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SAMPSON ESTATES BLK 4 LT 27
Sampson Estates Block 4 Lot 27 #051-822-17 Municipality of Anchorage Page i of —2— DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT 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: "JW11�o2� PID Number �� � ZZI Namt;:/v DNA v_tizi.f.i Wastewater System: ❑ New Upgrade (( Address: c' ' ✓cvaGI v l . t A-r-R 'r te . ABSORPTION FIELD Phone: No. of Bedrooms: jJ c. CI Deep Trench ❑ Shallow Trench Bod 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating: // O-`T(_; PD/Sg. Ft. Total Depth from original gradde/e!::lli l� ``-• 4. Lot: 4.24 Block: Subdivision: P t Depth to pipe bottom from orioinal grader -+6.5 —'3.5 Ft. Gravel depth beneath pipe r d.. Ft. Township: Range: Section: Fill added above origgii❑al grader: / G-- 2.5 FL Gravel length:: �J/ n I T`` /- t. WELL: ❑New ❑Upgrade Gravel width: n' Number of lines: Distance between lines: CI nific5tion �(Pr✓ivate, A, C): V-\JY�}moi (��t �� Total Depth: Ft. Cased To: FL Total absorption area: l'-el± SQ. Ft. Pipe material: -f-6(o�Ei2�r }��Jj�'(`1 .'t T VG Driller: / Date Drilled: Static Water Level: Ft. In taller: fN1 �! '/ J� .ei. -PVY4• TANK Date installed t,� C/ `17 Yield: GPM Pump Set at: Ft. Casing H ight Above Ground: Ft. SEPARATION DISTANCES // q,Septic60,/-4' f-)O Holding !Manufacturer: /f j j �/�� CIS.T.E.P. Capacity in gallons: `, 2. 7) To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Well lel' / / c� _� �� !� Material: � Number of Compartments: Wat re LIFT STATION 1�{-1- lam_}- — — _ Lot Line nom, / /i/ /f .�J�. �J jt� Size in gallons: Manufacturer: f 1 ( 64- --' "Pump on" level at: "- • mp of P' level at: High water alarm at: Foundation ! � Curtain 1 , Pump Make : -.del Electrical Inspections performed by: Drain s ��( �J-)1 X-440-01-)1\1 �iI Remarks: BENCH MARK 6Tt� � f V---. (/ Location an>d escr� ti 'LAT-'l ' Y6�Gjo ( Y'V-7_ Assumed Elevation: Ft. 4'1 i, / 1S\ -1. 3Q� 1��/ ENGI- ,. , ,SEAL Ay.. t to . tT j .. i S & S ENGINEERING Inspections performed by: 17034 Eagle River Loop Road, N 4: 1st 7 q�J Eagle River, Alaska 99577 2nd if: Department of Health . d Huma, -rvices appy val Reviewed and approved by: - . 46 Date. _ _,17/4 72-013 (Rev. 9/91) MOA 25 Permit No SW930231 Page 2 of 9 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 DescriptiorS T 27 PID No • 05182217 CO2 j FINAL GRADE IM EIMEAB DIAL GRADE 2. INSULATION FILTER FABRIC EXIST. 1250 GAL S.T. 94.3' 90.3' WATER FOUND 5/31/93 3.0 6.5 14.5 54.0 28.5 20.0 17.5 11.0 11.5 46.0 38.5 14.5 37.0 27.5 16.5 69.0 21.0 61.0 NEW BED EXIST 1250 GAL SEPTIC TAN RELOCATED SEPTIC AREA DRM HOUSE 100' WELL RADIU 10' T & E ESMT. 100' WELL RADIUS _—_— WELL SCALE 1" = 72-013 A (2/91) MOA 25 GOLIATH DRIVE 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 WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT DATE ISSUED: 7/20/93 EXPIRATION DATE: 7/20/94 PERMIT NUMBER:SW930234 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:FEDERAL NATIONAL MTG ASSN OWNER ADDRESS:23633 GOLIATH DR CHUGIAK, ALASKA 99577 PARCEL ID:05182217 LEGAL DESCRIPTION: SAMPSON ESTATES BLK 4 LT 27 LOT SIZE: 41004 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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 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: RECEIVED BY: �r`"✓ DATE: ISSUED BY: �% / VO°-72DATE: 7- 2a - /J MUNICIPALITY OF ANCHORAGE. Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR930036 PID# 051-822-17 HA# Permit # Date Received: June 30, 1993 Legal Description: Lot 27 Block 4 Sampson Estates Subdivision Engineer: Robert Shafer, P.E., S & S Engineering 17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99577 Applicant: Allen Stream Waiver Requested: Lot line - 5 feet; well to leachfield - 85 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: 5-4-F J 77/(HE/2 Date: 7--/q-9 3 By: Rec #: 1-\ is (o Amount: c\(0,(C)(_ Date Paid: Lc, -3Q-c Municipality of Anch3rage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 20, 1993 /fig\ 414 dllhs Robert Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 27 Block 4 Sampson Estates S/D Waiver Request #WR930036, PID #051-822-17,SW930234 Dear Mr. Shafer: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are to a lot line of 5 feet and from the private well to the leachfield of 85 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services ljm:#6 Concur: ohn Sm h, P.E. Program Manager On-site Services 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 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. June 26, 1993 Municipality ag Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L StIteet Anchanage, Alaska 99501 REFERENCE: Sampson E4tate4 Subdiv.i4ion, Bloch 4; Lot 27 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Request you £44ue a permit to upgrade the aeptie system 4envLng the fiowt bed%oom home on the aebe'erteed pnopeltty and £ague .ciao waiveka: 1) 5' pnopenty line waive& ,, �n 2) 85' cepa cation distance UJai.vea to the existing weft. L.0 01 d� bri-e:h N ¢ L� Dating an Lupecti.on og the existing septic system, the monitoring tubes within the system indicated. the system was completely 4atunated. An adequacy test was pergonmed and the system appeared to be $uncctioning adequately. Due to the manner .in which the system ne4panded to the adequacy test it appeared the system was being .i.n5luenced by gnoundwww . A groundwater moni.to'ung tube was .instatted and groundwater was determined to be enenoaeh%ng the existing system. The4e04e, the system is .in non-compliance with Municipal Regaea ..Lon. A test hale was excavated and a percolation test pensonmed .in the anew og the proposed upgrade. Owning excavation og the test hale water was encountered a 9', and agten seven day groundwater monito4ing water was Bound a 8'. Sevetat other test hales were excavated an the back og the property, however ground water nose to the surgaee duni.ng 4pning high gnaund water. Attached .is an upgrade design which shows the location og the proposed distribution system. We do not anticipate any adverse Wee& on neLghbo4ing properties by the installation og the proposed septic upgrade. A g,ield visit was made by Robby Robinson and a representative Am this ogg,iee during high ground water and the proposed site was the only site ava.ifable under current cki to .La. A wive.& ag 85' is needed Bon the draing.ield with respect to the existing well on the property. A waiver og 5' to the property line is also needed. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 27; Block 4; Sampson Estates Subdivision June 26, 1993 This is the only site switab.e 404 the upg'ade og this system in acco4dance with cunnent ctitetia. The 60116 an this tot and adjacent Lots pooJt y pe4m.i,ab!e and the mig'wtLon o4 e44tuent -towzvcLs the well h.Lgh.y un..ikety. Subsu4gaee migkation w.LC.e 4egwi4e a stow pen.co.ati.on .h4ough a dense, s.i,2ty soil which shooed 4emave a t contaminants be4o4e 'Leaching the weLe. Above g4ound m.Lg4ation in the event os su44ae.ing eitguent Witt be away $4om the welt since the slopes ane .towa4ds the back o6 the p4ope4ty and .the weL2 i4 Located .in the 6/tont. A waive4 to the p4opezty tine w tt not adve4seLy .impact the nei,ghbo4s and would not p'event the upg4ade og .the ne.ighbons septic system. Ib you have any questions 04 4egw.&e addit onaL .in4o4mation 404 you4 4ev.iew, please contact us. S.Lnce4 T A. SHAFER, P.F. gk 199 FEET. THE $7»7/c L ELFL 15 J /b FT. AT Tnc T/'4 ar ¢00 000 0,T 000 222 0 wfl/V�n %?EQuEfr /FOI Lor 27 /3LOfk ¢ Sf%/%PsoN ESTnTEJ- wt/VER NU,4j3& WI? 93003‘ t/h91UFR REQuE 5 r port D '-L oT w.ELL To P/oPc5<FP AO.so14Pr/o,v FIELO or 83" 1 Fl BSUIR Pr /Oa/ FI6L19 ra LOT L /.vE S ; 5EPr/c D/?rri- rW E 45XIS)-/N S EPr1G $ j'$TE^-1 If C u/eRE.vrLY 4/Vf/Po,9CHAvo, OA/ T/'E GROUNO tv/3T4k' rAgLE. TH/s was PlsfavIFRE.O pu47/a6 ,q.,,• .4117").1-.,wcr TEST ,015/N(, PFreFcR,keto. 13N /9. 1;721-1 TIC,A/ f!/ -f REE,v ,Su/7M/TIED TO T/t/; OFF/CE To Li PG/9A/0,5 rkE k-/91TEwvikTER ,rt'sI' Ai DN Th//J L oT, /Vumf_nauj fem., %E5r5 ME,%EgLEP VERY 1-1/6H (4i/JOA/AL 6/fou,, w/47 -ERR /N rg,s aonr'-[ERN Ponr7O.1. OF TW Lor rH/¢r EIre 1.i.4"AceeP ALE Fc'/2 /fd5ORPr/o, FICLO U SES TYE oNt Y 8fPE/4 4-/TH?.9-PE Qc ' reL Y PEE, 6Aau/'k2 V TE_V' puR/.t-6. s' 4,6 1gJPE4k1. /' /f sY5TE/-1 1f g/£/mob pito/Paso'', yak-EVE4' %a GE r y'/!/1 P/OPosE/7 /¢RfoNPT/o SYSTEMCoisr/? crEO, /T 1• -/LL /2E4h4/RE /i 1,.K3ovE/4 REOwC/,v,y T/1E /00 / SEP/ Rfr/av FR Om T/1E LOT Lv£LL r0 65 FELT; THE Solt$ rEsr rtiP,c -J-Ft PFRc. R/4 7 -E eF 23 REQa/ O H/w//1i /Apo 6/1 114rE/?/.4L. rK/S So/.. t.- 0 rYPIG/*LLr PRov/DE AtiO(¢aRrrr rRE»TME Alr op SEPric TANK EFFL u(.'7- pg Acme n,6A'/9-r/4v6 /9tii S/G,v/P/ Aker 0131-13A/CE FROM THF_ 12109-/AvF/ELO /' Q44F_./77 THE £ EP TYP fr•YJ M' T> -.v P1ELD PROPOfE'P /S f>E$/b/vED ro ,t9'E ,-BSORpTIDN OCGu/p /yr,q. RA -TE F o GPD/soft. 222 t 000 S. or A, D E. C, S. w 6. for S; _—_-- iv TER rime POj rr /3? , — ' peopoS6p Nqx Peery of S YI rem = /SS . ' . 9 8s x =.9sf 7 SD/L S oR97/oti 6-46-i)2 t�/8���¢(;��6 PEr'nEhlop4 TY (!4» t/®j w/HrE' rIDLE 6R1412/ENr PRo. Iny?LE of Co or.%40,,4n.4vy WELL. LUPSLOPE 01v .'../0% SL OPE4,yff HwrE Cv#'$Rupn've. Q e /ya/'/Za.v15EPAJ? 17o v SS' 2• 71 3.. 9 2.s 7 s 70 X=•471-2 2.� G/,vd Tar/LiL /7/ zdtiCL ulivti /914ow S YfriEM 7-0 Co".,rtie ucrF/' L,tRcrf of Cv1-Atm /d.I4 rd ✓`�' / 4'a 41 porEA.7-//pt. SITE PLAN 0 L() w J 0 ti) LEGAL SAMPSON ESTATES SURD ,, LOCI( 4. DRAWN L. S. ULSHER CKD. r R.A.S. DESIGN CRITERIA: 4 BDRM = 600 GPD SOILS = 0.4 GPD/SQ. FT. 600/0.4 = 1500 SQ. FT. REQ'D NOTE: All portions of system with less than 3.5' of cover require insulation. Contractor is required to obtain utility locates prior to any excavation work. HOUSE ) I EXIST EXCAV AND R DATE 6/15/93 rSHT. 1 OF 2 BED: 0' - 4' DEEP (SEE DETAIL INSTALL SAND FFRP2VEOORLEVELCS) BED 6" GRAVEL OVER AND UNDER DIST. PIPES SEE DETAIL FOR DIM. PROP. BE 250 GAL SEPTIC TAN TE, VERIFY INTEGRITY, LOCATE 4EPTIC AREA ccr 4PTIC EXIST. BED TO BE ABANDONED 100' WELL RAJ US WELL 100' WELL RADIUS 10' T & E ESMT. 100' GOLIATH DRIVE DETAIL/PROFILE LEGAL SAMPSON ESTATES SUBD.,BLOCK 4, LOT 27 DRAWN L. S. ULS CKD. R.A.S. HER DATE6/ 1 6/93 SHI. OF IMPERMEAB DETAIL CO MT co FINAL GRADE 13' 67,44 sc bert A. S!:efar No. 14.57-B m.. 4' MAX. DEPTH ANICS- 60' PROFILE DIST. PIPES LAID WITHIN SEWER ROCK, 6" UNDER & 2" OVER DIST. PIPES ORIGINAL GRADE PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST J� S� fEA-41 LEGAL DESCRIPTION:L-0in 4 Stem esrA 1 2 4 9 10 11 12 13 14 15 16 17 18 19 20 PF.:TIi Township, Range, Section: 6L COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L q, 0 P E Depth to Water After hh t �-31"-611 t �4 Monitoring? a Dat • SITE PLAN N i✓� G 1U Reading Date Gross Time Net Time Depth to Water Net Drop v 1 e -6-S o0t1Gl-L Li Dl" 1 S-'"2-4-13 2'•. 7 N — z Z:30 'iaAA. fr.i S 'A" 1 i/ 3 y�.Lfa 19 " ti 7/I V.. T Z. SO i0 A �1r /1/I yItU� -I it -4 J-JOJ L.,0 .4't1[14 SII " Illy0 PERCOLATION RATE ' (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN F AND 27 FT M S & S ENGINEERING 17034 Eagle River Loop Road No. 204 PERFORMED Bple River, Alaska 97577 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELe ECT ON THIS DATE. DATE' 72-008 (Rev. 4/85) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Sampson Estates Subdivision, Block 4, Lot 27 GENERAL: 1. The scope of this project includes the installation of an absorption bed to serve the four bedroom residence located on the referenced property. The existing septic tank is to be excavated and relocated as depicted on the site plan. If the septic tank is of poor integrity, the tank is to be abandoned and a new 1250 gallon septic tank installed. The existing leachfield is to be abandoned in place. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two Sampson Estates Subdivision, Block 4, Lot 27 June 13, 1993 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. LEACHFIELD BED INSTALLATION: 1. Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed -up) before gravel or sand placement. 2. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. 3. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. 4. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. 5. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Page Three Sampson Estates Subdivision, Block 4, Lot 27 June 13, 1993 6. Monitor tubes shall be of four (4) inch diameter and installed at the locations shown on the design. The portion of the monitor tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. 7. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finished grade over the bed must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation 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: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. Page Four Sampson Estates Subdivision, Block 4, Lot 27 June 13, 1993 7. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 \rte/ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME V G IPHONE'KNEW eaV�E��/thr/, 6,00Je,.'I•UPGRADE MAILINGADDR ,o. Box D Ch,cgrak, a.eastc, LEGAL DESCRIPTION fz'f 17 Rt4 4 Sampsrm e fz.4-CS actt VI Sic LOCATION Parrs n / /fie NO. OF BEDROOMS I DISTANCE TO: Manufacturer Well 1 i,j-r il`i Absorption area �r Dwelling f a� PERMI NO_�ryptl' ��V iVZ Q w p.. w Liq. capacity in /i �9,P� (� i. Materia t,t,,, 6 No. of compartments gallons /2,S IF HOMEMADE: I Inside length Width Liquid depth O 2 Z 1�� DISTANCE TO: Manufacturer Well /► // Dwelling v PERMIT NO. A Material Liquid capacity in gallons w = DISTANCE TO: No. of lines Well 1 gyp-, r Foundation �� r Nearest lot line ��r PERMIT NO _ � Os H Z w a cc Top of tile to finish Length of each lin , Total length of i s �j �^ f L' J Trench th ,5( X5(4 inches Distance between lines ! r O grade 3' Length Material beneath tile 6, inches to Total effective absorption area ! /q6-0' w F 9 Type Width Depth PERMIT NO. wQ a w of crib /� Crib diameter ! P'� Crib depth Total effective absorption area co DISTANCE TO: Class Well Building foundation Nearest lot line J J w Depth 4 Driller Distance to lot line PERMIT NO. 11 DISTANCE TO: Building foundation J t Sewer line Septic tank Absorption area(s) OTHER f PIPE MATERIALS I el i4) v-- ouLd P -z92'7 SOIL TEST RATING 32 r_42y3,22m INSTALLER REMARKS 6a c (015-firu.cfic Ex 65- 15.4 ltpc by e �{ Namil pa slop . o marc , ®„ ba -1 o -F Lee{ S'3� � c 'may v (gid APP'•Vrri 72-013 (Rev. 3/78 1 n ✓ fa 6- I I� Hots DA 0. J. _PRO EGA rwin �Naaa A ex 4-; ka l iosthi S . WE SERVE CHUGIAK, AK 688-3199 WILL/4 4111'DRILLING COQ P.O. BOX 670042 - CHUGIAK, ALASKA 99567 ALL ALASKA OWNER OF LAND T.7.47.1 ADDRESS ''.e'''' 2524 Palmer Ali.. WELL - SITE L 27 Samson Est. Potters Creek DATE - STARTED 4-26--8 5 DATE -.ENDED 4-26-85 DEPTH OF WELL 2 WASILLA, AK 376-3199 STATIC LEVEL OF WATER FT. 1 " DRAW DOWN FT. 220 = 1 GALS. PER HR. E5 -'7T :)r) KIND OF CASING 05t Bch KIND OF FORMATION: FROM A.) FT. TO 2 Overburden FROM 2FT. TO 47 FT.Sa-' & Gravel FROM 47FT.TO 183 FTClay & Grave,, FROM 183 FT. TO FROM 9 FT. TO 220Gray e1 atr FT. FROM FT. TO FT. FROM FT. TO FT. FROM FT. TO FT. FROM FT. TO FT. FROM FT. TO FT. FROM FT. TO FT. FROM FT. TO FT. 189 F.I C:a? y MISCL. INFORMATION: _-Dc Set 7-7 FROM FT. TO FT. FROM FT. TO FT. FROM FT. TO FT. FROM FT. TO FT. FROM FT. TO FT. FROM FT. TO A:f FT. FROM FT. TO ( .F FROM. FT. TO FROM FT. TO FROM FT. TO FROM FT. TO FT. rn FROM FT. TO FT. m.: F ...... . :Cvas O Z CTI >a, Q FT...O b DRILLER'S NAME IJINI C.., ..... CD ��1! .... -M-111FR:ir.1��� DFPARTMENT 8F HEALTH AND ENVIRONMFNTA!. PROTECTION 825 L STREET, ANCHORAGE, AK• 99501 26i! -472O ENIN11-~E3 1:11-1ES: PERMIT NO: 850090 DATE ISSUED: 04/0=78o APPLDCANT: ADDRESS: CONTACT PHONE: SKAGGS CONSTRUCTION P.0 BOX 670690 CHUGIAK, AK 99567 688~28�1 |EGAL Dr. S8RIF' ; SUBDIVISION: 'SAMPSON ESTf".;TES SECTION: 3 TOWNSHIP: 15N LOT SIZE: 41004 (SQ"FT. OR ACRFS) LOT LOCATION: GOLIATH DRIVE MAX BEDROOMS: LOT: 77 RANGE: 1W BLOCK: 4 • isted below arc the options available to you in designing your septic system. Choose the option that best fits your site. . .• DEPTH TO PIPE BOTTOM (FT,) ** GRAVEL DEPTH (FT.) 0,5 TOTAL DEPTH (FT ) . 2"5 GRAVEL WIDTH (FT.) 32,0 GRAVEL LENGTH (FT.) " 61,0 GRAVEL VOLUMF (CU.YDS.) 72.3 iANK SIZE (GALS) 1;250^0 *x SOIL RATING (SQ,FT./BR) 324 ** DEPTH TO PIPE BOTTOM < FT. REQUIRES INS04TION ** DFPTH TO PIPF BOTTOM < 4,0 FT, MAY RFQUIRE A LIFT STAT�ON ** TANK MUST HAVE Al LEAST TWO COMPARTMENTS � I certify that: 1^ I am familiar with •the requirements{ forth by the� Municipality o{ Anchoago'(on_sitesewe's and ue]ls as se� 2^ I will install the systcm in accordance/ e nu*) andthe State b{ Alaska, and in -Compliance With the d iwith all MO�codes•and es gn criteria of this it 3. I will adhere to all MOA n� State o{ Alaska� distances from- any exi�i�g'we�l �wa � requirements {o� the set bar� sewerage system on this or any •adjacent or n�arby lot, s permit• is valid � ` that.this or a maxim�m o{ 4 bedrooms any enlargement ill -~`~ � e rooms and w r�quire an additibnal permit. � � ~ ~ IF A /IPTV u�TArTO� IS INSTALLED IN AN 'AREA COVERED BY MOA BUILDING CO/ES THEN z/ � E/FCTRI�A/ PERMIT AND INSPECTION MUST BE OBTAINED�(2) A5-B�i� (AILTS WILL u|APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT. AND (3TE ELECTRICAL BE WORK �USTBE DOW BY A LICENSED ELECTRICIAN. / � / / �---����++*_ �/, � __� ___ _ ~^' rrL��H@T: SKAGGS C"3TRUCTION [SSUED BY (p`~a'm_tv . DA!E: .4��/S7..r PERFORMED FOR: LEGAL LEGAL DESCRIPTION: DEPTH (FEET 10- 11 - 12- 13- 14 r 15- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST / +-D 7 SOILS LOG 6p0�16 PERCOLATION TEST DATE PERFORMED: 3 -6 ---as o7 -5-&-/-k,/son .33 DS -11 RIO SfY) SLOPE SITE PLAN o-/' J 4-4- ,_Z °L/ 2-g //) s� d,/ 6-/v/j ,,6- 1 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L 0 P E w ccs2NCR '-}0 XS 70 Reading Date Gross Time Net Time Depth to Water Net Drop / 3 -s--5: //: 06' 0n„1 F410/ Z i ,.// 3- , 4 /SJ7 , o /S / 3 //: /4 5' , 0/30/ , o /S/ y //,Z/ 5- ,CVs/ ,0/s/ PERCOLATION RATE h TEST RUN BETWEEN COMMENTS 50(L /5 Iz. ir/eb A/ T 3/2 t� '/it/Z/ QC%WECA/ 2 /4T �( /c%S) 54, FT AND (minutes/inch) 3 FT PERFORMED BY: 72-008 (6/79) CERTIFIED BY: 40/ 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. 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 S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date \ OF/Ai' --3A RC�ERT C. COWAN 112 . apt 5. DSD SIGNATURE �A C -&30i •.:"mor Approved for / bedrooms. 3 ` ` ` Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: 13 (Rev. 12/00) X ., ON-SITE . 1J\f1Crtr:;iu YS - \NASTE'nNiT. ER ' F.OGttsM • Maintenance Agreements SUppiemental Engineer's Report Other Original Certificate Date: /z/ /-?%(7z 0 Legal Description:: A ..WELL DATA Well type ;` Date completed c ;` Sanitary seal (Y/Ny. , Total depth ft. Cased to 4 ft.e FROM WELL LOG.. Date of test 4/ �/ .. Static water lever `. . -,v ft. Well production /0: Municipality of Anchorage •Development Services'Departrrment Building Safety Division Ori=Site Water & Wastewater Program 4700 South Bregaw St 0;0.:136,:,400650- Anchorage, AK 99519-6650 www c) anchorage.ak:us -."(907).343.-7904 HEALTH pTHQRITY APPROVAL CHECKLIST. 2 GST�so�:S •1 - If A, B, or G provide PWSID # WATER: SAM KE- RESULTS:::' p11': • Coliform : . 0 colonies/100 ml Nitrate / 9/ : mg /1 Arsenic. ng /1 Date of sample /1111 194..': B : SEPTIGI OLD1NG TANK DTA Tank Type/Material GC Tank size ; ,i10:57.0$ gal NW:riiber of Compartments Foundation .cleanout (Y/N): Depression over tank (Y/N.) • A Date of rn m 1:r J Q!s P 9 Pumper C..:,A'BSORATIOht FIELD DATA, , T 0 SSA ETY/' Parcel ID:: OS"/ S a.i. .1 7 Well tog .(Y/N) `T Wires properly protected ty/N) y Casing lielght (above ground) / ÷ in. •AT:INSPECTI_ON. /VC>AV Otherbacteda : D colonies/100 :ml.. • . S&S, .ENGINEERING s CollectE' River Loop. R---' mo 2O4 Eagle Rivo r; Afaska 99577 /dV *T.7).4.c4.4.01 Date installed e f /g3 Cieanouts (Y/N) ..:. High water alarm (Y/N) A//t • Date installed Soil eating o p.d / orft2ibdrml • System type Length - i 1� Width,::. 1 ft Gravel below pipe ..£7, S ft; Toter depth tt Eff abs rption area ,ft2 Monitoring tube y Der sion over field T Date of adequacy test C� .I D ,: Results';(Pass/Fall). • p,i+S3 For 4 bedrooms Fluid depth in absocpttoo-,field before test Water adds gal: 'New depth `T in. Elapsed Time min Final fluid depth m Absorption rate >= 400 g.p.d. Arty reluyenetion treatment (past 12 mo) (Y/N & type) If yes,give date • D. LIFT STATION ' . . : -...'' •-• Date installed /V Size in gallons , Manhole/Access (Y/N) - . "Pump on" level at "Pump off' level at in. . ' High water alarm level at Datum, / Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT To• : Septic tank/Iyon lot ICC Absorption field on lot Public sewer main /1 Scx‘iseptic service line 93°36 On adjacent lots /00 On adjacent lots 1 00 ler— Public sewer manhole/cleanout Holding tank AVA". SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 1*-- Property line5 14-, Absorption field Water main 0..//0q. - Water service line /0 -Surface water Wells on adjacent lots /CO /tr'." SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: - - .6- t Property line. Building foundati-x-on .Water main il- Water Service line, . /c., .47• ,. .Surface water ( 00 4- Driveway, parking/vehicle storage / '' • Curtain dram cA/t);•J'i- `..61:ii-,4Wells on adjacent lots /4:2 /---- , ' .., -- - r • , • .,• •-• 4141":%. 5 /co F. COMMENTS G. ENGINEER'S CERTIFICATION , I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effecton this date. Engineer's Printed Name Date HAAFe $ r, Date of Payment //4/ o Receipt Number •cp i S*5- . • •. • . • • , . . • . •Waiver:Fee $ Date of:Payment.. Receipt Number CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix PWSID Sample Remarks: Parameter CT&E Environmental Services Inc. 1028335001 S & S Engineering Lot 27 Sampson E Lot 27 Sampson E Drinking Water 0 Waters Department Nitrate -N Microbiology Laboratory Total Coliform a 11. Results PQL All Dates/Times are Alaska Standard Time Printed Date/Time Collected Date/Time Received Date/Time Technical Director Released By -`� Units Method 1.91 0.200 mg/L EPA 300.0 0 Allowable Limits (<=10) col/100mL SM18 9222B (<=1) 12/12/2002 16:25 12/10/2002 10:00 12/10/2002 12:35 Stephen C. Ede s- Prep Date Analysis Date Init 12/10/02 JS 12/10/02 SKW SENT BY : STEYL- RT TITLE OF AK OPW ; 4-23-92 ; 2:33P1i ; T I TLE/ADM I N -S&S ENG 1 NEER 1 NG • tt • Y 1rl 1 • u1 Gi fJ •"""" -. 1_ • /D kI2sM-�r,L t' 71 f2 • :'d>r~t ri•' �„ Z"- II/ 11 It is the responsibility of the owner to determine the existence of any easements,'covenants, or re- strictions which do not appear on the recorded sub- division plat. Under no circumstances, should any data hereon be used for construction orfor estab- lishing boundary or fence lines. The surveyor takes responsibility far the initia1 transaction ploy. LOT _? . BLOCK ANCHORAGE RECORDING DISTRICT PREPARIELP By; DOWLING a ASSOCIATES 804 EAST 15th Ave, Suite 2 ANCHQ_R_ AGE* ALASKA 99541 DATE' _ Ri~YISlON 51) 44:47:14::;,s4h. � *ia•a+�. +r , . K •!. rGona* Kari Dowling J '� "►� 15644 ll • • `��pRRfb$Sl�M7i\t' wr QTE •4��+a�•"�"" SHOWN ON THE F RECORDED PLAT 'BARE NOT ,SHOWN HEREON. LEGEND anAss Cap RUNDMENT .._ LAT NO.B 'o) - 0 REOAR PRORCOR.FND ." L7 Hos a rack .M IGAMD: DATE., - " BY. /e/' frt/ //)-41,"" Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.t5/'% —/ cril)dis$141,14 HAA# I -Al m(2,224 Expiration Date: 1. GENERAL INFORMATION Complete legal description / 2• r3 41 S/0/ �/ Location (site address or directions) 2 �& 3 6 6- 417-1-�'2 CR(c'7 i , //c Current Property owner(s) <779 - /,H- Day phone "0788 Mailing address C� 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: e 2. NUMBER OF BEDROOMS: 4 4b/o. 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) 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. DHHS also issues HAAs upon request to home owners. 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 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. R-0251Rev. onoor 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 based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address 5 & 5 ENGINEERING 17C0': ��,':. 2: -._.� .:ca:::.,,. 2C Eat)le River.:i!ssice 99577 Phone .;.7P14 — 29 7-7 Engineer's Printed Name /\ 6. DHHS SIGNATURE v't Approved for Disapproved. Conditional approval for bedrooms. Date lr- (;;;N.Qvoa ...6;;; cc, OF ALSN c. COWAN i o- r -3501 �;?:-�✓ bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: pe.. --7/7„,./7 . Expiration Date: 7 / O -_ ,;25 rRea 01'001' Original Certificate Date: 6 -( (, - o d Reissue Date: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES JUN 05 20 Environmental Services Division MUNICIPALITY OF AN(. 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 4f SERVILES DIVici Health Authority Approval Checklist Legal Description: /- 2-91 94 io”N CST Parcel1.D.: (�'� — SZZ -/ 7 A. WELL DATA Well type (�U/1/7- If A, B, or C, attach ADEC letter. Log presen ) /63 Date completed Total depth ZiO / Cased to Z 20 Sanitary sea6N) CCS Date of test Static water level Well production FROM WELL LOG 4/Z676,( WATER SAMPLE RESULTS: 0 Coliform / Nitrate % R Other bacteria Date of sample: C(2'/ t� Collected by: B. SEPTIC/HOLDING TANK DATA rblNSTC^� Date installed S J Tank size I Z U &Number of Compartments 2- Cleanouts Y N) %-i- g.p.m. �S g.p.m. ADEC water system number Casing height (above ground) Wires properly protecte AT INSPECTION /7z' . a / g.p.m. it -o ay ®l i/A-Is/NG- S & S ENGINEERING Eagle River, Alaska 99577 I r Foundation cleanouteN) '7 L3 Depression (Y(F Date of Purnping Pumper T)% ''.`i C. ABSORPTION FIELD DATA Date installed /9/Zg93 Soil rating Length -466 L Width �'laT J Effective absorption area /5&9' Monitoring Tube presen Date of adequacy test 6 3 Results (Pass/Fail) High water alarm (Y/N) Afr- or ft2/bdrm) 00 4 System type can Gravel thickness below pipe / A Total depth C5 Depression over field (Y/e No 455 For —nut— bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): J �2 / t� d. Fluid depth Z (ins) Minutes later: g �zTZ//� �,,���IAbsorption rate = g.p.d. treatment (past 12 months) (Y/N) /VOif/6-laa4t If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size'n-cfallons Manhole/Access (Y/N) "P_ - on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main frAegi N/A On adjacent lots On adjacent lots Public sewer manhole/cleanout /CSD/7i- Sewer /septic service line 2.5/� I- Lift station A//4 0 M11vex 4 tot l3we4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: _/ / �i Foundation `J Property line Absorption field D Water main/service line Surface water/drainage /©v .t Wells on adjacent lots N/4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water /VC/'t /00 C* - Building foundation 5- / Water main/service line /0 t Curtain drain /VON6- /K/Y07/1W F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area Wells on adjacent lots /00 I certify that I have determined thru field inspections and review of Municipal in conformance wit O HAA gui�plinnes inn effect on this date. Signature }� ✓ ( /( " Engineer's Name Date gz/364r c, Co WAN 6/S'/oo recordjfr t1e.abov 04 -;),it ROBERT C. COWAN i �2 01 C •. CE -8864 et# tr HAA Fee $ 3E moo. °C Date of Payment U S -OC_-) Receipt Number (n vo—i \ (-agbr-t 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 06-13-00 16:24 CT&E Refit Client Name Project NameHm Client Sample 1D Matrix Ordered By PWS1D FROM -CTE ENVIRONMENTAL CT&E Environmental Services Inc. r 1002798001 S & S Engineering N/A L27; B4; Sampson Est Drinking Water 0 5615301 T-094 P.02/07 F-054 Client PO# Printed Datc/Tirnt Collected Date/Time Received Date/Time Technical Director 06/13/2000 13:52 06/07/2000 17:00 06/08/2000 15:25 Stephen C. Ede Released Bji(% e2_i h i n Sample Remarks: Parameter Results Pal. units Method Allowable Prep Analysis Limits Date Date init waters Department Nitrate -N Microbiology Laboratory 1.90 0.500 mg/L EPA 300.0 Total Coliform 0 cot/100m1 SM18 92226 10 man 06/08/00 SCL 06/08/00 KAP MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99.519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D # CYi- aa -`1 1. GENERAL INFORMATION Complete legal description HAA # �I �(�S`1 Lot 27; Mock 4; Samp4an E3tatez Location (site address or directions) 23633 Got iath Eagle. Riven. AK Property owner Wen S ream Day phone 688-0437 (cat be6one 11a) Mailing address 23633 Goti.a.th, Eag.2e Riven, AK 99577 Lending agency Day phone Mailing address Agent Vinq<in-ia Koh{,ie,2d/REMAX o4 Eagte Riven Day phone 694-4200 Address 16600 Centen6.ie.2d Rive, Suite_ 201 Eagle, Riven, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 XXX 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 XXX 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 #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature 5 & s ENGINEERING 17034 Eagle River L Eagle River, Alas 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Phone 6 9'1-2-7t bedrooms. Additional Comments By 1t � il/I L ;._411 Date 8'3 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1-691-(Z-- Parcel I.D. A. Well Data Well type Log presen Total depth Sanitary se If A, B, or C, attach ADEC letter. ADEC water system number I) /16' Date completed Z -Ca g< Driller LI) l t --L. I4 -r -f Cased to �l/�G Casing height LZ" I ( /N) Wires properly protecte. Date of test Static water level Well flow Pump levell FROM WELL LOG I1 -co 1 g.p.m. SEPARATION DISTANCES FROM WELL TO: 10.-I Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line 1)7 t—1 04 .va✓ WATER SAMPLE RESULTS: AT INSPECTION l (o -1j 7j • "r g.p.m. uL_ CD rn 0 rn 55 Z 55 c oz Z m Cr1 C ni -n < D 7_ rri ti (77 c. rt' z ; On adjacent lots ; On adjacent lots I Public sewer manhole/cleanout Petroleum tank > lAI2-97Epo Coliform b Nitrate Date of sample: B. SEPTIC/ GG TjTANK DATA 1114 Date installed 12 -6,ank size Other bacteria Collected by: 54 S .FL, e . Cleanout Foundation cleanou High water alarm (Y Date of pumping t2 ‘1 L_ Compartments Z— Depression (Y/) 14 Alarm tested (Y/N) Oh& - Pumper SQA VTOa-IGI SEPARATION DISTANCES FROM SEPTICS TANK TO: Well(s) on lot To property Zine On adjacent lots 1 (52) / --1- Foundation 2p�1 Absorption field Surface water/drainage 72-026 (3/93)' Front Water main/service line Iv -I' CONTINUED ON BACK PAGE C. LIFT STATION Date installed M. - # acturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" el at "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical co. -s (Y/N) SEPARATION . STANCE FROM LIFT STATION TO: Well o• of On adjacent lots D. ABSORPTION FIELD DATA Date installed �21-- I Ct�J Soil rating (GPD/Ft2) Length , pip idth Total absorption area /�� _ Cleanout presentN) Gravel thickness P. for After test Date of adequacy test Water level in absorption field before test 141. Results (pass/fail) Peroxide treatment (past 12 months) (Y(N)) h\ Surface water System type /r'lOu (4 0•S Total depth 2.— Depression over field (Ya V J SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot -IZ1-�I`LLOn adjacent lots To building foundation On adjacent lots X70 -r Cutbank Surface water \ODI -I' Curtain drain fJ 07) Bedrooms If yes, give date Property line To existing or abandoned system on lot Water main/service line 10 r t Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all M Signature Engineer's Name Date S & S ENGINEERING d HAA guidelines in effect on the date of this inspection. HAA Fee $ OiOC.) Date of Payment Receipt Number 25:2--/.2 9 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number LTE SINCE 1908 COMMERCIAL TESTING 8c ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES Chemlab Ref.# Client Sample Matrix Client Name Ordered By Project Name Project# PWSID :93.4577-1 ID :B4 L27 SAMPSON ESTATES S/D :WATER REPORT of :S & S ENGINEERING :R. SHAFER :UA ANALYSIS Sample Remarks: ROUTINE SAMPLE COLLECTED BY: J.K.B. Parameter QC Results Qual Units 5633 8 STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 WORK Order :70454 Report Completed :09/08/93 Collected :09/02/93 @ 10:15 hrs. Received :09/02/93 @ 17:00 hrs. Technical Director:STEPHEN C. EDE Released By : /'may C Nitrate -N 0.94 Allowable Ext. Anal Method Limits Date Date Init mg/L EPA 353.2/300.0 10 09/07 GLH See Special Instructions Above ** See Sample Remarks Above U = Undetected, Reported value is the practical quantification limit. D = Secondary dilution. UA = Unavailable NA = Not Analyzed LT = Less Than GT = Greater Than 4 MSGS Member of the SGS Group (Societe Generale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 P.I.D.# 051-822-17 ✓ H88-0406 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) IDT 27 BLOCK 4 SAMPSON FSTATRS Location (address or directions) NHN COLTATH 1)R TAT. PFTEBSCRFRIC (b) Property Owner tirxuAgx,x� AlaU.sphURe H mi ea Finance Co o. Mailing Address PO Box 101020, Anchorage, Alaska 99510-1020 (c) Lending Institution Fannie Mae Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: or: Check here Igt, if hold for pick up. List contacyerson and daplrp{ie number below. 1-1.kt. e ! e_Ceso i""7 EEI S 774- 762 2. TYPE OF RESIDENCE Single-Familya Number of Bedrooms 4 3. WATER SUPPLY Individual Welles Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite gc Public 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 80361 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and 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. (907) �7_7h11 Name of Firm EL.'S CONSULTING ENGINEERS, INC. Telephone Address 200 WEST 34th AVE. ANCHORAGE, ALASKA 99503 AUGUST 26,1988 Date 6. DHHS APPROVAL fdu,-(�) bedrooms by Date _ Approved for Approved Disapproved Conditional Engineer s Seal. Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev 8/861 Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION EP221.988 RECEIVED Legal Description' LOT 27 BLOCK 4 SAMPSON ESTATES NBN GOLIATH DRIVE A. WELL DATA Well Classification PRIVATE If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) y Date Completed 4/26/85**Yield est. 600gph ** _ Total Depth 220** Cased to 220^ this test PUNTED @ 4.5gpm for llhours Depth of Grouting Static Water Level 176** Pump Set At 215** Casing Height Above Ground 3' Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot 112' • On Adjoining Lots over 100' To Nearest Edge of Absorption Field on Lot 100* ; On Adjoining Lots over 100' To Nearest Public Sewer Line n/a To Nearest Public Sewer Cleanout/Manhole n/a To Nearest Sewer Service Line on Lot 105' Water Sample Collected by B D PATTERSON • Date 8/22/88 Water Sample Test Results SATISFACTORY FOR COLIFORM & NITRATES Comments B. SEPTIC/HOLDING TANK DATA Date Installed 5/11/85** Size 1250**"*) v No. of Compartments 2 Standpipes (Y/N) Y ' Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped 8/23/88 Pumping/Maintenance Contract on File (Y/N) N ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 117' To Building Foundation 8 5** To Property Line 55' To Disposal Field 5 To Water Main/Service Line 30' To Stream, Pond, Lake, or Major Drainage Course NONE WITHIN 200' Comments ** DATA PROM MUNI. PILES NOT POSSIBLE TO VERIFY Page 1 of 2 72-026 (Rev_ 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 324* Type of System Design hed Date Installed 5/11/85*k Length of Field Width of Field 30',K- Depth of Field 3 Gravel Bed Thickness 6" ' 65' Square Feet of Absorption Area 1950** Standpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test 8/23/88 Results of Last Adequacy Test AT)RQTTATE FOR A FOUR BEDROOM `-v Separation Distance from Absorption Field: To Water -Supply Well 1 OD** To Property Line 20'** To Building Foundation 23 5** To Existing or Abandoned System on Lot n/a ; On Adjoining Lots 105^x° To Water Main/Service Line 43** To Cutbank (if present) none To Stream/Pond/Lake/or Major Drainage Course none wi thin 200 feet To Driveway, Parking Area, or Vehicle Storage Area 60** Comments D. LIFT STATION Date Installed N/A Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify th. have ch- , verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed L_L: Date 8/26/88 CompanygE4 S COr75 Iry MOA No CEEO — 5- g'rqReceipt No. 05 "' 2-bC2S Date of Payment Amount: $ Page 2 of 2 72-026 (Rev. 8/86) Back 110 -CSO MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date +' ' 30 ' OS - 1. GENERAL INFORMATION (a) Legal Description (include lot, block, sub9f.vision, section, township, range) izglzaj3/,K4, SAM1750/I/ SueD,sec 3, %"/mit/, car Location (address or directions) Po-ERs(i€I (b) Applicant Name Ski/en 5 z s anbt Telephone: Home 600 zes I Business 6763(8 153/ Applicant Address PO. )C P C1 -11,G14 ALA -Sic A- 'g57,7 1, (c) Applicant is (check one): Lending Institution 0 ; Owner/builder ❑ ; Buyer ❑ ; Other j> (explain) ,f,fC��llpr (d) Lending Institution 1.) /R- Telephone Address (e) Real Estate Company and Agent AJ 1 b t' Address Telephone (f) Mail the HAA to the following address: — II Pick t 2. TYPE OF RESIDENCE Single -Family Q Multi -Family 0 Other Number of Bedrooms 4 3. WATER SUPPLY Individual Well Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite g Public 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and 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, A I Name of Firm ZR.W/ISI 4/110 A550C AJr'j Telephone S/' ea/57 Address /546) 8, T dOr Rd. Date ta`30•0. 6. DHEP APPROVAL Approved for z_—.:bedrooms by Approved Disapprove Terms of Conditi nal Approval stonNlikqtAirk fay t. OF A it ..414%L. 69. '* o a••••+a3•- ^ to d a „o V- a if u !.Corwin a ,9•;0,0 s °a N.. CE•5283 : ,',$',..,01�4g4koo Essi g Engineer's Seal Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION LAY 3 0 19861 RECEIVED Legal Description: LOT 27 &Lock. 6414 pc56A16'icQOr V/ 510/11 1 M01 V(17UA L If A, B, C, D.E.C. Approved (Y/N) N!%, Yes Date Completed 4• Z(O' 8S' Yield .CSt. &0O c9"'P/�t.f- Well Log Present (Y/N) Total Depth -10 Cased to ZZ(7 1 Static Water Level 17Co Depth of Grouting AqA Casing Height Above Ground 3' _ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot YES Pump Set At 215 Sanitary Seal on Casing (Y/N) YES Depression Around Wellhead (Y/N) N0 1 14' On Adjoining Lots 10C)/ To Nearest Edge of Absorption Field on Lot 1 00 / r To Nearest Public Sewer Line i iv/4 Cleanout/Manhole '=zi=grOi N/,4 • On Adjoining Lots >? 100 To Nearest Public Sewer To Nearest Sewer Service Line on Lot 1 AI Water Sample Collected by LAURA SEELE Y ; Date S• Z0 S5 Water Sample Test Results Comments 6 -M - is FAcro12y B. SEPTIC/HOLDING TANK DATA Date Installed J' /1 ' Os Standpipes (Y/N) 1eS Size 12.50 No. of Compartments Air -tight Caps (Y/N) `its /1_( o Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank—High-Water Alarm (Y/N) N/,4 Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line N%A 2 - Foundation Cleanout (Y/N) yes Date Last Pumped A%& 5y51 -cm ; for N// Temporary Holding Tank Permit (Y/N) Ai/A 114' r To Building Foundation 0.�7 ss7 To Disposal Field S I To Water Main/Service Line30 1 To Stream, Pond, Lake, or Major Drainage Course » 100 r Comments Page 1 of 2 72-026)11/84) C. ABSORPTION FIELD DATA r Soils Rating in Absorption Strata 324 t /LpRM Type of System Design Oed Date Installed �7 ' 1/' 85 Length of Field &s -r r Width of Field 30 Depth of Field Gravel Bed Thickness (G." Square Feet of Absorption Area i9g-O C Standpipes Present (Y/N) Yes Depression over Field (Y/N) Results of Last Adequacy Test N� Date of Last Adequacy Test Ak & S'1677 Separation Distance from Absorption Field: r To Water -Supply Well t00 To Property Line /LO r To Building Foundation V7.51 To Existing or Abandoned System on Lot AlIIIA On Adjoining Lots )05 I To Water Main/Service Line 'f r To Cutbank (if present) Nr A Al1A To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area &dr Comments D. LIFT STATION N/4 Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Per, fitted Bedroofr '.ting Against HAA Request ** I certify tha • �hhec�% erified, or conformed to all M A an HAA guidelines in effect on the date of this inspection. Signed.ate ge r Company * . °0 Receipt No 3 //1(.0 MOA No J7 /Q5 /5 q�qa --.......... °. N....• �`s¢ 7 °. Date of Payment 6 "5O' `d5^ Amount: $ N �' Page 2 of 2 72-026 (11/84) rn *. ce J. Corwin v5 • % o. CE -5233 , ?. ,hie. Mrd �� 8®�eOFESZ C. Engineer's Seal