HomeMy WebLinkAboutSAMUELSON LT 7Samuelson
Lot 7
#051-091-43
A
�ittirt ivxg
b3'
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
OWNER OF LAND 6_ ,;' \ t_po C
ADDRESS
LEGAL DESCRIPTION ,ee' 17 LJ mi
DATE - Started zi `7 MY� i� •r
Ended �p
PERMIT NUMBER
KIND OF FORMATION:
From I,3
Ft. to
r;
Ft.
C a A,,,y G i / r-,,< 1J get
From '2
Ft. to
;
Ft.
'2v0V,, ArArd .'dye -e'-)
From - q
Ft. to
!
Ft.
' .4-vd 6 C, 4,4
FromFt.
to
Ft.
Ft.
id 0y'c'04 A'r
From `''-t
Ft. to�Ft.
PFnl''F ' Cf
Ft. t /V1'
J a T l d€, 14 V i
From
Ft. -to-Ft.
N
6"r'I'k/
From_ ..I s
Ft. to
6 r
Ft.
S t r 7_j" 134th„ �
From
Ft. to
From
Ft.`
From
Ft. to
_ ,
Ft.����=nail
From 6E -L
Ft. to
Ft.
From
Ft. to
Ft.
Ke4�A•u6� .
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to Ft.
From
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
MISCL. INFORMATION`.
f s/
DEPTH OF WELL
STATIC LEVEL OF WATER FT. ? Y>
DRAW DOWN FT.
GALS. PER HR t3+?
t .,.
KIND OF CASING
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.
From
Ft. to Ft.
From
Ft. to Ft.
From
Ft. to Ft.
MUN/CIPq
From
PFnl''F ' Cf
Ft. t /V1'
Rp
It
1��� OE
H $
From
Ft. to -4-11f
N
From
ppnn
Ft. to --A l o
From
Ft. to
r
From
Ft. to �D
From
Ft. to Ft.
From
Ft. to Ft
DRILLER'S NAME
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
FEDERAL TAX ID N 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order # 6000
Date Report Printed: APR 11 88 @ 11:20
Client Sample ID:L7, SAMUELSON
PWSID :UA
Collected APR 7 88 @ 15:30 hrs.
Received APR 7 88 @ 16:00 hrs.
Preserved with :4 deg. C
Analysis Completed :APR 8 88
Laboratory Superviso :STEPHEN C. EDE
Released By
Special
Instruct:
Chemlab Ref #: 9608 Lab Smpl ID: 1 Matrix: Water
Parameter Tested Result/Units
----------------------------------------------------------------------
NITRATE-N 0.14 mg/l
Sample ROUTINE SAMPLE
Remarks: SAMPLE COLLECTED BY RJS.
Client Name S & S ENGINEERING
Client Acct SNSENGP
P.O.# NONE REC D
Req #
Ordered By : R. SHAEER
Send Reports to:
1)S & S ENGINEERING
2)
Allowable
Method Limits
----------------------------
EPA 353.2 10
1
Tests Performed
See
Special Instructions Above UA=Unavailable
ND=
None Detected
See
Sample Remarks Above
NA=
Not Analyzed
LT=Less
Than, GT-Gxeater Than
Owncr Nam�: �`H.F.C. / S&S ENS.
2wner A�|d/ess: 1(�928 EAGLE R�VER RD.
E�GLE R1VE1� AK 99577
Pzrc�1 Id: �51�0�1~43
|ct L l �G bdi i i SAMUELS[K� t
e�a : ` u v s on; ` Lo : 7 Block: �
Section: 8 [ownship: 15N Range: 1W
Lot Size 10680 (sq.�t" or acres>
Max 8edrooms: lhis Permit: 0 Tota1 Capacity: 3
Day Phone:
694�5500
WELL: Log must be submitted to Municipality oT Anchorage Department o� Health
and Human Services within 30 days o� well completion.
�BANDUN EXISTING WELL PROVIDE DHHS WITH WRITEN CONFERMATION
4LONG WlTH WELL LUG.
1 CERTIFY THA[:
iliar with the requirements �or on~site sewe�s and wells as set
forth by the Munici�ali�y o7 Anchorage (M�A> and the State o� Alaska"
2. I will insLall Lhe system in accordance with all MOA codes and regulati�ns�
aod in com�liance with the design criteria o� this permit.
3. I will adhere Lo all MOA and State o� Alaska requirements yor the set back
distances �rom a:y existing well, wastewater disposal systemor public
sew�ra�e system on i�is or any adjacent or nearby lot.
4. I undersia:d ihai ihis permit is valid �or a maximum of 0 bedrooms. l
a]so u/�derstand that the capacity o� the total sysLem is 3 bedrooms and
an� enlar�cmen� will req:ir� an additi�nal permiL.
(Owner) A.
�ssued 3�: �ATE:
�
• .. 111"-2ro �
SCALE
ti�1'P�Tf� 1r-�
l /a / 0-r/'-/ -T/
�►, ,V6,
��• � ._ 10.E "^�/
� � � � �-SG•, \,J�l- to
ItJ
�z
ll
Mol
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
0*
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
t//,lf/l l.�
PH NE �7
� �`��-,�
NEW
EJ UPGRADE
MAILING ADDRESS "�
=LEGALCRIPTION
LOCATION
NO. OF BEDROOMS o�
U Y
DISTANCE TO:
Well �,[
' 'Qo /
Absorption arPPS
/0
Dwelling
`�
PE IT N r,
J
1— Z
CL Q
w F..
Manufacturer //
[.
No. of compartments
���gallons
Liq�ap YY
IF HOMEMADE:
Inside length
Width
Liquid depth
Z
Z
DDISST7ANCE TO:
Well ' -
Dwelling
PERMIT NO.
Fes-
=
Manufacturer V- r --
Material
Liquid capacity in gallons -
w=
DISTANCE TO:
Well
un
Fodation
Nearest lot line
PERMIT NO.
J w z
Z W
No. of lines
Length of e lin
Total length of lines
Trench width
Distance between lines
~
inches
H
Top of tile to finish grade
Material beneath tile
Total effective absorption area
inches
U,
Width dr
Depth /, PE IT O
q7
n.
LU
Q(1)
Crib dia eter
Crib de rh Total effective a
p_ orption ac
"- p
7DISTANCE
J
U)
O:
Well /vim
Buildin undatt6n�
�--
Nearest lgtneDepth
etto
J
Driller
Distance lot line
PERMIT NO.
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
i F
SOI L TEST P1 TING
INSTALLER.
94
R RKS
�i 9 5 ✓Y F .�
0
It
ok
c �a
ha
Fobert A. 5fer w
e
No.
..........._m..
AZP� _.
DATE LEGAL r , �___................_._.-.,.�
SOPS i isN TY, AL A � 2U477iAlVe r ,ariv�
�
rul ! 1 t-4 I A,-- 1', ('_'9 E_ I T °-e A A F= H r-41:3: i--. _A FR, " CEi EE
GEPHRTMENT OF HEALTH AND ENVIRONMENTAL MENTAL PROTEC=TION l/ �
5 ' L ` STREET, ANCHORAGE: tit.:. 99501
64-4720
PERMIT NO. 82:1 97
APPLICANT R. B. WOODS PO BOX 90 EAGLE RIVER 995 7 694-2255
LOCATION
LEGAL L7 SAMi IELSON S/D LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL AB'_ORPTION SYSTEM IS: W-+ELG
MAXIMUM NUMBER OF BEDROOM_ = _ SOIL RATING (SO FT/BR) = 100
THE REQUIRED SIZE OF THE SOIL ABSORPTION _SYSTEM I' � :
a E F=' -E F i = 3-2 L F=P -413-r"= A� �� 1=1 °•e ° 0_ G■ E F� i- F-1=
THE LENGTH DIMENSION IS THE LENGTH <IN FEET:? OF THE TRENCH OR GRAINFIELD.
THE DEPTH OF A TRENCH OR PIT I_ THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCA`5`ATION <IN FEET;.
-r"F=- W I ED. -r" I �0
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E
AND THE BOTTOM OF THE EXCAVATION IN FEET:?,
Fr_ F= A_ a U 1 R_ F= C■ E= F=' i" I ! _ �" F� �`'� �':_ ft= -17F= _ -AND-121121 o ! =11_._ 1_
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
— -._ — T 1-•-$ 0 t= _.P --■ I N *=-. F=° WE A::: "r 1 0"_ n FRIE Fr' F= Q U I F -I! EE E.-■ — — —
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A bJELL AND ANY C N—=SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRI`v'ATE WELL OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
T� i A COMMUNITY _.EWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INS!ARE PROPER INSTALLATION.
1� �f<_t'Q 1 i �o��F=• 11�_ '_. C■�A= ��°{�:� 2J, ::LEF4e=.
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO i NCLUC?E tall -DRE THAN = BEDROOMS
-
SIGNED:_ _ �/�/_%�_��__ = 7l�'r"-------------
'LI—:ANT
�---------_-t%eve( I�G�Gvi�I %F(�g� e✓le--GiCbc(C"�t,dwlQC�iI�L
H 'F' I —:A dT R. E.. WOOD
ISS 1 I EP B `T`.i. • _[ !- ��`� i✓ v ��� r 7
----- -----GATE---=--� =.
L=
�:2f, K -2
to `(��12sa u�-� „fir rr,r�- (au)pip
4
SOILS LOG
MUNICIPALITY OF ANCHORAGE
• �.r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
r
PERFORMED FOR: c ✓ J- L/V �iJ J DATE PERFORMED:
LEGAL DESCRIPTION: /'6��(',�/
DEPTH
(FeE T)
2 CJ
C/
4 fill Q !���t° f GG
5�+ L
7 /<J
8
9-
10-
0
10
NONE
NONE
■■EE
NINON
ENE■
NONE
■NN■
NNEE
NNNE
E■E■
NNNN
■N■■
11 WAS GROUND WATER / S
ENCOUNTERED? L
O
P
12
IF YES, AT WHAT �� ` I E f
13 DEPTH? Z
14-
OF 41
15�
a as
16
17
.. o Robert A. ShQ'18- r
,
" a No. 1457-E
,.
19 '1E to PPF 55t(""
1'.aw..
20
PERCOLATION RATE
TEST RUN BETWEEN FT AND
❑ PERCOLATION
TEST
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
COMMENTS
PERFORMED BY:
72-008 (6/79)
CERTIFIED
(minutes/inch)
— FT
DATE:/2-t/
k� e
Dec. 16, 1982
MtjNICIPALITY OF ANCHORAGE
DEPT. OF ENVIRO`IENTAL QUALITY
Attention: Les Buchholz
�f1N SCENIC DRIVE -Lot 8, Samuelson Sub.
The well on Lot 8, SAMUELSON Sub. in Peters Creel; was permanently abandoned.
The well seal was removed, the well was filled with earth to the top
and the seal welded on. The casing is at ground level.
Signed .__.._f/1—�
KURT KOEHLER
by
DOC Co, dba
SULLIVAN WATER WELLS
-
P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
DEPTH OF WELL
0
STATIC LEVEL OF WATER FT. t t
LEGAL DESCRIPTION . DRAW DOWN FT.
DATE - Startedr Ended `'' GALS. PER HR
PERMIT NUMBER KIND OF CASING - l;
KIND OF FORMATION:
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to ._
Ft.
II, �' °<,� <a
From
Ft. to
Ft.
From
c Ft. to +'
Ft.
''f% ! a .- =�
From
Ft. to
Ft.
From
Ft. to
Ft
f = < I
r
From
Ft. to
-Ft
From
T—Ft. to °s
Ft.
--y< a f
From
Ft. to
Ft
From
Ft. to
"' r' :a r
From
Ft. to
Ft.
From ' .1 � Ft. to�;
Ft.
r'''' f,r. --+? ,J
From
Ft. to
Ft.
From
Ft. to
Ft.
L.'
From
Ft. to
Ft.
From �
-' Ft. to t -
Ft.
` `=' Kms.
From
Ft. to
Ft.
From
Ft. toi
Ft.
66 ^- !i j z / 114 cl,`. _„.
From
Ft. to
Ft.
From
Ft. to
Ft.
fo$'
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.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft -
MISCL. INFORMATION:
DRILLER'S NAME
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 �L` STREET, ANCHORAGE., AK 99501
264-4720
l -J 1* 1_ L_ F=' Iv FP r-1 I —r
PERMIT NO. C 8211.736 ;�
APPLICANT WAYNE CGI P INEA(J PO BOX 279 CHUGIRK 99567
688-3999
LOCATION
LEGAL L7 SAML �ELSOtd LOT SIZE 99999 1 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM I
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC bJELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND
TO A COMM►NITY SEWER LIME IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 70 GRAY=.
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND r':ONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F=' 1= F=_ M I —1-' 1= X F=' I F;l' 1= 4=. E:- 1= ®_ 1= 1•1 E--: 1= F-- . _� -1 = - ^� eE::_
I :ERTIFY THAT
1: I AN FAMILIAR WITH THE REQUIREMENT`_=. FOR ON—SITE SEWERS AND WELLS AS —SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
I G N E D ; i l
H�F'F' I CANT 14AYNE Ci IUS I MEAS
ISSUED tED EKY--__-- �—.--
X14 0
a
BE.J �uavtl�
Municipality of Anchorage
Development Services Department
s..r.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. a t -66 L 43 HAA#r)�)'lg
1. GENERAL INFORMATION Expiration Date:, — 3 ' d
Complete legal description SAMUELSON SUBDIVISION- LOT 7
Location (site address or directions) 2123 VALLEY AVENUE * CHUGIAK, AK 99567
Current Property owner(s) BENJAMIN HUMM Day phone (AGENT) 694-4804
Mailing address 21223 VALLEY AVENUE * CHUGIAK AK 99567
Lending agency Day phone
Mailing address
Real Estate Agent BROOKE STILTNER W/ REMAX PROPERTIES Day phone 694-4804
Mailing address 16635 CENTERFIELD DRIVE * EAGLE RIVER AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
i„divrhini WPn Individual On-site N
Community Class Well
Buater Safety
Community On-site
waterDivision
On -Site Water &Wastewater Program
Public Water System
4700 South Bragaw St.
Public Sewer
P.O. Box 196650 Anchorage, AK 99519-6650
iN
www.cl.anchorage.ak.us 343-7ge.ak.us
(907)343-7904
s..r.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. a t -66 L 43 HAA#r)�)'lg
1. GENERAL INFORMATION Expiration Date:, — 3 ' d
Complete legal description SAMUELSON SUBDIVISION- LOT 7
Location (site address or directions) 2123 VALLEY AVENUE * CHUGIAK, AK 99567
Current Property owner(s) BENJAMIN HUMM Day phone (AGENT) 694-4804
Mailing address 21223 VALLEY AVENUE * CHUGIAK AK 99567
Lending agency Day phone
Mailing address
Real Estate Agent BROOKE STILTNER W/ REMAX PROPERTIES Day phone 694-4804
Mailing address 16635 CENTERFIELD DRIVE * EAGLE RIVER AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
i„divrhini WPn Individual On-site N
Community Class Well
❑
Community On-site
U
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified b}fmy seal affixed hereto and as of the validation date shown below, 1 verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines foPtws application,
shows iit the on-site water supply and/or wastewater disposal system is(are) safe, functional ad adequate
for tlW number of bedrooms and type of structure indicated herein. 1 further verify that based ori. e
int mation obtained from the Municipality of Anchorage files and from my investigation and insp, ction, the
,onsite water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Date 10 /f Jamc —
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the flowing stipulations:
ttttrtrrrrii
�
vim
,�tttt3 Ur A ;
VQQy:• ' • • `'S'p'y;
i
ori-s�T�- • � .
•WATER
• WASTE _
..- • nnoAAA.
-PKvmP"`
Attachments: �io • 5�:
HAA Checklist Manitenance Agreements ��i • ",'
Septic System Advisory Supplemental Engineer'sReort
Well Flow Advisory Other
Original Certificate Date: 11-3-014
T
(Rev. 12101)
111un�c�p1
j Development'S
Bulldinc
r)n_Cif. WtAa
nnc�iorage �E
►s Department
visionA EY
=
ater" Program T
lw t. ..
5 ..>w
6a� 1
Ike
T;.. ror_Deorooms
dal e� ep h � in
absorption rate > �� g:p d
� if yes, give date —
I
"Pump off _in. High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
100+ ,
On to adjacent lots
Public sewer manholeideanout N%A
Holding tank
Property line 5v+ Absorption field o +
Water service line 0+ Surfacewater 9t70'+ r
C DRAINFIELD IS IN B�ROAD R.O.W.
vougn neia mspecoons ana
the above systems are in 0 ""
defines in effect on this date
,<
" Q eff e A Garnessr
JEFFREY A. `GARNESS;'' ����� C —79�3� •'�FeQ
to,.o_av
Date of Payment
Receipt Number
9-30-04; 4:33PM:
IGS ReC#
.tient Name
Project Name/#
]tient Sample ID
datrix
!ample Remarks:
1046247001
Gayness Engineering Group, Ltd.
Samuelson Lot 7
Samuelson Lot 7
Drinking Water
.907 5615301
All Dates/Times are Alaska Standard Time
Printed Date/Time 09/30/2004 13:11
Collected DateMme 09/21/2004 16:30
Received Date/Time 09/22/2004 16:00
Technical Director _ Stenhenot. Ede
# 2/ 3
'ammeter Results pQL Units Method Container ID Allowable Prep AnalysisLimits Date Date Init
7aters Department
Nitrate -N 0.940 0.100 mg/L EPA 300.0 B (<=10) 0923/04 T1B
li.crobiology Laboratory
Total Coliform 0
col/100mL SNU09222B A (<=1) 0922/04 DKC
9-30-04; 4:33PM;
i
i
I
SGSICT'geENVIRONMENTAL SERVICES
(Drinking Water Analysis Reptort for Total Coliform Bacteria
READ INSTRUMONS ,ON REVERSE SID& BEFQ;M COLLECTING SAMPLE
MUST BE COMPLETED BY WA'T'ER SUPPLIER —'
❑ PUBLIC WA-rERSYSTIEMIDM �- •_ _� __ _�
U PRIVATE nrt SYSTEM
Send Results Send Invoice 'w El Send Results
Nater System Name/COIDW�y 7m
/U'Yy IVB\
Gomiq Nar,la
'hone Nwnber
Fa Nwr0or
uailbla nddma.
:ity
61aH
ZIP 0
t
❑Treated Water
:907 5615301 # 3/ 3
200 W. POTTER DRIVE
ANCHORAGE, ALASKA 99518
Tel: 9077562-2343
Fax: 907-561-5301
I Lob Ref No.
ioasza7{J,
1111111111111111111111
Send Inwiee
Walar Sysnm NemelComgm•Name •--•��
CanleG NarM
Phone Number
FU fa m
MallingA m
city
Store
zip ca
t
❑Treated Water
E
SAMPLE COLLECTION:
SAMPLE TYPE:
l
fa,�.slaeerjW�x.m ��purl preF.lein yanya•mpr®rrOlen,
Date: 1 ^
Senito ADEC:
Analysis Began: '7117- 1 1041�'i Q�
t!—J -
Routine
❑Treated Water
Monro Day r..r,
Time: _ �' I , S D AM M.t4aa
onel
Repeat Sample
t—' Untreated Water
Location: S C'w\
Colonies1100ML
(refer to lab no.
)
collector. 0'C C�l ;t; o
®
Special Purpose
PnnlCa Nc a i � • I
SI511a1uR '
Unsatisfactory
/
ported By: Slgnalure l>•
t
7ansported I
jyfjp
TNT -=too Numerous te-oYM
as =ouNr '
to Lae By: Same as collector Other.
,
nlee
N.M. ipnaWe
BE COMPLETED BY LABORATORY
Sample Receiving:
Date[ ,D'
❑Sampleever 30hours aid:
❑ RUSH SAMPLE
Time.:
Results maybe unreliable
(�
Teme--- M—A +1 T
❑ 48 Hour.Waiver
I - Phnne
Delivery Method:
Received By:
Comments:
••....... . op•..• ••.......r...........eu...............rru.pru........ru......
r....................................
Bacteriological Water Analysis Record:.
Senito ADEC:
Analysis Began: '7117- 1 1041�'i Q�
MMO•MUG (PIA) RESULTS:
Total COMM:
ANC FI3K JUN
Date/Time:
Analyst: :D6i
F - Coli:
Sent to Client:
Analytical Method: i
QMembrane Filter
MMO-MUG(P/A)
MEMBRANE FILTER RESULTS:
(�(
Direct Count ^--- ---
Verification:
-
Tmeicwnprm J LTS:
Colonies1100ML
_
Phoned ❑ � Faxed ❑
Datefrtmet
spokewitn:
l`BGB:
®
Satisfactory
EC:
❑
Unsatisfactory
/
ported By: Slgnalure l>•
t
Date/Time:- tI��ql6�q
jyfjp
TNT -=too Numerous te-oYM
as =ouNr '
B' Form 4 FW- 0053 12/17/03
Municipality of Anchorage
Mark Begich, Mayor
Development Services Department
P.O. Box 196650.4700 Bragaw Street
Anchorage, Alaska 99519-6650
(907) 343-8101 Office (907) 343-8125 Fax
http://www.muni.org
November 1, 2004
Benjamin Humm
1200 E. 76' Avenue, #1200
Anchorage, AK 99518
p0ett
NaT S
o ��r Fq�
DEPARTMENT
RE: Encroachment: Monitoring tube and leach field in the 25' BLM Road Reservation Easement
Block N/A, Lot 7, Samuelson Subdivision, Grid NW 1357
Dear Mr. Humm:
The Right of Way Division has reviewed a request for a letter of non -objection to an existing monitoring
tube and leach field, which encroaches 18.0 feet into the 25' BLM Road Reservation Easement. On the
site plan dated September 29, 2004, submitted with the request, the petitioner has shown the monitoring
tube and leach field.
Right of Way Division issues this letter of non -objection with stipulations, and by using it the petitioner
is agreeing to the following:
1. Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages or
injury to any person as a result of the encroachments.
2. All applicable codes and regulations will be observed and maintained within the easement.
3. This letter of non -objection will in no way preclude MOA from full use and enjoyment of its rights
within any portion of the easement.
4. Additional and extraordinary costs incurred during any future required construction, repair or
reconstruction of MOA improvements to accommodate any or all of the encroachments shall be paid
by the property owner.
5. Obtain letters of non -objection from the following utilities:
®Anchorage Water & Wastewater Utility
❑Chugach Electric Association, Inc.
®Matanuska Electric Association, Inc.
❑Municipal Light and Power
❑Eyecom (Girdwood cable TV)
❑Alaska Communications Systems
®Matanuska Telephone Association
®Enstar Natural Gas Company
®GCI Cable of Alaska
All letters of non -objection should be retained in your permanent files. Should you have any questions,
please call me at 343-8033.
Sincerely, Concur,
Jack L. Frost, Jr.
Right of Way Supervisor
Property Owner(s)
IF
r.
APPROVED BY
LYNN MCGEE w/ RIGHT
OFVERBALLY
F ON 9 30 2004
\
— — —
— — — — — — — — —
— — —
10' UTILITY EASEMENT
— — — — — — — —
— — — —I— — — —
1pp
(STING �O�US
r
WELL
/
/
•
• "... •..
"
\
EXISTING'
3 BEDROOM •'""•
HOUSE ; -�/
EXISTIING1 TAGALLON
SEPTIEXISTING
20x23 BED.
..--•
CT LC O
"+•
OS UNKNOWN
� I
oIMT
x,,•
25' B.L.M. ROAD RESERVATION
I --- --J
VALLEY AVENUE
-
DATE:
�ob�
9/29/2004
0�
4
DRAWN BY:
GARNESS ENGINEERING GROUP, Ltd.
C.J.G.
O
SALE:
s:Avan CONSULTANTS & GENERAL CONTRACTORS
,. — 3O'
1
,
3701 E. TUDOR ROAD, SUITE 101 - ANCHORAGE. AK 99507 • PHONE (907)337-6179 " FAX (907)338-32A6
I
PREPARED FOR: PHONE NUMBER:
PAGE NUMBER:
BENJAMIN HUMM 694-4804 (AGENT)
1 OF 1
Q e e A. am
Q 9. •. E-79 �¢DO
���p
LEGAL DESCRIPTION:
SAMUELSON SUBDIVISION; LOT 7,
''.•....... FoAo
of esslp'o—
�400000�
TYPE OF WORK:U400'
SITE PLAN FOR LETTER OF NON—OBJECTION FOR ROAD RIGHT OF WAY
Sep -13 04 13:58.; Pogo 1/1
CALL ON YOUR COMPANYr'
NON -OBJECTION TO EASEMENT ENCROACHMENT DOCUMENT
By this document Matanuska Telephone Association, Inc. (MTA) declares that it has no objection to the
encroachment of a septic system pipe within the 25' BLM road reservation Easement upon Lot 7, Samuelson
Subdivision, according to Plat No. 67-156, AnchorageRecording District, Third Judicial District, State of
Alaska, situated in Section 8, T15N, R1 W, S.M,
Please be advised that MTA through the issuance of this document does not forfeit any of its rights to the use
of the area cited. In the exercise of these rights MTA will, if needed, upgrade, maintain, repair; and/or replace
buried or aerial telecommunications facilities within the easement. Any repairs that may be required to the
encroachment as a result of utility construction will be home by the property owner of record. This document
does not authorize the placement of any additional encroachments within the easement area. Property owners
are required to obtain utility locates before doing any kind of work in the utility easements and will be liable
for any damages caused by their construction work in the easements.
This document is. in no way, an agreement to vacate anv portion of the utility easement and should not be
interpreted as such.
Issued for Matanuska Telephone Association, Inc. this 26th day of October, 2004, by,
Real Estate & Properties Supervisor
THIS IS TO CERTIFY, that on this 26th day of October 2004, before me the undersigned, a Notary Public in and
for the State of Alaska, duly commissioned and sworn as such, personally appeared Bonnie Bailey known to
me and to me known to be the individual named in and who executed the foregoing instrument and
acknowledged to me that he signed and sealed the same as a voluntary act and deed for the uses and purposes
therein mentioned.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day and year first above written.
NotaryPudic i d for
My co lssion expires: -W-,;?&"J7
.
GRANTOR
Matanuska Telephone Association, Inc.
P.O.Box '3550r',�
` l A TjnU>
Palmer, AK 99645104
12Matanuska Telephone Association, Inc.
P.O. Box 3550. Palmer, Alaska 39645-3660
1.800.746.9510 907.761.2510. Fax 907.761.2646
, Matanuska Electric
,--
Association, Inc.
P.O. Box 2929
Palmer, Alaska 99645-2929
Telephone: (907) 745-3231
Fax: (907) 761-9368
Re: Lot 7, Samuelson Subdivision
To Whom it May Concern:
October 26, 2004
MEA has no objection to the one septic pipe in the BLM road easement as shown on the
attached map.
Si
Keith Quintavell
Right -of -Way Administrator
10/28/2004
Garness Engineering Group, Ltd
3701 E Tudor Road, Suite 101
Anchorage, Alaska 99507
To whom it may concern:
ENSTAR Natural Gas Company
A DIVISION QF SEMCO ENERGY
Engineering Department
401 E. International Airport Road
P. O. Box 190288
Anchorage, Alaska 99519-0288
(907) 334-7743
FAX (907) 562-0053
Re: Letter of Non -objection
ENSTAR Natural Gas Company has no objection to a septic encroachment into a 25 -
feet BLM road reservation easement on Lot 7, Samuelson Subdivision.
Acceptance and use of this letter of non -objection by yourself, your heirs, your
assigns, or your successors, will constitute agreement to the following stipulations:
ENSTAR will be held harmless, now and forever for any damages or injury to
any person or property as a result of this encroachment.
Any ENSTAR facility damaged or destroyed, as a result of this encroachment
will be repaired at no cost to ENSTAR.
Any costs incurred by ENSTAR for special construction necessitated by this
encroachment will be borne by the property owner.
All applicable safety code regulations will be observed and maintained.
This letter of non -objection will in no way preclude ENSTAR from full use and
enjoyment of its rights within any portion of its right-of-way.
cc: r-iie
ANCHORAGE WATER & WASTEWATER UTILITY
"A New Standard of Excellence"
Oumed by the
Municipalihj of Anchorage
Garness Engineering Group
3701 E Tudor Rd. , Suite 101
Anchorage, AK 99507
Engineering Division
3000 Arctic Boulevard
Anchorage, Alaska 99503-3898
fax 907.562.0824
http://www.awwu.biz
October 28, 2004
Re: Samuelson, Lot 7 (Grid NW 1357) Encroachment into Easement
Dear Property Owner:
Anchorage
All -America City
It,
2002
Mark Begich,
Mayor
The Anchorage Water & Wastewater Utility received your request for a letter addressing
AWWU's position regarding the existing septic system pipe that encroaches approximately
10 feet into a 25' utility easement located on the south property line of the referenced lot.
An as -built drawing was submitted with the request.
AWWU water and sanitary sewer mains are not available to the referenced lot.
AWWU is not using the utility easement and has no objection to the encroachment.
If you have any questions, please call me at 343-8009 or the AWWU Planning Section at
564-2739.
Sincerely,
Hallie Stewart
Engineering Technician
G:\Engineering\Planning\Planning\HMS\encroachments\encr Samuelson L-7.dot
Voted Best Tasting Water in America - 1998 U.S. Conference of Mayors
Oct 29 04 10:52a
October 29, 2004
Benjamin Flumm
21223 Valley Ave.
Eagle River, Alaska 99567
Dear Mr. Humm,
P.2
Subject to your agreement to indemnify the company as set forth below, GCI Cable Inc.
of Alaska has no objection to the septic pipe encroaching into the 25' BLM road
reservation located on the south property line of Lot 7, Samuelson Subdivision. Known
as 21223 Valley Avenue located in municipality city grid NW 1357.
This letter of non -objection in no way precludes GCI Cable from full use and enjoyment
of any rights it may have within any portion of the utility easement and or the! right -o£ -
way, including unlimited access for servicing its facilities. Also any additional and
extraordinary costs incurred during any future required construction, repair or
reconstruction of GCI's facilities to accommodate any or all of the encroachments shall
be paid by the property owner.
By signing below, you agree to indemnify and hold GCI Cable harmless, now and
forever, for any damage, costs, expense (including reasonable; attorney's fees), liabilities
and injury to any person or property occurring as a result of the encroachment.
Please indicate your acceptance by signing and returning this 1 e to myself at the
address below.
Sincerely,
A eptance
ee 4G i
Rebecca Co ton �� a
OSP Project Manager Date
5151 Fairbanks Street • Anchorage, Alaska 99503 • 907 / 868-5600
II
TO/TO 39Cd b3 XdW3d �SN1-IIIS 9 886b769LO6T 94:9T 4OOZ/6Z/TT
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services 44
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 051-6W-4,3
HAA # I-) �V11 ���Ci
1. GENERAL INFORMATION / / /r __//
Complete legal description Ls/1T Scaml<C�s sc/f d;y
Location (site address or directions) N, 81'l -6k r0001. -SCCr7iC I%a��P,�/
Property owner ".TjO/)e/Af L/%)7/I ?X2 Day phone 5 75;e'
Mailing address C!v fYU�/1'i
Lending agency QFIV, A• Day phone 7-7 -
0 %Z
Mailing address r . ��'x �co72y I�ACho1,Q�1P �/C %95 �C� �C3�Z0
Agent
Address
r
67//
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: ;7
3. TYPE OF WATER SUPPLY:
Individual well
Community well
2.
Public water
Day phone
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 /1
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #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 S�iL�� �iTr7SGGQ� Phone 34- ZQ 16
Address ULM Uashon «^cle cho�a5251s
Engineer's signature
6. DHHS SIGNATURE
Approved for I ( 0 2 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By:
Date 3
bedrooms, with the following stipulations:
Date 03 6!L0--
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 (Re -1/91) Back MOA W21
Municipality of Anchorage RECEIVE /
DEPARTMENT OF HEALTH & HUMAN SERVICES R E C E I V E
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34441 9 1997
Municipality of Anchorage
// 0Health Authority Approval Checklist Dept. Health & Human Services
L
Legal Description: 1 1-7 SA M U ELS6 Parcel I.D.: 105(-6 1-4S
A. WELL DATA
Well type PVT
If A, B, or C, attach ADEC letter. ADE/C! water system number
,/
Log present (Y/N) T Date completed 4 '9 - 86
Total depth 7 1 Cased toCasing height (above ground)
Sanitary seal (Y/N) Y Wires properly protected (Y/N) i �/
FROM WELL LOG AT INSPECTION
Date of test 4-9-68 ,31/15/97
Static water level 36 (�
Well production Jt" g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform Nitrate • Z Other lbacteria + O
Date of sample: ��97 Collected by: S = H cns I Pc.
B. SEPTIC/HOLDING TANK DATA
Date installed Tank size 000 Number of Compartments Z Cleanouts (Y/N) Y
Foundation cleanout (YIN) �_ Depression (Y/N) �_ High water alarm (Y/N) WA
Date of Pumping %(o Pumper R IS
C. ABSORPTION FIELD DATA
Date installed 10 i (a raj 2- Soil rating (g.p.d./W or@2/bdr-r System type 12M
Length 2.3' Width ZU! Gravel thickness below pipe %,t Total depth 4A
Effective absorption area 46, 0 Monitoring Tube present (Y/N)_Depression over field (Y/N)
,ytt
Date of adequacy test Results (Pass/Fail) For bedrooms
st+ 31Zs191,/ �Iv�t}
Fluid depth in absorption field before test (in.); _ j 0 Immediately after 23 gal. water added (in.): .145 3 W -MI
60 2314" 3/z5-191
Fluid depth _ 5 (ins) Minutes later: QFJ Absorption rate = 3W g.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)* EKiST(06 FIELD R&D No MT wsrAt_LED . DIzovE 2' STEEL PIPE
FDR NEW MT, PiPC PKI-VE0 AFf>KOx (2" FILST 130170M OF
P(CLD "It) 5YA9tuz.E bue TO StAXLww rict_O DEPTA. R TiOM OR PIPE
St dLEO_
D. LIFT STATION f A
Date installed
Manhole/Access (Y/N)
High water alarm level at* _
Size in gallons
"Pump on" level at*
*Datum
"Pump off" level at*
Cycles tested
E. SEPARATION DISTANCES C/,SSiM6, Pp -OP, 1-10C V lSr,
•TAt<EU FROM sU)LVC"( AS-RUILT.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot t i O
Absorption field on lot
l2e'
On adjacent lots 1500 ( co)PAG
On adjacent lots 110' ` l FACCC)�
Public sewer main Public sewer manhole/cleanout NA
Sewer /septic service line 1031 Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 7 Property line 2Z Absorption field L (o
t►ork 130. -
Water main/service line 40 Surface water/drainage Vi`.StBLE Wells on adjacent lots
wir too`
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 161, Building foundation �3 r Water main/service line
56 01
Surface water .��nN6 VISi13L Wl'5AID 100' Driveway, parking/vehicle storage area 6o,
Curtain drain U 0 NE Wells on adjacent lots
6U67ECt LOT ArJQ /�R€A CeyJE12�Q (3i
F. ENGINEER'S CERTIFICATION - 1-IEWPi SNQY.J pE-Ml.,
I certify that I have determined thru field inspections and review of Municipal record&-1hatJh&above systems are
,ti ,q.
Al
in conformance wi h MOA HAA/guidelines in effect on this date. c+'�� �`34
Je
`-
Signature
��Y•Yl ��•, �;j
Engineer's Name .S 7�UC'n C. �l ensu .. ..� •• I
f" ;� Steveri"'C ;Hsnsiae & �
Date 3%171%7, �� cE 604 ,r��r
HAA Fee $--Z LYV 11jv
Date of Payment 31 r//2
Receipt Number ;?6n C
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
CT&E Ref.k
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
Parameter
Nitrate -N
Total Coliform
CT&E Environmental Services Inc.
971131001
S K L H Consultants
Lot 7 Samuelson
Private Well, Kitchen Sink
Drinking Water
Client PO#
Printed Date/Time 03/11/97 10:56
Collected Date/Time 03/05/97 14:50
Received Date/Time 03/05/97 15:35
Technical Director: Stephen C. Ede
Released By
Allowable Prep
Results POL Units Method Limits Date
2.21 0.200 mg/L SM18 4500-NO3F 10 max
0 col/100mL SM18 92226
Analysis
Date Init
03/05/97 EMB
03/06/97 RAM
. SKLK Consultants
1700 Vashon Circle
Anchorage, AK 99515
24 March 1997
Mr. Jim Williams
Dept. of Health & Human Services
P.O. Box 196650
Anchorage, AK 99519-7750
Re: Lot 7 Samualson, HAA
9705
Mr. Williams:
RECEIVED
[OAR ? a 1997
iviunicipailiy of Anchorage
Dept. Health & Human Services
This letter is per your request during our telephone conversation this morning regarding
the installation of the new 2 -inch steel monitor tube for testing the existing leach field serving
the above referenced property.
Due to the absence of a monitor tube for monitoring the performance of the existing
leach field, a two-inch dia. steel pipe was driven into the absorption bed for measuring water
levels during testing. The proper depth was determined from actual field measurements and
from information contained in existing Municipality of Anchorage (MOA) files.
The invert elevation of the leach field cleanout was measured in the field to determine
the approximate invert of the perforated pipe. Since the cleanout was so close to the location of
the field, the invert of the cleanout was estimated to be at the same elevation of the perf. pipe.
To this measurement was added the depth of gravel below the perf pipe as recorded in MOA
files. An elevation shot on the ground surface coupled with the calculated elevation of the
bottom of the field gave the total depth below ground surface to the bottom of the field, i.e. three
feet. An additional 12 inches was added to this depth to secure the MT in the ground due to the
shallow elevation of the field. A sketch of the new MT installation is attached for your records
and for clarification.
This total burial depth was marked on the MT and the MT was driven to this mark.
Perforations had been drilled into the MT for six inches approximately 12 inches from the pipe
tip for measuring the liquid level.
While driving the MT it was possible to determine when the MT began entering the
Mr. Jim Williams, MOA DHHS, On -Site Services
^f Lot 7 Samualson; MT Installation,
24 March 1997, 9705, Page 2 of 2
septic rock by the reduction in ground resistance. Although it is not possible to measure this
horizon exactly, the encountered depth roughly coincided with the calculated depth to septic
rock.
Assuming the field was constructed as recorded by MOA records and the perforated pipe
is substantially at the elevation of the field cleanout, the perforated section of the MT is at the
bottom of septic rock. The behavior of the MT, as measured during the test, indicates the MT is
located within the leach field and the perforations are within the gravel layer.
The adequacy test was performed the day following the MT installation. The initial
water depth in the MT was six inches prior to the test. During the test, the maximum water
depth was approximately 10 inches. This depth was reached after the introduction of 77 gallons
of water. The water depth stayed at this level for the remainder of the four-hour test.
Hopefully, the information contained herein and shown on the attached sketch is
sufficient for your review. If you should have any additional questions, please do not hesitate to
contact me. On a closing note, after our telephone conversation this morning, I visited the site to
measure the liquid level in the MT and found it at six inches. I suspect the measurement of 10
inches you recorded during your visit was immediately after some use despite no one being
home at the time of your visit. In addition, I found no standing water over either of the two
septic tank cleanouts.
Sincerely,
Ste u n C. Henslee, P.E.
CE 7604
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, AK 99519-6650
LOT 7 SAMUELSON SUBDIVISION -- MONITOR TUBE SCHEMATIC
a7nr%
MT CAP
GROUND SURFACE EIev.95 2
E I ev, . 94 .85 -
0
w
r
r -
c� o-
J
W
zLLJ
N
4 ' 4.80' '
°� o o °
Elev.92.3'
SEPT IC ROCK °° °
0.
°o
°� °° Elev.91.8'
° 000
-- -- – - - F I ev . 90.8 '
Attachment to SKLH letter dated 24 March 1997
i
t
^� r
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH &. HUMAN SERVICES '
DIVISION OF ENVIRONMENTAL SERVICES
I 01-4CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date Apjri.2 11, 1988
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 7, SamueChon Subdi,vi6ion
Location (address or directions)
(b) Property Owner Jones Telephone: Home Business
Mailing Address AHFC #6391
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate Company and Agent JACK WHITE COMPANY/Lunda Banner
Address 10428- Eagte R.ive,% Road, Ecq°e 'aZcvzic, Alaska 99577
Telephone 694-5500
(e) Mail the HAA to the following address: or: Check here M, if hold for pick up.
List contact person and day phone number below.
S 9 S ENGINEERING1694-2979
17034 Eagle RiveA Loop Road, Suite 204
Eagle Rivet, A2a3ka 99577
ojcdejced by Lynda Bannejc
2. TYPE OF RESIDENCE
Single -Family
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well p Community ❑ Public ❑
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 0 Public ❑ Community ❑ Holding Tank ❑
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 8/861 Front
•1 .
e „
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 watersupply 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 §18Telephone `� l
Ra
Addres%7034 Eagle River Loop Road No. 204
Eagle River, Alas a
Date
6. DHHS APPROVAL ' -
3 -� Date
bedrooms b
Approved for � Y
Approved _ Disapproved Conditional
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 81861 Back
- - Page 2 of 2
A. WELL DATA
pA4t OF AtFPALITY OF ANCHORAGE (MOA)
MUNIQ
E MUNICINA0V SERVt\TF4(AbTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4744
Legal Description: I 1
Well Classification�If A, B, C, D.E.C. Approved (Y/N)
Well Log Present ON)Date Completed Yield
1 [I 1 u
Total Depth '71 1 Cased to _11 1 Depth of Grouting
i
Static Water Level -2-?lv Pump Set Atyf=::2
N
Casing Height Above Ground —
Electrical Wiring in ConduiQV2N)
Sanitary Seal on CasingcO%)
Depression Around Wellhead (Yd9P
Separation Distances from Well:
To Septic/Ho44�Tank on Lot ! L � j ; On Adjoining Lots —
To Nearest Edge of Absorption Field on Lot `�`� ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole 0 A To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
; Date A---3-50
• 0lYr�rf��i/I
B. SEPTIC/PKX--DING TANK DATA
Date Installed `Q-iSize � f�� No. of Compartments
2
lA-
Standpipes (N) 4 Air -tight CapsdN) — — Foundation Cleanout (YAQ tJ
Depression over Tank (YQ Date Last Pumped 2' r ��' 69
Pumping/Maintenance Contract on File (Y/N) 17-4 P` ; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) �'
Separation Distances from Septic/Hokliay Tank
To Water -Supply Well , otTo Building Foundation
I I
To Property'Line To Disposal Field \ O
I
To Water Main/Service Line c To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026 (Rev. 8/86) Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata `���Type of System Design��
�O Length of Field \ — gZ
Date Installed S
Width of Field
7 Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area ifl Standpipes Present (�1)
Depression over Field (Y/W
f- Date of Last Adequacy. Test 2 Zo ^ SB
Results of Last Adequacy Test
Separation Distance from Absorption Field:
00 (k
To Water -Supply Well _
To Building Foundation
r�,
Lot
To Water Main/Service Line o
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at —
Tested for
Electrical Codes (Y/N)
Comments
To Property Line (
epJ
; On Adjoining Lots
To Existing or Abandoned System on
-7D ��
To Cutban I (if present)
Dimensions
Manhole/Access (Y/N)
_ 'Pump Off' Level at
Vent (Y/N)
Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
certify that I have checked, verified, or conformed to all MOA andndHAA uidelines in effect on the date of this inspection.
*��P��1EERiNG Date a OO
Signed g��-..
034 Eagle River Loop Road) No. ZA
Compar MOA No. 15 -vim 3
age rver, (2) '? �
Receipt No Y�
Date of Payment �j
Amount: $ /�16 O
Page 2 of 2
72-026 (Rev. 8/86) Back
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a)Legal Descript on (include lot, block, subdivision, section, township, range)
; �ctl_ rY _) c J? l S �sv1
cgt,�on (address or direcoA
70
(b) Applicants NameQ��CC�Ct(Z�, Telephone - Home Business
Applicants Address • 0A D / U
(c) Applicant is (check one) Lending Institution ; Owner/builder ;
Buyer E�j ; Other [::::I (explain);
(d) Lending Institution Telephone
AAAoa
(e) Real Estate Co. & Agent
Telephone
(f) Mail the HAA to the following address:
2. TvDe of Residence
Single -Family Multi -Family Other (describe)
Number of Bedrooms>
3. Water Supply
Individual Well Community Public
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 Public Community Holding Tank El
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 21
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 regula-
tions in effect on the date of this inspection.
Name of
Address
Date
Firm �, j TelephonaJ /Q y
3-3
(ENGINEER SEAL)
6. DHEP Approval
Approved for 1,.;� bedrooms By;—
Approved_ Disapproved Conditional
Terms of Conditional Approval
CAUTION
9,e® aargom/ea0 saaoae%a;9� t�
ed
�oroy C. Reid, Jr. ° r•i,,
!Q No. 2257-,
or -
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQUIRE-
MENTS. 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.
RR4/ej/D18
[Page 2 of 2]
(DHEP SEAL)
7-19-34
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
A. ,ELL DATA
Well Classification '?(Z-iU +jE If A, B, or C. D.E.C. Approved(Y/N)
Well Log Present /N) Date Completed /'E 2- Yield M,
Total Depth Cased to LJ 0 t n 0 u,)r-) Depth of Grouting LI -r-1
Set At n U
Pump
Static Water Level [)
(�
Casing Dight Above Ground
Sanitary Seal on Casing
Electrical Wiring in Conduit y Depression Around Wellhead
Separation Distances from Well:
To Septic/Holding Tank on Lot �� ; On Adjoining Lots O
To Nearest Edge of Absorption Field on Lot �� ; On Adjoining Lots
To Nearest Public Sewer Lire
A To Nearest Public sewer
Cleancut/Manhole_4_�_ To Nearest Sewer Service Line on Lot K R
water Sample Collected By W ; Date
Water Sample Test Results -S�!}'1 t rwe 76)
B. SEPTIC/HOLDING TANK DATA
Date Installed 1V RZ Size C�[�L� No. C nts
Ila
Standpipes YY ) Air -tight Caps Y ) Foundation Cleanout (YM)
Impression over Tank (Y Date Last pumped l6
/ped
Pumping/Maintenanoa Contract on File (Y /K / for �✓
Holding Tank High -Water Alarm (Y Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Wall f U To Building Foundation
To Property Line ��
(� To Disposal Field /d
mn wat-ar Main/Service Line /(� To Stream, Pond, Lake, or Major Drainage
[Page 1 of 21 L(j vL
;2grjlu
2-15-84
n
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design
Date Installed )4 k2- Length of Field '� 3
a i
Width of Field 2-0 Gravel
of Field /� S
/ Gravel Bed Thickness 0, S
Square Feet of Absorption Area o Standpipes PresentN)
Depression over Field (Y& Date of Last Adequacy Test
Results of Last Adequacy Test !�F
Separation Distance from Absorption Field:
To Water -Supply Well LLU f To Property Line �U�O
To Building Foundation /3 To Existing or Abandoned System cn
Lot ; on Adjoining Lots oV /�
To Water Main/Service Line �\/ A To Cutbank(if present) A1119 -
To Stream/Pond/Lake/ar Major Drainage Course IVA
To Driveway, Parking Area, or vehicle Storage Area _ Ad
Comments Ems✓ f% - �L(; ��
D. LIFT STATION �— Al.
Date Installed Dimensions
Size in Gallons
"Pump on" Level at
High Water Alarm Level at
Tested for
Electrical Codes
Comments
Pumping
Manhole/Access
"Pump off" Loel at
Gent (YM)
ing Adequacy Test. Meets MOA
Check Permitted Bedrocm Rating Against HAA Request **
I certify that I have checked, verified, or, conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed Date %
Companyg MOA No. -
KB1/d5/s
[Page 2 of 21
®�64C4 4
e �°ao.090,n �T'
f °e
i�ea'Sa e^ n' ^'0 L.
,y C. Reid, Jr. .°
No. 2251
2-15-84
Time �—
i ime
Date ' '
Date
I
Inspector
Inc
Comments
p �kc�
Date Sewer Installed
Perm
" _ nC�
Soils Rating
Well
Well
APPLICAN'
Property Owner - W f} 14
Mailing Address Q ��X
�0U'D (d !2 D — Ct-
BuyElinstitution
Add
LenI e4 T-V—AT, 0
Add
Realty Co. & Agent -'U S
Address P, '42L,0
Legal Description It —r " F7/ y
Street Location C 1\l 1
Typyo Residence
Single Family
❑ Multiple Family No. of B
' ❑ Other
Wa er uppiy
Individual
❑ Community
❑ Public Utilit
Sett}}((����e Disposal
1�Individual
❑ Public Utility
❑ Holding Tank
NOTE: THE -=INSPECTION FEE MUST AC
or
4-A
Date
Inspector 1
Conditional Approval
MUNICIPALITY OF ANCHORAGE
DEPT. OF L'°'i1:I R.
VN- ENVIR( "'_P+iA." I.,O ECTION
RE E 1'*�
matin ^�
MCA-)�
I No. Septic Tank Size
�n Holding Tank Size
o Absorption Area Well Log Received I
R� 1 13-1 - no
o Tank
r FILLS OUT LOWER HALF ONLY
sl US 1 of E
! U L / A-yvt�
7 f+ L Ya-- V1 /C.
'_E141._ � s77�FTG
iryl UC_ L,-!;0 N
F)
Phone
Phone
D"al -f
Phone
ATTACH
WELLwellLdrGled pelolrloo IthatQdate, give uired for Iwele1depthls 1e6ftachelog nf
available )
Year Individual Installed:
When Connected to Public Utility:
COMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED REQUEST BEFORE PROCESSING CAN BE INITIATED.