HomeMy WebLinkAboutSAMPSON ESTATES BLK 1 LT 17 Municipality of Anchorage Page I or 3
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND]OR WELL INSPECTION REPORT
Permit Number: SW0~108 PID Number:. 051-053-65
Name:
MM&M Contracting WastewaterSystem: New
Address:
P.O. Box 670495 Chu.qiak, AK 99657 ABSORPTION FIELD
Phone: Number of Bedr~.~.
688-1236 Four (4) Deep Trench
LEGAL DESCRIPTION Soil Rat,,g: Total Depth fromorigirlal grade;
Block: Lot: Subdivision: Depth to pipe bottom from odginal grade: Gravel depth beneath pipe:
1 17 Sampson Estates 3 ' r,. 8
Township: Range: Section: Fill added above original grade: Gravel Length:
1-2 rt. 84
Walk New Gravel w~clUl: Nuttier el hnes: I D~stance between hnes:
Classification (Private. A. B, C): Total Depth: Cased to: Total absorption area: P~pe Matenal:
Private 205 205 1,344 re ASTM 3034 PVC
Ddller: Date Drilled: Stalic Water Level: Installer: Date Installed:
Sullivan Water Wells 4~30~2003 95 a. MM&M Contracting 7125-2612003
Yield: Pump Set at: J Casing eight Above Ground:
4 G.~ Ft.[ >2 rt. TANK
SEPARATION DISTANCES [] septic [] Holding [] S.T.E.P. [] Other:
T~To Septic Absorption Lift Holding ~ublic/Pdvate~lanu:acturer; ~..apaaly in ~a,ons:
From~
Tank Field Station Tank SewerLIne Anchorage Tank 1,250
Material:
Number of Compartmen[s:
w,~, >100' >100' N/A N/A >25' Steel Two (2)
S.,aceWater >100' >100' N/A NIA ~ / LIFT STATION - NONE ON LOT
LotUne >5' >10' N/A N/A ~.
FO~.da~on >5' >10' N/A N/A -~ump on',e.e, a,:',~ump o,~,eve, a,: [ .,~..ate, a,a.m
In. In.[ in.
Curtain Drain None Noted Pump Uake& Model Electhcal Inspe~on, performed by:
Remarks:
BENCH MARK
2:: insuiation Over Tank. Lop.on an.
Garage Slab
100.0
Engineer's Stamp
Inspections performed by: MEA Dates: 1~ 712512003 ~ '~f, 49th ')~" ,"~' ~
2nd 7~26~2003
Department of Health and Human Services approval ~ o% ..,~-
~..'~'n *. No CE-438!
*~ ~ .... ... ~ ~,
Reviewed and approved by: /~,///,,,~/ ~. Date: ]-- ,~ 0/7/
,.... .
O0'08L
H.I. NOS
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW030108
Page 3 of 3.
PID No. 051-053-65
99,8. l~rcdnFleld Rock
91.6
103.4
84' Trench Leng't;h (NTS)
85,0
99.7
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
/-,700 SOUTH BRAGAW STREET ANCHORAGE, ALASKA 99519-6650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
MM&M Contractin9
DATE PERFORMED:
LEGAL DESCRIPTION:
Lot 17, Block 1, Sampson Estates Subdivision
TEST HOLE
~, ·
· -. ~ · .'. W/Sand Clusters
... " GM
J' ':'
7 ... ~ . ..~ Nearly
8 '.' Perc.- 120 Min./Inch
II,
12
13 ,
15 ·
17
3 SLOPE
SITE PLAN
TH3
®
WAS GROUNDWATER
ENCOUNTERED? NO
IF YES, WHAT DEPTH?
',~' : '~J DEPTH OF WATER
~ '~l AFTER MONITORING:
· :,' a'J DATE:
"'. ,,""..,, ~:." ~'-L~ ~
,.;'.. ,;~... ..............................
~.~[ MIC~ELE.~DERSON ~ U~
~ ~. ~. No. CE~
......... .:, ,
BOH
None
7~27~2003
S
L
0
P
E
READING DATE GROSS NET DEPTH Of NET
TIME TIME WATER DROP
Start 7~20 2:25 8.62"
1 2:55 30 7.87" .75"
Recharge 2:56 9.25"
2 3:26 30 8.5" .75"
Recharge 3:27 9"
3 3:57 30 8.25" .75"
PERC RATE: 45 MIN./INCH PERC. HOLE DIAMETER: 6"
TEST RUN BETWEEN 4.0 FT, AND 5.0 FT.
COMMENTS:
Test Hole Pre Soaked Prior to Test.
TEST PERFORMED BY: MEA I, .,MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 12/23/2003
FROM : COUNTRY REALTY
...'
PHONE..NO. : 9076881238 Dec. 17 2003 03:03PM P2
.,.. : o , ,,.,..,,,", , .., .". ~' ,. .',o. . ~
· . . . ,. ,.....?..%. ~,'
DATA
'"' '~V",~ "':<~'"":'"":"': ' ' · ~ . '. '~ .......... ,;' ~.' ..... ".' "..." ·
'", .... "~ ~' ~:'..~ J-:".'"'. :'. ,..' :."..';""v':':"::'~':: " ;; '~,,,3 ~"~ ~,,3'd,'~ '.- ' ......
PERMIT. N~
TAX IDENTIFI(
.~ :' .'.:..':..':~.
I$ well [ocated 8t
Casing Stickup Above ~r~u'~d~ :'2 ~...~ '. ;- .'. ?'~' :<..~:.., . .....'
· .. ,., ~ ...... --dm..,' .... '.". ,' ......... · · ..
· · . , · _. -.:.., . ·.~q~ '..~ . . . . ... -, ...% ,.:' ;;.,.~,.. · ·
Stabc Water Level: · ' · ·
....... ' ........ - ' '"' :'"'". -" :. feet
Recov~.Rate: , ·
.... ...; ...'... .'. ..~ t... .: .~ .* .: .~.. .~. ..
gpm '. , ,...' .'.;; :':-. ,.'; ..... :'., ':
' ."" ".'.'.':.'~. ,' ;' :"' i '.'. -, ..... ,.'"' , :-' ':' %' . "'
Methdd'o~"~iin~.:-.'--':~)//2- :.. ~;::, '. ':' ::.:'; ?. :....,:;.'., :'~-:.".:",,',..... ---
' :.~ ..'. .,~. · · ,. .. ~. .:~..],,.'.,,~. , · · ... h~T:,., ~,..:. ..:..,.;,.'b* .
· . .. , .:' . ?.~'. · , ..... ¢. ·: ..... ..' . . ...~.'., .. · · - ~,. .., .,,.....~:.' ·
Well Intake Opening Typ~i.~n end.~.O o _.1:~_ liole%':'.:~:.-:~.:,',
. .. :..... .. : ..I. · ,.. ,.. :,.~ .,..,.:. ~,..,?:..:....;:;,.;~,~;.,:...-....;. '~.~"q;r -':'.';' '.
· , ~. ' ". ........ .'.'..:.;.~ '..:. ' '..'. · .',..'..~..
~! Screened; .' ,.:SL~rt :... :. '.
f~t. Stopped'.:" ' ." -.,:. '." feet '
. - · . .- · '~ - ':..'.., ..~.;. ~;... ~... *
J Perforabons i'.. Start" ';,'. ' .. ' feet: Stopped"
_ ",' ". ;-,:'L'i.!'..;~f,:,,,i~¢= .:':c~,'~J.'.';:'.;.:]:,'..~ ";:.:/...=:, :....;~..':...
~rou.tType~ !9~.,,~- :.. ..-' -...Volume.:-./~,z,~,S. ':".'
Depth:'" .:".'/D ... :.'.'".'~.:'.'.-':.-'.: :. :to" ::'~ O'"/.':'~-';',.,,~ "' '"'" ...... · '
"> · ' '~" ' ." ' ' '
· . · '.. -I..'. £'.;,.' .... ~- :, .',:'.":;, ",:...'.. '. ::., , ' ..... '.i :..~"~'. ' ' "'" '.:.'"'"."
.. ' · ,..% ': .....'., '% .. . · . .. .~. '... · '--.........~..
Memod o~'Oi~inreciioh:.~¢:~,~'~,~,;',~.~ '::":' ~"'~../~'~':.:.'.,,"..'. %- "' ' ', .'.-. '.. - ' '.... ', ...:,.,,,:::..""" .... '
· . ,.... -:; ,'......... ,.:..~,, .':.-.. . .. :.:?:,,. .*: . · · ...:.~:., · ......, .. : . ,. ,
..... ' '. ...... - .~ ..... '..' :' ' .'. .... '.-.-.,*'..'. :.,. , ~' '.'.'~',:x.'~=;':~'Y'~. "' """'"".' '.":' .~':r. .... ' ......... ,,..,.t:. ·
CoTn'~e~ts: '.,="'"'.':. ':':'*.":-. ~.",-~ :'.'.??...:~' ;-' ':: '. :: ' '" ...."!' ' :""' "' '"': .... "
.:;..:..::.':':_-}_,.:.~':, .' ':', .' : '.."..'J. : ..... * :' .':r' · ,"-"',',:'. ' ,:
· . ,~-'.~'.--'.:'. '-..".,.' ~.-~.'° ' '"'; .t,,:~'~ '.~-:'.":,*..~' ,' '"""'" · '" ~ ~'~"''$':: '*":':'~ ~ ' :"'' '" ':' '" ' ' ;' ' " ' ' '";"'':~'"~";"' '
c'-..':'~'r'~-..:.~I~' "" ': · -,.- :. :.',,C¢;".:., ,...',.". ;:.*..%"..'.'.:.... ..... '..-:~,';"-;%:;~;,.'.'~.
· . : · .. .~,.'.~-...' (; ,.,... ' :~:' -'.~-..'...- :',.:.."t:.%.".,;...'..~'?;:.:;~,~,.,.~.~'.~'.,,o.~:.~ ,.. . , ·
· ~':'~ '".:' '..~.:':. '":. ,"." ~. '.':.t." · ~' ""-:.,'~ .~-~:.'~k .'.-% ';'.~."- .-'..'-','"~" ' -t. , ." .' ,',. ~ .' : .'.~* .. ::':--,:%. '..' '-.,.4.,;.~; '. ' ' · :' '?;,',. 7'"-. 't:-,.*: '......
· .. . ......-. ~....,-, ,s..~..~ -....,. ;... ,..-..., . .-.;;.. .. ._ '". ¥.; ,.,.~' '. ~ .... .~.'.-...*.';; f.."-~..- .:%,-;. :..'., .....%'..'-.. .. ..... ~;..t :'"':~";"~:A ..... :~*'*;. ·
,' ..=,:,; · ..:, * ,,,.. :..-...:~.: .:.,.....,.....:,..,......,.. ......,..%;;;.:, -~...'.:'. , ' · ,.~"~. .. ,7'.' .'~ ;,:.*'%,'.." . . ,. ... .e . ~. ,~. .::...L.~....
" '.'";' ~'~ '~"~t' c' .. ...' '-'.%'?.~-.,~z '. '.;...':4..?~ ,1.~.;,t .[ ~.. ,,~.. [., ..:.%.;.. '. .
· :..% .;:, ~..~,..- .::;.-. -.. .. ...-... .:,.'....'~,;:/:,.'.
':' '" .... ';' ""' """:""':"" ':' '~':'":':':'"'" '"';~:";: "'"' I' "~'":" "'} '"" '
· . ... ... ::.- . ,-,..'.... '.:-'*:....: ::;.. :~t:...,.;-;!,'..~,..:y-';.~,.--::'"~s':" r:.:. o.,4.. ':"'* :':" "'"" '"~:'"~ . '" :'"':.:: :'":';'""~"'";:'"'.' - -'~.' '..' * "-" ..... - ' "'~"-' '.' .~'.',.*~ '" : ' '
.' ,"' '.'.";'. '":'~' ".'..b.'.':..~* · "':. '"' " :" .: .' ;'~:...'. '- .... '" "";~"" ' ' ...... ° .... '~ ' "' ' · '" ' '
· ';.'"':' .......: ¢:' , ":.~ .' .' ":"" ' .: ,~-'"," ' 'i:,t.~".', c.!.:'", ..": '
' "" "'" ': ....... *' '" ' '"""~'"'~'="?"~"::'"' ' "'"" ·: Driile~'-q N .'
· "'.':· Dnilei"-q Name"n{/:" ...... ~ · ~'-:...:;'."- ...::.'~-~.'..
· . . : ,. ,]. '. ,...-.-,~'; .... "....' .,. ~:~=...'. .'.'.;'-.. ..,'~ .. ' ..'. : '. , .~ ~.".~ ¢4, :- .....'.'.. .~' .:'.:."'-.. .... . ' ,'"..,.. ."
A'rrENTION. It I~ the respons;b~hty of the.property owner to submit a cony of the well Ioa to thi~ .n'roner authnrm,
........ . , · . ... .,. . ~--. -~ . · ,--. ,., . .: .... ,/. t-_.,~,,,,~,,~,L~,.,,,X
of Anchorage: ......Department of Health & Human. ........... Secv~ces ahd/or Depadm~n[ of' Environmental Cohservation MatSu';.Borough:.
Department of Enwronrpental Conservabon · :.. ' ;..' '..'.' · '. ~.. · ........ .. ' .:. · '. · .- · .... ..
· · ,'.. t . .., ... . .. ... '..' ....''..i~ L" ..'"' · '" ' ' ' ' '"'.'.:: *.'- ';. . .: ..~."."' .".
12--23--03; 3:49PM; ;907 5615301 ~ 2/ 3
SGS Ref.#
Client Name.
Project Name/#
Client Sample ID
Matrix
1037983001
Anderson Engineering
Lot 17, Samvson Est.
Lot 17, Sampson Est.
Drinking Water
All Dates/Times are Alaska Standard Time
Printed Date/Time 12/23/2003 9:39
Collected Date/Time I2/17/2003 15:30
Received Date/Time 12/17/2003 16:43
Technical Director ~. Ede
Released B~--~~~~ ~
Sample Remarks:
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID L~nits Date Date Init
Waters Department
Nitmte-N
0. I00 U 0.100 mg/L EPA 300.0 B (<=10) 12/18/03 J.fB
H/crobiology Laboratory
Total Coliform
0
col/lOOmL SMI8 9222B A
(<=l) I2/17/03 DKC
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Ahchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-7904
Parcel I.D.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING /~ F~ / 5'5 c., ~'
05t-053-65 HAA # (~ ~:~ 0 (~ ~f ~
Expiration Date: c~ _ I ~'- C~ ~
GENERAL INFORMATION
Complete legal description...Lot 17, Block 1, Sampson Estates Subdivision
Location (site address or directions) 22050 Sampson Drive
Current Property owner(~;) MM&M Contractinq
· Mailing address P.O. Box 670495 Chu.qiak, AK 99567
Day phone 688.1236
Lending agency
Mailing address
Day phone
2~
Real Estate Agent
Mailing Address
.Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: Four (4)
Day phone
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site I~'
[] Individual Holding tank I--I
[] Community On-site r"'i
[] 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 orca public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
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'sup'ply and/or
wastewater disposal system is(are) in complianc~ with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm Anderson Engineerin.q
Address P.O. Box 241)773 Anchoraqe, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
DSD SIGNATURE
~ Approved for . L.~ bedrooms.
Disapproved.
Conditional approval for
Phone 522-7773
Date 612/2004
bedrooms, with the following stipulations:
Additional Comments
E~'~,:' "ON:SITE
~ . WASTEWATER
~..,-.. .-'.o~-~
.. ....
"J)))))))))l~~'
By:.
Attachments:
HA,& Checklist
'Septic System Advisory ·
Well Flow Advisory
X
Maintenance Agreements
Supplemental ,Engineer's RePort
Other
· Origina! Certificate Date: '
(Rev. t2/OO)
Jun.16,'2004 6:2~AM 9075226779
06-07-04 02:32P1~ FROII-CT&E ESI, SG$ ENV SERVICES
SGS Ref.#
Client Name
Projc'tt Name/#
Client 5ample ID
Matrix
104304100!
Anderson Eng~aeertng
Lot 17, Block 1. Sampson ]~st.
Lot 17, BIo~ 1, S~n E~t.
~k~g Water
PWSID 0
Sample RemS:
9015615301
No.6534 P. 2/3
T-648 P 02/03 I--45Z
All Date~.q'imes are Alnd~ Standard Time
Printed D~te~l'im. 06/07/2004 B:$4
Collecled Dnt~ime 06~004 14:00
R~ed Dat~ime 06/0~004 16:03
pm~_6_er Ee~olls POL Uni~ Mcthofl
Conm~crID l..~its D~e Date ]pit
Nitmtc-N 0.100 U 0.100 m~/L EPA 300.0
06/04/04 J~13
Microb£ology Laboratory
To~l Col~'otm col/lOOmL SMlg 9222B
A (<=l) 06/02104 DKC
Jun,16, 2004~ 6:28AM:~.9075226779 ^.~.=o. ~.o~.. ~,~No.6534 P. 3/3~ =/ ~
CT&E Environmental Services Inc.
Laboratory Division
Name
Cily
SAMPLE DATE:
Month Day Y~r
SAM)LE 'I'~E:
,~ Reutlne
13 Repeat Sample (for routine sample
wRh lab ~f. ~. )
~ S~c~Pu~e
SAMPLE LOCATION
CommenL~:
0 Treated Watw
O Untreated Water
Tithe Collected
Coilec~d By
A~alysis shows this W~tcr SAMPLE to be:
Satisfacto~
[] Unsatisfactory
0 Sample over 30 hours OM, results n~y
bc umeliabl¢
n Sample too long in t~nsit; sample should
not be'over 48 hours old ax exend~tion
to indics~ ~liablo results. Please send
m~ san~le via .special delivery mail.
Date Received
Time Received
Analysb Began
Aualyt~ Method:
Membrane Filter
MlVlO-MU~
* Number n~'~,z-~'''lO0 mi.
1043315
. Anch
Annlyst
Jun F-I
Faxed
Time:
Client ~otlfled of ~matisfactory rr4~l~:
Phoaed Spoke v~ith
:Date:.
BAC'~RIOLOGICAL WATER ANALYSIS RECORD
£, Can
Colonies/lO0 mi
COL~,
CoBform/~O0 nd
MMO-MUO Reml~ Total Coliform
Membrane Filter:. Di~ Cou~t ~
VeHfi~flou: L~ BCB
F~I Co~fo~ Conflr~fion
_
Fa~ed
Member of the SGS Group {5oeiat~ G~n~rale do Surveillance)
ENVIRONMENTAl. FACILITIES IN ALASKA, CAUr-ORNIA FLORIDAv ILUNOIS. MARYLAND, MICHIGAN. M~SOURI; N~/JERSEY, OHI0. WEST VIRG~ffA
DevelOPment Services Depa'r~ment
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
~,~,,, ,, ,~,~l l:. OF,'-' ~ '" ,,-.,-,,-., ,' 'r',~ ,~,.,A',--,, , ,,..,, ,, '"'""'~ ' '-":, , ;~PPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-053.65
GENERAL INFORMATION
ComPlete legal description Lot '17, Block 1, Sampson Estates Subdivision
. ~
Loc~tion '(site address or directions) . ~ampson Drive at the Old Glenn Hi.qhway
Expiration Date: /-/-. -. ,.~-
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
MM&M Contractinq
P.O. Box 670495 Chu.qiak, AK 99567
Ma!l!ng. Address
Unless' otherwise requested, HAA will be held by DSD for pickup.
.2~". NUMBER oF BEDROOMS: F~ur
Well
Day phone 688.'J236
Day phone
o
TYPE~OF WATER'SUPPLY:
Individual ,Well
Individual water ~torage
"Community Class ~
Public Water System
Day phone
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
F-]' Individual Holding tank I-'1
[] Community On-site []
[] Public Sewer []
I
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.
' :ii.. MUnicipality of Anchorage '
:', . . DeVelopmeht serviCes Department; :
i!' ' .... ' J i ~,:! Building SafetyDivision ' .
, . ~ ~' On-Site Water & Wastewater Program :
ii', ~" '~: 47~)0 South Bragaw'St. , :'
I.~i: P.O. ox 1966.50I Anchorage, AK :99519-6650.
· ' ' ~ ' : ' , ~,' www.ci.anchorage.ak.us :.~ .
.,!;J :' ·. ,-., ' ~ (907) 343;7904, ~ i' . 'i,i,::r~ .: : , .
!t,;' HEALTH AUT'H0'RITyApPROvAL CHECiKI'I:ST, ';
, ' ;:t. . .' '~ . '~.! i' , " ' ~ · .
Leg d Desc, npbon: L Lot 17, Block 1, Sampson Estates Subdivision: ' ,: Parcel ID' 051.053.6-~
.We, lI type Private . .. If A, B, or C proVide PWSID # ' " ' ' W~ll'Lon tY/N~ Y
' it, ~ : ' ' !' ' ." ,,:~'' , ' .... 'l ', ,~t / ~-..,--,.,~..,j..._~
,,~il ~ ' ' ;: ; ' ' :'~ i' : '; ' , :
Date~ completed 4~30~2003 , ' Sanitary sea, (Y/N) Y ' ' Wires properly m-otected (Y/N/Y
!l , . · . . ~ . , .! : , , ' t , . ,, ' I,,,
Totaldepth- 205 ft :l~ . Cased tO ;'205 ft '.' ' . .~ , ': ,",-,-=,,- ~,~,-,',' ,-,- .......... ; ;,,-
, ' ~ . , , : ,:,[ ~Ir ~! ' :,' : ' ' i, r' "
' FRO ' ',' ' '
' !1, , 1 -. ' M.WELL LOG :i : : ';" ~ .' '"-.:' AT INSPECTION
ate of test .~ . . .413012003 .... , . . - ~ . ,.,.
i , ' . , , ' ' ' -~,--~~-.~ ' ·
,I ........ ,, f !. , , ........
Stabc water level 95 ' . :~:'. ;ft ' ';.' ?,
Well. prodUct on . , , 4 ..... , ..... n.n.,.,.m .' - ,~., · , ' .". ~ ,,,. , ... _
:t , ~ , ~,or ,,[ , ....
1'.1 ~ ' ; .., .. ' i I - : ' I "!'' ! : ,.', .... ! . ' !:: : ' .
WAT, ER SAMPLE RESULTS;",, ": ,. ! i':l,['i~", '., : ;,;. .
[ ' i ' t . ;' ~,, .... ," ,3, ., , · . - ~
Cohf0rm '0 colomes/100ml .... ' .~Ntrate~ ,t mg/I ' , .... Oth~rbantnrin n
Date of sample' 12/1712003 i ' r : - C01~C(~d by.": MEA : '. ' :I:' :
SEPTIC/HOLDING TANK DATA !; !..; ~ i ; ' ',:! i !I:,: . ' "
, I , ' ., . . , ~ ::' ' ,:.: ',~ ~ : "
Tank~Type/Matenal. Septic/Steel : ,,' ' i.l,I, , ' ' : ~': :..': ' Datein,~'-~
Tankjslz, eI t,250 gal. NumberofCompadments2 :',,:,~,, Ceanouts(Y/N)Y ,
....... , ........ .. . -,
, , ' , : : ' ,J ~ I' . , ,J ; r, , r ·
FouR ,a ,on, 91eanout(Y/N)_Y :: : Depression ~ver tank (Y/N)f!N ::i!' : High war
Date ,of pu ,m, plng.-~,',' .-.~ ~ i ....IPumper, NewConstructlon ;i~i '
' ~ ........ I ~ ' .' ,. :[, ' ' ' '1"i-',' ' "
ABSORPTION FIELD DATA ..... ~ , , ,,~ . :.., . · . .
~ ' 't ...... I t. i ." :' ~' E' :"' :' ' ' ,' L,' '"" : .... Ii`
Date !ns, tall.,e,d,~ ,Sod rahng (g.p.d.i!ft,~ or ,ft~/bdrm):45 GPDISF sysl&rh type;Deep Trench
I ' t -' : t' :' ,, . ,, , ,,. ,;. ; ; ,,, , ,, ,, ~ r,
Lengt, h.84 .... ft .... Wdth '3J,~ ',' .'~" ',: %?; ft .... Gravel be ow nine.
. ' ~ t ,~ , ,'~ · .~,,': : '31 ., '~ ~ .,I,~ ~ ' t ' I'~ '
Iotal~e3th12ft ..... Eff. absorptonamal,aa4ft~ IVlonit0dnotubeY D6 r0's'sion'ovc_rfi~rl~i
'..I ' !~ ..... ~ ...... t I ;,! -~: ',:[2.1¢ h' "r''*' I ". .ir: ~' ' ,.~,:~,,],~,
Date 'of ; ~dequacy test ,, '.; ' ' :' ~'ResutstPas~/~& ~ :~, . '
Flua oe)th,,inabsorptionfield beforeteSt. I: 'I, n'i, ,, ; ~^¢..,A,~.,.i,~, _,_,,i
~ ,, .... ; ,, ~7 . : , , , , f¢ : ,.;, r~ewoepm
. ¢ · ,'; .:., · !i · ' · ,, .~ ,:,, .
Elap. l T~,me: min. , : ,. F~nal fired depth . r I ' ' ~n . ,: ' ~Absorpton rate >= '
Any : /enation treatment (past 12 m°') (Y/N'&t(,nel~! N ' ' ~' ':":' ' ' ' ' ' [ ¢.',.../'.,.';.-,~,~ '
, ~ .~ . . ,, r,,,,;. ,, , ,, , , , .
, ~ ," , , . .p, . , , , ;
' ' : , t ~ : :, . ": : ' ' ,,' ;!, : ,.
, :, ~ :.; ; : ,, ,' . ' , , i ] '; , .
..... '., , . : , ' ', ,' , ' ~ ..... . r '
FI~OM : COUNTRY REALTY
PHONE NO. : 98?6881238 Oct.
:°
I ~ez~b¥:~erfify ]that ~['have ~s~.-'veyed the 'fo .?~'w~§ 'delhi.bed '
prOl~erty. 7._o"~ ..~.~, .~/~-~ [ :. . . ~,.
~, ,,,_. ~ _...? ,:..., ._~._,--.~,,;~.4.~.' .~ .... :.
.,c'~.' ~;. '- · ~ ,, '. ~ ' -.'7- I~'/C;~
_.....'~'..~ _ ~ ~, ...... · .......
~arismi~r~ lin.es or o.~.~ v~'bte, easement' ~n ~ PmI~
except ~'ir~cli~,~ecl'he~on. ~ .: ;..' '. · L.. ,,, ....·
Da~ecl at F..~I, l~iver.,,AJ, asLa. . :'. :. ;. '... .. '.......
· ' · ,.' '. ROnL~I~..C-JOHN,s~.N 7~?~/,'~."'
,c, CAL~:' ' . ..'_l:~,~s_~cl, l~ncl..~_u~...~or No....."dt~0-t~' .
~.-- . , .t~hone I9071 694:25~ ..., ' : ... ,.
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
0N-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Apr 30, 2003
Expiration Date: Apr 29, 2004
Permit Number: SW030108 Parcel ID: 051-053-65
Legal Description: L~-~MPSONESTATES SUBDIVISlON'.,'B~OCK 1 ;LOT;1
Design Engineer: 0014 Anderson Engineering Site Address: NHN SAMPSON DRIVE
Owner Name: MM & M CONTRACTING Lot Size: 55403 SQ. FT.
Owner Address: PO BOX 670495 Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK, AK 99567-
This permit is for the construction of:
r-~ Disposal Field ['~ Septic Tank [] Holding Tank E~ Privy
r~ Private Well
Water Storage
All construction must be in accordance with:
1. The attached' approved design.
2. All requiremehts 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 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.
--,'Jo
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
ON-SITE SEWERJVVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0
Permit Number SWO_..~_,~~
Property owner(s) MM&M Contracting
Mailing address (1) P.O. Box 670495 Chu.qiak, AK 99567
Mailing address (2) ~VH~ ,~'~MO$~'~ I~,q, Zip Code
Legal description (Lot, Block & Sub'd.) Lot 17~ Block 1, Sampson Estates Subdivision
Legal description (Section, Township & Range)
Lot Size .~-,~j 40~ acre~ Number of Bedrooms Four (4)
Day phone 688-1236
??5-a 7
THIS
THIS
APPLICATION IS FOR:
Sewer Only [--] Well Only []
Sewer and Well [~3 Water Storage []
Sewer Upgrade I-"]
PROPERTY CONTAINS:
Hot Tub [--I Jacuzzi []
Swimming Pool [--I Water Softening Unit []
Therapy Pool I-']
I cedify 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 owner or authorized agent)
Permit Fees: ~-~-O
Receipt Number: ~' ~ ~-"' '~0
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
April 23, 2003
· Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
'Anchorage, AK 99519-6650
Subject:
Lot 17, Block 1, Sampson Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 17, Block 1, Sampson Estates Subdivision intends to construct a new
four-bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new well and septic system to serve the home. The attached Site Plan
and backup documentation identify the location of the well and configuration of the new
septic system and alternate site and the parameters used in the design. Also identified
on the plans are the test hole locations and the wells and septic systems on the
surrounding lots. Drainage arrows and spot elevations are shown indicating the current
drainage patterns. The drainage patterns will be maintained after construction.
The test holes placed near the location of the proposed absorption trench indicated
dense silty gravel with percolation rates approximating 35 minutes per inch. No
ground water was found during placement of the test holes and none was noted during
the monitoring period. We are therefore proposing to place a 1,250 gallon septic tank
and a new 84' long by 3' wide by 8' effective depth absorption trench. The total depth
of the trench will be' 10'- below the surface with the distribution pipe at 2' below the
surface. Sufficient fill will be placed to prevent freezing of either the septic tank or the
absorption trench.
The ground surface on the lot slopes as shown on the site plan from north to south at
varying slopes. The absorption trench will be constructed parallel with the slope as
much as possible in conformance with Municipal requirements. All components of the
new septic system will be constructed a minimum of 100' from any surface water and
wells in the area.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
· Lot 1'7, Block 1; Sampson Estates
'April 23, 2003
Page Two
e
The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
12
18
1 ?g.26
13
VACANT
AREA MAP
1'5
Jun. 2. 2003 9:59A~t
9075226779
~1o.2696
P. 1/2
TO:
WITH:
FROM:
DATE:'
SUBJECT:
MESSAGE:
FAX MEMO
Dan R~th
MoA/Water and Wastewater Program
Mike Anderson
June 2, 2003
Lot 17, BlOck 1~ Sampson Estates SubdiviSion
Permit No. SW030108
Revised Well 'Location.
The builder wants to revise the well location to that shown on the
drawing. It is a better location and will not Impact surrounding lots.
Let me know if you have any questions. Thanks for the help.
attached
2 Pages Being Transmitted. Please call 522-7773 if there are any problems.
Jun. 2. 2003 9:59AU
9075226779
I1o.2696 P. -,"/'',
O0'Ogl,
~lnos
SOUTH
180.00
LOT
17, BLOCK
1, SAMPSON ESTATES SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom House Deep Trench System
Perc. Rate: 35 Min./Inch 1,250 Gallon Septic Tank
Application Rate: .45 GPD/SF 8' Drainfield Rock
4 Bedrooms X 150 GPD/.45 GPD/SF (Application Rate) = 1,333 SF Absorption Area
1,333 SF/16 SF/LF = 83.3 LF TrenchLength
THEREFORE: Construct a 84' Long x 3' Wide x 8' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 2' Below Original Ground Surface. Total Depth to be
10' Below Existing Ground. Maintain 100' Separation From Well on Lot. Place 2' of Direct
Bury Insulation and 2' of Fill Over Absorption Trench or Provide Minimum 3' of Cover to
Prevent Freezing.
#
8'0#
I I Geotextile
· I ,///~ -- Fabric
4" Perforated
',, O
'~ PVC (Holes Down) -- Drainfield Rock
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
~ ~,..' ~.....~ ~
NOTE:
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
I
2
&-
5
6
7
8
9
18
PROJECT #: M0318
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 L STREET, ANCHORAGE, AK 99502-0605
SOILS LOG - PERCOLATION TEST
PAUL MYERS / MM&M CONSTRUCTION
DATE PERFORMED:
LEGAL DESCRIPTION:
LOT 17, BLO£K 1, SAMPSON ESTATES SUBD.
TEST HOLE #
SILTY-GRAVELS
WELL COMPACTED - OM
1 SLOPE
SITE PLAN
TH2
O
NO SCALE / SEE ASBUILT
COMMENTS:
WAS GROUNDWATER
ENCOUNTERED? NO S
L
IF YES, WHAT DEPTH? 0
P
DEPTH OF WATER None
AFTER MONITORING: E
DATE: ~,/22/2003
< 2%
READING DATE GROSS NET DEPTH OF NET
TIME TIHE WATER DROP
Start &/8/03 8:2'/ 9.0~'
-/ 1 8:57 30 8.125" .8'/5"
Recharge 8:57 10.0"
2 9:2'/ 30 9.125" .8'/5"
Recharge 9:2'/ 9.125"
3 9:57 30 8 250" 875"
B0H
PERC RATE: ~i5 MIN./INCH PERC. HOLE DIAMETER: 6"
TEST RUN BETWEEN ~..5 FT. AND 55 FT.
NO IMPERMEABLES ENEOUNTERED / HOLE PRESOAKED PRIOR TO TEST
TEST PERFORHED BY: T.L. KIMBROUGH
I, MICHAEL E. ANDERSON, CERTIFY T~AT THIS TEST WAS PERFORMED IN ACCORDANCE'
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: ~,/22/2003
I
2
5
5
6
7
8
9
II
18
PROJECT #: M0318
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 L STREET, ANCHORAGE, AK gg502-0605
SOILS LOG - PERCOLATION TEST
PAOL MYERS / MM&M CONSTRUCTION
DATE PERFORMED: /./8/03
LEGAL DESCRIPTION:
LOT 17, BLOCK 1, SAMPSON ESTATES SUBD.
TEST HOLE
SILTY-GRAVELS
WELL COMPACTED - GM
2 SLOPE
SITE PLAN
TH2
O
IH~
N0'SCALE ! SEE ASBUILT
COMMENTS:
WAS GROUNDWATER
ENCOUNTERED?
If YES, WHAT DEPTH?
DEPTH OF WATER
AFTER MONITORING:
NO
None
S
L
0
E
READIN6 DATE GROSS NET DEPTH OF NET
TIME TIME WATER DROP
Slat! /./8/03 8:/.0 8.5"
1 9:10 30 '/.5" 1.0"
Recharge 9:10 9.25"
2 9:&O 30 8.3-/5" .8'/5"
Recharge 10:10 10.0"
3 10:/.0 30 9 125" 8'/5"
BOH
PERC RATE: 3~ MIN./INCH PERC. HOLE DIAMETER: 6"
TEST RUN BETWEEN. /.5 FT. AND 5.5 FT.
NO IMPERMEABLES ENCOUNTERED / HOLE PRESOAKED PRIOR TO TEST
TEST PERFORMED BY: T.L. KIMBROUGH
I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE .
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: /.12212003
.. ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 17, BLOCK 1, SAMPSON ESTATES SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,250-gallon tank at the location shown on the site plan. Work
also includes the construction of a new absorption trench 84' long by 3'
wide by 8' effective depth also at the location shown on the Site Plan.
The total depth of the trench will be 10' below existing ground and the
distribution pipe will be placed at 2' below the surface. All components
of the new.absorption trench and septic tank must be constructed a
minimum of 100' from any surface water or wells in the area. A
minimum of 4' of cover is required over the septic tank and 3' over the
absorption trench. In lieu of cover 2" of direct bury insulation and 2' of
cover may be placed.
Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
Unless specifically agreed otherwise, the contractor shall be
responsible for.final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
pdor approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,250-gallon septic tank must be procured from a certified
septic tank manufacturer if the 'existing tank is found to be defective.
A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
o
All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
Tanks installed without 4' of cover shall have a minimum of 2"'of direct
burial insulation.
, Eot 17, Block 1, Sampson Estates
April 23, 2003
Page 2 of 3 ..
A foundation cleanout shall be installed one to four feet from the
building foundation; Two cleanouts are required between the tank and
the drainfield.
Final grading . over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions .shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution piping must .be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
m
Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
Grade area surrounding the absorption trench to drain away.
A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
' Eot 17, Block 1, Sampson Estates
April 23, 2003
Page 3 of 3
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil lay.er.
6. Ali drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted 'after the excavation of trenches, beds or Pits and before the
installation'of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in Place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as-built of the completed system.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 'i96650 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. 020-281-34
GENERAL INFORMATION
Complete legal description
LocatiOn (site address or directions)
Expiration Date: . ~ -~ '~ .. (~ Z.~
Lot 1 Block 2 Potter Heiqhts
7041 Potter Heiqhts Drive, Anchora.qe, AK 99516
Current Property owner(s) Kirsten Newby & John Sheppard Day phone 345-6380
Mailing address
7041 Potter Heiqhts Drivel Anchora.qe, AK'99516
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS: 3
e
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
I~ Individual On-site
I"-I Individual Holding tank
[-'l Community On-site I'-']
D Public Sewer D
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) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for propert!es served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. 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.
(Rev. 11/99}
Legal Description:
A. WELL DATA
Well type P
MUnicipfility of Anchorage
!Devel,opment Services Department
r ~ .Building S~fety Division i ~ '
"on,Site Water' and Wastewater Prog~am
4700 SoUth Bragaw Street , ,
~: P.o. Box 196650 Anchorage, AK 99519-6650
· , www.c~.anchorage.ak.us
(907) 343-7904.
HEALTH AuTHoRiTY APPROVAL CHECKLIST
Lot I Block 2 Potter Heights
~ 'If A, B, or C provide PWSID #
Parcel I.D.: 020.281.34
Well I~og _Y..
Date completed 711711985
Total depth 248 ft
Date of test
Static water level
~anitary seal~ Y
Cased to.~244
FROM WELL LOG
7117/1985
201 ft
Well production
15 ~ ~g.p.m
WATER SAMPLE RESULTS:
ft
Wires properly protected _.Y,
.Casin'g height (above ground) . 22 m.
~AT INSPECTION
9/1712003
212
6.0+
g.p.m
~Colifor~' col°nies/100ml, Nitrate :[' /'~' mg/I : Other~bacteria. ~colonies/100ml
Date o~ 03/'~/'~o): CollectedlY: Laura Pannono
SEPTIC/HOLDING TANK DATA
Tan'kType/Material GreerSteel
Date installed 7[~1~994 Tank size ~000 gal
Clean6uts ~ ~ " Foundation cleanoUt ~ , Depression over tank ~: High'water alarm N/A
Date of pumping 0/lS/~003 Pumper A+ Home Se~ices ,
ABSORPTION FIELD DATA :
Date installed 711311994 Soil rating (g.p.dJft2 or ft2/bdrm) ! 87.5
Length 40 .ft , ~' Width~ 15 ~ft
Total depth 3..._~5 ft Effective absorPtion 'area 600 .ft2
Date of adequacy test 9/1712003 Results (Pass/Fail)
Fluid depth in absoFption field before test Dry in
.Elapsed Time: 1..~5 min Final fluid depth Dry in
Any rejuvenation treatment (past 12 mo.) (Y/N &type) N
(Rev. 11/99)
,. =~ System typ,e. Mounded Bed
Gravel below pipe. 0.S.. ft "
Depress'ion over field' Nm
Monitoring tube Y
Pass ' For ~_ bedrooms
Water added450 gal. NeTM depth0.~ in:.
Absorption rate >= 450+, g.p.d.
If yes, give date
12-17-03 12:~11~ FR~,~"T~E ESI, SGS ENV SEiWI~S 90T5615301 T-885 P.01/01 F-68~
CT&E Environmental Servicee Inc.
Laboratory DM.lan
200 W. Ponm Dri~
Drinking Water Analysis Report fox To!~! Coliform Bacteria
'Tel: (907) 562-2343
IU~AZ3 IN~-~-~U¢~ON$ O~ {~.t~- ~, $-~- ~ ~$~Oit]~ COT_ r FCT~ S~MPA~ Fix: ~ 661.63OI .
. MUST BE CO~LE~ BY WAlK SUPPLER
· ~'pmVATE W~R SY~M - -
103787 """"'
~mOL~[C~ WA~ ~YS~ ~CO~
TO BE COMPL~.i 6-U BY LABORATORY
Anely~{s ~o.wl ~is Waler SAMPLE Io be:
S&tisfactor~
SatT~l~ over30 h~ ol~ ~sulu ~y
S~k ~ I~ i~ ~iR ~le should
new s~le ~t ~M ~Hv~ ~1.
Time ~. ~ ~ ~
~ MM~MUO
AnMyR
Jun []
Fixed
. Time:
Cilenl notified of u~atlsfaetory results:
!~: .__.._......__Time: ____.__
· MlmW ol the Sill ------------
--~- ----------- -----'-----------'--~ NM JERSEY. 01410. WP. ST ¥IRGINL~
....... MARYLAND MICHK{AI'L MISSOURI,
: .'~ ,, ,.,B,.'& ~AJIC,'NeiflA, FLOR]OA. IIIIMO~. ,
All Dntes/Tlme~ nrc Alaska Stnndard 'flint
l~rhtcd DatMTIme ~3 12:~2
CoI~ D~ime ~/17~3 l~:l~
~ Dn~lme 09/17~ 14:00
T,~nl~ ~r~~ ~Ede
~itrete-N
UnP, Method
1.18 0.100 ~ BPA$O0.O
Allcr~hle {*rep .4x~iy~s
Con~ e.r ID Limit~ P;~ 1~$ Init
B (<-I0] 09/t7/03
Tor~! ¢ol~orm
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(<=1) 0~/17/03
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10' UTILITY EASEMENT
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MUNICIPALITY OF ANCHORA GE
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 ! WATER SUPPLY PERMIT
Initial
Date Issued: Apr 30, 2003
Expiration Date: Apr 29, 2004
Permit Number: SW030108 Parcel ID: 051-053-65
Legal Description: SAMPSON ESTATES SUBDIVISION BLOCK 1 LOT 17
Design Engineer: 0014 Anderson Engineering Site Address: NHN SAMPSON DRIVE
Owner Name: MM & M CONTRACTING Lot Size: 55403 SQ. FT.
Owner Address: PO BOX 670495 Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK, AK 99567-
This permit is for the construction of:
~'~ Disposal Field r-~ Septic Tank [] Holding Tank ~ Privy
r'~ 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 ( 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.
Date:
Parcel I.D.
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
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
05'! - 05-$-6
Permit N u m b e r S W?_~i~{~_
Properly owner(s) MM&M Contractinq
Mailing address (1) P.O. Box 670495 Chuqiak, AK 99567
Mailing address (2) ~VH~ ~'~.,Hf)$c/,4,,J~,q.
Day phone 688.1236
Zip Code
Legal description (Lot, Block & Sub'd.) Lot 17, Block 1~ Sampson Estates Subdivision
Legal description (Section, Township & Range)
Lot Size ...,~',~j 40,~' Acre~G Number of Bedrooms. Four (4)
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] Well Only []
[] Water Storage []
[] Jacuzzi []
[] Water Softening Unit ['-I
I cedify 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.
(Signature of property owner or authorized agent)
Permit Fees:
Receipt Number: ~'/'{ "~ ~-
(Rev, 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
· . P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 .(FAX)
April 23, 2003
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 17, Block 1, Sampson Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 17, Block 1, Sampson Estates Subdivision intends to construct a new
four-bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new well and septic system to serve the home. The attached Site Plan
and backup documentation identify the location of the well and configuration of the new
septic system and alternate site and the parameters used in the design. Also identified
on the plans are the test hole locations and the wells and septic systems on the
surrounding lots. Drainage arrows and spot elevations are shown indicating the current
drainage patterns. The drainage patterns will be maintained after construction.
The test holes placed near the location of the proposed absorption trench indicated
dense silty gravel with percolation rates approximating 35 minutes per inch. No
ground water was found dudng placement of the test holes and none was noted during
the monitoring pedod. We are therefore proposing to place a 1,250 gallon septic tank
and a new 84' long by 3' wide by 8' effective depth absorption trench. The total depth
of the trench will be 10'. below the surface with the distribution pipe at 2' below the
surface. Sufficient fill will be placed to prevent freezing of either the septic tank or the
absorption trench.
The ground surface on the lot slopes as shown on the site plan from north to south at
varying slopes. The absorption trench will be constructed parallel with the slope as
much as possible in conformance with Municipal requirements. All components of the
new septic system will be constructed a minimum of 100' from any surface water and
wells in the area.
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
· Lot 1.7, Block 1, SamPson Estates
'April 23, 2003
Page Two
The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future·
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
o
The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area· The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
13
12
15
VACANT
18
AREA MAP
SCALE 1' ,- 'lDO"
SOUTH
180.00
~osd~
LOT 17, BLOCK 1, SAMPSON ESTATES SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom House Deep Trench System
Perc. Rate: 35 Min./Inch 1,250 Gallon Septic Tank
Application Rate: .45 GPD/SF 8' Drainfield Rock
4 Bedrooms X 150 GPD/.45 GPD/SF (Application Rate) = 1,333 SF Absorption Area
1,333 SF/16 SF/LF = 83.3 LF TrenchLength
THEREFORE: Construct a 84' Long x 3' Wide x 8' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 2' Below Original Ground Surface. Total Depth to be
10' Below Existing Ground. Maintain 100' Separation From Well on Lot, Place 2' of Direct
Bu~ Insulation and 2' of Fill Over Absorption Trench or Provide Minimum 3' of Cover to
Prevent Freezing.
1
#
8'0"
Natural
Backfill
Geotextile
,//~-- Fabric
I 4"Perforated
I PVC(H°lesD°wn)
x-~ Drainfield Rock
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE:
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
2
$
6--
7
8
9--
18
PROJECT #: M0318
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 L STREET, ANCHORAGE, AK 99502-0605
SOILS LOG - PERCOLATION TEST
PAUL MYERS / MM&M CONSTRUCTION
LEGAL DESCRIPTION: LOT 17, BLOCK 1, SAMPSON ESTATES SUBD
TEST HOLE # 1 SLOPE
SILTY-GRAVELS
WELL COMPACTED - GM
DATE PERFORMED: ~/8/o3
SITE PLAN
NO SCALE / SEE ASBUILT
COMMENTS:
WAS GROUNDWATER
ENCOUNTERED? NO S
L
JF YES, WHAT DEPTH? O
P
DEPTH OF WATER None
AFTER NONITORING: E
DATE: ~/22/2003
~ 0%
~ 2%
READING DATE GROSS NET DEPTH OF NET
TIME TIME WATER DROP
Start /./8/03 8:2'/ 9.0"
-1 1 85'/ 30 8.125" .875"
Recharge 8.57 10 O"
2 9:2./ 30 9.125' .875"
Recharge 9;2./ 9.125"
3 9.5'/ 30 8250"
BOll
PERC RATE: , ~,~ MIN./INCll PERC. HOLE DIAMETER: 6"
TEST RUN BETWEEN /,5 FT. AND SS FT.
NO IMPERMEABLES ENCOUNTERED / HOLE PRESOAKED PRIOR TO TEST
TEST PERFORMED BY: T.L. KIMBROUGH
I, MICHAEL E, ANDERSON, CERTIFY ]'HAT TH)S TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: /./22/2003
5
6
7--
8--
9
18
PROJECT #: M0318
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH 8, HUMAN SERVICES
825 L STREET, ANCHORAGE, AK 99502-0605
SOILS LOG - PERCOLATION TEST
PAUL MYERS / MM~M CONSTRUCTION
DATE PERFORMED:
LEGAL DESCRIPTION: LOT 17, BLOCK 1, SAHPSON ESTATES SUBD
TEST HOLE # 2 SLOPE
SILTY-GRAVELS
1WELL COHPACTED - GH
SITE PLAN
TH2
0
N0 SCALE / SEE ASBUILT
COMMENTS:
WAS GROUNDWATER
ENCOUNTERED?
IF YES, WHAT DEPTH?
DEPTH OF WATER
AFTER MONITORING:
NO
None
E
/./22/2003
S
L
0
P ox
READING DATE GROSS NET DEPTH OF NET
TIME TIME . WATER DROP
Start Z./8/O] 8:/.0 8.5"
1 g 10 30 ?.S'; 1.0"
Recharge 9.10 925..
2 9/.0 30 8.375' .875'
Recharge J 1Q10 10.0"
3 10:/.0 30 9 125"
BOH
PERC RATE: ~ MIN./INCH PERC. HOLE DIAMETER:
TEST RUN BETWEEN /. S FT. AND 5 S FT.
NO IHPERHEABLES ENCOUNTERED / HOLE PRESOAKED PRIOR TO TEST
TEST PERFORMED BY: T.L. KIMBROUGH
I, rVhCHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE .
WITH ALL STATE AND HUNICIPAL GUIDELINES ON THIS DATE: /./22/2003
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 17, BLOCK '1, SAMPSON ESTATES SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,250-gallon tank at the location shown on the site plan. Work
also includes the construction of a new absorption trench 84' long by 3'
wide by 8' effective depth also at the location shown on the Site Plan.
The total depth of the trench will be 10' below existing ground and the
distribution pipe will be placed at 2' below the surface. All components
of the new absorption trench and septic tank must be constructed a
minimum of 100' from any surface water or wells in the area. A
minimum of 4' of cover is required over the septic tank and 3' over the
absorption trench. In lieu of cover 2" of direct bury insulation and 2' of
cover may be placed.
Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
o
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified
by the Municipal Depadment of Health and Human Services for
system installations. Owners installing their own systems must receive
pdor approval from D.H.H.S. before beginning system installation. ·
SEPTIC TANK INSTALLATION
1. A new 1,250-gallon septic tank must be procured from a certified
septic tank manufacturer if the existing tank is found to be defective.
A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
· Eot 17, Block 1, Sampson Estates
April 23, 2003
Page 2 of 3
o
A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabdc must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated,
Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall vedfy this condition prior to
placement of the rock. Ail pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or PoV.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
' t:ot 17, Block 1, Sampson Estates
April 23, 2003
Page 3 of 3
5. A permeable geotextile fabdc (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as-built of the completed system.