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SAMPSON ESTATES BLK 4 LT 13A
Sampson Estates Block 4 Lot 13A #051-811-45 /'r� Municipality of Anchorage ;r=" . t_ , Development Services Department �,- Building Safety Division ''. (]Cy: ' On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of WPM .ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW010322 PID Number. 051.811.45 "'"°' Laurie Kimper Wastewater System: • New @Upgrade 22566 Sampson Drive. Peters Creek. AK 99567 ABSORPTION FIELD Phone: Number N Bedroom.: O ®Shalom Trento 0 Bad O Mound O Other. 3 Dep Trench LEGAL DESCRIPTION Rating: 0.6 GPDrFf ngnal snide: Total Depth from « 1.54 FI. Blocs Lot BWd aan: 4 13A Sampson Estates Depth m pope bottom from atonal grade: 0.53 FI. Gravel depth beneath ppe: 1.01 Ft. Towehp: Nape: Section: FS added Wove origami grade: 1.75 +l- Ft. Gravel MOMS: 135 Ft. Well: • New N Upgrade Grawlrndth: 5 Ft. ember of hen: 2 Distance between het 10 FL CW VMaoon (Poeta. A B. C): Private Total Depth: Ft. Geed a: FL Total sampan area: 770 FIT Pipe Meant: 03034 & F810 Dram F,AC1In f eDiaad: Belcw.tertsvel: FL kneeler Calkins Const. Date natant Yee: GPM Pumps.tac' FL Caaag"aam Move Ground: Ft. TANK SEPARATION DISTANCES • Septic 0 Holding ta S.T.E.P. • Other. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Line Manufacturer. Anchorage Tank Camay. 1250 Gel. Wel 100'+ 100'+ 100'+ NA 25+ Maw. Steel NumbaoCompa : 2 Sway, Water 100,+ 100'+ 3r I+ NA LIFT STATION Lot 5'+ 10'+ NA NA: Sae. 1250 Gel. Manufacturer. Orencorenco F0 dation 5'+ 10'+ NA NA 'Pump n evel al 44" h. Pump orf eve at 42" in. .gh meta Won et 48" h. G.ea o .a NA •50'+ NA NA Pod, Makety97t� c° 30 Gal. (11:10 /9b Meanest Impactions peened b( Northland Electric Remarks:BENCH 'None known , STEP tank installed due to elevations, MARK existing tank abandoned per code, Location and D.mpbom: Bottom of siding tank and field Insulated. A.anee LeraSon. 100 Ft. � / 64/ /L „// %DEngineefs �� /4A# L1y�!4�tOF4`q%i Stamp it: se . •Ms.ae.e s s+rryl ti's r49L .e.ee •....f. e. ... j ... ..»....... i ,�'; Kenne:n .. n me/ ,4jt 9A,•e : E 7116 is •... E��'.r(Re. 11 IIROFESStONP+ Inspections performed by: KND Enqineerinq Dates: 1" 10/3/2001 2"d 1014/2001 Development Services Department ApprovalAp Reviewed2bl and approved by: �oK Date: JO - ll' 4 AS - BUILT SYSTEM DETAILS/SITE PLAN Permit SW010322 SAMPSON ESTATES S/D, LOT 13A, BLOCK 4 PID#051-811-45 EXISTING BED A -D=12.0' B -D=8.8' A -E=14.9' B -E=14.9' B -F=17.9' C -F=55.7' B -G=77.8' C -G=96.9' B -H=80.4' C -H=92.2' B -I=14.2' C -I=40.7' »(99 ctt- 70 9.5 t0° ITR NBC FINAL GRADE 'lra - Ii i m1250 GAL zryiz S.T.E.P. =�-n I TANK=. = =11=11= 97.9 VM1 TASK TOIT1DR TIJK oo.l IMIelelfanaglISIOIrrr IMu*IIUS SEWER ROCK TRENCH 1 C97.* - SCALE: NTS It TUK =amour 675 FINAL GRADE KINITD4 TUK 00.3 a - run MINK ilMutt �� 98.017 97. 0? 9 7. Iglk71C ICIGIt�IHIr+„--In--In--nFyIG1 67.5 SEWER ROCK TRENCH 2 PREPARED FOR: LAURIE KIMPER 22566 SAMPSON DRIVE PETERS CREEK, AK 99577 (907) 688-7553 98.0 97.0 (� CIIH: SCALE: NTS FIELD BOOKS cpNVUTCO VBG ocam KMD MOULT: aR: 10/9/01 LEND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 ao NW1580 ""0 "`t' 01075.DWG a N" 01075 (907)698-8111/FAX (907)698-8111 , /q 1 MUNICIPALITY OF ANCHORAGE ( �l 1 ,'ice Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW010322 Legal Description: SAMPSON ESTATES BLK 4 LT 13A Design Engineer. 0070 KND Engineering Owner Name: Laurie Kimper Owner Address: 22566 sampson Dr. Peters Creek , AK 99567 - Date Issued: Aug 16, 2001 Expiration Date: Aug 16, 2002 Parcel ID: 051-811-45 Site Address: 022566 SAMPSON DR Lot Size: 40426 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of. ❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18M072 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: 8'/c, -Q Issued By: /141 P Date:B—/4-0i Parcel I.D. 051411-45 Municipality of Anchorage Development Services Department ;`-' 'Th`'•. Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Property owner(s) Iaurle klmper Mailing address (1) 22566 Sampson Drive Peters Creek Mailing address (2) Permit Number SW0/0 3 22 Day phone 688-7553 Zip Code Legal description (Lot, Block & Sub'd.) Lot 13a, Block 4, Sampson Estates Legal description (Section, Township & Range) Lot Size .928140,426 Acres/Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ® Well Only Sewer and Well 0 Water Storage Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub 0 Jacuzzi Swimming Pool 0 Water Softening Unit Therapy Pool 0 0 0 0 0 certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property ownef or authorized agent) Permit Fees: 37.0 Waiver Fees: Date of Payment: 07/01 Date of Payment: Receipt Number: g y f I -I Receipt Number: (nev.12ro0) )K D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 August 6, 2001 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Sewer Upgrade — Sampson Estates B4, L13a Gentlemen: The owner has requested we proceed forward to obtain a septic permit to upgrade and replace the existing septic system and tank if necessary, for the subject lot. The existing septic tank will be abandoned in place, if necessary, and in accordance with municipal standards. On July 30th, 2001 we dug one testhole for the proposed system. The results of this test are attached. The general slope of this lot is from south to north at a grade of approximately 0 — 2%. We have designed our system utilizing the testhole we excavated for the 3 -bedroom house. The lot is served by an individual well. We propose to install a 5' wide shallow trench. Water was encountered during the excavation (at 8.5') and monitoring (at 7.5'). There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, ]ICND Engineering Kenneth M. Duffus, P.E. attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN SAMPSON MO PUtIC VCLLS VITHIN DOC OF PROPOSED SYSTEM PC PRIVATE YELLS VITHIN 200 OE PROPOSED SYSTEM EXCEPT AS MOTE& PC SEPTIC SYSTEMS VITHIN 200' Of PROPOSED WELL EXCEPT AS KITED ESTATES S/D, LOT 13A, BLOCK 4 %�CQ�$ OF�.j.LqA}4��, Art \w UFESS(ON� DESIGN DETAILS 3 BDRM X 150 GPD = 450 GPD 450 GPD/.6 GPD PER SO. FT. (20 MIN/IN.)= 750 SQ. FT (750/5'(V)) X .88(RF) (1.0' GRAVEL) = 132 FT. TRENCH USE 2 TRENCHES - 66 CO X 5' (V) X 1.0'(D) Total depth of system Is 1.5' Fron original grade. Total depth of gravel below distribution pipe Is 1.0' . NOTES: 1. CONTRACTOR 6 ENGINEER TO VERIFY INTEGRITY OF SEPTIC TANK AND REPLACE AS REQUIRED. INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES VITH 2' HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MINIMUM 27. SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED. 5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS 6 SEPTICS. PREPARED FOR: LAURIE KIMPER 22566 SAMPSON DRIVE PETERS CREEK, AK 99577 (907) 688-7553 Scale: 1'= 100' PAGE 1 OF 2 MID BOOKS COUPUTED DOUMASPA Du.o VBG STAPMQ D'Ecxect KMD ABDUCT. °•R' 6/15/01 gailth ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 DMO PU: °tltr NW1560 •E•° "1 01075.0WG '0B K" 01075 (907)698-6111/FAX (907)896-8111 WASTEWATER DISP❑SAL SYSTEM DETAILS SAMPSON ESTATES S/D, LOT 13A, BLOCK 4 0 D fU co MT lo• CO 22' ILLS T P`S$ OF 440 Air ESSIONI= PREPARED FOR: LAURIE KIMPER 22566 SAMPSON DRIVE PETERS CREEK, AK 99577 (907) 688-7553 Scale: 1'= 20' PAGE 2 OF 2 FIELD 800K5 ws„no: OaA-I: V8Q STANMQ OCOMO: KA(D OA Q 8/15/01 ]1 ND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 D : ac NW1560 MAD "Lc, 01075.DWG K'= 01075 (907)696-8111/FAX (907)696-8111 )KN' ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 1 :1E OF Al. �'�P�•'''.N...,.•.gs , co . ' SOILS PERCOLATION TEST Performed fon. Suzanne Cool Project: Depth (Feet) 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- Sampson Est. B4, L13A Org/ - brown, sandy gravelly silt w/organics CM/SM- med dense, grey w/cobbles to 6", wet seeps B.O.H. HOLE PRESOAKED PRIOR TO TEST This test was performed by Victor Godfrey. 1, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. .•N.• i i • /•% .� JI jF9 ••''••... •.. . /180�10q 0FESSO .•••• Date Performed: 7/3�1t(1Lft�•��5— TEST HOLE # 2001-1 SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? YES Depth to water after monitoring?7S' What depth? 9.0' Date? 8/6/01 Reading Date Gross Time Net Time Depth to Water Net Drop 1 7/30/01 9:30 - 6" - 2 10:00 30 min 48/16" 18/16" 3 10:01 - 48/16" - 4 10:31 30 min 3" 18/16" 5• 10:32 - 6" - 6 11:02 30 min 48/16" 18/16" * Water Added Percolation Rate 20.0 (min/in) Pere Hole Diameter 6" Test Run Between 2 feet and 3 feet Municipality of Anchorage Page ' of I 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 5v,193 °08Z PID Number' vS 1 Qj 1) 45 Name: 1�1 Co,.�T M Y1�1 � Wastewater System: New ❑ Upgrade Address: Po13ov 670495 , CIJG)A\5 9956-9- ABSORPTION FIELD Phone: 688- I z36 1 No. of Bedrooms: 3 0 Deep Trench 0 Shallow Trench 4' Bed 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating: 0,3 GPD/Sq. Ft. Total Depth from original grade: Z.0 Z, .S. Lot: 13 A Block: Subdivision: 5A M PSo 1J Gs-ne TGS Depth to pipe bottom from original grade: /. S 'Ito Z. O FL Gravel depth beneath pipe 0.$-- Ft. Township: ISN Range: l/,) I I t Section: 1 3 Fill added above original grade: I,s+UZ,o Ft. Gravel length: SI Ft. WELL: !31 New ❑Upgrade Gravel width: A(‘) 6- Z.9•S Ft. Number of lines: S Distance between lines: b Ft. Classification (Private, A,B.C): -Pptv+rTE Total Depth: i61 Ft. Cased To: i6 1 Ft. Total absorption area: I Soo SQ. Ft. Pipe material: Pv C-•) AsrW' D3034 Driller: 5bLL)V/ wA1'r t,t.ELLS Date Di Iled: 7193 Static Water Level: 11S- R. Installer: MM7M COr.,M!}C,T1.1'y Date installed: 7-93 Yield: ,1,,o 4GPM Pump Set at: Ft. Casing Height Above Ground: Z. Ft. TANK SEPARATION DISTANCES $.Septic ❑ Holding ❑ S.T.E.P. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Manuf eturer: 2AT G. Capacity in gallons: 16vp Well f O7 109 +1 oo Material: STes 1. Number of Compartments: Z. Surface Water +lam CICO, +16t5r LIFT STATION / Lot Line , S$ , fS Size in gallons: I Manufacturer: / Foundation 9, /_ 15/ "Pump on" level at: "P off" level at: I High water alarm at: Curtain Pump Mak ode. Elec rical Inspections performed by: Drain I Remarks: t.) e,..--) 5 sos-r1=rn IQsTati.eO peR BENCH MARK PeRnuNT /be-strsiJ Location and Description: cort,.,c,e... of G•as`fc-E. ,4T G-b Ge. OP vt?1vwA`/. Assumed Elevation: 100 kr. Ft y o•® 400.. �'ejs•°w V 81' ° as i fir\-/-"(1" t> ' 93 Inspections performed by: 4.1 bates: 1st 7-16- OF.itz f '6 w—. 2nd —)} 93 a18rstt¢/sg0ens4x r.»ws0avM•� • NO.1732.E. ; ,,". 8-zo-93 Department of Healthd Hu • ervices approval t /� J��� Juno 12, 1946 :EQ. W.. 9 WO 4s° .W2 Si1.1V. �: m Reviewed and approved by d �� Date @Y 72-013 (Rev. 9/91) MOA 25 Permit No. 5-uv93oo8Z Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: 1--131 )3' 4 S a '?5o--1 '+ PID No.: i g' l 4s 9= 36- 0 53- 459- of J NT5 72-013 A (1/93) • MOww IiaecJ W "Tea 1"Q'f 1'�IGLC L DUTTON-. =PFIM : 1.11'1M COIITP.ACTitIF; PHONE t O. . 03177; (Jhr*ifir' irtUing tog 1-1-7.: 1.0F Doc CO, dbk SULLIVAN WATERWELLS P:4. SOX 870272. CIiUr3f AK, ALASKA 98687 • TELEPHONE 2T 59t �,rl DEPTH OF WELL '—__ OWNER OF LAND -� �! ' �/C. �01 .(' L STATIC LEVEL OF WATER PT �— _ _An' ./213/111-55 / DRAW L)OWN FT. -1— ^- LEGAL aESCRIP"fia 1 ` � �� ' r � � `—"'~_ GALS. PER HR EndCd r� /) DATE • Started KIND OF C, ,SING PERMIT NUMBER �- KIND OF FORMATIONt t n Ft. to Ft. % C..0 J 1" From--__ �.,._Ft. to �-+ �t.j �-� -'-- Frum Ft. to _Ft, From — C From.:.: ---Ft. , Ftom_�.-�FL to____Ft. x� From. -1 Ft to r�"—t.�.�-.---�� From 0 Ft.�— From _ Ft. tu__--- Ft to__ ---Ft From -f Ft. to From�..—Ft: to Ft. C)�Ft to Ft. From From.„;Ft. i't.,-�---- Ft. to �1Ft. `, —Ft. to_—Ft• { w,Y (: r LAY ,�?�fl Js�t:. From _.-- Frorn�Ft. toFt,.��.. From----Ft.:to.r---Ft. m From Ft, to Ft'. r T r From- Ft. to --FI o_. ----Ft. -------- From,,--Ft. t r.....,, Ft.t From ----.Ft. Fromr- _pt. to: -Ft. From -----Ft. Ft.�to Ft. From. OCT 81993 From —Ft. Mu( u . n ervices rucipak:y From1 H; cno�rayg Ft. to_ --Ft — ea4t.w& Htrrrh. " ._.--- From --_Ft• Misct . INFORMATION: from—,Ft• t From ..Ft: t From. --•—Ft. Frotn_..—Ft. From From„ ---Ft. to Ft.. - ---� • 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:SW930082 DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC. OWNER NAME:LAND TECHNOLOGIES OWNER ADDRESS:440 W. BENSON STE 103 ANCHORAGE, ALASKA 99503-3845 PARCEL ID:05181145 LEGAL DESCRIPTION: SAMPSON ESTATES BLK 4 LT 13 A LOT SIZE: 40426 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 5/03/93 EXPIRATION DATE: 5/03/94 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 343-4329 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: 1. WAIVER TO BED WIDTH GRANTED. SCARIFY ALL AREAS OF CONTACT WITH EQUIPMENT -.e! 0 RECEIVED BY: DATE: ISSUED BY: /° DATE: GT -3-93 • HENRY WILSON 9601 BUDDY WERNER DR.: ANCHORAGE, AK 99516 (907) 346-2000 April 15, 1993 Constructing Engineers Engineers, Surveyors Municipality of Anchorage On -Site Services Division PO Box 196650 Anchorage, AK, 99519 CHARLES A. LANDERS HC83 BOX 192-A, MYRTLE DR. EAGLE RIVER, AK 99577 (907) 694-9098 Attn: John Smith, P.E. re: Submittal for Septic Permit, L13A B4 Sampson Estates Sub Gentlemen: Attached are plans for a new wastewater absorption system for the subject lot. The lot previously has had two soils tests performed which are the basis for the design. Although we were not the engineers which performed the tests, these tests did meet the MOA requirements for water monitoring. The soils tests indicate a presence of ground water at 7', and we have remeasured the monitoring tubes and found water at 8' in the same hole. The design is based upon the bottom of the bed to be only 2' below grade to allow for increased vertical separation. The normal requirements for area around the test hole require 60' diameter coverage, and since the test holes indicate consistent soil characteristics on the lot, we ask for approval as shown on Drawing 93-S1-06-4. If you have any questions, please contact me at 694-9098. Respectfully submitted, Chuck Landers Constructing Engineers WATER AND WASTEWATER ABSORPTION SYSTEM , 4 a sem,-TxL erg LOT AREA LESS: PERIMETER SETBACKS, BUILDING FOOTPRINT TOTAL AREA AVAILABLE FOR ABSORPTION SYSTEM MO. 1732-g SITE PLAN DETAILS PROPOSED WATER AND WASTEWATER ABSORPTION SYSTEM LOT 13A BLOCK 4 SAMPSON ESTATES SUB PREPARED FOR: MR. PAUL MEYERS 688-1236 PO BOX 670485 CHUGIAK, AK, 99567 SCALE: 1" = 100' DRAWN BY CAL CONSTRUCTING ENGINEERS 346-2000 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 4-12-93 DRAWING # 93—S1-06-4 0 131 C.b. vl Q MON 111 TVE;- ABSORPTION SYSTEM DESIGN DETAILS So' 4"5o �. p F,2om TArv4 5LPC TO 71ZIL)N CCF ANS jiWAY t2o.' FILO (J:1 M2/0. ses Nvice 4 Betow -ospp¢ , CONSTRUCTION NOTES 1. Bottom of Bed to be scarified prior to placing sewer rock. 2. Contractor to minimize use of mechanical equipment on excavated area. 3. Bed to be level + 2" including bottom of bed and distribution latrals. 4. Minimum 2' cover over pipes with 2" HD insulation, or 4' ground cover. 5. Finished installation to be top -soil and seeded. ABSORPTION AREA CALCULATIONS: Minimum Required: 3 Bedrooms x 150gpd/bedroom = 450 gpd capacity Soils rating, proposed addition, 0.3 gpd/sf Minimum sizing: 450 gpd _ 0.3 gpd/sf = 1500 sf absorption area Bed Design: Use 30'W x 50'L bed (minimum) w/ 5 ea 4" Perf pipes on 6' centers, each 44' long. IMPACT ON ADJACENT LOTS: There are no private wells within 100' of this proposed absorption system. The proposed absorption system has no adverse impact upon any adjacent lots as shown on attached site diagram. 50' a. C,FAoe r,. DeA)i 6FC F.Etq 10.19010teli FRl ' 4 5Ee .x,vc 4 gEt,Ow 7Y 00v< obi..,..,, Gt? of � 0 o a 0 2 0 4 v A 1 2' 1 1"0" 16' I 6' I c' I el 31 30' 'C3. iO3:0%11 fixo if 19t ENGINEER'S SEAL PROPOSED LOT 13A PREPARED FOR: NOT TO SCALE DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM BLOCK 4 SAMPSON ESTATES SUB MR. PAUL MEYERS PO BOX 670485 CHUGIAK, AK, 99567 CONSTRUCTING ENGINEERS 346-2000 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 DRAWN BY CAL 4-12-93 DRAWING k 93-S2-06-4 PERH, F Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ED i" OR: 1 a7> t-'1 �.% &-' t;`r-f._- ✓7�'"i'--�� L.i�iii ..2 ownship, Range, Section 12- ` SLOPE SITE -LAN i LEGAL DESCRIPTION: 1s7 12 14 1s - 19 20 COMMENTS NORtEARN Oq 10 .. '4.r1 A. Sheet. : No, 1447-E :.4021re �. DATE PERFORMED: ta$ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? O r 1) jai, -I Geplh 10 wetar Alter 1 Monitoring? 7 Data, s L 0 E mow mot Mar poi jReading 1 Date Gross Time Net TTma Depth to Water Net Drop '7"3 1^' - i't-ice S :' aS - w►,a i Vii' 42:4 1 Lipi' J,t5a1 1a t -n4 "f 4t/&' " +,:35; A . 1 h �9 L... c :a 4'p t Aii1p4 tU PERGCLATION RATE -2^`• tminl es(incn)), PERC HOLE DIAMETER TEST RUN BETWEEN -z /) FT AND ` FT / --•--- t,'. 'i CEa e River / �� :::r- lriN?�D ai103 Eagle River Loop Road No. 2Qq !!!�•-1- "f Eagle River, A isx' a z3937i- ��/, e,-JoRDANCE WITH ALL STATE ANO MUNICIPAL GUIDELINESMfEVFECT ON THIS DATE. DATE - CERTIFY THAT THIS JJEST WAS PERFORMEC- IN �/ 2 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 1 r1 ':RFGRMED FOR: I c7h1 _EGAL DESCRIPTION: 2 (// < 3- �.l k; rft fl a' DATE PE-FOP`O '0.ob* 1 No, 1157•E ."i . IF •V��%r Township, Range, Section;71-i6 k� ' ,� ,rte SLOPE - j SITE.F1.AN: � I � 4 0 6 d 7- 20 H ;Ot.IME';TS $ & S cNGlt c .r WAS GROUND WATER ENCOUNTERED? C d-13 E Dale. 1%r7-i?/1 C7 IF YES, AT WHAT DEPTH? \Ti+ov- flepth In Water Atter Maniloring7 it i II J-1,- If ! Reading pate Gross Net Time Time ' Da th to P Water Net Drop ► V/`°)1." '_: ? ._-- 4 y "` — - 47 `� ' '3 1 3 1:: l,, .., 41 t�,, `- I ),)-1.P la `t1 `' a 1 • •• .2,,c-'... , ,c, -, i /mak 4I.11.JA. I�1i I/4_ ti la J t.© " <T ic r Ti (-4.;!7 PERCOLATION RATE 4-2;2 tmInutes?incn) PER HOLE DIAMETER I 14 tc, TEST RUN BETWEEN FT AND CO FT 'E Rr0Et.'.E[A1gle River, Alaska 99577 Na. 204 CERTIFY THAT Thu TEST )VAS PERFORMED !N --CCORI)ANCE V:ITr+ ALL STATE AND MUNICIPAL GUICEL(Ni1N - FFECT ON THIS DATE. 0A -E: d-004 4i8.5) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O 5 l- Ali 11- 4 5 cosA# O q 01-111 1. GENERAL INFORMATION Expiration Date: a - 10 _ / Complete legal description SAMPSON ESTATES VD; BLOCK 4, LOT 13A Location (site address) 22566 SAMPSON DRIVE * CHUGIAK, AK * 99567 Current Property owner(s) JOSEPH CLAUSER Day phone 947-0651 Mailing address 22566 SAMPSON DRIVE * CHUGIAK, AK • 99567 Lending agency Mailing address Real Estate Agent ANNE ROBERTS W/PRUDENTIAL VISTA Day phone 244-3392 Mailing address 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK * 99577 Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well [♦ Individual Water Storage ❑ Community Class Well 0 Public Water System 0 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer • The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS. P.E. Engineers Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational hie of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions aro 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 therefore not provide any warranty or future estimate of how bng the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. My reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE /Approved for 3 bedrooms. Disapproved. Conditional approval for Phone 337-6179 Date 11 /b'109 o�4p c.• QF oA... gS11 • essr• to 79 3 • OJ d0 taw p,�' .1)16/c.6**• �.Ao 4,Q�profeeefoao 1/4.%\3c . 0F4'. • ON-SITE ` •���. WATER AND • m= WASTEWATER PROGRAM • ;' bedrooms, with the fllowing stipulations:;,Qct•.•• .• Qc if rrs Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Other Original Certificate Date: ) . -) lO - 09 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519.6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST ! Legal Description: SAMPSON ESTATES S/D; BLOCK 4, LOT 13A Parcel ID: OCT"g 1/.", 73 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 7/1993 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depth 162 ft. Cased to 162 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 7/1993 1/30/2009 Static water level 115 ft. 118 ft Well production 40m - 7.75 9•P• gpm. WATER SAMPLE RESULTS: Coliform t0 colonies/100 ml. Nitratel.1 V mg A. Other bacteria l J colonies/100 ml. Arsenic. /JC') ug./L. Date of sample- 10/26/09 Collected by GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material S.T.E.P./STEEL Date installed 10/4/2001 Tank size 1250 gal. Number of Compartments 3 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping 11/2/09 Pumper SANITARY PUMPERS C. ABSORPTION FIELD DATA hSELow EXISTING GRADE SOUTH TRENCH/NORTH TRENCH Date installed 10/3/2001 Soil rating (g.p.d./ft2orV/bdr0_6 System type DUAL TRENCH Length 135 (2 0 67.5)ft. Width 5 ft. Gravel below pipe 1.01 ft• 413.6-4.4/ Total depth 3.8-4.6 ft. Eff. absorption area 770 ft' Monitoring tube YES Depression over field NO Date of adequacy test 1/30/2009 Results (Pass/Fail) PASS For 3 bedrooms 460/470 Fluid depth in absorption field before test 0/0 in Water added 930 gal. • New depth 4/0 in. Elapsed Time: 60 min. Final fluid depth 0/0 in Absorption rate >= 450+ g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed 10/3/01 'Pump on' level at 44 in. Datum BOTTOM OF TANK E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ Size in gallons 1250 YES "Pump off' level at 42 in. High water alarm level at 46 In Cycles tested 3 Meets alarm & circuit requirements? YES Septic tank/lift station on lot Absorption field on lot Public sewer main 100'+ N/A Sewer /septic service line Animal containment areas 25'+ 50'+ Manhole/Access (Y/N) On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas 100'+ 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 5'+ N/A Property line 5'+ Water service line 10'+ Absorption field Surface water Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 0'+ Building foundation 10'+ Water main Water service line 10'+ Surface water 1 00'+ Curtain drain NONE KNOWN F. COMMENTS Wells on adjacent lots 100'+ N/A 100'+ 5'+ 100'+ N/A Driveway, parking/vehicle storage 10'+ G. ENGINEER'S CERTIFICATION 1 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 Date 11I q 109 JEFFREY A. GARNESS 38 �ET 79p3 `SO Dicdpr0 essfoog0 �400001S COSA Fee $ `. 9 0 Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SCS Refit Client Name Project Name/M Client Sample ID Matrix 1095794001 Garness Engineering Group, Ltd Sampson Estates I34,L I3A Sampson Estates O4,L13A Drinking Water Printed Date/Time Collected Date/Time Received Date/Time Technical Director 11/09/2009 9:05 10/26/2009 9:00 10/26/2009 14:25 Stephen C. Ede Sample Remarks: Parameter Results PQL Allowable Prep Analysis Units Method Container ID Limits Date Date !nit Metals by ICP/MS Arsenic Waters Department Total Nitratc/Nitrite-N Microbiology Laboratory Colony Count Total Coliform Fecal Coliform ND 5.00 ug/L EP200.8 C (<10) 10/29/0911/06/09 NRB 1.70 0.100 mg/L SM204500NO3-F 0 (<10) 0 0 0 coV100mL SM20 92220 c01/100mL SM20 92220 co1/100mL SM20 92228 A A A 11/04/09 LCE 10/26/09 DLC 10/26/09 DLC 10/26/09 DLC 4 era,. 4•(/La/6- 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# PetrI0- , Expiration Date- — c. 0 — 0,5r Parcel I D. 051-811-45 1. GENERAL INFORMATION Complete legal description Sampson Estates, Block 4, Lot 11A Location (site address or directions) 22566 Sampson Drive, Chuglak, AK 9%67 Current Property owner(s) Terry & in Osbourn Day phone 688-6665 Mailing address PO Box 771356. Eagle River. AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: __3_ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of Installation. Name of Firm KND FNGINFERING, Inc_ Address 20441 Ptarmigan Blvd., Eagle River, AK 99577 Engineer's Printed Name_Kenneth M. Duffus Engineers Comments: This investigation was completed In compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE V Approved for Disapproved. Conditional approval for 3 bedrooms. Phone (907) 696-6111 Date 1/10/05 141/4'./s :j%' ••• ;;P li i .....fie ..NN Kenneth i '.U' r wArr Ti CE :w?/ t.44114 e�91. F�p OFESSt 1:r bedrooms, with the following stipulations: ON-SITE • •er�' z S' WATERANP `� • WpRo RAMR • Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By. G7i%%7 / W. P Maintenance Agreements% yrturss^I`wfr •_ Supplemental Engineer's Report Other Original Certificate Date' 1 — 2- 0 _0 ii' 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: Sampson Est. B4, L13A Parcel ID: 051-811-45 A. WELL DATA Well type °rivet. If A, B, or C provide PWSID # Well Log (YM) Y Date completed 07/1993 Sanitary seal (Y/N) Y Wires properly protected (Y/N).Y____ Total depth 161 ft. Cased to 161 ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test 7/1993 1/4/2005 Static water level 1 1 5 ft. 1 21 ft. Well production 4 0 g.p.m 7.5 g.p.m. WATER SAMPLE RESULTS: Conform 0 colonies/100 m1.Nitrate 1.53 mg•fl•Other bacteria 0 ,colonies/100 ml. Arsenic: mgJI. Date of sample: 1/4/05 Collected by: KND Engineering. Inc. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC (STEP)/STEEL Date installed 10/04/01 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) 1 Date of pumping 11/03/2004 Pumper SANITARY C. ABSORPTION FIELD DATA Date installed 10/03/01 $oil rating (g.p.d./ft2 or ft°/bdrm) 0.6 System type TRENCH Length 135 (t. Width 5 ft.Gravel below pipe 1.01 ft. Total depth 3.2 ft. Eff. absorption area 770 ftr Monitoring tube y Depression over field )y Date of adequacy test 1/04/2005 Results (Pass/Fall) PASS For3_ bedrooms Fluid depth in absorption field before testp_024 (dn1 in• Water added 450 gal. New depth 2.s & a 5 in. Elapsed Time: •55• min. Final fluid depth 0 (dryl in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. UFT STATION Date installed 10/04/01 Size in gallons 1250 Manhole/Access (Y/N)Y 'Pump on level MS in. 'Pump off' level at 42 in. High water alarm level at 4$._ in. Datum bottom of tank Cycles tested at Meets alarm & circuit requirements?i E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllft station on lot 1001+ Absorption fleld on lot 1001+ Public sewer main 75'+ Sewer /septic service line 25'+ On adjacent lots 100' + On adjacent lots 1 00'+ Public sewer manhole/cleanout Holding tank 1 0 0 + 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line _51± Absorption field 5 + Surface water 100' + Water main 101+ Wells on adjacent Tots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 100+ Building foundation 1 0' + Water Service line 10'+ Surface water 100'+ Curtain drain 501+ Wells on adjacent lots 100' + F. COMMENTS Water service line 1 0' + G. ENGINEER'S CERTIFICATION 1 certify that I have determined through held inspections and review of Municipal records that the above systems am in conformance with MOA HAA guidelines In effect on this date. Engineers Printed Name Kenneth M. Duffus Date 1/10/05 Water main 10' + Driveway, parkinglvehide storage 10 ' + • HAA Fee $430.00 Date of Payment Receipt Number (Rev. 12/01) VPlos- 14,2592 D5 Lot592. kM Waiver Fee $ Date of Payment Receipt Number SURVEY CERTIFICATION PLOT PLAN 1 MM/ ...- M 1 M OAP S, V.I..PPM Iwo « •.w... t•-• « M L Peon Os Ow M « to .M boot/ n,^ PM•••o.•tro r_ wow Raba Pm. M « est 'Ou.IOATION AS -BUILT L Rosin (yn. Jr_ tie, .,NII M I has —spoof Rn..Mt w, MPP MY1M- PP M, « *_t NO IM s-_. « ..MM•,Y, Poo - so Poo « *•-e....._..mon anis ens .booboo. RAC STRUCTURE AS -BUILT ' t •sen .( ase,. Jr_ Poser Potty t1 Pop Saud /so- navy II Vol. OPackto PP Mt OW POI Vs •••••••11,11 « a,.s.aMlM - Mom In So.M «- -- -.00I. *4.odea Sewn .....M. ILOT SURAY • FOVMDA1lo.. AS-Bu(T ❑ MAL STRUCIURC AS -BAIT ❑ PLOT PLAN ... AS -BUILT ... LOT SURA T .. • TOPOGRAPHY A5-Bl'R* .. HQ CORNERS SET ® RICERS/VASQ1 AS -PIAT .. NO CORNERS SET PLOT PLANS & LOT SURVEYS :1 IS THE RESPONSIBILITY OF THE BUILDER OR ONNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. 4011, y • • �.: NS, JR. : Si0 P • BF •• •. 4 _ .• S•C ♦1/ 11 4• ° salons : TI ..�•••• SURVEY TYPE Prepared by Robert E. Johns, Jr. & Assoc. • Professional Land Surveyors 642 E. 12 AVE ANCHORAGE ALASKA 99501 Seals:to Dat. Survey** Dot. Drown: = 40' 1-10-05 L.9.1 D.wptlon: Lot 13A, Block 4 Sampson Estates Subdivision 1-11-05 jN?11560 wO' 2005-1 Roc. Lot S.F. R.c. Plot no No. Drown by: Ch.c.s REJ REJ SYMBOLS • SET REBAR '�• W. DRAINAGE �+O0FOUND REBAR .0-0-0 WOOD FENCE VIA2l ASSUMED ELEV. METAL FENCE1771/ Arr: NOTE: ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE 'AIL- Bt. SHOWN. FENCES, WELLS. SEPTIC CLEANOUTS, SIDEWALKS. DR:vE'AAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. S`::t MAY PREVENT SOME IMPROVESAENTS FROM BEING SEEN AND LOCAT;. ALL DISTANCES ARF__W,FSnRf_ UNI F44 CTTHERW^SE ASP! -A_ cascpcz UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CCNSTRUCTIDN OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAXES RESPONSIBNTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVEY. USTED DISTANCES PREVAIL OVER SCAUNC. REPRODUCTION MAY CAUSE ERRORS IN SCALE. 1-12-05; 11290m; SGS SCS Ref/ Client Name Prefect Plaae/N Mat Sample ID Matrix Sample Remarks: 1050061001 KND Engineering Sampson Est 84, LI3A Sampson Est B4, L I3A Drinking Water ;907 5815301 Alt Daha?Imn are Alaska Printed Date/Vine Collected Data?Ine Received Date/rime Technical Director Re Standard Time 01/11/2005 15:28 01/03/2 115 13:45 01/03 115 15:00 en C. Ede a 2/ 6 Parameter gent Unita Method Waterer Department Nitrate -N Microbiology Laboratory Total Coliform 1.53 0 Container ID Umita Deto Date Inst Allowable Thep Analysis 0.100 rng/L EPA 300.0 B (o-10) col/100,nL 5M20922213 A (o-1) 01/04/05 XM 01/03/05 DKC Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051.811.45 1. HAA # 7/4 0/0 535 Expiration Date: (— / 1 0� GENERAL INFORMATION Complete legal description Sampson Block 4. Lot 13A Location (site address or directions) 22566 Sampson Drive. Peters Creek. AK 99567 Current Property owner(s) Laurie Khmer Day phone 688-7553 Mailing address 22566 Sampson Drive, Peters Creek, AK 99567 Lending agency Mailing address Real Estate Agent Day phone Suzanne Cool - Prudential Vista Day phone 2424330 Mailing Address 16635 Centerfield Drive. Eagle River. AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND Engineering Address 20441 Ptarmigan Blvd. Eagle River. AK. 99577 Engineer's Printed Name Kenneth M. Duffus 5. DSD SIGNATURE Approved for _ Ri bedrooms. Disapproved. Phone 696-6111 Date 10/10/01 = iS....OF•q?g3,1!! •t?GIh, %SP'4 br *� •._,: . .• ••••• •••r 00000 c'. Kamo.n,,,...,r:c. ei:A • CE 711.5 •+/ t,, it0 ROFEssOnlOr e Conditional approval for bedrooms, with the following stipulations: k<<t\�Fr 11 OF l`Pf\Q•- nu err p� •-9 Additional Comments WATER AND ; r^ WASTEWATER . PROGRAM Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory BYe4 (n.v. 12100) �• ,moo e/( Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: / 0 —1/ — O / Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 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 Sampson Estates Lot 13A. Block 4 A. WELL DATA Well type crNate If A, B, or C provide PWSID # _ Well Log (Y/N) Yes Date completed 0711991 Sanitary seal (WN) 7!3 Wires properly protected (WN) Yes Total depth 161 ft. Cased to 191 ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test 7193 7123/2001 Static water level 115 ft. 117 ft. Well production 40 g.p.m 10 g.p.m. WATER SAMPLE RESULTS: Cditorm _g_colonies/100 mi. NitratejL mg.A. Other bacteria] colonies/100m1 Date of sample: 10105101 Collected by: KND Engineering B. SEPTIC/HOLDING TANK DMA Tank Type/Material Anchorage STEP 1 Steel Date installed 10/04191 Tank size JILL gal. Number of Compartments 2 Cleanouts yaFoundatIon cleanout Yes Depression over tank yq,HIgh water alarm Yu Date of pumping New tank Pumper C. ABSORPTION FIELD DATA Date installed 10103101 Sol rating (g.p.d./ftor ft2/bdrm) Q,¢ System type ShafowTrench Length 135 ft. Width .5 ft. Gravel below pipe SQL ft. Total depth I/ ft. Eff. absorption area 770 ft2 Monitoring tube Yes Depression over field 149 Date of adequacy test NA -new System Results (Pass/Fail) Pass For I_ bedrooms Fluid depth In absorption field before test _ in. Water added_ gal. • New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes. give date Parcel ID: 051411-45 D. LIFT STATION Date installed 10/0412001 Size in gallons 1250 Manhole/Access (Y/N) Yes 'Pump on" level at in. 'Pump off" level at 42 in.High water alarm level at 48 in. Datum Bottom of tank Cydes tested 3 Meets alarm & circuit requirements? Yes E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main 751+ On adjacent Tots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout 1001+ Sewer /septic service line 25'+ Holding tank 100'. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line ,., Water main 1Q'+ Water service line 10'. Wells on adjacent Tots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'. Building foundation 10'+ Water Service line 101+ Surface water 1001+ Curtain drain 501+ F. COMMENTS Wells on adjacent Tots 1001+ Absorption field V. Surface water 100'. Water main 10'+ Driveway, part ing/vehide storage 25'. G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Kenneth M. Duffus Date 10110101 �PL 01? t •(.••.«..••. ti•4st11 • .••• ~� , : MN 04 G ♦'ST47ILts HAA Fee $300 Date of Payment 10/10/2001 Receipt Number 11106?4, (Rev. 72/00) Waiver Fee $ Date of Payment Receipt Number OCT -10-01 17:09 FROU-CT&E ENVIRONMENTAL SRV CT&E Ref.# Client Name Project Name/N Client Sample ID Matrix Ordered By PW S1D Sample Remarks: CT&E Environmental Services Inc. 1016849001 KND Engineering Sampson Est 134, L13A Sampson Est 134,1.13* Drinking Water 0 9075615301 T-589 P.01/02 F-034 Client PON Printed Date/Tlme Collected Date/Time Received Date/Time Technical Dieeetor Released �y /' 10/10/2001 17:00 10/05/2001 15:00 10/05/2001 16:10 Stephen C. Edo Parameter Results PQL Units Method Allowable Prep Limits Date Analysis Date Inst dna Department Nitrate -N Microbiology Laboratory Total Coliform 1.09 1 OD, No Coli 0.500 mg/L EPA 300.0 col/100ml. S11418 92229 (<10) (<1) 10/05/01 SCL 10/05/01 KAP MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D # C)S I �l (4/5 HAA # 'Sol°1 /2")(1(nA.4 1. GENERAL INFORMATION Complete legal description L t 3 A $k 4 5a•-1.pso-k C-5 42ies Location (site address or directions) Sarapsorx Property owner M M M Cca^ Day phone 6 8 8— IZ3 Mailing address P" tau 6� 0495 ) C-zk( J4-1 9956 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA t21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. CsFjnsin' u c r Ge -9 Name of Firm S o1 Budd Werr,2•-Pv chso,-'2.. .JFK .99510' 4040,4 Address Engineer's signature 6. DHHS t—'— SIGNATURE � Approved for Disapproved. Conditional approval for ne�vS oci/9"1 909$ Nc $ j Pox (�Phon fr t—E 04x, 9 9572 bedrooms. bedrooms, with the following stipulations: Additional Comments Date /69/233 CAUTION The Municipality of Anchorage Department of Health an Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representation:; given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS doe:. is as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain fede nd state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate: is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L13A 4 Sflmvsbu �s Parcell.D. oSI 81 145 A. Well Data Well type p '\V 7c" If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) y Date completed -7-93 Driller 51-)1111-,"a+. Azie,.We1s Total depth I G I Cased to 161 Casing height Z Sanitary seal (Y/N) Y Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION Date of test -7-93 Static water level I I S Well flow 4o g.p.m. Pump levell MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION g.p m. OCT 071993 RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 167 ; On adjacent lots rl cx� Absorption field on lot I0 ; On adjacent Tots tt00' Public sewer main +-Zoo Public sewer manhole/cleanout -1-Zoo' Sewer service line rloa Petroleum tank -Ft oo' WATER SAMPLE RESULTS: Coliform 4 Nitrate 61.7Other bacteria Date of sample: 8 3 i-93 Collected by: ' Sr ^"�'^� C �' ^ B. SEPTIC/HOLDING TANK DATA Date installed 7- 95 Tank size Ippa Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N Alarm tested (Y/N) Date of pumping NC`-) SySIE \ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I O -7 On adjacent lots -Hoc;Foundation 5 To property line Ss' Absorption field 7` 1P[a#er-rata' service lin Surface water/drainage -Hoc) ' 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 % ump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DIST • FROM LIFT STATION TO: On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 7-93 Soil rating (GPD/Ft2) 6 3 System type BEP Length 5' Width Z9, 3a(i''c--z�•s1 / Gravel thickness Total depth d bk- j p - Total absorption area I So or Cleanout present (Y/N) Y Depression over field (Y/N) t•-) Date of adequacy test "SY `' "SmThResults (pass/fail) _ ^' ° for — Bedrooms Water level in absorption field before test N..) A After test Peroxide treatment (past 12 months) (Y/N) N H If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / b4 ' On adjacent Tots ) 00 Property Zine is To building foundation I S To existing or abandoned system on lot NA On adjacent lots +30Cutbank +So' Water main/service Zine 40 ' Surface water +t oo' Driveway, parking/vehicle storage area Curtain drain -1-tooL E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effectere4 sghgpection. f%. d,° 1 ° sr• b 41; Signature � •40rr�� Err n .:. ti, RAlYfi;N ?0k Nft011 es r*r 0.19 Juror 22. 1463 � r8 Engineer's Name Go.v1T. �ic%j�Cl Date /0 5 y 3. 0� i -IAA Fee $ ,30c) Waiver Fee $ Date of Payment Receipt Number Date of Payment Receipt Number 72-026 (3/93)* Back l4 ' 7 -7-3 �2 s ---3o zIt CO s_ NOR HER 3330 INDUSTR AL AVENUE 2505 FAIRBANKS ST. EST NIG ABOR ORIES 1 FAIRBANKS, ALASKA 99701 ANCHORAGE, ALASKA 99503 INC. 907-456-3116 907-277-8378 Constructing Engineers 9601 Buddy Werner Drive Anchorage AK 99516 Attn: - Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: Method Parameter F127775 L13AB4 Sampson Est Water Units Report Date: 09/13/93 Date Arrived: Date Sampled: Time Sampled: Collected By: 09/02/93 08/31/93 1530 CL MDL = Method Detection Limit * Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. Date Date Results * MDL Prepared Analyzed EPA 353.3 Nitrate -N Reported By: Patricia Woody Senior Chemist mg/1 0.79 0.05 09/11/93