L—: LJ UDATE PERFORMED: 7/1I/04- LEGAL DESCRIPTION: 16% ,q,f%2p,wy► bf�d� Pi SLOPE SITE PLAN 1 I / IIII, OL 2 5:i I!y Saad if, Qin 64in 4 5 6 7 8 9 10 11 WAS GROUND WATERS ENCOUNTERED? L O 12 P IF YES, AT WHAT E 13 DEPTH? 14 Date Gross Time NetjDe,to Time Net Drop +07-0 7/0/8- j 16 63 °ecn�a �C 9 tl 4,10 17 FrY F6 o ;� t 18 !O t t6 f4j c uce J. Corriin e 19 n'a ao. CE -5^83 q 20 Fl c-3 Reading Date Gross Time NetjDe,to Time Net Drop +07-0 7/0/8- j t oa+�x0 4,10 fo "w2 !O iJ. ..�t7 0. zU PERCOLATION RATE 8,3 �J �1 p I / TEST' RUN BETWEEN 2,5 COMMENTS /C L��()Iln7i�il/I %QG+ iZ(/ly�L]j� W%fIii �LC� PERFORMED BY: c. r CERTIFIED BY: 72-008 (6/79) (minutes/inch) AND - FT T DATE: L O O z u a) 4-1 JN N a 03 TJ 0 bi 00 Iq 0 04 rQ 00 Sa rci rQ -J rc) rQ rd 0 rd (d 0: cn M. M. rq M ST (9 4-9 44: O 0: u): ci M .0 4J! Ca r -I N C) o c) 0 o 44: o 0 o o o o 0: 0:, w 0., 0: 0:: F- C: oh: (N: of vs r-- oi O Cq Iq LQ kv. W ad u "i ce w (A w ce 94 ce W w 94 U. LZ. w w w EA U. w V. wo < X u MA LU > I UM CC ® w V) X 0 09 w LL 0 'a0 A41 43 CO W. 00: (0: a4: w E: 0 a. y. x cn 0: 4-) —i a) A < M w -et O 00 F. Z < co 0 Ln Ln C7 N Ix w I I I w O O z u a) 4-1 TJ 0 bi Iq 04 rQ 00 Sa rci rQ -J rc) rQ rd 0 rd (d cn M. M. rq M V3 (9 (Y) ci Ca r -I N C) o c) 0 o o o 0 o o o o of vs r-- oi O Cq Iq LQ kv. W ce w x w ce 94 ce W w 94 U. LZ. w w w LT. U. w V. ` MUNICIPALITY OF ANCHORAGE t 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. # 051-822-14 HAA # Qaq: n H C) 1. GENERAL INFORMATION Complete legal description Sampson Estates, Lot 24, Block 4 T15N R1W Section 3 Location (site address or directions) 23807 Goliath Drive Chugiak Property owner James & Geraldine Schave Day phone 688-4457 Mailing address P.O. Box 670228, C'huaiak, AK 99567 Lending agency NSA Day phone Mailing address Agent Audrey Mason/ReMax Day phone Address 16600 Center Field Dr., Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 694-4200 0 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Do 5. 6. By STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Eagle River Engineering Services Address P.O. Box 773294, Eagle River, AK 99577 Phone 694-5195 Engineer's signature s Date 6� 9;.a- DHHS ;.2 � a ,;�., j�gT4 b a , -t 5 yt c`9 R` Louis A. But ra 4;, y- I J ••a G'c-6735 0� PRCF�SS4��. DHHS SIGNATURE Approved for !4= bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: /✓r�NL� Additional Comments lt1TIC 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 N21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SAMPSON EST. LOT Z�}, 81-&"44 Parcel I.D. ©SI - YZZ'/4� Tisa, 2/W, 56CTioN 3 A. WELL DATA Well type 29/11A76 If A, B, or C, attach ADEC letter. ADEC water system number 141A L Log present (Y/N) l V 65 Date completed UyY91 Driller ,TAY N1LLiAM Total depth Zoo 4 Cased to zoo / Casing height IS /" Sanitary seal (Y/N) '165 Wires properly protected (Y/N) 1455 i FROM WELL LOG AT INSPECTION Date of test U -7.112 92 _ �15/09�9Z (S ,� $ 6N6r) Static water level 30 M Well flow /5 g.p.m. g.p.m. ;v o Z Pump level UN/GNOW/y UNkNUGUN _D SEPARATION DISTANCES FROM WELL TO: rn o c_n Z Septic/kie,1444rg tank on 4f lot /ae' On adjacent lots f/oo M VIJ M s VJ o0 Absorption field on lot On adjacent lots ¢san y o Public sewer main —IV 1A Public sewer manhole/cleanout NJA Z Sewer service line Petroleum tank nit., %fiih�•Y. Y,.�r WATER SAMPLE RESULTS: Coliform __ Nitrate 0. 90 Other bacteria _ Date of sample: i Collected by: U/,y B. SEPTIC/HOLB+NG TANK DATA Date installed 0� � &0 474 Tank size /250 Compartments � Cleanouts (Y/N) Y9 -S . Foundation cleanout (Y/N) yEs Depression (Y/N) i65 High water alarm (Y/N) I�A' Alarm tested (Y/N) /V 1A Date of pumping "2'5 Z0,2 9 Z Pumper SEPARATION DISTANCES FROM SEPTIC/FtOlUNG TANK TO: Well(s) on lot On adjacent lots t/Do Foundation 9 To property line 6� g Absorption field ell-� Water r/service line 3 -Al Surface water/drainage /✓/A 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access-� Meets MOA electrical codes (Y/ SEPARATION DISI CE FROM LIFT STATION TO: Well D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water Date installed Ol�� d_�92 Soil rating a k 6PP Zhu System type 86D Length l -.;z, - �— Width A' 41 ` Gravel thickness Total depth '41 Total absorption area /6-019 0' -'- Cleanouts present (Y/N) m/ S - Depression over field (Y/N) N0 Date of adequacy test /`�1'4 _ N414j'^ Results (pass/fail) %�fi55 for 4 — bedrooms Peroxide treatment (past 12 months) (Y/N) 1414 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: tntaii n., Int On adjacent lots To building foundation O d'acent lots Y,�, n a) Cutbank Surface water Al /A Driveway, parking/vehicle storage area �1 � Curtain drain /VA i Property line To existing or abandoned system on lot as n'/,4 Water r*ait'r/service line _f AQ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. O✓r 4/ -%a Signature % *1491N. Engineer's Name'N' /.Owes.e"I's" . . //3 �o5F Louis A. fluterp e: 4Z,Date �, �A �• CE -6736 -;z.14 110FESEMCY� HAA Fee $ 170, 1(YD Date of Payment — Z Receipt Number Z 3 U Waiver Fee: $ — Date of Payment Receipt Number 11054 4911 River loop Road _ _ ROBERT A. SHAFER Eatp►a Pivot, Afeeks 90677 CIVIL ENGINEER '* WELL FLOW TEST DATA SHEET 1:0422?9 PROJECT: o 6� DATE OF TEST► S "L? LOCATION OF WELL (L90al 06e0rlpllon): o Z E stir WELLDEPTH: 1.00 1- FT. CASINt3:—..4".1_ �. .. FT. SCREEN: DATE DRILLING COMPLETED; �� I"I • f3'F _ _ DRILLER; TimQ\*�I UA A 1%4,q STATIC WATER LEVEL (Top Of Casing): --IL 1 _ FT. DATE; .-,?L CLOCK TIME ELAPSED TIME SINCE PUMPINGfI / PAIN. $TOOPEp,MIN. DEPTH TO WATER, FT, DRAWDOWN/ RECOVERY PUMPING RATE, QPM REMARK$ D' ', O 0. 0 Lr ► (awl) 00 Bldrl �4 i N1 1 9 -as r-je r cr a to 15 20 25 —30 to' D '1 Lo 3 40 a5 — 60 -- — 55 _.... — 60 (1 hour) 90 120 (2 hour a) 1500 - 180 3 hour 210 240 (4 hours) 1 G N REOOVERY t 0 p fi 10 16 20 25 30 Gpmmanu; FJOWIsnot QusrsMtl$ed Sub,oqubnt Vaistlons Coln Occur. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING S ENGINEERING CO. 6833 B STREET ANCHORAGE, ALASKA 99310 TELEPHONE (607) 552.2343 FAX: (907) W-6301 ANALYSIS RIBULIS ter INVOICE 1 6426 Chemlab Ref.I 92.1691 Semple I 1 Mattiw: WATIA Client sample ID : L24 I4 SAMPSON RST. Client flame is R 9 INGINEIRINO PWSID : VA Client hoot :91113INGP Collected MAY 4 92 i WOO his. WE : POI :NONE RICIIVID Ieoeired MAY 4 92 4 14:S4 his. Rag4 f Preserved with : AS REQUIRED ordered By :R, BIWIR A?AIYIIe Completed : MAY 6 92 Send Reports to; LabaRupe rie x IPREN C. LD_E _ 1)S 4 S RNGIMELRLNG Wallis! or ....w.ru u..u. uo.u..u.o....o..w.....ww ww.......................................... uw................. aardu.u.a+.uuu Pa:amlter Results Unite Method Allowable Liaite NITRAIE-N 0196 nq/1 IPA 36112 10 Semple ROUTINE SAMPLE COLLECTED IY: RAY. Remarks: ........................................................••-----------........._..........._................................... dooms 1 Ieete Performed ' See Special I"tructiont Above UA -Unavailable ND- None Deteated " Sae Sample Rourke Above Rio Not Analysed LT -Leer Than, CT -Greater Than 1*8(38 MOM& of the SGS Group (Socialri (36n6rals de Surveillance) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH•AUTHORITY APPROVAL CERTIFICATE 1. General Informatibn Application Date �� _ / ' F�t (a) Legal Description (include� lot, block, subdivision, section, township, range) 1�( Location (address or directions) (b) Applicants Name Siwe_ Skn59S Telephone - HomebFj,__2r,,iBusiness Applicants Address_po p,n,4 ( 70G p AK 0.9567 (c) Applicant is (check one) Lending Institution Owner/builder ; Buyer El ; Other 1-1 (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Number of Bedrooms 4 3. Water Supply Individual Well ET21 Community M Other (describe) 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 E=1 Community = Holding Tank = Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and.status. [Page 1 of 2] 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm , - w� 'n + Telephone Address lSyq CE'��..ct-✓ Avec �!`�r�caC1 ei Date vU1� 4 6. DHEP Approval / (` bedrooms ``By / f Approved for � �'« � sem— �i/�--�-�� 1 Date Approved X_ Disapproved Conditional Terms of Conditional Approval CAUTION THE 14UNICIPALITY 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 r. MUN DEPTLf � Y OF A JCHOP,AC r OF HEALTH F, MUNICIPALITY OF ANCHORAGE (MOA) r, ".,r L P;; r crioV HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 IVOV 11984 A. WELL DATA Well Classification p"'vale- If A, B, or C. D.E.C. Approved(Y/N) Well Log Present (Y/N) Y Date Capleted -7-tq-04 Yieldto aleti'r a�)a�E Total Depth 2 -co' Cased to Zou' Depth of Grouting - Static Water Level 20/ iF Pump Set At — Casing Height Above Ground z'�z� Sanitary Seal on Casing Electrical Wiring in Conduit (Y/N) Depression Around 1%b1lhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot /00' on Adjoining Lots 7 loos To Nearest Edge of Absorption Field on Lot /101 ; On Adjoining Lots >(0 o To Nearest Public Sewer Line /✓/ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By L, Date 0-3o B Water Sample Test Results Comments B. SEPTIC/HOLDING TANK IATA Date Installed Size No. of Compartments Z a -- Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) /J Date Last Pumped 411A Pumping/Maintenance Contract on File (Y/N) — ; for Holding Tank High -Water Alarm (Y/N) — Temporary Holding Tank Permit (Y/N) — Separation Distances frau Septic/Holding Tank: To Water -Supply Well too' To Building Foundation 3? To Property Line > tn' To Disposal Field lo' To Water Main/Service Line To Strea-n, Pond, Lake, Cr Major Drainage Course > Comments [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I S0# �bd rn, Type of System Design __LCL. Date Installed 9--ze)-aLength of Field y3 Width of Field -z/' Depth of Field `f' Gravel Bed Thickness 1.Z.1 Square Feet of Absorption Area qD® Standpipes Present (Y/N) i Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test N//k Separation Distance from Absorption Field: To Water -Supply W911 lib To Property Line >IU� To Building Foundation '7ro` To Existing or Abandoned System on Lot nonce On Adjoining Lots > To Water Main/Service Line AJI I -To Cutbank(if Aresent) none To Stream/pond/Lake/or Major' Drainage Course O� To Driveway, Parking Area, or Vehicle Storage Area >f0� Comments D. LIFT STATION Ivo ne� 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 'lest. Meets MOA Electrical Code"" Com vents ** Check permitted Bedroom Rating Against HAP. Request nes in effect �� �h I certify at I hav checked, verified, or conformed to all MOA HAA Guy 9 cticn. E� on the da of this i� " `` ` a o Date Signed Compan C�� J '�� (N MOA No. �! �'�1 L EN Ewa i„�° Ci - J Cir m - '•i KB1/d5/s (Page 2 of 21 2-15-84