HomeMy WebLinkAboutSAMPSON ESTATES BLK 1 LT 7Sampson
Estates
Block 1
Lot 7
#051-822-25
USMITTAr
Municipality of Anchorage All 161 11 1 414
Community Development Department Page 1 of 3
On -Site Water and Wastewater Program
4700 Elmore St. • P.O.
Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP141051
PID Number: 051-822-25 ❑ New 0 Upgrade
Name:
Thurman & Carol Tucker
ABSORPTION FIELD
❑ Deep Trench ❑✓ Shallow Trench ❑ Bed ❑ Mound
Address
23814 Goliath Drive
❑Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
0.6 GPD/SF
6.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.0 Ft.
Gravel depth beneath pipe
4.OFt.
Subdivision
Block Lot
Sampson Estates
1 7
Fill added above original grade
Gravel length
Township
Range Section
1.5 Ft.
100.0 Ft.
Gravel witlth
5.OFt.
Beds: Number of Lines
NIA
Distance between lines
N/A Ft
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
1,000Ft2
1
N(AFt.
well
108.0
119.5
N/A
N/A
81
TANK❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
Surface Water
100+
100+
N/A
N/A
ANCHORAGE TANK
125OGal.
Material
Number of compartments
Lot Line
38.2
6.7
N/A
N/A
Steel
2
NA
Foundation
13.0
26.0
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
N/A
N/A
N/A
N/A
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
-
PIPE MATERIAL House to tank Tank to 3034
3034 drainfield
JR'S Septic
Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering
Services
BENCH MARK (Assumed elevation) 100ft
Inspection ,
dates: t` 5/16/2014
2 n 5/19/2014
Location and descri tion
p
3'tl 5/19/2014
0
House first floor F.F.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Stamp
Engineer's
Conditional Approval:
Date
'3 Gi ♦� {f f�i.
tmtsv�8 � �art"rroiae
r C( 8149
n
ApprovedGf/
Date
nRnPrfinn Rand 1-1_19 An
/
!
\
------
DV
15.7
56.7
DCO2
16.5
57.6
EC1
14.2
55.2
EMI
13.7
53.1
EM2
48.8
16.1
M1
40.2
8
C2
74.8
35
/
!
\
------
`\
`
SEPTIC AREA (E) W,
LOT 080
INSTALLED NEW 1250g SEPTIC8
4BR oc6l TANK WITH DCO AND DV
NN HOUSE A mi ABANDONED EXISTING 10OOg
IV, (E) DV C I SEPTIC TANK PER CODE
95
NEW DRAIN FIELD
SEPTIC AREA (E) ss
M2 TH
(CONSTRUCTING EN GINEERI NG)
Co
NOTES: Date
RECORD DRAWING PAMONE ENG SVC, LLC A IiNh
PHONE (907) 272-8218 FAX (907) 272-8211 Scale
SAMPSON ESTATES, BLOCK 1, LOT 7
THURWAN AND CAROL TUCKER teven R. 6�wone PERMIT NO.
23814 GOLIATH DRIVE
CHUG|AK, /\K 99567 '
SPECIAL PROVISIONS TO SPECIFICATIONS
ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE
STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE
WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS,
2. SCOPE OF WORK: ABANDONED EXISTING 1000g SEPTIC TANK PER CODE AND INSTALLED 1250g SEPTIC TANK WITH
DIVERTER VALVE. INSTALLED NEW SOIL ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT OBSERVED TO A DEPTH OF 12.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 12.0 FEET
BELOW EXISTING GRADE.
SM/
GM
-12.0
PROVIDE MINIMUM 3' OF COVER
/-OR RIGID INSULATION
�4" 6 PERF PIPE
FILTER FABRIC
`DRAIN ROCK 6"
/ ABOVE PIPE INVERT
9T0.8 3:1 MAX
I
TS&V
4.0
h
186.8
0 35.0
SECTION
z
�s s
COPPER
DIP
DUCTILE IRON PIPE
TH
TEST HOLE
<o 0
0
T#
TANK CLEAN OUT NO.
C#
CLEAN OUT NO.
o
EXISTING CLEAN OUT NO.
<qo
MONITOR TUBE NO.
EM#
EXISTING MONITOR TUBE NO.
R.I.
RIGID INSULATION
oV
p
~
ILTER FABRIC
4N ROCK 6" ABOVE PIPE INV
I I I I I
I I
I II I�
ORIGINAL GRADE
FG
4" 0 DRAIN PIPE
91.5/I 1250 g SEPTIC
TANK (P)
DESIGN PARAMETERS
UPGRADE SEPTIC SYSTEM
NO. BEDROOM: 4 (600 gpd)
TANK SIZE: 1250g
PERC RATE = 19.6 MPI
SOIL RATING: 0.6 GPD/SF
AREA RQD: 1000 SF
SYS. TYPE: WIDE TRENCH 4.0' E.D
RF: 0.50
MIN LENGTH: 100 LF
USE:
100 LF X 5' WIDE, 4.0' E.D., 6.0' TO
TOTAL AREA: 1000 SF
PROFILE TRENCH SEE DESIGN
LEGEND
yy WATER LINE/
WELL RADIUS
— SS — NEW SEPTIC
ABBREVIATIONS
CU
COPPER
DIP
DUCTILE IRON PIPE
TH
TEST HOLE
FC
FOUNDATION CLEAN OUT
T#
TANK CLEAN OUT NO.
C#
CLEAN OUT NO.
EC#
EXISTING CLEAN OUT NO.
M#
MONITOR TUBE NO.
EM#
EXISTING MONITOR TUBE NO.
R.I.
RIGID INSULATION
DCO
DOUBLE CLEAN OUT
DV
DIVERTER VALVE
FS
FLOW SPLITTER
OG
ORIGINAL GRADE
FG
FINISH GRADE
TS&V
TOPSOIL & VEGETATE
NOTES: PC]1\1�ONE Z71�T/'r SVC, LLC !'1 �,�r�� \\ Date
RECORD DRAWING P.O. BOX 1002171 ANCHORAGE, AK 99510 �rG OF ALgSI�' 7/30/2014
PHONE (907) 272-8218 FAX (907) 272-8211 yScale
j*:49TH *Ir NTS
�...... . .. . ...... P.I.D. NO
SAMPSON ESTATES, BLOCK 1, LOT 7 / 051-822-25
THURMAN AND CAROL TUCKER / teven R. Pannone PERMIT NO.
23814 GOLIATH DRIVE �'P�•, CE 8149 j OSP141051
DESIGN DETAILS CHUGIAK, AK 99567 +��l��F....... sheet
3 OF 3
Panna a Engineering ServiceS LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steveepapenmak.com
January 13, 2016
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road
P 0 Box 196650
Anchorage, Alaska 99519-6650
Subject: Sampson Est, Block 1, Lot 7
Lot Line Waiver Request
Ladies and Gentlemen: Wpv) 90
Six PO
We request a waiver to -s a feet (6') to the lot -line. The new field was installed 6.7' off the lot line on
5/19/2014. Granting this waiver is not likely to affect the health and safety of this lot or the surrounding
lots now or in the future.
If you have any questions or concerns, please contact me at 907.272.8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
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: OSP141051
Tax Code Number: 05182225000
Work Type: Septic Upgrade
Permit Effective Dates: April 16, 2014 to April 16, 2015
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: SAMPSON ESTATES
Site Legal Address: SAMPSON ESTATES BILK 1 LT 7 G:1560
Owner/Address: TUCKER THURMAN & CAROL
PO BOX 672617 CHUGIAK AK 995670000
Site Mailing Address: 23814 GOLIATH DR, Chugiak
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy
Lot Size in Sq Ft: 42119
Total Bedrooms: 4
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.
Special Provisions: During construction, slopes within 35 feet of the drainfield shall be
substantiated to be less than 25%.
Received
Issued By
�e Q�l
By: Date:
Date:
Municipality of Anchorage
•
Development Services Division
On -Site Water and Wastewater Program
rt.ent
ftpmtmel't
**** VARIANCEIWAIVER REVIEW ****
Waiver#: OSP141052 COSA#: _ Permit#: OSP141051
PID#:051-822-25
Legal Description: Sampson Estates, Block 1, Lot 7
Engineer: PES
Applicant: Thurman & Carol Tucker
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to the 25% or greater slope has been approved. The approved separation distance is 35.0 feet.
This waiver approval applies to the proposed 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 non -objection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
...............................................................................
Waiver is Granted: X Waiver is not Granted:
Date: I �L Approved by -
A of Reviewer
IA
Name
An ajAi+4'oAa� wai'vcr- �-or -tic sf,'cid -/-a lol-kn,e, has bOcn
fovj, _Fh e_ a p provcd 5earcAfibn is 6
l�zr�j6
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
�.,
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-822-25
Property owner(s) Thurman & Carol Tucker Day phone
Mailing address P.O. Box 672617, Chugiak, AK 99567
Site address 23814 Goliath Drive
Legal description (Sub'd., Block & Lot) Sampson Estates, Block 1, Lot 7
Legal description (Township, Range & Section)
Lot Size 42,119 Sq. Ft.
APPLICATION IS FOR:
(® all that apply)
Absorption Field
❑X
Septic Tank
❑X
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms 4
APPLICATION IS AN:
TYPE OF DWELLING:
Initial ❑
Single Family (SF) ❑X
(w/wo ADU)
Upgrade �
Duplex (D) ❑
Renewal ❑
Multiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Drain field to slope >25% Distance: 35
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
of property owner or authorized agent)
Permit/Rush Fees: 611
Date of Payment: o%L�
Receipt Number: Q��aZr3ra
Permit No. a SP/U/0,�
Permit App__ ::L.:c.
Waiver Fees: 07«�
Date of Payment: c3�ci�
Receipt Number: h
Waiver No. gSpl d'
Pannone Engineering Services u.c
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steveCwpaneneak.com
March 21, 2014
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Sampson Estates, Block 1, Lot 7
Septic System Upgrade Permit Request
Ladies and Gentlemen:
I am writing to request a permit to install an upgrade septic system be issued for this property. The
proposed systems will serve an existing four (4) bedroom house. Currently the lot is developed. The
existing drain field is in failure. It will be reused as a reserve. The proposed system will utilize a 1250g
septic tank with a wide trench type drain field. The surrounding lots are served by private wells. There
are no wells on surrounding lots within 100 feet of this system.
1. Soils. One test hole was performed by Constructing Engineering in 1988 and one test hole was
excavated in the area of this drain filed by Pannone Engineering Services in March of 2014, and
groundwater was monitored for seven days. Ground water was not encountered in the test hole after the
seven day monitoring period. It is my opinion, based on the results of the percolation tests and overall
soils appearance; an application rate of 0.6 gallons/day/square feet should be used for a conventional
wastewater system.
2. Soil Absorption System Design.
a. See Sheet 2 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain
field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
4. Topography: The existing topography slopes from the north to the south at approximately 25% in
the area of the proposed drain field. There is a steep slope approximately 35 feet downhill of the drain
field. See waiver request.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8215 FAX: (907) 272-8211
Page 2 of 2
5. Waiver Request: I am requesting a waiver of the minimum distance to a slope of greater than
25%, to a distance of 35 feet (35.0'). See design section on sheet 2 of 3.
6. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification
that the review is complete and that there are no further comments is received from MoA On -Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of the surrounding or existing lots. There
are no surrounding wells within 100 feet of the proposed septic location.
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Pox 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
E �
—
of
/1
/ ,WELL (E) G ` ` n
Y I3
WE L (E)
W
SEPTIC AREA (E)
- L
w,
OT
= / 105.6 s'
12508 SEPTIC TANK (P)
WITH DC4BR / ABANDON EXISTING DV
1000
tv .� HOUSE " SEPTIC TANK PER CODE
TH-1-1988
(CONSTRUCTING ENGINEERING) W
DRAIN FIELD (P)
SEPTIC AREA (E) 10OLF x 5W x 4.0'ED x 6.0'TD
10.0ise" TH 1
\6'5 0 -
10� F
NOTES:PAMONE ENG SVC, LLC —�A \y Date
�F
FOR Construction P.O. BOX 100217 ANCHORAGE, AK 99510 C�...qsl4/15/2014
PHONE (907) 272-8218 FAX (907) 272-8211 /rg�Q 9to Scale
.... ... ..... P.I.D. NO
SAMPSON ESTATES, BLOCK 1, LOT .7 / / 051-822-25
THURMAN AND CAROL TUCKER Steven R. PonnonW PERMIT NO.
23814 GOLIATH DRIVE +,}�P,,.. CE 8149 r/ OSP141051
PLAN CHUGIAK, AK 99567 •• PG sheet
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON—SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS.
2. SCOPE OF WORK: ABANDON EXISTING 1000g SEPTIC TANK PER CODE AND INSTALL 1250g SEPTIC TANK WITH DIVERTER
VALVE. INSTALL NEW SOIL ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT OBSERVED TO A DEPTH OF 12.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 12.0 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
TH-1
SM/
GM
-12.0
z
COPPER
3:1 MAX
.0
QO
�QZ
JW
D
Z
Q
U
O
Z
�
U
j
p
m2
pU
1250 g SEPTIC
TANK (P)
DESIGN PARAMETERS
UPGRADE SEPTIC SYSTEM
NO. BEDROOM: 4 (600 gpd)
TANK SIZE: 1250g
PERC RATE = 19.6 MPI
SOIL RATING: 0.6 GPD/SF
AREA ROD: 1000 SF
SYS. TYPE: WIDE TRENCH 4.0' E.D
RF: 0.50
MIN LENGTH: 100 LF
USE:
100 LF X 5' WIDE, 4.0' E.D., 6.0' TO
TOTAL AREA: 1000 SF
PROVIDE MINIMUM 3' OF COVER
OR RIGID INSULATION
r4" 0 PERF PIPE
FILTER FABRIC
DRAIN ROCK 6"
ABOVE PIPE INVERT
PROFILE TRENCH SEE DESIGN
LEGEND
W WATER LINE/
WELL RADIUS
— SS — NEW SEPTIC
257,
CU
COPPER
3:1 MAX
.0
-
T
TS&V
FOUNDATION CLEAN OUT
T#
4.10
C#
CLEAN OUT NO.
M#
MONITOR TUBE NO.
R.I.
0
L5.0
DCO
DOUBLE CLEAN OUT
_
DIVERTER VALVE
35.0
SECTION
BFG
j
OG
m
0 o
FILTER FABRIC
o
Z
o
O
DRAIN ROCK 6"ABOVE PIPE INV i
'�4" tl DRAIN PIPE
0
PROFILE TRENCH SEE DESIGN
LEGEND
W WATER LINE/
WELL RADIUS
— SS — NEW SEPTIC
257,
CU
COPPER
DIP
DUCTILE IRON PIPE
TH
TEST HOLE
FC
FOUNDATION CLEAN OUT
T#
TANK CLEAN OUT NO.
C#
CLEAN OUT NO.
M#
MONITOR TUBE NO.
R.I.
RIGID INSULATION
DCO
DOUBLE CLEAN OUT
DV
DIVERTER VALVE
FS
FLOW SPLITTER
BFG
BELOW FINISH GRADE
OG
ORIGINAL GRADE
FG
FINISH GRADE
TS&V
TOPSOIL & VEGETATE
NOTES: .������\\\ Date
PANNONE ENG SVC LLC
FOR Construction ��OF gCq`l 4/15/2014
P.O. BOX 100217 ANCHORAGE, AK 99510 r C .. ' •.s ��
PHONE (907) 272-8218 FAX (907) 272-8211 r�g�pyI Scale
*.. t}JTH*II NTS
�... .. . ....... P.I.D. NO
SAMPSON ESTATES, BLOCK 1, LOT 7051-822-25
THURMAN AND CAROL TUCKER I.. teven 'R. anno.ne'�PERMIT NO.
23814 GOLIATH DRIVE I+�?T��• CE 8149/ OSP141051
DESIGN DETAILS CHUGIAK, AK 99567 "••• ''EAG Sheet
__ `1q'%0 qA�'2 OF 3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
TEST HOLE 1
OR ORGANICS
SILTY SAND W/
SM/ SOME SILTY
GM GRAVEL -
BROWN
BOH
DATE PERFORMED: 317114
SOILS LOG - PERCOLATION TEST
SLOPE
X
TH
SRE N
LOT
4BR
HOUSE
(E)
TH-1-1988 /
(CONSTRUCTING ENGINEERING) ; --- -
TH-11, /
a \ /
WAS GROUND WATER
ENCOUNTERED? N
IF YES, AT WHAT
DEPTH?
DEPTH TO WATER AFTER
MONITORING? DRY
DATE: 3/14/2014
SLOPE
TH
X
READING DATE
CLOCK
NETTIME
WATERTIME
LEVEL
READING
NET DROP
1 3/7/14
11:40
--
3.51
—
2
12:10
30 MIN
5.05
1.54
3
12:10
--
3.51
--
4
12:40
30 MIN
5.09
1.58
5
12:40
—
3.51
--
6
1:10
30 MIN
5.04
1.53
PEROLATION RATE 19.6 (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 3 FT AND 4 FT
COMMENTS: Test hole excavated by JR'S SEPTIC PUMPING. Perc hole was presoaked. Perc 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 ACCORD
NOTES: PC1MONE ENG SVC, C LLC ��QF q\\\ Date
FOR Construction P.O. BOX 100217 ANCHORAGE, AK 99510 (L' • • `.4slll 4/15/2014
r�P••' l Scale
PHONE (907) 272-8218 FAX (907) 272-8211 * .� TH *��/ NTS
/.......:.. / P.I.D. NO
SAMPSON ESTATES, BLOCK 1, LOT 7 // 051-822-25
THURMAN AND CAROL TUCKER / Steven Pannone PERMIT N0.
23814 GOLIATH DRIVE �+•, CE 8149 .Ctj OSP141051
SOILS LOG CHUGIAK, AK 99567 Ilk T, •..•• �: Sheet
1`\PROFE`=.�+ 3 OF 3
r
Municipality of Anchorage Page ! of a
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: 88 o8c- PID Number: cTSI 157.7. 7.5
Name: 1elsovt
M 11c� � SoJ ca
® Wastewater System: New O Upgrade
Address: O�e`v. H�08'3 C�, lel
ABSORPTION FIELD
Phone: No. of Vqprooms:
• 4.
fl Deep Tzench ❑Shallow Trench O Dotl ❑ Mountl ❑Other
LEGAL DESCRIPTION
s°""°ice sr/&J"
PDQ
Total Depth lo�riginelgrade:
F
Lot: 7 Dlocl{' Subdlvlsen
1 �2rs
Dopth to pipe boll°m from original grade:
Gravoldopth Beneath Pipe
pSO Yt ��
FI
Ft
Township:
Range. 1 L�
Section:
Fill added above original grade:
Gravel length:
1$
3.0 FI
74 Ft
WELL: New ❑Upgrade
Gravel width: 3
Numbe; of linos:
Ddlancatlewshilim:
I
FI
Ft
Classification (Private. A.e.C):
Total Depth:
I Cased To:
Total absorpti0(l area'
P'67.
Pipe material:
T'n1VATE
199 Ft
199 Ft
SO Ft
n 703 / F810
Driller.
'5ULLIVA4J WATER WELK
Dale Drilled:
7.Im
Suee wall,( Level'
I IP{ Ft.
Installer.
r$ scu) AZO
Data installed:
F—R8
Yield:Pump
Setat
Casing Heighl Above Ground
TANK
3C) GPM
Ft
z Ft.
SEPARATION
DISTANCES
jr'Septic 0Holding 0S.T.E.P.
To
Saolic
Absorauon
Lill
Hoidng
ftba timate
Man uf@elurer:
Capacity In gallons:
From
Tank
FINd
station
Tana
S.~tewa
i{=2A&C
I -45n
Well
I I L)
IO S
�} O
Material S -Met-
Numbe�f Compartments:
Surface
Waere
+Iro
+-lea
/
;�
}foe
LIFT STATION �''
Lot
4e)
7Tr
y
r4l,
size in gallons:
Manufacturer. P
Line
Foundation
I:;
14'
/
-Pump on" level at: "P II" level at;
High water alarm at:
Curtain
+1:>rs
•
}1(1(h
Pump Ma cl
Electrical Inspections performed by:
Drain
Remarks: I -in ALit-wo c. -sit' FIP.LD INsrver-heoJ
BENCH MARK
r FOCLNI t'�i 1?J'CI I.I Lr IN%TALL.J�TIpv . N� }17V��
Location and Description:
rM v_-vIth1T SLAA la SubeIc• pot7"
vOfYrs 'Tls"sCC tNT' rtZ.
()o . acs -BUILT FvOi... 1naSI IVOTICSIess.✓i
-!v- 9?�,
Assumed Elevetigg:
100
jZZzv'BMITyt- d/lYtIEMT b1MW%J5Ib 4.0v( -ENGINEER'S
SEAL
arTk gg'Rov%ir Jar t7. 7y/).:..•
,�.$'wSi'@.S,�y
OF A/ %t
AJy.Y ^:L`ri�cYeaaaaJ.01 ��
Crnx nrJcr�c, Far�ti•Rrns
Inspections performed by: Dates:
2nd FBa i
'W
„dt ('4t^4�Rfaovet'eat....<cMsr.�
air. )ta. usze i,�'--✓
Department of Hea Ind Huma ervices app ro al
letc.IJ'
~'k,a
Reviewed and approved by: jq Date:~'iina
114J Cyr'
ns CC ee*eJrwanaea tt'}��11:ai0•
a
n-oldmay.9/91)MOA 25 Rc3✓fMn/1ril Qr'4yd
a
Permit No. 88086
Page Z of Z
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
laz 1 61 or -V- 1
szmpso 647�5
PID No.: ori'- bzz-IS
C
I � GP.N✓o � 4' I
i 9orro.n oc` S?
• FIe�D �8'
izso�- I,'74 �
a
TIPfr 89sT
i
..
1
9 mss 59s �_,�LA 1
�
L r
i
TALC 1"•3o'i
e"v
i ; I
i 1
I
_ 3n�e R!aT 1
1
I00 L i i i
G
rs,l;('t
ADC i
t
� 1250
L-Ca..D'QTmerf
1
AL j
(� FreLo I
I ;
i
i[PT
f
TArvK
i
.
i
i
i
o.. �f �3'• 8
a ^t `caP ss
I
ad
r; �: ren, 8
I
Vii;, �r .; •=
.°. y, p
i ' f
1 i
� 4✓
j.aa OG••ga!•0•Ms1•H••••t••0 `fr
NO. 1732.2 • P'
.(
22,1908
A
i i
' I•' � YIJe
585e58r40
i (�OiiakhR: 376.6a
Oars
Mom
S Sq.oB
1,4-
J
.vt,tEt�t�_-
to - ,
N
p �r
��1. • �
V
•
3f.
F
rf
y2
,•
.
N
N
r�
o
N
5�
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to
t 2
i
0 9°0
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l
a ,
4
1
.e
5 qo
•oo
t�
hereby certify that a survey of LOT 7 BLOCK 1 SAMPSON ESTATES SUBDIVISION was a
n MARCH 13, 1992 and that the improvements situated thereon are within the prope
Ines and do not overlap or encroach on the property lying adjacent thereto, that
mprovenents on property lying adjacent thereto encroach on the premises in quest
nd that there are no roadways, transmission lines or other visible easements on s
roperty except as shown hereon. It is the responsibility of the owner to determine
K13tence of any easements, covenants or restrictions which do not appear on
ecorded subdivision plat. Under no circumstances should any data hereon be used
onstruction or for establishing boundary or fence lines.
ated in Anchorage, AK, OCTOBER 20, 1992.
CONSTRUCTING ENGINEERS
9601 Buddy Werner Dr
Anchorage, AK, 99516
346-2000 694-9098
AS—BUILT SURVEY
SCALE 1• - 50'
I r f! ,'l:r.
• T' I I ' \
RAMS£Y
A•
Q9Ce
S(c,NP I q, f� Ql
A,
North Municipality Area Reference Map -10 14 16
Y
99
NW 1500
15
9) co"HIGH7 1909 Jun
Municipality of Anchorage Page I 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: 8808(. PID Number. DSI $LL Z$
NameM
/7,64u Na1so,�
Wastewater System: 0 Now o Upgrade
ItC,2
Address'Podo)t' t:� 0833 Ct,lxll
ABSORPTION FIELD
Phone:
No. of 89 (come: •r
6J Deep Trench D ShatlowTrench ❑Bad O Mound O Other
DESCRIPTION
Solt Rating:
t30
Total Depth from grade:LEGAL
'sns
sFl s Ff.
Lot: Block: Subdivision:
I ! iae,. (a-Ir2ica
Depth Io pipe bottom from original rade:
$'
Gravel depth beneath pipe
6•S
sin,
Ft.
Ft.
Township:
Range:
1 V,
Section:
Fill added sboveorigl�n]grade:
Gravel tongth: '74
3.2 Ft.
Ft.
•
WELLMr NBW ❑Upgrade
Gravel 49eph' wile"
Numberot linea:
I
DPrtanabetaeenllaa:
14 A
3461-Fr
Ft.
Classification (Private, A,B,C):
Total Depth:
Caged To:
Total absorption ares:
Pipe materiel: F8t b PVL
pk2l�
199 Ft.
199 Ft.
96Z So Ft
D3034 Ai71'Y1
Dnuer.
5L)LLIVIii WPrIVf- v_VYU L
Date Drilled:
17-se
Staucwater Level:
1 t Ft.
I staler.
a"
Date Installed:
a8
Yield: (SUWAPump
�J 01%
Sat at:
1
Ching Hepht Above Ground:
Z-
TANK
lob PM
Ft.
Ft
SEPARATION
DISTANCES
Jeseptic 0Holding 0S.T.E.P.
To
geode
Abierption
LIN
Holding
btiWriraia
Manufacturer
AWNC1wY
Capacity ingallons:
IZSo
From
Tank
Field
station
Tank
Bawer ling
e—
Well
IIctL
r
WMaterial:
S Al
Number of Compartments:
e
Water
+100'
-/-I17Q
1100'
LIFT STATION
Lot
• _,
`t'p
�I
w r
'jp
SI=eingallons:
Manufacturer:
Line
Foundation
til
141
-Pump on- level at: -P -' level at:
-Pump
High water alarm at:
Curtain
-t- t
1
Pump lake d Moral Electrical Inspections performed by:
Drain
k--
t0
Remarks: InJl-,llaal l:,D. 198a. ,Z11
BENCH MARK
Location and Description: (FjCpy,v A*r4WKk Tagnra(a 1-79
PQ�(O-na .n-P,4 tVww
L L.Dlet'L
elf
t4kibtla�tl.. �c-Q; }� Ifo Fti 1s
Assumed Elevation:
lftoR
ENGIALFZ4MCF6L
Ivn. J M eA11,1
� �� OF AIL %I
r�•eaae tea s f
»;49 �
Inspections performed by: 4+hs 'O ales: lst 6t 88
O. aaa
2nd
ee•r eeaaaa M
d� �.. >to.in"
t O • Juna 2211 A
Department of Health and Human Services approval/SFS
••.•-,,,,e..•ac3.
Reviewed and approved by: Ji11i*I ` pulTMf Date:
72-013 (1/91) MOA 25
Permit No. gi8o86 Page Z of z
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: L-190 PID No.: C4: 1 847- 75
8A'Srmwt su+v
1saGp
crw.o
rr ,
— 74'-rvw%4%
I;
(S S'-�I •' I
I G"v loot •�,'' i
PKQ w "Ov"
\ I 1
72-04 A (2/01) MOA 25
�
I
I
v
✓�
\
•KMtY
i Ge�w1a
�a5ob irnNk
r!��
i
Z Co..�Ats.M1
ELN
4orro.Ko�
I
—m+ „c,..
72-04 A (2/01) MOA 25
�
I
I
v
r-1,bis µgp
i Ge�w1a
_ oew.,►2ur..
Gwf
i
+oF A�
I •
v""4
00 g.
io!...' ..Mr •e►r.NnN•
•� .e L NO. tTJL! .
June 2% Im
Dridt 585'SSr4W
Goli�12kh tt: 376.06 28.00
SIt•LQIgA"r' Lc:sf.I5
54 . V }`I .t `� L,
10
' N
* r
p`r
X1,4 I R , �,•
/f \
•
rf •
yi N
ad`e p
r� o
N
19 moi' ' D
so
i t' • s
c o
os
A A V, ,
C1
J
NI
510
\oo•
hireby certify that a survey of LAT 7 BLOCK I SAMPSOM ESTATES SUBDIVISION was mad
� ++ j'ti.�•'""`-^`aYt
$!7
n MARCH 13, 1992 and that the improveo*nts situated thereon are within the propert
0'4: f1J
e'"9•�a iJ,, Vii.
ines and do not overtop or encroach on the proporty tying adjacent thereto that n
'04
mprovements on property lying adjacent thereto encroach on the premises In questio�sav01"
.' r,4r••,w,,: �r ^-r ..
nd that there are no roadways, transmission lines or other visible easements on smi
except as shown hereon. It is the responsibility of the owner to determine th
nf';C �roperty
n pLg. nt•sv1:xistence
of any easements, covenants or restrictions which do not appear on th
*corded subdivision plat. Under no circumstances should any data hereon be used fo
),AT givanQpei ..;•
onstruction or for establishing boundary or fent* lines.
�:.: i•I•:I c •'4
gated in Anchorage, AK, CCTCBER 20, 1992.
K�1 '^,•r°,,M `••- a•(�+Y
CONSTRUCTING ENGINEERS AS -BUILT SURVEY
;:.•.,
9601 Buddy Werner Dr
^ J.Ai;r`
Anchorage, AR, 99516
346-2000 694-9098 SCALE 1e - 501
�. Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Rice Mysrrom, P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor
January 17, 1995
Michael J. and Joyce R. Nelson
P.O. Box 670833
Chugiak, AK 99567-0833
Dear Mr. and Mrs. Nelson:
During the fall of 1994, the On -Site Services Section of the Department of Health and
Human Services conducted a review of on-site septic systems involved in the legal
proceedings concerning Chuck Landers. Your property, Lot 7, Block 1, Sampson
Estates Subdivision was involved in this review process.
Following site visits and submittal of additional required information by the engineer
on this project, Mr. Henry Wilson, P.E., your system was determined to be in
compliance with applicable municipal codes.
One of the additional submittals required for your system was a Certificate of Health
Authority Approval for a Single Family Dwelling. I have included the original of
this certificate and an additional copy for your files. The original blue copy of the
certificate should be delivered to the lending institution which processes the mortgage
on this property, for the existing original in their possession includes an invalid
signature.
All remaining paperwork (permit designs and/or as -built inspection reports) concerning
your on-site septic system has been updated and is on file at the Department of Health
and Human Services. Should you desire, you may obtain a copy of this paperwork for
your files.
If you have any further questions regarding this matter, please contact me at 343-4744.
Sincerely;
,9-tf Cali
times Cross, P.E.
Program Manager
On -Site Water Quality
cc: Robert O. Baker, Ph.D., Acting Manager, Environmental Services Division
HENRY WILSON
9601 BUDDY WERNER DR:
ANCHORAGE, AK 99516
(907) 3462000
3
July �, 1994
Constructing Engineers
— Engineers, Su'veyors —
Muncipality of Anchorage
DHHS, On -Site Services
Po Box 196650
Anchorage, AK, 99519
CHARLES A. LANDERS
HC87 BOX 192,4, MYRTLE DK
EAGLE RIVER, AX 99577
(907) 6949098
re: Lot 7 Block 1 Sampson Estates Sub
Septic inspection report, health authority approval
application and certificate, survey as -built for waiver
Gentlemen:
Please substitute the attached original signed reports for the
reports originally submitted and processed, and remove the file
copies and send to me at the above address.
Henry H. Wilson, P.E.
Municipality of Anchorage
Department of Health and Human Services
Tom Fink, 625 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
November 13, 1992
Hank Wilson, P. E.
Constructing Engineers
9601 Buddy Werner Drive
Anchorage, Alaska 99516
Subject: Waiver Request for Lot 7 Block 1 Sampson Estates S/D
Waiver Request #WR920074, PID #051-822-25, IIA920750
Dear Mr. Wilson:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 3 feet.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sin Ierely,
��.N l�ltf iL
.john Smi
rogram Manager
On—site Services
ljm
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR920074 PID# 051-622-25 HA# HA920750 Permit
Date Received: NOvember 3, 1992
Legal Description: Lot 7 Block 1 Sampson Estates Subdivision
Engineer: Hank Wilson, P. E, Constructing Engineers
9601 Buddy Werner Drive, Anchorage, Alaska 99516
Applicant: Mike/Loyce Nelson
Waiver Requested: Lot line waiver - 3 feet
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Points:
Waiver is Granted: x_ Waiver is NOT Granted:
List Conditions or Reasons for above: /110 /c1+0A� i ON r4DJACE�/r Loi v�
Date: /3 jcrz, By:
Rec #: 24212/4675 Amount: $ 70.00
of Reviewer
Date Paid: Nov 3, 1992
� SANP30U E$TATE$
A9;+c. pinu F -alt VQoposEo SybrEM Tole Lot /o f, EArAp3oM
S+ioWS CL-F%`LouTS For SySrENA oN LOT 'T APPCAE TO SC.
I -FSS, TMAlJ 13 FEET fstow�. Loi LiNZ FIEt.D m5pt.
CO)VOti TED TiO z LoT (o C-oti f"am cO Z1115 -To BE A
'DtSTINGT- Pos5lBULITy,
KEEP TO'S NOTE Ou G14 -E 19 Evr-Ni • Atj ri AA. IS
Ev1r2 - for_ Lot' -7 B1 -r-1 -
PROP
WeLL LOC .
.�
b2Aa
g3
p40 \0� 100'-0 WILL '
\ _ LOCATION
weLL LOC'`6
V �
Z
7H2® V
TH I
- TEST HOLE
�C
bf
Of
- MONITOR TUBE
5ePTIC Z � 9�P�
ARPA 0 ! W 35
-� N
•/'
95
+
m p �LOPt
•Li®LL.
- PROPOSED LEACHFIELO
6
- EXISTING LEACHFIELO
NO SURFACE WATER
NO KNOWN CURTAIN DRAINS
WELL/SEPTIC SITE PLAN
LEGAL: Lot '6 BK 1 SAMPSON ESTATES
OWNER: LANCE
UUN I KAL; I UK: N A I SL;ALL 1. = bU-
J08�97-036A DATE: 07/31 /97DATE: 07/31 /97
EACLE RIVER ENCINEERINC SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
®
- TEST HOLE
•
- MONITOR TUBE
0
- SEWER CLEANOUT
+
- WELL
- EASEMENT
- PROPOSED LEACHFIELO
- EXISTING LEACHFIELO
%ta
v.prtifird Drilling ng
by
Doc co. do.
SULLIVAN WATER WELLS
P.O. BOX 870272, CHUG IAK, ALASKA 99567 • TELEPHONE 888.2759
OWNER OF LAND /Yl / kl: '- r.'/•Su rd
ADDRESS Pa LI M r2/0 •Y3.? (? f/%j g,T,-C
DEPTH OF WELL
STATIC LEVEL OF WATER FT. �/• .i
LEGAL DESCRIPTION % % /.f C / �`t��l!'J'a.._t C"S %' DRAW DOWN FT.
DATE ' Started '12 Ended F'!± GALS. PER HR F 12 C3
PERMIT NUMBER Z"4/I6"'d in
KIND OF FORMATION:
KIND OF CASING
From (•t
Ft. to-�Ft.'
C.ys"`� `� ` +( •C
t1('From
Ft. to
Ft.
From C)
FL to . Et.
OOL 1't P✓��4 W
From Ft. to
Ft.
From 0
Ft. to Ft.
1614,0/4ftA 'rte/ C, M4,CT' From
Ft. to
Ft.
From 'S J
Ft. to /, .P Ft.
z G 612Z4
C<NY From
Ft. to
Ft
From
Ft. to Ft.
/h 0,42-0
From I. to
Ft
From/
FLto115- Ft.
S/c' r CA/?l:
(',eifljC('Frdm
Ft. to
Ft.
From /
Ft. to
}-f}.ui) ti f44v, c.
C4"'r From
Ft. to
Ft.
From
Ft. to Ft.
/ % t r X /-- el
From
Ft. to
Ft.
FromhL�Ft.
to d o / Ft
�S r?rJ 0 �r ,,8 /t?c
? From
Ft. to
Ft.
From
Ft. to Ft.
(()/}1 r=/L
From
Ft. to
Ft.
-From-Ft.
to Ft.
From
Ft. to
Ft.
From
Ft. to Ft.
From
Ft. to
Ft.
From
Ft. to Ft.
From
Ft. to
Ft.
From
Ft. to Ft.
From
Ft. to
Ft.
From Ft.
From Ft.
From Ft. to Ft�=OL.,OJT AF ANCHOmoe From Ft.
61 to Ft._
E��From FL to Ft
From Ft. to Ftmµ4T
MISCL„ INFORMATION: AUG 4 S88
RECEIVED
D RI LLER'S NAME
Municipality of Anchorage
Department of Health and Human Services .
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
January 9, 1989
Michael J. Nelson
PO Box 670833
Chugiak, Alaska 99567
Subject: Lot 7 Block 1 Sampson Estates Subdivision
Permit 188086, PID #051-822-25
A permit issudd by this Departmea•_ for an individual well
and/or on-site sewer system has expired as of December 31,
1988.
Permits are issued.on a calendar.year basis by authority of
Municipal Ordinance. 'A'new-permit must be obtained from
this Department for any well and/or on-site sewer system
not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as -built inspection report
(three-part form) must be sent to this office for review and
approval, and for documentation.
When applying for a new permit, the fees are: $90.00 for
an on-site sewer permit; $50.00 for a well permit; $140.00
for a combined sewer and well permit.
If there are any further questions, please call this office
at 343-4744.
Sincerely,
A-��A ,g�
Daniel J. Roth
Acting Program Manager
On-site Services Section
DJR/ljw
enc: Copy of Permit
C1 Qh Au
M IJ N I C I P A L I T Y O F A N C H O R A G E
Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343-4720
O N- S I T E S E W E R & W E L L P E R M I T
permit Number: 880086
Date Issued: 06/16/88 Engineer Designed
Owner Nam*: MICHAEL J. NELSON Day Phone:
]wner Address: P.O. BOX 6701333 688-9531
CHUGIAK, AY. 99567
Parcel Id: 051-822-25
Lot Legal: Subdivisions SAMPSON ESTATES Lot: 7 Block: 1
Section: 3 Township: 15N Range: 1W
Lot Size 42119 (sq.ft. or acres)
Max Bedrooms: This Permits 4 Total Capacitys 4
SEPTIC TANK: Minimum total septic tank capacity: 1,250 gallons. Each septic
Lank must have at least 2 compartments. Depth to top of septic_ tank(s) < 4.0
(eet requires insulation over tank(s).
4ELL: Log must be submitted to Municipality of Anchorage Department of Health
itnd Human Services within 30 days of well completion.
INFORM D.H.H.S. PRIOR TO IST & 2ND INSPECTIONS BY ENGINEER, -IF
'AFTER OFFICE HOURS CALL 343-4681 AND LEAVE A MESSAGE
:ONSTRUCT PER ENGINEERS ATTACHED APPROVED DESIGN
fHIB PERMIT EXPIRES 12/51/88
CHIS PERMIT VALID FOR A SINGLE FAMILY RESIDENCE ONLY
I CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by they Municipality of Anchorage (110A) 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 4 bedrooms. I
also understand that the capacity of the total system is 4 bedrooms and
any enlargement will require an additional permit.
31gned:
(Owner)
Issued By:
alt
MICHAEL J. NELSON
DATE:
c v Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "V Street, Anchorage, Alaska 89502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: M tWe IV eJS 6 n DATE
LEGAL DESCRIPTION:_ L-7 9k I $-zMPSor, 6s4 • Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
13r
14
15
16
17
18
19
DEPTH
SLOPE
(FEET) ,I-
5w /SP
13o S.F.• �hed.ov.•y,
WAS GROUND WATER
ENCOUNTERED? NO
L s
M
IF YES. AT WHAT
PER &141#601 lwaaw(gEPTIR
TNI! 04rE11AL If !A#PI•
AND 6RAveilr ear DIIIII to vialer.Al�r
rr� 1 Moniloring? NNS
neading I Date
P
E
Date: -if
Gross Not
Time Time
Oy le
:#
rob !: C
° June 22,1960 �• b
P �J
N //2 S
SITE Py
Depth to Nor
• :__ -,
20 -j I
lU� PERCOLATION RATE (rrunutevmch) PERC HOLE DIAMETER
` ,,L TEST TIUN BETWEEN FTAND `FT 1
COMMENTS �I 13.—so', �_ 0- 'It, R c t,�p,4`141 I O S•-, / betlyoom. Sni 1% Lx! IO'•'I �_'•
PERFORMED BY. Cn'S ur• 1�}l
h•m '� I 'h � =0s2o CERTIFY THAT THIS TEST WAS PERFORMr.0 IN
—�
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: TT 14-8$
co w �
N O m
t }
Y
t
t "rn
�.ks
f�'C,l : �� •�
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Municipality of Anchorage
Development Services Department
Building Sarety Division
On -Site Water 6 Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519.6650
www.d.enchorage.ek.us
(907) 343.7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-822-25 HAAN M
1. GENERAL INFORMATION Expiration Date:
Complete legal description SAMPSON ESTATES SUBDMSION: LOT 7, BLOCK 1,
Location (she address or directions) 23814 GOLIATH DRU' • CHUCIAK, AK 99567
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
MICHAEL J. NELSON Day phone 367-9531
4441 E. BIRCHWOOD DRiVE • CHUCtAK, AK 99567
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup.T1C SYSTEM 1ZED
FOR 4 BEDROOMS
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Wen 0
individual Water Storage ❑
community CWss Well ❑
Public Water System ❑
Individual On -she
N
Individual Holding tank
❑
Community On-site
❑
Pubric Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of tine (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues HMIs 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 samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
Q. STATEMENT OF INSPECTION BY ENGINEER
As cer0od bymy seal affixed hereto and as of fho validation date shown below, I verify that my
Investigation, based on procedures outlined to 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 ofbedrooms and type of structure Indicated herein. l further verify that based on the
Information obtained from the Municipality ofAnchorago files and from my Investigation and inspection, the
on-site watersupplyand/or wastewater disposal system Is(are) In compliance with all applicable Municipal
and State codes, ordinances, and regulations is effect at the Gmo ofinstallation.
Name of Firm CARNESS ENGINEERING CROUP. Ltd.
Address 3701 E. TUDOR ROAD. SUiTE 101 • ANCHORAGE. AK 99507
Engineer's Printed Name JEFFREY A. CARNESS. P.E.
Englneees Comments:
In conducting flits evaluation, CEO, Ltd. atlomptod to provide a thomugk
conscientious engineorfng analysis of the system H accordance with ADEC and MOA
DSD Guidelines 6 Regulations. The reported results described the performance of Ne
system undor the conditions encountered at the Gme of the lost and separation
distan Cos measured to readily ldontifiabto toatures. fie opomtional Ere of all wells and
soptic systems depend on the local sacs condition, groundwater lovers that may
auctuale during the year, and the water usage of the family being served by the system.
Those conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG. Ltd. can thore fore not provide
any warranty or future estimate of how long the system will confimm to meet the
oporaGonaf reeuimments of Ne ADEC orMOA DSD. The content of this reportIs for
the sole bonefrt of the ownerGsted above. Any nNiance upon or use of this report by any
other person or parly Is not suthorhed, nor won it confer any legal fight whatsoever.
5. DSD SIGNATURE
Phone 337-6179
Date 7 /L;-5-
Approved
oS
Approved for _,3— bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations: (ittlfflfllri
of ltttw'Y 0 r re;
WATERAN
PROG ER
Attachments: �� •• •.....••���
HAA Checklist Maintenance Agreements
Septic System Advisory Supplemental Engineers Report
Wet! Flow Advisory Other
Original Certificate Date: 05�
rn...�yon
Municipality of Anchorage
• Development Services Department
eutiding Safety Division
OrnSRe w,tsr a Weat&Aftr P►ogram
4700 South Bragaw SL
P.O. Soot 198830 Anchorage. AK 0951118830
www.d.andtorageak.us
(907) 343-M
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SAMPSON ESTATES: LOT 7. BLOCK 1. Percell0: 051-822-25
A. WELL DATA
Wee type M*TE K A. 8, or C provide PWSID# N A
Data pompleted 7/1988 Sanitary seal (Y/N) YES
Total depth 201 R. Cased to 201 ft.
FROM WELL LOO
Date of cosi 7/198$
Stew water level 185 ft.
Wet production 30 —
g -p.m -WATER SAMPLE RESULTS:
.Coliform _t&- ccloniesl100 M. Nitrate 1MngJL.
Well Log (YIN) YES
Wires property protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
7/5/2005
172 R
5.8 g.p.m.
Otter bacteria „n_colorues1100 ml.
Arsenio: N/A mg A- Date of sample: 7/5/2005 C llected by: GEG. LtD.
B. SEPTIC/HOLDINO TANK DATA
Tank Typeimaterial , STEEL Date installed 6/1988
Tank size 1250 gal. Number of Comport-, W- 3 Cleanouts (Y!N) YES
Foundation deanout (YIN) YES Depression over tank (VM) NO High water alarm (YIN) N/A
Date of pumping 7/12/2005 hImPer JR'S PUMPING
C. ABSORPTION FIELD DATA
Dale Installed 6/1083 Sol rating (g.p.d1R'o►� 130 System type TRENCH
Length 74 R. Width 3 ft. Gravel below pipe 4 R.
Total depth w.e & Eft. abeaption area 597 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 7/5/2005 Results (Pass/Fall) PASS For **3 bedrooms
Fluid depth In abswpbon field before test14 in. Water added 642 gel. New depth 35 In.
Elapsed Time:397 min. Final fluid depth 28 In. Absorption rate >: 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN a type) NONE KNOWN If yes. give date
•• SYSTEM SIZED FOR 4 BEDROOMS
D. LIFT STATION
Date installed Sae M gallons
'Pump on" level at _in.
E. SEPARATION DISTANCES
High water alar levet at kr.
Cycles tested Masts alar & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAlR station on lot 1001+
Absorption tledd on let 1006+
Pudic sewer main N/A
On adjacent lots 1001+
On adjacent lots 100'+
Pudic sewer manholekbanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Property lire 5'+ Absorption field 5'+
Water main N/A Water Service line 10'+ Surface water 100'+
Wells on adjacent lets 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 03' Building foundation 100+ Water main N/A
Water service line 101+ Surface water 100'+ Driveway. parking/vehicle storage 10'+
Curtain drain NONE KNOWN Weds on adjacent Jots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certiy that I have detemaned through fieid Inspections and r !
review of Municipal records that the above systema are in
conformance with MOA HAA guidelines In effect on this date.
Engineer's Printed Name JEFFREY A. GARNESS
Date :01 t%f yr
�a
HAA Fee S LIQ 11Waiver Fee S
DateorPsyment i-lN'oS
Receipt Number 1172'70C1�R V4�ln
(Rev. 12)0 1)
Date of Payment
Receipt Number
GE
.• - ® MUNICIPALITY
HEA TH & HUMAN
• DEPARTMENT OF HEALTH 8, 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. N OSI SZE ZS
HAAN LLA 9zoT60
1. GENERAL INFORMATION
Complete legal description L-+ V S a. rsc, C-�+z'tc'$
Location (site address or directions) Goliath w1 Chvgro�_
Property owner WES / Toyce 1`44040^ Day phone
Mailing address F66" 67.6833
Lending agency .Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
x
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.
aaarn�.+nq Fm MOAm
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verifythat 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 forthe number of bedrooms
and type of structure Indicated herein. I furtherverifythat 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- Cc" S4vvC11nQ 9225lneeK Phone
Address -9GOI A cho,Z�)z- AK 9�6
Engineer's signature �'P'' Date 111-3
B. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
bedrooms, with the following stipulations:
and theirlending institutions In orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct Inspections or analyze data before a certificate is Issued. The Municipality of Anchorage Is not
responsible for errors or omissions In the professional engineer's work.
naxr m... uan Back MOAAW
P'W
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:_ L-1 S1 5-e..11562Q1'ates Parcell.D.
A. Well Data
oSl 9,27 75
Weli type PQ'\1A•'K If A. B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Y Date completed Te`Y 199E Driller SUU4JAA WAiM2 WGus
Total depth t9 s Casod to 199 Casing height
Sanitary seat (Y/N) y Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump levelt
FROM WELL LOG
AT INSPECTION
Y
SLY f 9t; i3 3 -1z -9Z
I(,S 1'io
3a i o
g.p.m. g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
no
l05
On adjacent lots
On adjacent lots
+1zS
i%�5
Public sewer main �'� Public sewer manhole/cleanout *400
Sewer service line 8° Petroleum tank 4-'c�o
WATER SAMPLE RESULTS:
Coliform
I Nitrate 0.9
Other bacteria
td
Date of sample:
3-61"9Z Collected by:
C" 13r+' �cA,=5 `-'9
t9,v'
B. SEPTIC/HOLDING TANK DATA
Data installed G- 1958 Tank size I_LrAo Compartments Z'
Cieanouts (YM) Y Foundation cleanout (YM) %� Depression (Y/N) 0
High water alarm (YM) NA Alarm tested (Y/N)
Date of pumping 0__4_ 7_% \392- Pumper. a¢'s
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK TO:
Well(s) on lot
110
On adjacent lots 4-"'o
Foundation 13
To property line
40
Absorption field S
Water main/service line 75'
Surface water/drainage .atcm'
72M6 (3183)1 FAmr CONTINUED ON BACK PAGE
C. LIFT STATION
Date Installed Manufacturer
Size in gallons Manhole/Access (YM)
Vent (YIN)
"Pump on" level
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DIS NCCFROM
Won t
D. ABSORPTION FIELD DATA
LIFT STATION TO:
On adjacent lots
tested
Level at
Surface water
Date Installed '$-So Soil rating (GPD/Ft=) 13O s{ �� System type
Length -7`( Wtdth Z's Gravel thickness � 4:�.1Total depth tdX i �ii..l
L
Total absorption area STCloanout present (Y/N) i Depression over field (Y/N)
Date of adequacy test 199L Results (pass/fall) _ PA -SS for 4 Bedrooms
Water level in absorption field before test — After test
Peroxide treatment (past 12 months) (Y/N) ^i If yes, give date =
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 105, On adjacent lots 41od Property line
To building foundation
14'
To existing or abandoned system on lot
3'
NA
On adjacent lots +XO6 Cutbank 41 W Water maiNservice line -11;0
Surface water 1100 gNehlcte —Driveway, arkin 60,
y p storage area
Curtain drain
'1'100'
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guldefin47n eN@j
Signature 40, " -KOµ
Engineer's Name Sbo% s„ z VJr P- t�
cwrsyc_
Date
HAA Fee $ 1300u
Date of Payment
Receipt Number Z4Zt 2. (9i; -?-S)
Waiver Fee $ 40 ac
Date of Payment
92,
11-3-9z
Receipt Number Z4Z1L (46-75)
Inspection.
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES w1
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. N oS I 9zz tS
HAA P VA W)'7101 �O
1. GENERAL INFORMATION
Complete legal description L7 8t 5ZO ^pst,^ —s+z3s -
Location (site address or directions) oJI inti
Property owner M%v. / Uoyc.o "o-Isorl _ Day phone
Mailing address TP.?00V676833
Lending agency
Malling address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well X
Community well
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-0250t.r.Iro11 F,o.l 1AOA021
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the iacadjolon date shown below, I n shows that he on-site verity that t.
water supply
investigation of this Health Authority Approval app
and/or eafstwucturerindlcatedhereiis safe, n.Ifurthervterrinal and adequate ifytha basedonthe nfoematitonobtained from
and typ
the on-site water
the Municipality of Anchorage files and from my investigation and inspection,
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. G�_9o98 /�4r -moo
`}; 6 , ,, -'s Phone /
Name of Firm ^
99516
Address
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
Date.
Disapproved.
bedrooms, with the following stipulations:
Conditional approval for
Additional Comments
Date
By: ,�rrw 4rci,�t-� ,
Issues Health Authority
Ivan In paragraph 5 above by an Independent
The Municipality of Anchorage Department of Health and Human Services (DHH
Approval Certificates based only upon the representations g
Alaska. The DHHS does this as a courtesy to purchasers of homes
professional engineer registered in the State of state
and their
lending
ti analyze data satisfy
before a certificaertain te slssuedr The Municipality ofeAncho age is not
co professional engineer's work.
responsible for errors or omissions in the p
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LIB 5-Qy Dpon Esla-k,s Parcel I.O. OSI $ZZ
A. WELL DATA
Well type 271"A2 If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
I Date completed TJLY 1968 Driller CVLL)vAQ WhTtKc.+6LLS
Other bacteria
Date otsample: 3'1��9�^
Total depth 1q9
Casedto
199 Casing height Z'
Sanitary seal (Y/N)
%r
Wires properly protected (Y/N) Y
FROM WELL LOG
AT INSPECTION
Date of test
-SuL11 1988
Static water level
IGS
17o
n
p
'
3o
S•o
Well flow
g,p,m. g.p.m.
rn
0
Pump level
I -r7
V
SEPARATION DISTANCES FROM WELL TO:
0
Septic/holding tank on lot
110.
; On adjacent lots
Absorption field on lot
io S'
_;On adjacont lots * 125'
Public sewer main
+%00'
Public sewer manhole/cleanout +100
Sewer service line
E d
- Petroleum tank +•too'
WATER SAMPLE RESULTS:
Coliform Nitrate
0.5
Other bacteria
Date otsample: 3'1��9�^
Collected by:
gen"�"^5 CSS,^Pates
B. SEPTIC/HOLDING TANK DATA
Date Installed 198$ Tank size Iz.So Compartments Z,
Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Dopression (Y/N) is I
High water alarm (Y/N) "A � Alarm tested (Y/N) Nth
Date of pumping OcrT Z t 9 9 L• Pumper SK $ yye^p 1 m(r
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot 110 On adjacent lots +100Foundation
15,
To property line 41� Absorptionfleld V' Water maln/service line -15'
Surface water/drainage `r 100
72-026 (Rcv.7N1) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date Installed
Size In gallons
Vent (Y/N)
High water alarm level
Manufacturer
Manhole/Access (Y
"Pump on" level at "Pump off' level at
Meets MOA electrical codes (Y/N)
SEPARATION
Well on lot
D. ABSORPTION FIELD DATA
LIFT STATION TO:
On adjacent lots
Cycles tested
Surface water
Date installed 1908 Soil rating 130 SX/Wym System type 4rencti
Length Width Z. -S, Gravel thickness 6•S I Total depth 19.5
Total absorption area Cleanouts present (Y/N)
Depression over field (Y/N)
Date of adequacy test
Results (pass/fail) 'PMS for
4
Peroxide treatment (pas? 12 months) (Y/N) N If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
MAR.crt \99L
Well on lot IbS On adjacent lots t \oo' Property line $
To building foundation 14' To existing or abandoned system on lot NA
Onadjacentiots )-too Cutbank
Surface water +1b0,
Curtaln drain } IM,
E. ENGINEER'S CERTIFICATION
Water main/service line -7S'
Driveway, parking/vehicle storage area 4601
bedrooms
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in, et/qct oftxhh.'dat 17Kig1psx
• `" t .�"`a K."O er,
Signature
Engineer's Name 13<15 I 97 NO. rrua?
.• .� ,,
Data :3\.`7?°q�•lo.erny,P>P, r� N
HAA Fee $ 170'42 Waiver Fee: $ 00
Date of Payment 5 Z-- Date of Payment _ L
Receipt Number X 02 /Z 614%? Receipt Number .2Z42 / Z (4/4%__7