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Home My WebLink AboutSAMPSON ESTATES BLK 3 LT 6Sampson Estates Lot 6 Block 3 #051-811-32 MUNICIPALITY OF ANCFIORAGE DEPARTMENT OF HEALTH & ENVIRONMEN'rAL PROTFCTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaslca 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE ,,~ EW NAME '~)'~ '~c ~' ?/~-%<~ ~ O1'"~ ~¢"~-¥ ~-~ c~ ?c ~o'''~ ' ~.~J- ~ 'c/ ~(~/.~- ~o []UPGRADE MAILING ADDRESS EGAL DESCRIPTION LOCATION NO, OF BEDROOMS Well DISTANCE TO: IManufacturer ~' DISTANCE TO: Manufacturer IAbs or ptiol~,~r e/~ Inside lengt>/ Dwe ng / DISTANCE TO: ]Well Length-of Ne. of lines / J Top of tile to finisb grade Foundation Total length of lines Material beneath tile Dwelling j~ / PERMIT NO. Liquid depth PERMIT NO. Material Liquid capacity in 9allons Nearestlotline Trench ~'dth ~2~ ~5~ inches inches PERMIT NO. Distance b tween lines Total effective absorpti, /o z/ 7 Lengtl~ Widtb D0pth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area . . . Well Building foundation Nearest lot line DISTANCE TO'. Class Depth Driller Distance to lot line JPERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank LAbs°rpti°n area(s) OTHER PIPE MATERIALS S O I ~T~'ST RATING INSTALLER REMARKS DEPT. OF HEALTH ENVIRONMENTAL APPROVED DA' E LEGAL 72-013 (Rev, 3/78) WATER WELL RECORD 81'ATE OF ALASKA OEPARFMENTOF NATURAL RE$OURES Divlsio. of Geological ~ GeophyslcolSurveys Gravel, soil, Gravei, silt,.sand Gravel~ sil~,'wa~er Gravel, silt, semd', ~ravel, g:ay sand -~ravel, sand, si2~, Gravel, sand, water ¢5 55 b ~ --Y'i O ~ [v~. ;' Ray Pelletier Addre,$: ,' Shasta Construction Anchor~age, Ak. WELL140. DEPTH=.fi.(fi"oll §,~ATE O. F20 -84, . Q Irrl~allon ~ R,~har~, ~ Commefl=al ~ Tilt Wall ~ Other: . ~ ,~. ,o_140,.~.~, w.~ ST*Tm WATER LEW::: _U. / / C3 Abovo or ~ ~.low land · MUNICIPALITY (~F ANCHO-[, DEPT. OP- .... · O ENVIRONMENT' - pROTECT~I REC t 1 198~ 16, WATER WELL CONTRAOTOR'S CERTIFICATIONt 3_.N.~ iE,SflOUTINB Well Orouled: [] Ye, [] No Malorlol: []Neat Cement [] Other:. iS, PUMP: (if available)' HP [] s.~.,. L3 ~.' [] ~.,,,,,.~ [] O.h.r M'"EM^""s:Produotlon of 15 GPM L~, W.~or Tomperalure . o []~.F [] C Magnuson Drilling AA 5385 P.~. ~ox ~)~ Eagle River,. Ak. A~,,,,:__.~__ /" -- ' o,o June _ 20, 1984 HLINICIPFILIT~¢ OF HNL. H,-.-..R_~E DEF'RRTMENT OF HERLTH FIND EN'¢IROI"~htENTRL F'ROTEE:TII]N 25 L =,TREE. T., RNSHDF'R3E, RK 995~ 264-4728 F'ERHIT NO: [:'RTE ISSUED: 8405±0 0.5,'"26,.'"84 RF'F'LICRNT: RDDRESS: CONTRCT PHONE: LEGRL DESCRIP: LOT' SIZE: HRX BEDROOHS: LOT: 6 BLOCK: 2: F. HhlL~E. LISTED BELOH RRE THE OPTIONS FIVRILRBLE TO YOU IN DESIGNING YOUR SEPTIC S'¢STEH. CHOOSE THE OPTION THRT BEST FITS YOUR SITE. T R ES F,i C: H B i E:, L,.I. E:, F..' £-~ ][ N E:,EEF'TFt 1'0' PIPE E:OTTOH ,.'.FT. ) 4. 0 4. 0 4. 0 GRRVEL DEPTH (FT.) 8. 0 0. 5 ~. 5 TOTRL DEPTH '.'.F'T. > :L2. 0 4. 5 7. 5 ~RRVEL NIDTH (FT.) 2. 5 26. ~ 5. 8 ~:RVEL LENGTH (FT.) 66. 8 58. 8 tiZq 8 '"ERR',/EL ',/OLUHE (CU. 'T'DS. ) 5$. fJ '$EL ~. 8~. 7 TRNK SIZE (GRLS> :&, 000. 0 ** :L, 000. 0 ** :~¢ 000. 0 SOIL RRTING (SQ. FT. ,/BR) 349 284 ,+::+: GRRVEL LENETH :> ~= ¢, FT. ERCH) ,.., FT. REQUIRES HULTIF'LE RLINS ,::NOT EXCEEDING :4-:~-: TRNK MUST HR',,,'E FtT LERST THO COHPRRTHENTS I CERTIF"r' THRT: %. I RI"1 FRF'IILIRR HITH THE REQUIREMENTS FOR ON-SITE SEHERS RND PIELLS RS SET FORTH B'¢ THE HUNICIPRLIT'¢ OF RNCHORRGE (MOB) RN[:, ]'HE STRTE OF' RLRSKR. I HILL INSTRLL ]"HE S'-~'STEM IN RCCORDRNCE HITH RLL HOB CODES RN[:, REGULRTIONS., RND IN COHPLIRNCE NITH THE DESIGN CRITERIR OF"' THIS PERHIT. 2:. ,I HILL RDHERE TO RLL HOR RND STRTE OF RLRSF'.'R REOUIREMENTS FOF,' THE SET BRCK DISTRNCES FROM .RN'¢ ,ENISTING HELL. NRSTENRTER [:'ISPOSRL S'¢STEI'"I OR PUBLIC SEWERRGE S'T'STEM ON THIS OR RNa' RDJRCENT OR NERRB'¢ LOT. 4. I UNDERSTRND THRT THIS PERMIT IS "/FILID FOR R MR;4IIdUM OF -~ BEDROOMS RND RN9 ENLRRGEMFNT 14ILL REC..!UIRE RN RDDITIONRL PERMIT. IF R THEN HILL ELECTRIE:FIL WORK MUST BE DONE BY R LICENSED ELECTRICIFtN. RPPL~E:RNT: SHR~TR E:ON~TRUE:TZON : ...... :~ EW ___~ ................................ LIFT _,THTIEN IS IN=,THLLE[ IN RN RRE:R L.C/EFE[ E& MOFI BUILDING L. LI[:,E=,., (:L) RN ELECTRICRL PERI'tIT RND IN:.,FEE. TIuN MU_,T BE OB'THINEE.,., (2) R::,-BI_IILT_, NOT BE FtPPRO',/ED 14ITHOIJT RN ELECTRIE;RL INSPECTION RE. PERT., RND (~:.'. THE MUNICIPALITY OF ANCHORAGE DI:PARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska BBB01 264-4720 SOILS 1_O(3 - PERCOLATION TEST SOILS LOG PERCOLATION TEST LEGAL DESCRIPTION: SLOPE SITE PLAN "7 10 11 12 13- 14- 15- 16- 17- 20- COMMENTS WAS G, ROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Read ng Date Time Time Water Drop PERCOLATION RATE L.~'~ .(minutes/inch) TEST RUN BETWEEN FT AND ~ FT 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SErVICeS Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone ~,g~- ~4-~-z Day phone Agent ./~*-~ ' '- Address ~¢~,-,<Z.~ .,¢~ ' Unless otherwise requested, HAA will be held for pickup, NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 'rYPE: 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. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Eas'le l~ver ]~ng~zeer[~¢ ~¢Z't~l~ Phone d,~' -J'>~y' Box 773 , Address Engineer's signature Date DHHS SIGNATURE YApproved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) 8ack MOAg21 of Anchorage R E C E Municipality DEPARTMENT OF HEALTH&HUMAN SERVICES M Environmental Services Division AY 18 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) ,~,~;~ o~ ^NCHO~e~ -~VIRONMENTAL SEP, V~CES DIVISlf' Health Authority Approval Checklist Legal Description: A. WFLL DATA Well type Log present (Y/N) Total depth / Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed / Cased to ~.z/¢~ FROM WFLL LOG Date of test ~/,¢¢' Static wa[er level #,,v/c-,,, /,~ / Well production /,5- o",'~-",~ g.p.m. ~ ~ WATER SAMPLE RESULTS: Coliform ?" Nitrate_ ~' '2~" Date of sample: '~ /~-~ ~ z) Collected ey: SEPTIC/HOLDING TANK DATA Date installed ~/,~-'v' Tank size /¢~'~ Foundation cleanout (Y/N) ?' Deeress~on (Y/N) Date of Pumping. ,'~¢75'- ¢¢ ~ _ Pumper 3-'~'~" C. ABSORPTION FII=LD DATA Date installed /?~ 'Y Length ~'"'~ Width _ Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Other bacteria Number of Compartments ~L Cleanouts (Y/N). ~ High water alarm (Y/N) Sell rating (g,~./~ or fl~/bdrm) :2¢ "' Gravel thickness below pipe ,,'~ ""' g.p.m. Monitoring Tube present (Y/N) ~ Results (Pass/Fail) ./~-,¢J'J- For ~ /,- 5~ mmediately after/,~,5'agal, water added (in.): /-?'%~ Absorption rate = '/' ~"~-~ .g.p.d. /~///4 If yes, give date - -~ Effective absorptien area Date of adeauacy test Fluid depth in absorption field before test (in.); Fluid depth /3" (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) _ 72-026 (Rev. 3/96)* System type Total depth /,¢~ .5- Depression over field (Y/N) ,'~ bedrooms Manhole/Access (~__ ~'~e; ;tee.~ rt ~ Ida r m ' eve ' % Size in gallons "Pump on" level at* *Datum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot ¢-,"~-'2 Public sewer main /v' ,/,4~ Sewer/septic service line --/- On adjacent lots '/-?~ / On adjacent lots "¢-'"~'¢ / Public sewer manhole/cleanout /--'//4 Lift station '¢' /'~ / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /-¢- / Property line '~/'¢ / / Absorption field 7 Water main/service line f/,¢" Surface water/drainage ¢/'¢¢' / Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ¢-/¢' '/ Building foundation 3~ ' Water main/service line Surface water Y-/d~ / Driveway, parking/vehicle storage area ¢'/'~ Curtain drain Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name Date ~'- -- / '~ ---~d HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTN CERTIFICATE OF INSPECTION FOR I-IEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Descriptioo (include lot, block, subdivision, section, township, range) Lo'~ 6 ~ Block ~_S_am_.pson Est. '~].5N R~JW Sec. 3_ Location (address or directions) (b) Applicant Name ___~a]_- ROIllaZ¢;WS_~_ .... Telephone: Home Business 6_9li-'L1200 Applicant Address P.O, Ilex .Z~J~ t%g~le River, (c) Applicant is (check one): Lending Institution ~; Owner/builder []; Buyer El; Other ~ (explain); .... Re~.].l;or (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail tile BAA to tile following address: TYPE OF RESIDENCE Single-Family ~ Multi-Family Number of Bedrooms. '~_ Other WATER SUPPLY Individual Well [] Community [] Public [] Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAl. Onsite ~ Public [] Community [] Nolding Tank [] Note: If community well system, must have written confirmation from the State Departmeet of Environmental Conservation attesting to the legality and status. Page 1 of 2 ENGINEERING FIRM PROVIDINg. ~NSPECTIONS, TE:STS, FILE SEARCH, DA..-, AND INFORMATION AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and lype of structure indicated i~erein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. EAGLE RIVI:'R ENGINEERING SERVICES Name of Firm ~'/~TRIVE~ ,.FAW995-77'---- Telephone Address .[~L _ 0 ,J~ OY-~7~2¢~9_,'L ,~2 -... ~' -"=- ~.:~ d~ 694-5195 Date -,~ · Approved _~.. _ ...... Disapproved ....... Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DFIEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registerad in the State of Alaska. Tho DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employaes of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 { I 1/84) MUNICIPALITY OF ANCHORAGE (MO~t HEALTH AUTHORITY APPROVAL (HAA) ¢ ' CHECKLIST* FEBRUARY 1984 ~4UNICIPALIT'/OF ?,NCHORAGR DEPT, OF HEALTH & ~ENVIRONMENTAL Pi~OTECI'ION 1986 264-4720 R.~/~'~ ~V Legal Description: ,Z~ /- -~ '~ .~m~ WELL DATA Well Classification /o/.~ / ~,~ )...,~_ if A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) >,~ Date Completed ~'- ,~_o ~,~, Yield Total Depth /~z¢ '"Cased to /~¢ / Static Water Level _ ,~o / ~¢/~, Casing Height Above Ground Electrical Wiring in Conduit (Y/N) _ Separation Distances from Well: To Septic/Holding Tank on Lot ./¢~ TO Nearest Edge of Absorption Field on Lot To Nearest Puhlic Sewer Line Cleanout/Manhole ?~'//~ Water Sample Collected by '5~'5 Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) ,~' Depression Around Wellhead (Y/N) Water Sample Test Results ; On Adjoining Lots '%'"'¢ ' ///~ / ; On Adjoining Lots Y'/¢0 ~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~'~ J"-" Comments Bm SEPTIC/HOLDING TANK DATA Date Installed. "-7/}¢~ Size __~-,)4~r"~ No. of Compartments Standpipes (Y/N) y _ Air-tight Caps (Y/N) ~Z __ Foundation Cleanout (Y/N) _ ~/..~'~/ Depression over Tank (y/N) --~/V Date Last Pumped ,/~P I/c* r' Pumping/Maintenance Contract on File (Y/N) I~/,A, ; for Holding Tank Fligh~Water Alarrn (Y/N) _~/_,~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~ ~,/ To Property Line _ ~ ~i'~ i To Water Main/Service Line _ Course_ To Building Foundation /~-/ To Disposal Field .~ i To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well [ /E~,f To Building Foundation ,3 ~ ~ Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots ¢-%O/ To Cutbank (if present) /U/~ /uA Commenls LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Bating Against HAA Request I certify that I hav..~ checked, verified, or conformed to all MOA and HAA g uiddines in effect on the date of this inspection. Signed ~/~----~¢*~ Date Company .~¢"~,~,¢', MOA No. Receipt No. L~ O0 1 ~ Cx:~O"~ Date of Payment Amount: $ (o ~' Page 2 of 2 72-o28 (11/84) Eagle River En~lin~eri~g Services P. O. Box 773394' Eagla River, AK 99577 694~-Sf95~ CE-6736 Engineer's Seal §615301 T-162 P.OZ/03 1:-888 Ordvr~d By pW$1D 10f)22~ 1001 Drhaking Water Sample ll.emafl~s: PrmYe0 Da[e/l'ime 05/1'//2d00 14:35 RceeiveO Dare.me 05/15/2000 17:45 Techmc~ Dlre~nr S~pheu C. Ede Pill 0.500 ri~J/L EPA ~,OD.(] 10 [mx 05/16t§0 SCL