HomeMy WebLinkAboutSAMPSON ESTATES BLK 4 LT 4Sampson
Estates
Block 4
Lot 4
#051-811
-O9
.~) Municipality of Anchorage
Development Services Department "'~ '~°,
Building Safety Divlsk:m..~,..~:,---.-
On-Site Water & Wastewater Program, 4700 South Bmgaw SL
www.ci.anchorage.ak.us (907) 343-790~ Page 1 of
On-SEe Waetewater Disposal System and/or Well Inspection Report
Permit Number:. $W010442 PID Number:. 051-811-09
Name: TIMOTHY PAGE c/o PRUDENTIAL VISTA Westewater System: D New · Upgrade
ATTENTION: LES BAILEY
~e635 CENTCRnEL~ eR. * ~C£ R~R. AK 9~577 ABSORPTION FIELD
(907) 689-6464- 4 13Deep Trench · Shello. Trench abed nMouml 130~her
LEGAL DESCRIPTION ~' ~'~ o.$ ~/~. 5.5 - 6.0
4 4 SAMPSON ESTATES 2.5 - .3.0 ~t
SEE DWG. r~ 124' TOTAL (20 62')
WELL: D New I-1 Upgrade 5.0 ,. 2
...-' n. r~ 1069 s~.,. D 3054/ F-810
n. EAGLE MTN. EXC. 11/2-5/2001
,, ,,. TANK
SEPARATION DISTANCES ·s.~ a,o~,,,g as.~z.,.
From Tank Station Tank s,,. u,,. ANCHORAGE TANK 1250
Well 100'+ 100'+ - - 25'+ ~ STEEL ~ e ~ 2
s~,~o~, wot,, 1ua'+ lOO'. - - - LIFT STATION
~"- ~'+.,' - - - '""-I' --
~o~.~o,o. ~.+1o. _ _ _ --.----.~...~-I---.~
Curtain Drain ,. NONE KNO'~P'"~'~_~.-~'*"~ I,~ee~ ~ ~
I
~er~ar~,: 'SEE ~.OZ UNO W~, tW,O~OOS? BENCH MARK
BOTFOM OF DECK ~ POINT
100.00
WWO.,NC.
~oa 11/~-s/o~ "'~':~ .... i';;~..;;> .........
e~d 11/6/Ol ~y. ~ I.(. ................
, _ ~ · ,' IA% Gan less.-'
Department of Health.. and Human Services a. pproval. . ~t...... c [ -?'~- ...-'.,,,...,,~
R~vlewed and approved bY--ate. //- I ~ - O/ ~'~[°"' ' ............. '"°~"~'
AS BUILT DRAWING
SW010442 - 051-811-09
SP~ER (~) ~I~ING D~N~ELD TO B~
~s * s ENO. /USED ~ A R[SE~ ShE.
T~ .OL[ ~
~ (~PROX.LO~T~ON)~ - /~
[ t ~ / D~ER (~) ~ ~EXI~NC
N~ D~NR~DS~ ~ ~~ ~ .... '~ ~ 4 BEDROOM
rco ~.9 - - ~ ~V ~':'u~ ~_t~o~o~1 ~/ .,
s~ ~.~ ~.~ ~.o ~ ~V'::.".._'::' .;?~ ~
~DB~ ~4.0 14.3 43.1 . .,
FS 42.~ -- 74.9 · -
C02 42.1 - 75.5
C05 12.0 10.6 -~
MT1 11.2 12.3 -- ~ ~ ~ ~ ~ ~
C04 72.1 -- 92.5
MT2 69.9 -- 92.1
C05 15.1 26.0 -- ~' ~
MT5 14.4 25.5 --
C06 73,~ -- 104.0
MT4 69.1 -- 99.9 ~
~/~/2oo~ ~c
CONSULTANTS, INC.'
6~,~r~e~GE,~S~e~[~I~I~I9.FU~901~2~ 1' - 30' l, ~..% t.% .......
TIMOW PAGE (907) 688-0580 2 OF 3 ~_ ,, ~}"~y~.. G~:
LOT 4, BLOCK 4; SAMPSON ESTATES SUBDIVISION ~/~ ...U ....
- ........
AS-BUILT OF SEPTIC SYSTEM UPGRADE
pERId~ NUMBER: AS B'L~../T D:~~G pARC'EI,~D NUMBE~
SW010442 - 051-811-09
IWEST TRENCHI I~T TRENCHI
~S~ WATER & WASTE~TER ~ ', . ·
TIMO~ PAGE (:907) 688-0580
LOT 4. BLOCK 4; SAMPSON ESTATES SUBDIVISION
PROFILE AS-BUILT OF SEPTIC SYSTEM UPGRADE .~
MUNICIPALITY OF ANCHORAGE
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
Date Issued: Oct 18, 2001
Expiration Date: Oct 18, 2002
Permit Number: SW010442
'~egal Description: SAMPSON ESTATES BLK 4 LT 4
Design Engineer: 0041 AK Water & Wastewater Consultan'
Owner Name: Timothy Page
Owner Address: PO BOX 670332 Total Bedrooms: 4
CHUGIAK, AK 99567-0332
Parcel ID: 051-811-09
Site Address: 022662 SAMPSON DR
Lot Size: 41477 SQ. FT.
Permit Bedrooms: 4
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 ( 18AAC72 ) and Drinking Water Regulations ( 18MC80 ).
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.
Issued By:
Date:
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Sitc Water and Wastcwater Program
4700 Btagaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Waiver Review Worksheet
WRY: WR010087 PIDg: 051-811-09 HA~:
Date Received: 10~t2/01
Legal Description: ~m~son Estates Block 4 Lot 4
Engineer:..,leffmv A Garness PE
p, laska Water & Wastewatar Consultants
Applicant: 'rimothv Paoe
Waiver Requested: 1 f~mt from lot line to absomtlon bed
Criteria: Geology
A. Water Table
B. Soil Sorpfion
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Permit#:
Points:
Waiver Is Granted: ~ Waiver Is not Granted:
List Conditions or Reasons for above: ~'~ ~-
p A/
Name of Reviewer
Rec~: 11428 Amount: $t15.00 Date Paid: t0112/2001
Municipality of Anchorage
P.O. Box 196650 * 4700 S. Bragaw Strcct
Anchorage, Maska 99519-6650 * (907) ~3-8301
http://~'~'w.cl.anchoragc.ak.us
10/18/2001
Jeffrey A. Garness, PE
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B
Anchorage, Alaska 99504
Subject:
Waiver Request for Sampson E~tates Block 4 Lot 4
Waiver Request #WR010087
Parcel ID//051-811-09
Construction Permit Number SW010442
Public Works
Dear Mr. Gamess:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
1.0 foot.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site waste~vater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Water & Wastewater Program
Municipality of Anchorage
Development Services Department
Bullding Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 N,z:horage, AK 99519-6650
www.cl.anchomge.ak, us
(907) 343-7g04
ON-SITE SEWER/WELL PERMIT .b, PPLICATION
FOR ~, SINGLE FAHILY DWELLING
Parcel I.D. 051-811-09
Permit Number
Property owner(s)
Mailing address (1)
TIMOTHY PAG[
22662 SAMPSON DRIVE * CHUG~AK, AK
Day phone
Mailing address (2)
~pCocle 995§7
Legal description (Lot, Block & Sub'd.) SAMPSON ESTATES SUBDMSION: LOT 4. I~LOCK 4~
Legal description (Section, Townshlp & Range)
Lot Size ~1"'17 7 Acr~
THIS APPUCATION IS FOR."
Sewer Only ~]
Sewer and Well
Sewer Upgrade ·
N/A
Number of Beclroome
Well Only
Water Storage
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Jec
Water Softening Unit
I certify that the above Information is correct. I fudher certify that this application Is being made for a
Single Family Dwelling and Is in accordance with applicable Municipal codes.
ALASKA WATER & WASTEWATER CONSULTAkrTS, INC.
Permit Fees:. ~3 ~,~, C~O
Date of Payment: 10- I~'Ot
Receipt Number:. ~ I t1-,~. ~
Waiver Fees: ~ ~ ~. ~ - ~
Date of Payment: /4~)-/c~ -<::2/
Receipt Number:. ///'/' ~'
ALASIG WATER & WASTEWATER
CONSULTANTS, INC.
October 10, 2001
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650,
Anchorage, Alaska 99519-6650
Reft Proposed Septic Upgrade for Lots 4, Block 4; Sampson Estates Subdivision
To whom it may concern:
The existing 4 bedroom house is served by a private well and septic system. The existing septic
system consists of a 1250 gallon septic tank and a bed type drainfleld. The drainfield is in a state
of failure and must be upgraded prior to the sale of the house. A test hole was excavated in the
area of the proposed septic upgrade by S&S Engineering. The septic system will be designed
around the 30 foot radius of this test hole. We are proposing that the exising 1250 gallon septic
tank be excvated and the integrity verified. If of good integrity, install a 500 gallon lift station
(with dual outlets) as shown on the design drawing. If of poor integrity, install a new 1500 gallon
S.T.E.P. tank with dual outlets in place of the existing tank and a 500 gallon lift station. We are
also proposing that a dual 5-wide trench pressurized type drainfield be installed. Comments
regarding the proposed design are summarized as follows:
1. SOILS: See the attached logs .which shows the soil classifications, groundwater monitoring~
and the percolation test results. It :s our opinion that an application rate of 0.6 gallons/day/ft'
should be used.
2. TRENCH DESIGN:
a. Pemolation Rate: 27 minutes/inch
b. Allowable Application Rate: 0.6 gallons/day/ft2
c. Number of Bedrooms: 4
d. Design Flow: 600+ gallons per day
e. Minimum Absorption Area: I000 ft2
f. Total Depth: 6.0 feet (max.)
g. Effective Depth: 3
h. Width: 5.0 feet
i. Minimum Length: 120 feet total length (2 ~ 60' long each)
j Effective absorption area = 1034 ft2
k. Reduction Factor: 0.58
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
3. SURFACE WATERS: There is no surface water within 100 feet of the proposed septic
system.
4. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography in
the area of the proposed upgrade is generally flat and then slopes near the end of the proposed
drainfield; in short, there are no slope concerns.
5. LOT LINE WAIVER: We request that a 1 foot lot line waiver be issued, we are unaxvare
of any advers impacts this waiver would have on adjacent lots.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
Sincerely
NOTE: .,lttached is a site plan drawing, a design drawing, 1 soils logs, and a 7 page
construction specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
~,~.-/ ..~ .-
~~" / ~L~,~-¢--.~
~~-~i /
'~ ',:'X"~, .4-"~~ ~',~" X ,/
,~ ~: ~-~..,. , .... ~ ~,,
J.LM. ~.' ~ /I I~'.~,
~S~ WATER & ~TE~VATER
TIMOTHY PAGE 688-0580
LOT 4, BLOCK 4; SAUPSON ESTATES SU.D~VlS~ON
SITE P~N FOR SEPTIC SYSTEM UPGRADE
/ \ / ~IOTE: THE CONTRACTOR SHALL HAVE THE 100 FOOT
/ \ / NELL RADIUS AND THE WEST PROPERTY UNE FLACGEC
. \ .~ 5Y A R£GISTE:RED LAND SURVEYOR PRIOR TO ANY
/ ~ ~ ~/~ / ~ ~ 1~ S.T.~P. T~K ~ O~ O~
~VA~ ~ ~'~T
~H 020 *~ ~T~)~~t
~ ~~ s6~':~-,'
A~S~ ~TER & WASTEWATER J.L.M.
.o,~-~..~...-~... ~,~...,~,~,,.,,...~.o,~.,.,.~°~[~"~"~' ~:,- = ~o..~'rz:q'~¢ ~z~. ......v.~:~
x~uomY PAGE ~-0S~o
DESIGN OF SEPTIC SYSTEM UPGRADE °fes~l°°~
Municipality of Anchorage Page
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
Address:
Phone: No. of Be~:~oms: [] Deep Trench [] Shallow Trench /,~ed [] Mound [] Other
LEGAL DESCRIPTION soil Rating: 6,~rGPD/Sq. Ft. Total Depth from original ~'grade:
Township: Range: Section: Fill added above original grade: Gravel length: ~, /'
Number of lines: Distance between ~nes:
cation(Private. A.S.C): Total Depth: Cased To: Total absorption area: Pipe material: ~J~'~t~
Yield:GPM Pump Set at: Ft. Casing Height Above Ground: Ft. TANK
SEPARATION DISTANCES ;l~'Septic [] Holding [] S.T.E.P.
To Septic Absorption Lift Holding Public/Private Manufacturer: Ca'pacit~, in gallons:
Surface
LineL°t ~.~l x ~..~ / ~ ~ ~ Size in gallons: Manufacturer~,~
Foundation jz~ ~ ,~..) ! ...-.---- ~ ~ "Pump on" level at.Pump off" level at: High water alarm at:
CurtainDrain '---'----~.[ ~ ~1~,-~ ~.~ ~ ~ j~ ~ ~ ~ump Make &,~ Electrical Inspections performed by:
Remarks: BENCH MARK
~ Location and Description:
IAssumed Elevati°n:
ENGINEER'S SEAL
Department of Health and Human Services approval ~)%% N;;8¢~
72-013 (1/91)MOA25
erlifieh rilling
DOC Co.
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
LEGAL DESCRIPTIo " '
st, nc ~v~L oF w.,t~, F'r. ~ _
~.^w oow~ F~..
XinU) OF C^S~G ~C} L)
KIND OF FORMATION:
From ('J Ft to~_~*. ~' '~
, ~ . --Ft. {~d ~V'7"'~ C" d~C)/) From ~. - Ft. to -- Ft.
From ,:t, Ft. to <'/ Ft. ~ O~g~_.~'OA~r~eF,~j
~ Fro~ Ft. to Ft.
~ ~ ~-r_~ / From ~
~-~ '~ - ~.. , From Ft. Io Ft.
Fr°m~'~Ft't°/i~' Ft. ~00 ~: ~ ~(~(~ From _F/.to ~Ft.
Fr°m~Ft. to__Ft, c'- ~
. ~ ..~om~.
"~'"' ~, ,. . ,- ~ ~From
~ _ j ~ ...... ~.~ _Ft. to Ft.
From Ft. to--__Ft. ~ /~:'/~
Fr°m~Ft. to --Ft.
From Ft. tofft
Fr°m~Ft. tO__Ft.
Fr°m~Ft. to_~.~Ft.
From_ ~Ft. to__Ft.
MISCL. INFORMATION:
From ~Ft. to____~..pff~ _LS_~. 9 9_9~
~,- r~ealth & Human Services
Fr°m~Ft. to__Ft._
Fr°m~Ft. to__Ft.
Fr°m~Ft. to _Ft.
Fr°m~Ft. tofft
· ) ! ~ ,
DRILLER'S NAME .-;'., ,,,t ~ ~-' .......
' Permit No. ~!/.-J ~ ~ ~- Page '~- of ~
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:
$ 8~ S ENGINEERING
7034 Eagle River LoOp Roa~
Eagl~ River, Alaska 99577.
72-013 A (2/91) MOA 25
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
SLOPE SITE PLAN
3
4
5
6
7
8
9
10
11
12
13
14-
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~)
DEPTH? p
E
Depth to Water Aller
Monitoring? Date:
COMMENTS
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE / ~ (minutes/inch) PERC HOLE DIAMETER __
TEST RUN.ETWEEN .TAND .T
I
ACCORDANCE WITH~L~J.J~'~-~F~-~AJ~Ij~J~I~j~I~ GUIDELINES IN El-P:-',.,, DATE. DATE:
72-008 (Rev. 4/85)
PAGE 1 OF 1
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:SW920052
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:SLAYMAKER RONALD F &
OWNER ADDRESS: 5761 SILVERADO WAY
ANCHORAGE, AK 99518
DATE ISSUED: 4/10/92
EXPIRATION DATE: 4/10/93
PARCEL ID:05181109
LEGAL DESCRIPTION: SAMPSON ESTATES BLK 4 LT 4
LOT SIZE: 41477 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
~/ 1. THE WELL ON THIS LOT WAS DRILLED WITHOUT A VALID WELL
PERMIT ON 4/7/92, AND A CITATION WAS ISSUED ON 4/10/92
TO THE OWNER AND TO THE WELL DRILLER. THE WELL LOG MUST
BE PROVIDED TO THIS OFFICE BEFORE THE AS-BUILT DRAWING
WILL BE APPROVED_
,' 2. THE GP SOIL STRATUM FROM 1.0 TO 6.0 FEET IN WHICH THE
BED IS TO BE INSTALLED MUST BE PERC TESTED DURING THE
BED INSTALLATION TO ASSURE~-TH~T THIS STRATUM PERCS NO
MORE THAN 30 MI~INCH. //'
RECEIVED BY: ~ /:~ DATE:
April 7, 1992
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, AK 99519-6650
REFERENCE: Sampson Estates, Block 4, Lot 4
We request you issue a permit to drill a well and install a
septic system to serve the proposed 4 bedroom house on the
referenced property.
Test holes were performed on the property on March 30, 1992.
The approximate location of the test holes are located on the
attached site plan. The monitoring tubes within the holes'
have been checked and found to be dry.
This property has enough area for a septic upgrade which can
be seen on the attached site plan. We do not anticipate any
adverse effects on neighboring properties by the installation
of the proposed septic system.
If you have any questions, or require additional information
for your review, please contact us.
Sincerely,
Roger J.
RJS/lsu
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
I"= 40'
SCALE
fT'-
/0¢
30'
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: '~"'~L.-~')~- ~r; ~ ..,~"~'~1~ ' Township, Range, Section:
- ' ~ SLOPE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
WAS GROUND WATER d ~-~.
ENCOUNTERED?
L
IF YES, AT WHAT O
DEPTH? P
E
Monilorin6? ~/~¢--' I OaLe: ~ ~
SITE PLAN
I
Gross Net Depth toNet
Reading Date Time Time Water Drop
~ 4/,l'~Z- ~:rr~ ~ ~'/~'
.~ ~ i:~o' '~,,~ a-.W,," ~/~"
~,~ ,, ~I~" ~1~,,
,,
~ I ~ " "
PERCOLATION RATE '~-~ (minutes/inch} PERC HOLE DIAMETER
TESTRUN ETWEEN r'&TAND
]7034 Ea~le River Loop Ro~d No,~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
PERFORMED BY: Z,~ie ~,ver, Alaska 99577
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
I
2
3
4
5
6
7
8
9
10
11
12
13
14
15--
16
17
18
19
2o
DATE PERFORMED:
Township, Range, Section:
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
SITE PLAN
Monitorin0? _ 1~/~'(~'/ Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
;~ ,r~ ~','~ ~'~p." ~!~"
~ ~ i0~,,0 ~'/¢" '1~''
PERFORMED BY: 17034 Eagle River [,eop Eoa~ NO, '~(1~_ ~'-~,/~/'~ CERTIFY THAT TH~S TEST WAS PERFORMED IN
ACCORDANCE WITH ALL ELINES IN EFFECT ON JS DATE. DATE: ~--l-~-
72-008 (Rev. 4/85)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and 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. 051-811-09
Expiration Date: / ~ '"
GENERAL INFORMATION
Complete legal description SAMPSON ESTATES BLOCK 4, LOT 4:
Location (site address) 22662 SAMPSON DRIVE, CHUGIAK, Ag: 99567
Current Property owner(s) GORDON P. HANES Day phone
Mailing address 4964 OAK POINT DRIVE, SHREVEPORT, LA 71107
Lending agency Day phone
Mailing address
Real Estate Agent LES BAILEY & ASSOC. Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OFBEDROOMS:
TYPE OF WATERSUPPLY:
Individual Well r ~
Individual Water Storage []
CommUnity ClaSs ~ Well []
Public, Water' System []
4
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 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 Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792
Address 20141 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 09/20/2010
Engineer's 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 inland 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,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
DSD SIGNATURE
t.~'~'/Approved for ~)L
Disapproved.
bedrooms.
J;
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: ~
(Rev 11/05)
Original Certificate Date:
Municipality of Anchorage
Development Se ices Department
BuildingSafety Divjsion
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 BLOCK 4, LOT 4
A. WELL DATA
Well type~~ IfA, ,B, or Cprovid~-PWSl'D # We!l' L0g:(~/N).~
Date cOmpleted 4/1992
Total depth 140;7 fl.
Sanitary seal (Y/N)~
Cased to 1~1.7 ft.
FROM WELL LOG
Date of test 4/1_992
Static water level I14 ft.
Well production 20 g,p.m.
WATER SAMPLE RESULTS:
Coliform NF.G colonieS/100mLNitrate 5.68 mg/L
Wires properly Protected (Y/N)'X
Casing height (above ground) 24+ in.
AT INSPECTION
s/3!/2(no
120 ft.
6,5+ g.p.m.
C. ABSORPTION FIELD DATA
Date installed 1!/~5/0i ' Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 System type ,5 Wide Trench
Length 2 x 62 ft. Width --5 ft. Gravel below pipe 3 ft. Total depth 7.3- 9.1 ft.
Eft. absorption area 1069 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 8/3~2010
Fluid depth in absorption field before test __
Elapsed Time: 125 min. Final fluid depth
Results (Pass/Fail) Pass For 4__ bedrOoms
7 & 0 in. Water added 680 gal. New depth 11
7 & 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N__lf yes, give date --
in.
Tank:T~pelMateriai SePtic/Steel Date installed 11/2-5/2~ Tank size 1250 gal.
· Number of Compartments _2 Cleanouts (Y/N) X Foundation cleanout (Y/N) ___'Depression over tank (Y/N) _N
High water alarm (Y/N) N Date of pumping 8/30/10 Pumper Sa~ita~
Parcel ID: 051-811-09
Arsenic: ND .mg/I Date of sample: 9/1/2010 Collected by: ArcTerra
B. sEpTIC/HOLDING TANK DATA
LIFT STATION
Date installed'
"Pump on" level at __in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at
Cycles tested
Manhole/Access (Y/N).
High water alarm level at in.
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Abso~tion 'field on lot 100'+
Public sewer main 75'+
Animal containment areas
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer mar~hole/cleanout 100,+
Manure/animal excrete storage areas 1017+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation $'+ Property line 5'+
Water main 10'+ Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '1'+ Building foundation 10'+
Water Service line 10'+ Surface water !00'+
Curtain drain 50'+ (None
COMMENTS
Absorption field 5'+
Surface water 100'+
Water main llY+
Driveway. parking/vehicle storage,
Wells on adjacent lots I00'+
LOT LINE WAIVER #WR010087
G. ENGINEER'S CERTIFICATION
, certify the!l have determined through field inspections and
review of Municipal m~s that the above systems are in
EngineersPrintedName ,~ ~ENN~.~.DU~S
DMe 09/20~10
COSA Fee $490.00
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # 101220
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 4, Lot 4 of
Sampson Estates subdivision. This inspection revealed a nitrate
concentration of 5.68 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate. -
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
BOLS
SURVE ~' CERTiF CAT~ON
Prepared by
9/t 5/10
9/1610
i NWt560, .... 1272
SAMPSON ESTATES
BLOCK 4 LOT 4
· SGS Ref.# 1104570001
Client Name ArcTerra Engineering and Surveying Printed Date/Time 09/07/2010 16:27
Project Name/# Sampson Estates Block 4, Lot 4 Collected Date/Time 09/01/2010 13:55
Client Sample ID Sampson Estates Block 4, Lot 4 Received Date/Time 09/01/2010 15:53
Matrix Drinking Water Technical Director Stephen C. Ede
PWSID 0
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 09/02/10 09/03/10 NRB
Waters Department
Total Nitrate/Nitrite-N
5.68 0.100 mg/L SM204500NO3-F B (<10) 09/02/10 AYC
Microbio local Laboratory
E. Coli
Total Coliform
Negative 1 100mL SM20 9223B A 09/01/10 DLC
Negative 1 100mL SM20 9223B A 09/01/10 DLC
Municipality of Anchorage
Development Services Department
Building Safety DIv~lon
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
ParcelI.D. 051-811-09
1. GENERAL INFORMATION
Expiration Date:
Complete legal description ~LOT 4, BLOCK 4; SAMPSON ESTATES SUBDMSION
Location (site address or directions) 22662 SAMPSON DRIVE * CHUCIAK~ AK
Currant Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
TIMOTHY PACE Day phone
c/o LES BAILEY w/ PRUDENTIAL VISTA
Day phone
LES BAILEY w,/ PRUDENTIAL VISTA Dayphone 689-6464
16635 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577 ' :
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OFWATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WAS P-WATER 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 (HA, A) based only upon the representations given In paragraph 5 by an Independent professional cml
engineer registered tn the State of Alaska. Certificates of Health Authority Approval are required for the lransfer
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. Certificetes 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 fora period of
up to one year with valid water samples.) Certificates ara 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.
Note: Alaska Water end Wastawatar Consultants, Inc. shall be paid $ ~7-/ O"--at, or pdor J
to dosing for the engineering san/ices provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto end es of the validation date shown below, I verify that my
Invastigab'on, based on procedures outlined In the Health Authority Approval Guidelines for this application,
shows that the on-site water supply end/or wastawatar disposal system Is(are) safe, functional and edequata
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 end from my investigation and inspection, the
on-site water supply end/or wastawatar disposal system Is(ere) in compliance trtffh alt applicable Municipal
and State codes, ordinances, and regulations In effect at the time of lnstallab'on.
Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone
Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE, AK 99504.
Engineer's Pdntad Name JEFFREY A. CARNESS. P.E.
Date
557-6179
Engineer's Comments:
In condu~Jng this evalua~xt, AWWC, Inc. attempted to pmvfde e bXm=ugh,
conscisnfous engineering analysis of the ~y~tem In accorcisnse wRh ADEC end MOA
DSD Guidelines & Regulations. The mp~led results descn'bed the perfo~nance of the
system under the conditt~ts encountered et the time of the tes~, end separation
d/stances measured ~o mad#y Identifiabis foatum& The operaEonal li~ of eft wells end
septic ~Tstems depend on the Iocal sells co~di~ton, groundwater levels that may
Ifuctuete during the year, end the water usage of ~he family being serwd by the system.
The~e cond/tlon$ am outside the conbol of the evalue~' of the system. Satisfactory tosf
results do no~ guarantee future pe~ormense of ~ system, nor do they guarantee that
there em r~o hidden defoc~ er encroachments. A WWC, Inc. can therefore not provlde
any warranty er fufum estimate of how long the system will continue to meet the
operattonal fequlmments of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner ~isted above. A~y mltence upon er use of this report by any
o~her pe~on ot party Is not authorized, r~r will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for /_iL
Disapproved.
Conditional approval for
bedrooms, with the fllowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advlsory
Manitenance Agreements
Supplemental Engineer's Reort
Other
.,.?.:~'"". · ' '..
ON-SITE '. ¢
· WASTE-WATER.
odoinal Ce cate Date:
Municipality of Anchorage
Development Services Department
Bulkllng Si~e¥ Olvtalm
On.,.Rlte Water & Waatmva~' Program
4700 ~u~ emgaw St
P.O. Box 196650.*achomge, AK g95~ 9.66_ ~
WELL DATA
Well type IqWA~;
Date completed 4/I 992
Total deplh ~4o'-8' lt.
HEALTH AUTHORITY APPROVAL CHECKLIST
LOT 4, BLOCK 4; SAMPSON r.~iAlr.~ SUBDMSION Pa~cellD:_ 051-811-09
ifA, B, ~'O provide PWSlD~
Sanlta~/~eal (Y/k) Y~S
Cased to
FROM WELL LOG
fL
g.p.m.
Nlbate 3.06 mg./[.
Date of test 4/1992
81aUc~ateri~wl 114, ,
Well producBon 20
WATER SAMPLE RESUL'FE:
~ i 0 colonies/100 mL
Date of 8ample: 1~/6/2001
B. SEPTIC/HOLDING TANK DATA
Tallk Type/Material ='~L=L
TankNze t250 ga]. NumherofCompertmente 2
Depression over tenk (Y/N) NO
Pumper
Founda~on cleanout {YIN) Y~S
Date oflx~nplng NEW,
C. ABSORPTION REt.D DATA
Date Installed ,,,
Lenglh 124'. (2052")
Soa ratlng ~tt¥odrm) o.s
Casing height (above ground) , 24+ In.
AT INSPECTION
1 ~/6/2001
,120 ~.
, , 7,2 g.p.m.
O~erbac~ 0 colonies/IiX) mi.
AWWCt INC. ,
Width, 5.0 , . It.
Totaldeplh .7..3-g.I fl, Eff. adsorplion ama1069 It' Monilndngtuhe YES
Date ofadequacytest NEW Rebuffs (Pass/F~I) -
Fluid depth In absorplion field before test - In. Water added - gal.
E]apead Time: - min. Final fluid depth - In. Absoq~lon rate
Any mJuvenaaon treatment (past 12 mo.) (Y/N & type)-
System lype5-WlDE DRAINRELDS
Gravel below pipe 3.0, It,
Dapm~slon overlleld. NO
For ,4 bedrooms
Newdepth - In.
- gpd
ff yes, give date -
O. UFT STATION ,
Date Installed ~lz~ M gallo{~ ~
"Pump on' level .t ~ High water_elam1 _.l~l a.t .- In.
~ Cycles tested Meets slam & circuit requirements? ,
E, SEPARATIOH DISTAHCES
SEPARATION DISTANCES FROM WELL ON LOT TO'.
~e~ tank/l~ MaUon on lot 100'+
Absoq)Uon field on lot , 100'+
Public ~ewer main N/A
Sewer/sepUo ~ervlce ;ne 25'+
On adjacent lots 100'+
On adjacent lots lOO'+
Publi~ ~ewer manhole/deanout
Hold[ng tank N/A,
SEPARATION DIS'rANCES FROM SEPTIC/HOLOING TANK ON LOT TO:
Bulldlng foundation 5'+ Property line 5'+
Water m~n N/A, Water wVk:e line 10'+
Wells on adjacent lots 100%
~EPARATION DISTANCE FROM AB$ORPllON FIELD ON LOT TO:
Pmpefl3f ~ne .1'+ Bulidlng foundaUon lO'
Water ~en/~ce line 1 O'+ Surface water 1 OO'+
Cuttalndmln NONE KNOWN Wellsonad]aCelltlOt~ 100'+
F. COMMENT~
G. ENGINEER'S CERTIFICATION
I cerfffy that I have de~effnlned ~rough field InaioecffM~ and
mWw of Munlcipal reconfs ~hat the above ~/sfen= ~ In
cordixmance wf~ MOA HAA guidelines In effect on ~s date.
Date # ~ ol
Waiver Fee $
Date of Payment
Receipt Number
*LOT UNE WNVER ~WR010087
Water main N/A ,
Driveway, paddngNehlde ~orage 25'+
AbsorptJm~ tleld 5'+
Surface water t0o'+
9075515101
T-985 P.01/0l F-Gl0
CT&£ Ret.#
Client Nime
Project Ni meJ#
Client Snmple ID
Ordered By
PWSID
Sample Remarks:
1017702001
AK. Water & Wastcwatcr Consultants
Sampson ~t L 4 B 4 Outside HB
S~pson Esl L 4 B 40mstc ~
~inking Wa~r
Client PO#
Printed Date/Time 11/08/2001 8:27
ColJeeted DnIeJTImn 11/06/2001 7:$0
Received Date/Time 11/06/2001 I 1:20
Teehnh:st Director Stephen C.. Edn
IteJeased_B~
Nitratc-N
3.06
P0L
Unica Method
Allowable Prep AnnJysis
LimiLs Date Date Init
0.500 mg/t. EPA 300.0 (<10) 11/0~o1 SCL
llierobiolo~fl, Laborat:or?
Total Cnlif0rm 0 cnl/100mL SMI8 9222B (<1) 11/06/01 KAT