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HomeMy WebLinkAboutSAMPSON ESTATES BLK 4 LT 15Sampson Estates Block 4 Lot 15 #051-811-20 On -Site Wastewater Disposal 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: OSP151379 Tax Code Number: 05181120000 Work Type: Septic Upgrade Permit Effective Dates: January 29, 2016 to January 28, 2017 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: SAMPSON ESTATES Site Legal Address: SAMPSON ESTATES BLK 4 LT 15 G:1560 Owner/Address: WITTKOP JAMES V 22420 PHARAOH CIR CHUGIAK AK 995670000 Site Mailing Address: 22420 PHARAOH CIR, Chugiak Lot Size in Sq Ft: Total Bedrooms: This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage 42610 4 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. Received By: MUNICIPALITY OF ANCHORAGE Community Development Department Development Services On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 06I — g t("7-0 Property owner(s) JIM WITTKOP Mailing address 22420 PHARAOH CIRCLE, CHUGIAK; AK 99567 Site address 22420 PHARAOH CIRCLE CHUGIAK, AK 99567 Phone: 907-343-7904 Fax: 907- 343-7997 Day phone 907-469-0423 Legal description (Sub'd, Block & Lot) SAMPSON ESTATES, BLOCK 4, LOT 15 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 4 APPLICATION IS FOR: (g al I that apply) Absorption Field Septic Tank Holding Tank ❑ Privy 0 Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade Renewal 15 TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) 0 Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: NONE Distance' - I certify that the above information is correct. 1 further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. ©5916 f2110( Waiver Fees' Date of Payment: Receipt Number: Waiver No. (Rev. 01111) GARN ESS ENGINEERING GROUP, Ltd CIVIL &ENVIRONMENTAL ENGINEERS October 26, 2015 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System Upgrade for Sampson Estates S/D; Block 4, Lot 15 To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The drainfields are in a state of failure and needs to be upgraded. Due to the high groundwater table in the area and the need for a S.T.E.P. tank, we are proposing to utilize a Cat II Quanics Aerocell treatment system for this property. Any other MOA approved Cat II or Cat III system can be substituted with MOA approval. We are proposing that the maximum excavation depth be 1 foot deep (removing all organics and that 2 feet of MOA approved sand be installed to provide a 4 -foot separation to the high groundwater level. Comments regarding the design are summarized as follows: 1. SOILS: See the attached soil logs for the Pannone Engineering test hole and S & S Engineering test holes, which shows the soil classifications, groundwater monitoring, and the percolation test results. The Pannone Engineering test hole location is shown based upon our swing -ties taken from the corners of the house. The S & S Engineering test hole locations are shown based upon scaling them from the 1993 design that is on file in the MOA records. The proposed drainfield has been designed around 30 foot radii of S & S Engineering TH#1 and Pannone TH#1. We propose that the S & S Engineering TH#1 peroclation rate of 53 minute/inch be used for this design. Pannone TH#1 was excavated in August of 2015 and was found to be dry to 11 feet on September 20, 2015; however, we checked groundwater level in the hole twice in October and found the liquid level in the monitoring tube to be at 3.3 feet below grade. Based upon our knowledge of this area, we believe this reading to be representative of the area. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns. 4. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography around the proposed drainfield is 1-7% running approximately south to North. In short, there are no slope concerns. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com Page 2 of 2 We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assista , e. Since y Presid 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 ;// / I / /; 4s ' /// / Cc,y �4, l' / / / ��4��ryQ �JtP O J /I / / # 0 eb / I / /' O.4' y�QJF' / / / / , It 7 7 // ! /7 7 /1 1 1 // 7 F\ 1 1 1 / GLENN VIEW ESTATES NORTH; / / SEPTIC AREA / / SERVED BY PUBLIC WATER w1 > E 0 BLOCK 2. LOT 3 w 0 CC Q, 0 0 etC VJ SCALE: PROPOSED S.T.E.P. TANK PANNONE THN1 1" = 100' GLENN VIEW ESTATES NORTH; BLOCK2, LOT2 SERVED BY PUBLIC WATER SEPTIC AREA r / / / ��\ \}''� /� SAMPSON ESTATES S10; - \ . 1 BLOCK 4, LOT 13A ---:s":S--.. SAMPSON DRIVE . I 1 1 I SAMPSON eC4LO • "YIOK, OT 19 SAMPSON ESTATES S/D; I' BLOCK 4, LOT 14 I EXISTING 4 BEDROOM HOUSE / ♦ �t 1 �, ;ry•\ . Ti of4 ' 1 ' / 1 1a�1��1-I RADIUS ,1 i SAMPSON ESTATES S/D; I -); / 1 \ \ BLOCK 4, LOT 18Tit 1 1 \ 1 1 \ 1 i X \ I / / 1 . \ i' I 1 / \ I i \ • '1' p S&S ENG. © y I TH#2 kV- S&S ENG. 4/'D t1O TH61 yP4�OOp, PROPOSED DRAINFIELD UPGRADE GLENN VIEW NORTH S/D; BLOCK 2, LOT 1 SAMPSON ESTATES S/D BLOCK 4, LOT 28 III-LO'W LLRADIU T 1 may/ F\ 1 F 1 SAMPSON ESTATES S/D; BLOCK 4, LOT 26 lF SAMPSON ESTATES SID; F BLOCK 4, LOT 27 1 F SAMPSON ESTATES S/D; BLOCK 4, LOT 17 1 c;PTIC AREA ; /1 / I likkikka 1 1 CIPTIC AREA FF j • FA li`. Y ' 11 11 11 GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3701 E MOOR ROAD, SUITE 101 'ANGWFM3E, AK9A5W' PHONE (907) 3374179` FAX (007) 3984046' WEBSITE wem'4ameeseglreed,p.mm PREPARED FOR: JIM WITTKOP PHONE NUMBER: (907) 469-0423 PAGE NUMBER: 1 OF 4 LEGAL DESCRIPTION: SAMPSON ESTATES S/D; BLOCK 4, LOT 15 DRAWN BY: J.L.M. TYPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE DATE: 11/4/2015 GEG, Ltd. HAS A 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. 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. SCALE: 1" 30' EXISTING SEPTIC TANK TO BE ABANDONED PER UPC CODE. PROPOSED 1500 GALLON GREER S.T.E.P. TANK WITH QUANICS PUMP AND CONTROLS PANNONE THN1 -GROUNDWATER AT 3.3 FEET ON 10/12/15 & 10/19/15 IN MONITORING TUBE 4 N 00' WELL RADIUS 2 TO 3 FOOT HIGH RETAINING WALL c0 co 00 0 PROPOSED 600 QUANICS AEROCELL UNIT PROPOSED DRAINFIELD ( SEE DESIGN CRITERIA) NOTE: S&S ENGINEERING TEST HOLE LOCATIONS ARE SHOWN BASED UPON SCALED DISTANCES OFF THE PROPERTY LINE FROM THEIR 1993 DESIGN THAT IS ON FILE AT THE MOA. THE PANNONE TEST HOLE LOCATION IS BASED UPON SWING -TIES PERFORMED BY GEG ON 10/19/2015. NOTE: THE SOUTHEAST PROPERTY LINE MUST BE FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO ANY CONSTRUCTION. EXISTING DRAINFIELDS TO BE ABANDONED IN PLACE FOR POSSIBLE FUTURE USE. DESIGN CRITERIA: NUMBER OF BEDROOMS: 4 GALLONS PER DAY (GPD) : 600 PERCOLATION RATE/S: 40 & 63 MINUTES/INCH PROPOSED APPLICATION RATE: '1.0 GPD/SQ.FT. MINIMUM DRAINFIELD SQ.FT.: 600 'USING CAT II ADVANCED TREATMENT SYSTEM DRAINFIELD DESIGN: MAXIMUM DEPTH: 1' (REMOVE ALL ORGANICS) WIDTH: 15 FEET LENGTH: 40 FEET M.O.A. APPROVED SAND FILTER: 2.0+ FEET EFFECTIVE: 0.5 FEET ACTUAL SQ.FT.: 600 GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3701E.TUDOR ROAD. SUITE 101• ANCHORAGE. AK 895%• PHONE (007) 397.0170• FAX (907) 3383240• WEBSITEWNx.9ammxnplmeMp.corn PREPARED FOR: JIM WITTKOP PHONE NUMBER: ( 907) 469-0423 PAGE NUMBER: 2 OF 4 LEGAL DESCRIPTION: SAMPSON ESTATES S/D; BLOCK 4, LOT 15 DRAWN BY: J.L.M. TYPE OF WORK: DESIGN OF SEPTIC SYSTEM UPGRADE DATE: REVISED 1/20/2016 • i ku ' •i• -793 i r 0FWmcENmro 0 y 1 z y < y 0 Aa-1Amzm7z 'y%0pm z_o 0,1 9A▪ Z=mH=ZAwCCm.7 cFO90 DA W Cm m o Z m 0 0 m) U min 0-a0 m -4> - C0 A - m A m r M0 3. -D400 M I C -‹CO Z A 0 V) 3 • Om A -1 mmm A m m 210 rA-0 A m 0 0 24 -1 ®z> c 7SPC A D r N Z ( ) 0 n A O Omr C>Z Z 0 co -D12C 00 O co K c -1 Z DZ I Z-ZO O CAv)A r m oo 00 0-1 m C e r 0 00 0 m om 2 D A -02)0<0 1-70 Zmm M 0 m O A =FlZA Dm mD-I V1 r _�-1 / V)rz key II -o A X A(A- j_O -INA 2D 0 Z m A O2 -I ti m 1 CUM IJHIIU4110 N C r _l Fl c4 C O c4E- r .= r COCO Nm O o H O O OM 2 r 0 A ZOm m 2 m V) y XO C 0 A A N m r 2 A 0 r D 2 O C H04 SHMISVM/S111 1,`121031V1d dWfld 0 0 C c r O r -1 rn 01 ▪ T - C_ 0 o >D n D > A Z c in m Z A 01210 K fn D Z -IDmmCrno D O o = A _l �20=DO!?1 2 A D m 0 Z -13> Zr m D O m _• m r r y A 0 r W 3 U _loin -(00 m -<02O OCZ • m 20 0 M GO Z,_,oy10 022M> 2 ~mrD-� r{ m O D r r rm-I r* D co m O rr13V -Ix) r -_D ti AZ - O D ADm V) m 011 Z V1 O M ZDS 20 Dm> Z A r d (3j0/NO) 1V013 0 0 mm 0 • D C Z r -o mn m 2 0) O m O 0 W Om -1 m_0 2 m nO me m 3 -n 0 1V 3N11 NOI1V1113211332i „Z 3N11 AlddflS „SC t N O 01 0 2 a A 0 Fl r m Z Z m 0 0 Z'A AA mm Or 0 0 . 01 U 0 m Z D 0-0 O Z o N ▪ / LJ O D E0 01 m D A m Z 0m <- r 0 A p D A ✓ D D Z m Z rn Z 0 r cn m O 0 D 2 m 01 r 0 ONIH GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS- a� 3701 E.T000R ROAD SUITE 101 • ANCHORAGE, AK 99507 • PHONE (907) 337-6179 • FM (907)335-3046 • WEBSITE: Iwrvw aarnessenanwerina.com LEGAL DESCRIPTION: SAMPSON ESTATES S/D; BLOCK 4, LOT 15 TYPE OF WORK: PROFILE OF CAT. II AEROCELL SYSTEM O m ozZ C Damn 0 0 C y > c O to O A p 0 z 0-oo A 2 Z O 0 -1 Z rn m ro 0 z 0 0 0 m A A O m 0 ti y A 0 O D 01 m m 0 K A 0' m D 0 m M 01 A N An m to 0 N co 0 01 a' z 0 A 0 z a 0 z c O 2 mxmZ• z0o•Y crr'm C•nAzn' m ArymO m OmOZ mcaiw9 Ziy0 z c -m A20 i -ia.{i Zp>Z 0y • i0ocmy3 i<yZmmmom>CA • ffr mr7z oa Z01<IIrizi> 03ZmCrpr m W Zt?',WWW 9 mC00m•p X0 C°=m mpam >0>ZI lli wn- 1 zA -n 0OmZn20 ni00rri - m�"oa*it i0Z=r0 > I •13 W W i r SZOO CZ • yi m U W 0 XI So a m m A r m A O C O o 1• CA 11 o_a 70 - m O O O 3?m y0r- • C -i.< rn 3 co -Im • 53 z PREPARED FOR: JIM WITTKOP PHONE NUMBER: (907) 469-0423 QUANICS AEROCELL CAT. 11 PAGE NUMBER: 3 OF 4 DRAWN BY: J.L.M. DATE: REVISED 1/20/2016 i 1.25. FEED LINE TO AEROCELL UNIT 4" MONITORING TUBE 4" CLEANOUT 4" CLEANOUT 4"CLEANOUT 2" RECIRCULATION LINE 4" MONITORING TUBE �O O-.)-4" MONITORING TUBE 4" MONITORING TUBE �O 36 FEET LONG LATERALS 40 FEET LONG 15 FEET WIDE NOTE: THE ENTIRE MOUND IS REQUIRED TO BE TOPSOILED AND VEGETATED. 4" MONITORING TUBE 4" CLEANOUT 4" CLEANOUT 4" CLEANOUT 4" MONITORING TUBE 2" INSULATION FILTER FABRIC PANONNE TH#1 & S&S ENG. TH#1 -\ DESIGN CRITERIA: NUMBER OF BEDROOMS: 4 GALLONS PER DAY ( GPD) : 600 PERCOLATION RATEJS:'S53 MINUTES/INCH PROPOSED APPLICATION RATE: *1.0GPD/SQ.FT. MINIMUM DRAINFIELD SQ.FT.: 600 *USING CAT II ADVANCED TREATMENT SYSTEM DRAINFIELD DESIGN: MAXIMUM DEPTH: 1' ( REMOVE ALL ORGANICS) WIDTH: 15 FEET LENGTH: 40 FEET M.O.A. APPROVED SAND FILTER: 2.0+ FEET EFFECTIVE: 0.5 FEET ACTUAL SQ.FT.: 600 L 0.5' OF [EFFECTIVE 1 1 FOOT DEEP ( REMOVE ALL ORGANICS) 15 FEET WIDE NO IMPERMEABLE SOILS OR BEDROCK TO 13 FEET PER S&S ENG. TEST HOLE #1 =GROUNDWATER AT 3.3 FEET ON 10/12/15 & 10/19/15 GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3701E.TUDOR ROAD. SUITE 101 'ANCHORAGE. AK 99507' PHONE (901) 397-6178' FAX (907) 338.3248•WE9917E: wwx.8ammw9gbMBAI9.MIi PREPARED FOR: JIM WITTKOP PHONE NUMBER: ( 907) 469-0423 PAGE NUMBER: 4 OF 4 LEGAL DESCRIPTION: SAMPSON ESTATES S/D; BLOCK 4, LOT 15 DRAWN BY: J.L.M. TYPE OF WORK: DETAIL DRAWING OF DRAINFIELD UPGRADE DATE: REIVSED 1/20/2016 a .♦♦**Ot* ♦,CE s i • ►••.. ".. j to ' r.' 2 4 5 6 7 8 9 0 2 PES TEST HOLE OR ORGANICS GM BOH GRAY SILTY GRAVEL DATE PERFORMED 8/11/15 SOILS LOG - PERCOLATION TEST SLOPE X TH WAS GROUND WATER ENCOUNTERED? N HZO 33' IF YES AT WHAT -�� DEPTH? -: GA 16/,z11s P040 0,4 i0h1i:i Pee. GU. 5i -r Per Per Gar'vt4ss Crep 1lleer;» pp i:s saris 1 as not -Pm" ae<5>,fr�1I. k. stJ✓'j4(4p W'*6 I4eJ TQvv delI44i r 1444 +1'e PERCO ION RATE 40.0 (miNlnch) PERC HOLE DIAMETER 6 inches CL4V'YG�} i'WhJWa'JtV' • de V 1 DEPTH TO WATER AFTER MONITORING? DRY DATE: 9/20/2015 READING DATETWE CLOCK NET TME WATER LEVEL READING NET DROP 8/11/15 12:05 — 3.90 — 2 12:35 30 MIN 4.605 0.705 3 12:35 — 3.90 — 13:05 30 MIN 4.648 0.748 5 13:05 — 3.90 — 6 13:35 30 MIN 4.651 0.751 RUN BETWEEN 5 FT AND 6 FT COMMENTS: Test hole excava 7 13 JR'S SEPTIC. PUMPING. Pere hole was esoaked. Pere test ran for at least 1 hour. Last three readings reported. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES FOR MOA REVIEW ONLY PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 DRAWN JRL SOILS LOG SAMPSON ESTATES, BLOCK 4, LOT 15 JIM WIflKbt 22420 PHARAOH CIRCLE CHUGIAK, AK 99567 0.......,410, • /*• '*�l "t e've'n'k: Pannone Dote 9/21/2015 Scale NTS P.I.D. NO 051-811-20 PERMIT -RC OSPXXXXXX Sheet 2 OF 2 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Aiaska 99502-0850 SOILS LOG — PERCOLATION TEST DATE PERFORMEDr75 -- LEGAL DESCRIPTION: L&13i1 Township, Range, Section: SLOPE D6aTN ^T (FEET' vILGP'LJ1G� 1 1t`t I aIw/9CW Sean. 2 CSIvt •' N-rY CA.vo y Grznvfc 10 11 12 13 14- 15- 16 17- 18- 19- M ■ GM 60140€1... C61urtaA7? tCaC.R A5rm& A)/DEP7N, WAS GROUND WATER At \,0 ENCOUNTERED? Pa Cir YES, AT WHAT DEPTH? S L 0 P E Depth to Wolor Dal 1/ 4,73 SITE PLAN T 1L fi. Crig Reading Date Gross Time Ne Time Depth to Water Net Drop ce;lire , yc t0;,, ski ` *1S /0 -` 3.r ri 31,6C*to •. a ., :i5 to •, .3444"v" =AS io • • &'v" 3/761. 20 — PERCOLATION RATE 53' {minulestmch} PERC HOLE DIAMETER Li( TE`SITrRUN BETWEEE7N- FT AND FTp } tt COMMENTS ca ,c1440.1_04,3ILu (U� i S) -S. &o? e ? S.S Per S & S ENGINEERING 17034 Eagle River Loup Read No.204 PERFORMEgB kid Alin f ACCORDANCE WITH ALL STATE AND MUNICIPAL GUID£L��� IN ' FELT ON THIS DATE. DATE. 72-008 (Rev. 4!85) ------CERTIFY THAT THIS TEST WAS PERFORMED IN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99602-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 1C-I-44RO rY'!W)Poi, LEGAL DESCRIPTION; (.FI�, 13/-yTO 1 10 11 2 13 14 16 16 17 18 19 20 40P -PH son aacs a:SM &czp $4s•sp. Mi - S9.. SAAsoy 614 c_ • 6An — &now ac. Oommsen QEcizrzAsss fr3/4)70, COMMENTS VSE St5A7 tW PERFORMED FM E:'";::1 :11/4° 11034. "t"%i:lvar L.%.Q ACCORDANCE*Te AbiL4STytlAINC51inCIPAL QUID 72-008 (Rev. 4186) DATE PERFORMED: SLOPE SITE PLAN Gross Time— Ne Time Depth to Water Net Drop C� F•.ir'!�EIFFIR"■PI■■ /4/ (i3 2:30 r —* .. ■■■■ :g a lit +),� ■Eli ■ ■■■■■•■■Mi■ JO t0 " Si%Yt' 1;0 Lo ' SZ" 'Y" 1■■IIIFS!MiIII BM II OM ■■■ Vida ■IMJ ■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■■■■■ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? too S L 0 P kph rwar AlliI MRlkrhg7 /3 Mit E Reading Dat. Gross Time— Ne Time Depth to Water Net Drop lie /4/ (i3 2:30 r —* .. — :g a 10/A004 +),� d' JO t0 " Si%Yt' 1;0 Lo ' SZ" 'Y" PERCOLATION RATE TEST RUN BETWEEN ` Wt 40 immutarinah) PERC HOLE DIAMETER sr r FT AND `t___ FT _ /nJ 12AINF/aap f"QGW (;s.)GC?u7Asre. CERTIFY THAT THIS TEST WAS PERFORMED IN FFEGT ON THIS DATE. DATE: ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND 3 a fig C ; �YJ THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this 9 Day of n u of 20 I (o, by and between J un e \- }- IC ve herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description). 2. Definitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On -Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS B. service and maintenance provider approved by the municipality and the manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and -orders for theAWWTS.-- C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. H. 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. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof,—or the right -of such party -thereafter to enforce each -and every provision hereof. 7. Amendment. _ A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed ':pith, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: �Gtm e k/, + k o p b. Municipality: Director, Community Development or designated authority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair 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 Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: STATE OF ALASKA (signature) (print name) ) ss. THIRD JUDICIAL DISTRICT The foregoin instrument was acknowledged before me this a 9 day of 20 I (0, by ctnn e s tiJ i 4k ke Date: /—a9'/C, NOTARYPi7BLIC FOR ALASKA My Commission expires:01A. t vt y� 2-o /' MUNICIPALITY: By: (signature) (print name) *S Date: Title: Municipality of Anchorage Page —of ?— DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5.-1443a4/1v PID Number 057f 112.0 Name: /cHiRi) 4E41 /06-4V Wastewater System: New 0 Upgrade Address: �'HUCr//4le- 0 2¢�G /�/ e,4otf.c/e _. 9yrs<o� ABSORPTION FIELD Phone: 27/ - 23 Po, No. of Bedrooms: q ❑ Deep Trench OShallow Trench 0 Bed 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating: es. 4SGPD/So.R. Total Depth from original grade: 4.s s" 6,3-' Lot: Block: Subdivision: /S- 4' S4-/1..P/o,0 EST»T57 Depth to pipe bottom from original grade: /.5 2-'/ 3.6'Ft. Gravel depth beneath pipe 3 Ft. Township: Range: - Section: Fill added above original grade: Q / Ft. Gravel length: / SS Ft. WELL: -New • Upgrade Gravel width: 5 Ft. Number of lines: 3 Distance between lines: /O Ft. Classification (Private, A,B,C): /%t / VAT& Total Depth: / ea-Ft. Cased To: / 4'Z- Ft. Total absorption area: /314..2— SQ. Ft. Pipe material: fig) PE/2•F. Asrlin A2.039 pvc_. Driller: ,' ATE /1- itlE «s Sv G L /Vsr% Date ■ rifle l: l'[- Static Water Level: / Ft. Installer: ll ! eel, E.)4c.4 Vff r/O, S Date installed: s, Ql 4.74( Yield:r 5—GPM Pump Set at: Ft. Casing Height Above Ground:oTANK SEPARATION DISTANCES %Septic 0 Holding 0 S.T.E.P. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Manufacturer: / ce.# .2.4&6 /4.jh_ Capacity in gallons: /zsv Well'/9j / /(Dz ' z5 A- Material: STesL Number of Compartments: 2- Surface Surface - Water Sao-1- /60 14- LIFT STATION LotS13eti Line /0/ i- /Dl l" allons: Manufacturer: Foundation r / 7 / __ "Pump on" level at: mp off" level at: High water alarm at: Curtain/00 Drain A.E XNO Pump Make 8Model IElec rical Inspections perfo ION Remarks: BENCH MARK Location and Description: 7-8,4,- % oP or= f' Ou,c'P 4 r/o-' L4.)/4 LC. Air S & 2,4GE co/2,0CA- Assumed Elevation: /00.06 Ft ENGINEER'S SEAL .. 1 " yt' ` ,ri A. 3i4:‘.,.z- A dr b traultvcINING 17034 Eagle River Loop Road, No. 204 Inspections by: Eagle River, Alaska 99577 Dates. 1st s/s/91i performed 2nd 5APM:.„ Department of Heal h and Human Services approval Reviewed and approved by: /e, 6P' Date - /3-?4 -411P,, .�..�� 72-013 (Rev. 9/91) MOA 25 Permit No SW930499 Page 2of 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, BLOCK 4, LOT 15 PID No .05181 120 C01 CO2 100.7' A B FC0 C01 CO2 CO3 C04 C05 C06 C07 C08 MT1 MT2 MT3 13.5 20.0 28.5 45.5 98.0 57.0 97.0 68.5 104.0 78.0 89.5 91.0 27.0 24.0 18.5 79.0 20.0 71.0 28.0 65.0 58.0 62.0 51.0 97.3' 94.3' C04 MT1 CO6 MT2 100.5' 97.3' C08 MT3 100.0' 99.8'/ 94.3' ♦ 87.5' NO WATER FOUND 97.3' 94.3' 10' ELEC. & TELE. ESMT. LOT 16 WELL FNGINEEF'S,SEAL obc5.71 A, 72-013 A (2/91) MOA 25 Ctortifirb rtiling ?Cog by DOC Co. ODA SULLIVAN WATER WELLS p.+ . of X8PO2?2,bitt1CIA!S„"t„" A885S? a `Ff:LEPNt7rdEM.2758 `OWNERLANDQt41 't✓.( ';i77'_ J1 tE D.1114 OF WELL � Morta6s':17 s/. , ;. ‘ rr /1.4,...i.-1 T.1.570t ST%TIC LEVt"L. OF WATER r F i gS1 LEGAL DESCt tptioN ___ ._... 4- 'i..—�.,�.�. 4 r- . )RAW DOWN FT DATE •Started Ended -____,`! CALS. PER HR .,0? - •P,kRMIat NU;pER,,.__..,.,�, _��.��..}. ,,,w...1.a._..,..6... KiNI) (Trt`ASiNr. • l 1,? KIND OF FORMATION: • From 2.rFt. to F From_ Pt to F From Li • Ft to 67- P From S rt. to 7k F Fi'om 73 Ft. to 430 F t Srs r LM F'rnm Ft 1.1 CrQm..�-,,.Ft. t0_ . FI. tX E,l Ftottl..Ft. to Ft t. !-' i�C rrr,ltt . Ft. to .. _ Ft, t 16,1•A:::4/17,40J From ./3t Ft, to / 5 O Ft. From / Ft. to / G, L Ft, From Ft: to Ft From_..f't. to From Ft to_Ft. S4 4 644,„).41_.4: From ,fit to— Ft, t'.roln F. h.. -_ Fi. From__ Ft. to FI. From - Ft. to rt. FF0VI5 Ft. to - Ft. From —Ft. to F. From Ft. to Ft.__�,_ ._ 3 19'34 From,_Ft, to Ft From Ft to pnchora9e Ft Ut cserattce5pHAM__.__.___Fc t:;�_ Ft (�',untclp� Nu�aYr From Ft to Ft.___...Dept.Neatth&mm________._ From Ft to Ft , From . .Ft to Ft. FromFt. to Ft. From TPf to Ft MRS 'MISCL. INFORMATION: tuss..a'.4.,...• From f t to Ft From _ - Ft, to.. Ft. From__ _Ft. to Ftv. DFt1Lt.C.Rt'S NAME ._1ti"`'t`� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930499 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:T & D CONSTRUCTION CO INC OWNER ADDRESS:22420 PHARAOH CIR CHUGIAK, AK 99567 PARCEL ID:05181120 LEGAL DESCRIPTION: SAMPSON ESTATES BLK 4 LT 15 LOT SIZE: 42610 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED:12/15/93 EXPIRATION DATE:12/15/94 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: DATE: (1e (3 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. December 13, 1993 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Sampson Estates Subdivision, Block 4, Lot 15 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property. Test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation no water was encountered. After seven day water monitoring water was found at 13 feet in test hole #2. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Sincer ert A. Shafer, P.E. RAS/LSU/Isu 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 w J S co w 0 0 0 0 0 Z IL') 0Z 4ZlZ OOO =o N aQ1- =o w ,_�� a(n Uzap 01 � >„Lid wICD(n ~ww 0 O 0 a z 0 li _1 0 V) F- O Z ?a - O w w Q QQ— w>- 5Q> NJ0?-1= ,. 0UU E2I- a 0W 1- w X00 LA LA >Jvia _1w ��wnmzce u.) wcn»Nwa N :V Zg ->-Q Q(nto Ovi wp OF- Z 0 wF Z WwQ0 Q O V) J— CC Z 'XZO�w )-V)0 ~a0� OmW LAW ZF--O 5 (1)„..1- ~wZ H. 003E0 aCC 0 N>� Z u) V (Om< 11_o0 I� 0 0z 0 rz 00 • 7 �0w U) © O w Wp2 F moo co �+�� ONW W U) • U] W C�'J W (1.oto6 1- OZw D E”( C� M W2' z H h-1 0Or UJ p�W Qi CID '7I- II W >z °(nNI rx II CSinI-P dwwo p0"a� Z ii 't. Z Wow^ Xi X CC o w—wco I -1,-,o Cb stn\ c L- ¢mac, macro ICI Ntild 3115 3lYos ,05 = „l Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: reN/Zitiy 7 L07 / -'{Township, Range, Section: SLOPE LEGAL DESCRIPTION: 2 s 3- 4- 5- 6- 7- 8-� 9- 10- 11 - 12 - 13 - OW a NEIL IL DATE PERFORMED atiC-s @D-27SM. SlC17 1I SD. .�� - SILT? SA -N1)?. L 6,14 — 6f2A1-1 6Onse&r'r? � 5 v/v ,1 14- 15- 16- 17- 18- 19- 20 - COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN �7 N 7E_ S L 0 P E Depth to Water Atter f /3 Date: //b9/..3 Monitoring? Reading Date Gross Time Net Time Depth to Water Net Drop u(a9 ( 3 a:10?� — 41/1 , : LUS �MfN 4 �Z - : SO lD " [tT/8rr I[ Ov 10 r' Ug., 1/4„, tr t( !Q i. s vs n Ve PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER A re TEST RUN BETWEEN -_ FT AND 4 FT ^ (-UV-) 11. F ��r2F1-,NF _ — f D��cw &fedu,- PERFORMED (*A S E7:3C : `5'?14,::Ca 17034 ;:>' a`; := Lc -4) Road NO.ZO ACCORDANCE VaVLT¢HA1-J,4pT;IIE1Rt D,� eli CIPAL GUIDE�r S I FFECT ON THIS DATE. DATE 72-008 (Rev. 4i85) �JJ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST RIC-4ARO �cwN>=oma/ DATE PERFORMED: LEGAL DESCRIPTIONS M /O , Li ,,& 1 Township, Range, Section: SLOPE DSETH (FET) r r I�ld: MIA 8- 10- 11 - 12- 13 14- 15- 16- 17- 18- 19- 20 - COMMENTS o(1c,-/Sr c.7 Si sti-N SN-ry 5A.,,Ay (112 tl2L &AA GftaOE C mJ ,j7 c.f2�tzf -.S /„i/ DEP?N. (itSE-&--Ifllzt-or.i S & S ENGINEERING WAS GROUND WATER ENCOUNTERED? Yv� S L IF YES, AT WHAT 0 DEPTH? P E Depthto Water An Monitoring? gate: Ii X9/53 SITE PLAN T N 176 Reading Date Gross Time Net Time Depth to Water Net Drop R (�3 //%9-?- R:C" (:•:C/8 t` :LIC 10/.4o4 a�s,r yy„ ve rt :IS (O -' 34l4" 'lv't 6'` PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN J FT AND ` FT Ir�1 tum ( = Sys. &vz r• S.S D t 17034 Eagle River Loop Road No. 204 EEPERFORME❑alglle River, Alaska 99377 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEL`. IN 'FFECT ON THIS DATE. DATE' CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Sampson Estates Subdivision, Block 4, Lot 15 GENERAL: 1. The scope of this project includes the installation of a 1250 gallon septic tank and five foot wide drainfields to serve the proposed four bedroom residence for the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two Sampson Estates Subdivision, Block 4, Lot 15 December 13, 1993 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalis of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Sampson Estates Subdivision, Block 4, Lot 15 December 13, 1993 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfleld gravel layer and the native soil backfill. 6. All Ieachfield gravel (sewer rock) shall be a5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Sampson Estates Subdivision, Block 4, Lot 15 December 13, 1993 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 RUSS Certificate of On -Site Systems Approval Parcel I.D. 051-811-20. Expiration Date: / / —� 9 -1,5"" 1. GENERAL INFORMATION Complete legal description Sampson- Est. Block 4, Lot 15 Location (site address) 22420 Pharaoh Circle Current Property owner(s) Pamela Bruneau Day phone P.O. Box 672048, Chugiak, AK 99567 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBEROF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance reque TYPE OF WASTEWATER DISPOSAL: Individual (] Holding Tank ❑ Community ❑ Public Sewer ❑ Distance: Received by: COSA to be released to the r neer, unless otlierwise requested by the engineer. P�r,el� Date: COSA Fee $ 524 'F' 315.(°° Waiver Fee $ - Date of Payment gl oI'4 l I5 Date of Payment Receipt Number C3126‘ Receipt Number COSA# el 4--16 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 • Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD,SIGNATURE [ System #1 Approved for 4- bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for By: Date 7/22/15 _s t'& '''''CIO1 1 4b 4g TH A \f* aRQ onnate CE -8149 bedrooms, with the following stipulations: $2pJ$�kY OF��Vc^� . _ . ON-SITE WATER AND II WAS EWAI Lt2 gs: PROCRAM '/1rin-SER\ `` --�)/J11111,11AA�vA Original Certificate Date: 2 ' —JS TheMdniciall ly f�tfichorage Development Services Division (DSD) 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 blue sheet r L, c If mete than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system --1 Certificate of On -Site Systems Approval Checklist Legal Description: Sampson Estates Block 4, Lot 15 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 3/1994 Total depth 161 ft Date of test Static water Levet Well production Sanitary seal (Y/N) Cased to 161 ft FROM WELL LOG 3/1994 130 15 ft. g.p.m. All Oil colonies/100 mL Nitrate 2/'3 (ing/L )1/4Th`1 Arsenic � ug/L Date of sample: x 0/5- B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) Date of pumpingPumper JR's Pumping 'a p, p0is C. ABSORPTION FIELD DATA Date installed 6/9/1994 Parcel ID: 051-811-20 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 7731/2014 WATER SAIJ{1PLE RESULTS: Coliform 123 ft. 5.0+ g.p.m. Collected by: PSS Date installed6/9/1994 Cleanouts (Y/N) Y High water alarm (Y/N) N Soil rating (g.p.d./ft2 or ft2/bdrm) 0.45 GPD/SF System type Shallow Ttench Length 155 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 4.515165ft. Eff. absorption area 1336 ft2 Monitoring tube Y Depression over field N Date �f adequacy test 7/31/14 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test in. Water added 649 gal. New depth > in.22— iNISET Elapsed Time: 130 min. Final fluid depth in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access (YJN) in. "Pump off' level at in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO:. Septic tank/lift station on lot 1 00+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50# SEPTIC/HOLDING TANK ON LOTTO:. Building foundation 5+ Water main 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Water Service line 10+ Curtain drain 50t On adjacent lots 100+ On adjacent lots 100+ 100+ Public sewer manhole/cleanout Holding tank 100+ Manure/animal excrete storageareas100+ Property line 5+ Water service line 10+ Budding foundation 10+ Surface water 100+ Wells on adjacent lots 100+ Absorption field 5+ Surface water 100+ Water main 1 0+ Driveway, parking/vehicle storage 10+ F. COMMENTS Drainfield installed in 1994. System was tested 7/31/14 and found to arrcept.600 GPD. System reinspected 7/16/15. Water levels dropped 1 inch from original test. G, ENGINEER'S CERTIFICATION - / 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 Printed Name Steven R. Pannone Date 7/22/15 COSA canary sheet 2-6-15.doc t}et?en '.'&inane; CE -8149 Parcel I.D. 051-811-20 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approv Expiration Dare UBMITTAL AUG 7 2014 j(-13 -/4 GENERAL INFORMATION Complete legal description Sampson Est. Block 4, Lot 15 Location (site address) 22420 Pharaoh Cir. Current Property owner(s) Pamela BfUneaU Day phone PO Box 672048 Chugiak, AK 99567 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) n Duplex n Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 4 n n TYPE OF WASTEWATER DISPOSAL: Individual n Holding Tank Community Public Sewer n WaiverNariance request for: Distance: Received by„ice COSA to be released to the engineer, unless otherwise requested by the engineer. Date: f i ” ; ! J, ,L COSA Fee $ 59&. -. Waiver Fee $ Date of Payment $ f %ha Date of Payment Receipt Number 676-7-267 Receipt Number COSA # 45e1103902 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. 1 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 Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for 4 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By: Date 8/7/2014 At Pe 417.,41 "*.-.49 Stever CE -8149 41" 011, v �vttl;ff; \G\4 •• OF �C�'D/'29% �� ON-SITE WATER AND J WASTEWATER o1 PROGRAM j ttj�FNT S ER\I\C`,���\,, 6/11. jr-R(--X- Original Certificate Date: S The Muurs,- rage Development Services Division (DSD) 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 Septic System Advisory Well Flow Advisory COSA blue sheet i- Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Sampson Est. Block 4, Lot 15Parcel ID: 051-811-20 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 3/1994 Sanitary seal (Y/N) Total depth 161 ft. Cased to 161 ft. Date of test Static water level 130 ft. Well production 15 g.p.m. FROM WELL LOG 3/1994 WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 2.44 mg/L Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) 18+ .AT INSPECTION 7/31/2014 123 5.0+ ft g.p.m. in. Arsenic ND ug/L Date of sample: 7/31 /2014 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Date of pumping 2/13/2014 Depression over tank (Y/N) N Pumper JR's Pumping Date installed. 6/9/1994 Cleanouts (Y/N) Y High water alarm (Y/N) N C. ABSORPTION FIELD DATA Date installed 6/9/2014 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.45 GPD/SF Length 155 ft. System type Shallow Trench Width 5 ft. Gravel below pipe 3 ft. Monitoring tube Depression over field N Total depth 4.5/5/6.5 ft. Eff. absorption area 1'336 ft2 Date of adequacy test 7/31/2014 Results (Pass/Fail) Pass Fluid depth in absorption field before test 0/0/22 Elapsed Time: 130 min. Final fluid depth 0/0/22 in. For 4 bedrooms in. Water added 649 gal. New depth 0/0/22 in. Absorption rate >= 600+ g.p.d. No Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum Size in gallons Manhole/Access (Y/N) "Pump off" level at in. High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line Water main 10+ Wells on adjacent lots 100+ On adjacent lots 100+ in, On adjacent lots 100+ Public sewer manhole/cleanout Holding tank 100+ 100+ Manure/animal excrete storage areas 100+ 5+ Water service line 10+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Curtain drain 50+ F. COMMENTS Absorption field 5+ Surface water 100+ Water main 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ 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 Printed Name Steven R. Pannone Date 8/7/2014 COSA brown sheet 10-10-12.doc 11everi R. %oririorie : • •j✓/ CE -8149 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 HAA # /11 -Dann 613 Expiration Date: 5-' - D.L. Parcel I.D. OSI -Ill - Z a 1. GENERAL INFORMATION Complete legal description 'L 15; B 4; Sampson Estates Subdivision Location (site address or directions) Current Property owner(s) Mailing address P.O. Box 100600, Anchorage, AK 99510 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless ethpnvise requested, HAA will be held by DSD for pickup. 22420 Pharoah Circle Attn: Linda Welts Fargo Bank, Lester Day phone 265-2864 2.. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 4 TYPE OF WASTEWATER DISPOSAL: ❑x Individual On-site ❑ Individual Holding tank 0 ❑ Community On-site ❑ �] Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 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 Tess than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certifictales 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 dale 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 North Eagle River Loop, Ste.204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan, P.E. Date .2-8-2002 5. DSD SIGNATURE L/ Approved for Lb bedrooms. Disapproved. By: Conditional approval for bedrooms. with the following stipulations: Additional Comments I t t nrrrry6 ON-SITE . •e ti. WATER AND mt. WASTEWATER PRfC,RAM . t • •c • •• •• d° Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X (rev. 12/00) Maintenance Agreements Supplemental Engineer's Report Other .1. /` L 7.-.11-2571--- L` v71--- Original Certificate Date: a.- s " 0 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 /5i &OLg 4; Si%i`1ntiAMST A. WELL DATA Well type !✓/E'/- If A, B. or C provide PWSID # Date completed3 44 Sanitary seal (YM) Awl- Total ►- Total depth fit ft. Cased to ft. FROM WELL LOG Date of test 3/14 Static water level 1 3 3 ft. Well production 15 9•p.m• WATER SAMPLE1RESULTS: Coliform (� colonies/100 mI. Nitrate 1.11 mg.A. Collected by: t" t G (Need -ea Date of sample: Parcel ID: 0 S/ — 8'// —a O Well Log (Y/N) l Wires properly protected (WN) Casing height (above ground) 1t3 in. AT INSPECTION OZ ft. .3 • S g.p.m. Other bacteria 6 colonies/100 ml. B. SEPTIC/HOLDING TANK DATA G / Tank Type/Material %i f1L/ / .- Date installed 6/ / 94 Tank size /Z6-0 gal. Number of Compartments 7/ Cleanouts (YM) 1 //( / Foundation cleanout (YM) Y Depression over tank (Y/N) n4 High water alarm (Y/N) �! A t Date of pumping 1 1 S/OZ- Pumper J 2 IS iii C. ABSORPTION FIELD DATA _O_ Date Installed s `% Soil ratan r ft/bdrm)QL 4 System type 4.----E 0-69x/ G et Length IS ft. Width ys ft. Gravel below pipe 3 ft. Total dept 4. 55 -ft. Eff. absorption area / ft` Monitoring tube 7 Depression over field NJ Date of aALy test i f Results (Pass/Fail) 745 For 4 bedrooms Fluid depth In absorption field `before test fl in. Water added 10 gal. New depth 33 in. Elapsed Time: /*min. Final fluid depth in.,,// Absorption rate >= ko g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) /DONE KNifkVAI If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level a _ in. "Pump off" level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflifstnGn on lot /00 r4- On adjacent lots Absorption r field on lot / 0 D 4- On adjacent lots Manhole/Access (Y/N) High water alarm level at Meets alarm 8 circuit requirements? Public sewer main N / 00 T' in. /b0 4 - Public Public sewer manhole/cleanout 'VA / Septic service Zine 2 — Holding tank N7,41 - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: / - / Building foundation r7 no- Property line 5 Absorption field Water main n/ Water service line /LI t Surface water Wells on adjacent iota O Cr SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1.0 t Building foundation / 0 Id -- Water Service II e / O r+ Surface water /00 I t - 100rFCurtain drain l Wells on adjacent lots 10014- F. . COMMENTS 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 HAA guidelines in effect on this date. Roa4 er C. C84 4.✓ Engineer's Printed Name Date a/k10 z Water main /0 0 r -t- n/ fr Driveway, parking/vehide storage J 0 .oce+1. , HAA Fee $ 3'7S. co Waiver Fee $ Date of Payment Receipt Number 0 /.i 7 8 1 Receipt Number Date of Payment 3-/ 1170 (Rev. 12/00) (84s/s) /i/. O °oz '33. "` W Z6 270€962) '°= co 33 00 6)0' 1 NS 490-"4,5` 01EAsa %J 90, 60 1'ac.) m 6a co 'ON 1Vld n r m 0 NO(1d180S30 117931 3 m a • 3 w s n O 0 a 0 CL 0 n • • 'a O 0 Y Y o c Y 0 v n • a 00 0301 LID sag c Y a 0 • o O x • 3 8 1 0, 0 Q Y a 0 0 • • a 0 5 O 3• a, c 0. p 0 a 3 • • i O a- O c 0- n a.. n.... _'. i0 't. _ Q__O it.Y a Y 0• a• • o '' w 3 w a • p O D 0• a s •+ a ti n 2 0 CL • w n 0 �w1 a • O 1 • • 0 cs. � 3 e.. — na n 0 . y • • a � � 06- - � N O 6•a e co 3 - a 0. 0 0 0 a a O O 3: 2 0 2 = 3 aA w a. -? < 4 • •• ,0. a • at,. •a 3 a • a 0a - Y 0 •a e • -„ • O' Y'n 4 a Y 7.N 1g Z O -1 m w /I • 0 -4 m \ ter• t tD I ,-n • . :too .•-4 J c i 'j tl t 0 • N1/44 tA Sv Tit it. TO ?00' t"T '111'f roast" -.} r -1h - •nii .. FEB -01-02 05:47PM FROM-CTLE ENVIRONMENTAL SRV AL CT&E Ret N Client Name Project Name/N Client Sample ID Matrix Ordered By PW SID CUE Environmental Services Inc. r 1020561001 S & S Engineering N/A Sampson Est S/D Drinking Water 0 toy- rr g Leet r 9075615301 1-071 P.02/03 F-459 Client PON Printed Date/Time 02/01/2002 17:48 Collected Date/Time 01/30/2002 12:00 Received Date/time 01/31/2002 10:30 Technical Director Stephen C. Ede Sample Remarks: Sia{ Parameter Results PQL Units Method Allowable Prep Analysis Limits Date Date Inst gat ars Department NitratrN $larobioloay Laboratory Total Colitonn 1.12 0.200 mg/1. EPA 300.0 0 (<10) 01/31/02 1DT coV100mL SMI8922211 (<1) 01/31/02 SBH lzY Vow lUO d ({6/1 '.'a& Szo-zl •wejsXs Jo snlels pue Ole5el ay; o; 5ul;sejle 030V elelS woJJ uo►lewJ!juoo ualllJM epino.rd 'weisds JeleMalseM Apunwwoo 11 :310N -lselle 030V eleJS wo.J{ XXX JOMOS ollgnd a;ls-uo Apunwwo0 Nue; 6ulploH a;ls-uo Ienp!mpul :IVSOdSIO Id31VM31SVM dO 3dA1 •walsXs {o snlels pue /;lle5eI ay; oj 5u! uo►;eWJ►Juoo uallrJM epinoJd 'wejsXs Hem Ailunwwoo dl aLON auoyd i(ea XXX Ja;eM ollgnd Ilem Apunww00 118M lenpinlpul :AlddflS 1:131VM d0 3dA1 'E b :SWOOa039 dO 838W11N 'Z •thnlord .rol play eq IIIM VVH `pelsanbei esrtieq o sselun ssOJppy auoyd Apo 98£Z-1LZ LO566 ply `a6roiroyauy auoyd Aea neuro 7]v 0£ IL hpauuaX punpn ;ue6y 'ssaJppe 6ullleW Aoue6e 6ulpuel ssa,ippe 6ullleW JBUMO /JedoJd L9566 fly `21n7bny3 aPkyD 110770711d OZtiZZ (suol;oeJlp Jo ssa.ippe a;ls) uol;enol ?''3 uosrdumS `b po2S 5I xol 1)0 3 $L olo-G 01�bKi # VVH uol;dposep 1e691 eleldwo0 NOIiVWHOINIIV!l3N3O '4 (%e' \ l•?j — # a I lowed ONIll3Ma AIIWyd 3"I0NIS V IdOd 1VAOHddV A11tJOHlflV H11V3H dO 31VOldl11:130 44.4-£4£ 0999-61.966 eisely 'e6eJoyouy 099961. Xo9 •O•d uogoo9 sa9ln.1aS a;1S-u0 SOO!AJeS le;u9wu0J!AU3 10 UO!Sp' la S3OIAa3S WINN'8 H11V3H dO 1N3LLLUVd20 30H1:10HONV dO AlllVdIOINf1W 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 . this i spection. /� Name of Firm s & S ENGINEERING Phone 6C// te` �/ 7f. 17034 Eagle River Loop Ro Address Eagle River, Alaska 99 Engineer's signature 6. DHHS SIGNATURE Approved for 1 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By t) - Date C - ?4- The ¢ 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 professio,ial engineer's work. 72-025 (Rev. 1/91) Back MOA 021 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1—=r 15 15,..,,F-4 Sp _ sI:sn Parcel LD. A. Well Data Well type 02, stn - If A, B, or C, attach ADEC letter. ADEC water system number Log present ON) Total depth Sanitary seal tifioN) Date of test Static water level Well flow Pump levell Date completed 7,- `14 Driller Sou-, J r� Cased to 1 U 1 Casing height 1 2.`1 FROM WELL. LOG 3 -94 13 D /S 6 UiL SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot II L.� ' Public sewer main r` A, 15S ` Wires properly protected (S9N) AT INSPECTION �� O g.p.m. g•11 Sewer service line ; On adjacent lots ; On adjacent lots t. 4- a� Public sewer manhole/cleanout 1/1C ` Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: 0,B1, Other bacteria U Collected by: S S B. SEPTIC/HOLDING TANK DATA Date installed 5-- (a - /f Tank size /.?So Compartments Z Cleanouts CON) Foundation cleanoutN) / Depression (1�N� t% AG High water alarm (Y/A A Alarm tested (Y/N) / Date of pumping /1/ �4 - W6 �J Pumper ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /9S/ On adjacent lots /(.o i j- Foundation 9 To property line /a 14- Absorption field /o f Water main/service line /v Surface water/drainage /0.b /' 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at p off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N SEPARATION D CE FROM LIFT STATION TO: W on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA S— G - y Soil rating(GPD/Ft2)0.4-r System type 5 /4rc_o La /. /cr Date installed � Length /SS r Width 5 r Gravel thickness 3 ' Total depth S /.4/saLi�E-D Total absorption area / 33 G . 2. t4 Cleanout present&N) y Depression over field (Y) J Date of adequacy test ti/A - Ai i -t Results (pass/fail) for -- Bedrooms Water level in absorption field before test After test / Peroxide treatment (past 12 months) (Y&) ti r( If yes, give date A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot lloz� To building foundation / 7 On adjacent lots On adjacent Tots 3n' Cutbank Surface water /(2,. tI/A- Curtain drain /o o ' f Property line ///a ,,//4 To existing or abandoned system on lot .J�a. Water main/service line Driveway, parking/vehicle storage area E. ENGINEERS CERTIFICATION 1 certify that I have checked, verified Signature Engineer's Date /c "f ed to all MOA and HM guidelines in effect- -, 'JNI2I33N10,J3f5/0 of this inpection. HAA Fee $ 00 • ():9 -- Date of Payment (0` r/ 10/1 Receipt Number 25(Iq5 s0 72roa (RAM' Rack Waiver Fee $ Date of Payment Receipt Number 06/07/94 46. Y,l4CL 1200 CT&E Ref,# Client Sample ID Matrix Client Name Ordered k3y Project Name Project# PWSII) 12:33 CT&E ENVIRONMENTAL LAB SERVICES NO. 059 904 Commercial Testing & Engineering Co. Environmental Laboratory Services uses ir,,t , Aistw re �r���Arr..ara,,r.,.or s LABORATORY ANALYSIS REPORT 94.2655-3 LIS 13LK4 SAMPSON EST WATER S & S ENGINEERING R. SHAFER tJA Sample Remarks: ROtTLTNE SAMPLE COLLECTED BY: RAY, Parameter (?C Results Qual Units Nitrate -N 0.h6 * See Special Instructions Above • * See Sample Rerruirks Above U = U d tested, Reported value is the practical quantification limit. D = Secondary dilution. WORK Order 79019 Printed Date 06/07/94 (4 09:02 Collected Date 06/02/94 (aI 09:30 Received Date 06/02/94 (0,11:45 Technical Director STEPIIEN C. LDL Released By: �..--!-.._ �i F Method Allowable Ler: Limits Date mg/1 EI'A ?53.2/3U ,p 10 I)A =Unavail ab1e NA :=Not Analyzed LT= Lass Than OT= (.heater Than • hra, lues. hrs. Anal Date 06/03/94 CM.R. 5633 B Street, Anchorage, AK 99518-1600 - Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, 01410, UTAH, WEST VIRGINIA 06/07/94 12:32 CTE ENVIRONMENTAL LAB SERVICES NO. 059 M3 Commercial Testing & Engineering Co. Environmental Laboratory Services egerAittarAerAgararaturAWArttrairAdwar'AVAVirdrlucrowararAtrorArarorAiggilrar 5633 B Street Anehorage, AK 99518-1600 Tel (907) 562-2343 law (907) 561.5301 Drinking Water Analysis Report for Total Conform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE •7 ia MUSTfr- BE COMPI..ETRD BY WATER o PUBLIC WATER SYSTEM I.A. # tg--. PRIVATE WATER SYSTEM 1j 1 1 Ite Seidl Results Svid Invoke !. 5 w.., Syr= Na,,.ComPany • WO k_ont, 10 LOCI* "- 2 -el 1 LSO2 I I ax um.,eP ?bone iNumber ltr-utiasi—gars.e uFr Suat 1.2?Co [(3 Send Results N-ot Send Invoice Acidmse Ctcy nun• 7.1p ,ado SAMPLE DATE: IZ(1, F4-11 Month Day Year Sikivff-1 TYPE: d Routine o Repeat Sample (fOr routine sampla with lab ref. no.) O Special Purpose SAMPLE LOCATION L15 r• ,5;47t CommeMs: O Treated Water O Lair -anted Water Time Collected Collected By TO nE C.`,OMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory Iinsatisractori O Sampic over 30 hours old, results may be unrellah!e o Sample too long in transit, sample should pot be c.,,ver 4S hours old at examination to indicate rclable results. Please send new sample via special delivery mail. — CL 2 1994 111.<=30.. Date Received Time Received Analysis Began Analytical Method: <Membrane Filter 0 1\410.0-1\41.JCi Number a colo....ics1100 Lab Ref. No, Result* Analyst Sent to A. D.E,c. ,)a1 • LoN ,a: LJ Fbks Jim Faxed Client notified of unsatisfactory resultsl phoned Datr BACTERIOLOGICAL WATER ANALYSIS RECORD o Colonies/1GO nil COLIIIRM MMO-MUG Result: Total Coliform Membrane Filter: Direct Count Verification: LTB _ BGB Fe -1 Coliform Confirmation r Final Membrane Fitar Results Reported By /1-Datc -114 Tinto ColiformI1416 ml PART ONE OF TWO: , REMAINDER TO FOLLOW Spoke with 0 Faxed THTC Too MimoflJUS Tu Court! OB Other Bacteria —10St e) ENVIRONMENTAL FACILITIES IN ALASA. COLGRADO, FLORIDA, !LLINUM",trICTILKTTP, rimy, ..rarkv.ft. ../H10, UTAH, WEST VIRGINIA