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HomeMy WebLinkAboutGREENBROOK BLK 2 LT 10Greenbrook Block 2 Lot 10 #017-431-18 Municipality of Anchorage Page 1 of 3 Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage. AK 995136650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW010110 PID Number: 017-431-18 Nem.: Ha en Investments Wastewater System: New Addest: P.O. Box 240186 Anch., AK 99524 ABSORPTION FIELD P : "'"e d aedO : 229-8400 Four 4 Deep Trench LEGAL DESCRIPTION sce (w". a" Depd Irom av" grace: 1 .7 ci-Ewe Ft. emrA: Ld: SNbdwYm: Depm to ppm boame Irma mqn" grade: GrsM 0." ter ppm: 2 10 Greenbrook .5 Ft. .5 Ft. TpeeaM: R✓": sedum: F. added abort or n" Pec.: Grew. Largm: 3 Ft. 60 Ft. Well: Community Water System Gnr" eidd: 15 N=W "Yrs.: 3 Deteme ber.•ean Ynea: 5 Ft. FL obss tete (Rivals. A a. c): Total Deep: Geed p: T" sbeapbdn area: Ppe WIer : A R. Fl. 900 Fr ASTM D3034 PVC DM . Dale Dded: Slabs water Le'wl: Wla b: tealeMWd: FL Whitters Excavating 6/14-15/01 Y.vd: Pimps"": `a" Abd Co'.m: TANK GPM Ft. FI SEPARATION DISTANCES STEP To From Septic Tank Absorption Field Lift Station Holding Tank uwitrPrwate w soerLim mer:per+Tn Anchorage Tank 1,500 weer>200' >200' N/A N/A >25' Met" Steel Naber parMen". Three (3) smradaw.ter >100' >100' N/A N/A LIFT STATION Lot LM >5' >10' N/A N/A .. 250 G". mer. Anchorage Tank/Orenco Faad"ron >5' >10' N/A N/A p0e Ww at. 43 p 0tr Wei al. 43 bw"er.Wm.0 45 „. 11 Y. None Noted Pmp M.Ae a Mod" Ebopral IrWeobmw pert"'..° by. G"sn0 " Orenco City of Anchorage Rpeeraa 2" Insulation Placed Over Tank. BENCH MARK von bon: Garage Slab. Asea.ed Vev"an: 100.0 FL Engineer's Stamp OF Not '•�� Inspections performed by: Mike Anderson Dates: 1" 6/14/01 / 49th /` C --� --' � 2x` 6/15/01 �� MICHAEL E. AN Department of Health and Human Services approval', s'�t No. CE -+381 Reviewed and approved by: P Date: L •��� 5;; �•�: toed ; Municipality of Anchorage Page 2 of 3 DEVELOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK 99519.6650 -343-7904 Onsite Wastewater Disposal System or Well Inspection Report Permit Number SWO10110 VON SCHEBEN DRIVE M S 56'01 235.00' (R) S 56000'00"E 235.11'(M) ib •- N N7 co N W W . N 400 r- h po on �t C) M Z Z �I nit r r TH2 4r 10' (mL ESQ - N 49°17'24" {y 2-0:2- ' (M) N 49000-00,.W203.00' (R) PID No. 017.431.18 PLAN AS -BUILT SCALE 1" = 40' s MICHAEL E. N+UERSON f 4 fj., No. CC -4381 A B S1 9.6 11.9 S2 17.0 16.8 MH 19.0 18.3 M 1 72.3 82.8 M2 32.0 34.6 PLAN AS -BUILT SCALE 1" = 40' s MICHAEL E. N+UERSON f 4 fj., No. CC -4381 Municipality of Anchorage Page 3 of 3 - DEVELOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK 99519.6650 -343-7904 . On -Site Wastewater Disposal System or Well Inspection Report Permit Number SWO10110 PID No. 01743148 h 7.5 98 11� Lateral Orifice Diameter: 3/16" Total Number of Holes: 30 Hole Spacing: 6' Distribution Pipe: 1 PVC 94.2 60' Fabric PROFILE AS -BUILT 1"= 10' s 102.0 cz:Rcugi 1 2rcooaiompl:anceob:crv:d. E3 1Mnot wnceelanWrc•lrsp:cxd. u =•C•'4i'*ond• ,.,,,.,,,,• , • Cartert3ons essential as explained behnv. Q will rfocan+ine at nen fru,:ectien. L C.C.O. approved (conwr¢[x bdox). • f"l NVDhS (Stormwma) NoY�r Ufr-- rCJ1!�EN,t��• ectim+? I i f✓N�5 �Zv Mit — I Z '- o l ! N'SP��oc�l Go ��>✓�f ��'-� OF Gq-h3C� t �t2 �, r t L 5 EST tr •1 M1Y.• •tee-wv\/ VVV��' N ,Q��-t �'-' _ -. Jnr,► � OI - ��� .dT F-FaVS;F— c,J'1�, �NaviJ P��'�caN •°moo (�" r3' �J Le :IUi�C���.€�'�' OF ANCHOI3AGE--,'6'JiI.^►'it`+� S.°;F.�.iy TiiVISI®1`h' • 4700 &O'aTiIi TiIZA :A'i3' S'IT'.l•,S:I', afQCU C�,-,F.GZ, ALASKA ;1VSPEC17J1�:S:• Lolce:. (gFj9) 3414300 I%¢s: (90� 2t9••T7Ti liVr0NPfA7701J• (9-7,)3434211 �•�: ,S�l.VA s�_itvt�;ts • aE.z%arrti�t�tbcn: N-0507 riDDRPSS: 12640 LUf1SCH'AVAN DR 9/1S/01 P.rGiXtY1f 5092.^w.98 Fc7DI+S:iz_• Lf?T} IO IiitJCC03 MEAMY Z- 2 !r. ' .PEcnf).ti'.• .Elacti l.°5Pr CT'OR Wd9i:ll It 1300 awll pan18388 • _ w 3mr•.^was [rcisre . UruS�.•J�+a. an xiu, 0 8io^.mv's. r:y..u: �:: n�:d • '� Si:doffsi:e drain;i^ o[bein3 eactrolicd j i iueL•:1L'cOtYctit rw aw ba.�d;iL'�.N f��.'.�.��iL. 'j InsirlVeoaedsit!tmxs. Ortterbesemr�:fgemwtpracNc:son [_] sl:eviceded '1 see atta�eddet3l'.dnate�Imctrvcton<. (� FaiS!vc[ocnm:+`imxvi�e��hin�5�.--G,I r. ?u}:cr.3icnanm I` Ksir.•�;c�`or;tvi::E -+'=�f i ,_1 iic:,:cG:S�W. � �: • t1'l l ;, a r:h'E.'!j !iC,Cfl •�„iv'_'.f to: --_�.—._.. r,f •-• " =C7i/ �C►'NCOF_RF..G",i'.'�;+:?'ti.RRE:iF...iw , .Sr', 04 TL r:::! .t ..,.,. V (.i.'1 ijy-a liV I L iaJa.% 1+VT a i• Zd WF1Z£:TS Tooz b0 'z;aQ 9L556t+£L66I 'ON XH3 N39dH : ViDU ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) MEMORANDUM DATE: December 4, 2001 TO: Jeff Poet FROM: Mike Anderson, P.E. SUBJECT: Lot 10, Block 2, Greenbrook Subdivision Septic System As -Built Certificate of Health Authority Approval Attached is the Septic System As -Built and the Health Authority Approval documentation for the subject lot. Please note that the orientation of the absorption bed is different than that shown on the original plan. Once the lot was cleared we determined the best orientation was that shown on the as -built. The ground surface in the area was fairly flat and the optimal location for the new absorption bed is that shown. Please let me know if you have additional questions concerning this lot. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) MEMORANDUM DATE: December 4, 2001 TO: Jeff Poet �A �, - FROM: Mike Anderson, P.E. AJVI SUBJECT: Lot 10, Block 2, Greenbrook Subdivision Septic System As -Built Certificate of Health Authority Approval The low area shown on the Site Plan for the design of the septic system for Lot 10, Block 2, Greenbrook Subdivision has been filled and graded. No surface water is closer than 100' to the new septic system and alternate site. Please let me know if you have additional questions concerning this lot. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SWO10110 Legal Description: GREENBROOK BLK 2 LT 10 Design Engineer: 0014 Anderson Engineering Owner Name: John Laverty Owner Address: 12640 VON SCHEBEN DRIVE ANCHORAGE. AK 99516 - tel, 4-11s/pl (f:oo l-4 Date Issued: May 11, 2001 Expiration Date: May 11, 2002 Parcel ID: 017431-18 Site Address: 012640 VON SCHEBEN DR Lot Size: 60589 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of., ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be In accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: c `4 Cl Date: S— /l — of -\ Municipality of Anchorage 1 OSA.11 Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-431.18 Permit Number SWO/0/ / 0 Property owner(s) Hagen Investments LLC Day phone 229.8400 Mailing address (1) P.O. Box 240186 Anchorage, AK 99524 S/TF -Ms"invaddress (2) /2640 Vow $[HEBEA/ Zip Code 99S/6 Legal description (Lot, Block & Sub'd.) Lot 10, Block 2, Greenbrook Subdivision Legal description (Section, Township & Range) Lot Size 6 Uj f8 9 Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms Four (4) Sewer Only ® Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being madefor a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: (1no+© Waiver Fees: Date of Payment: 5'0061 Date of Payment: Receipt Number: i } 9c) Receipt Number: (Rev.12100) ANDERS_ON;ENGINE_ ERING P.O. BOX 240773 ANCHORAGE, AK 99524 5224773 522.6779 FAX May 2, 2001 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 10, Block 2, Greenbrook Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 10, Block 2, Greenbrook Subdivision intends to place a new 4 - bedroom home on the lot. We are therefore applying for a permit to construct a new septic system on the lot to serve the proposed home. The lot and surrounding subdivision is served by a community water system. The attached Site Plan and backup documentation identify the location and configuration of the new septic system and the parameters used in the design. It also shows the location of the test holes and the alternate septic site. Existing drainage patterns are shown and will not be altered by the development of the lot. Some surface water accumulation was noted along the southeast property line, which will be filled during construction to provide the necessary 100' separation to the septic system. Alaska Water and Wastewater Consultants (AWWC) placed two test holes on the lot during the spring of 2000. Soils were found to be silty sand in the upper reaches underlain by silt. Percolation tests in the sand were 5.3 minutes per inch in Test Hole Number 1 and 15 minutes per inch In Test Hole No. 2. Percolation tests on the underlying silt material indicated it was not impervious. Groundwater was not found during the excavation but was noted during the monitoring period at 11' and 5' respectively. The bed has been designed for a water level of 5', which was noted during the high water period of the year. We are therefore proposing to place an absorption bed 60' long by 15' wide to treat the septic effluent. The pipe will be placed at .5' below the existing ground surface and the total depth of the system will be 1'. Clean coarse sand may be required to level the bottom of excavation prior to the construction of the new bed. AWWC originally recommended use of a bottomless sand filter on this lot. The owner, however, is leery of the cost and has elected to construct the bed. The alternate site, however, will remain a bottomless sand filter In the event it must be used in the future. Some grading and filling will be required around the new bed to allow for the most effective installation of the system. Lot 10, Block 2, Greenbrook Subdivision May 2, 2001 Page Two The ground surface on the lot slopes as shown on the attached Site Plan with slight grades from north to south. The new absorption bed will be constructed parallel to the contours of the surface in conformance with Municipal requirements. Grading will be accomplished to assure surface drainage Is away from the new bed. The existing drainage pattern on the lot will not be affected during development. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The lot and surrounding subdivision is currently served by a community water system. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed In the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns In the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments ,swwwo\l,OF At"; tt i : 491" r ;*�i i*. Q•s: MIGIAFL E. ANDE25ON N 1p • GE • 4381 i' .* ' t1kq1\ L4ow��o Sent By: Alaska Water 6 Wastewater Consu; 807 338 3245; LOT 11. BLOCK 2. CAmaROOK 3/0 SERVED WATER CDMUNT/ SYSTEM Jul -31-00 13:12; Page 6/20 LOT B, BLOCK 1. GREEXLi S/C SEWED N' A COXNUNnY .\ WATER MTpI 602 LOT 5. BLOCK 4, SERVED BYTER ASYCOM COMMUNITY KEY BOX \ , 0 LOT 12A BLOCK 2, GREEMSROOK S/C SERvM BY S"TY SC WEW AU SKA WATER & WASTEWATER CONSULTANTS, INC. RICK HAGEN (907) 229-8400 SUBOIYISION; LOT 10. BLOCK 2. SITE PLAN FOR NEW SEPTIC SYSTEM KEY SOK LOT 9, HLOC GREENBROOK ca ._ SERVEO BY A CO WATER PST TO Be flULO LOT a. BLOCK 2. GREENBROOK B/D SERVE] BY A COMMUNN MATER SYSTEM FA J.W.M. �l Ilow f.: µJMBER: 1 OF 1 VON SCHEBEN DRIVE 0 e ► S 56000'00"E 235.00' (R) roi y T7 S 56°00'00"E 235.11' (M) r41--�-�-� --� rn t�\�+ m N W \o :' Four ° N °i / Bedroom h House 1500TGallon SHP• ' r A. 7 a Surface _5� �aa betFilled r Al ernate Site Abs rptzon Bed Long • r 10' UT1L ESR .•• -_ _ _ _ N 49017•240,W 202.64• f *()0'00"W 203.00• (R) OFMCMAEL L ANDERSON to • q �. q c ` Y. SITE PLAN 44�;: CE -4361 SCALE 1" c 40' �O`� 0 PRpFCSS1... 'oma t1 LOT 10, BLOCK 2, GREENBROOK ABSORPTION BED DESIGN FACTORS: 4 Bedroom Home Perc. Rate: 5 MinAnch Application Rate: .7 GPDlSF SYSTEM REQUIREMENTS: Shallow Bed System 1,500 Gallon STEP System 1' Total Drain Field Rock 4 Bedrooms X 150 GPD 1.7 App. Factor = 857 Square Feet 857 SF/15 LF Width of Bed) = 57.13 LF Length of Bed Therefore: Construct an Absorption Beds 60' in Length by 15' Wide. Bottom of Distribution Piping to be .5' Below Existing Grade. Total Depth of Bed to be 1.0' Below Existing Grade. Level Bottom of Bed with Coarse Sand Prior to Placement of Drain Field Rock. Mound Over Bed to Provide 3' Minimum Cover or Provide 2' Direct Bury Insulation and 2' Minimum Cover to Prevent Frost Penetration. 3 Natural Backfill (3' Minimum) 1 Geotdktile Fabric or 2" Direct Bury Insu 6.. Drainfie Rock 1" PVC Remove Organics and Replace With As Coarse Gravel (See Specification) Req'd -To Underlying SP/SM*Material. 2.5'� 5'"? 5 � F Lateral Orifice Diameter: 3/16"_ Total Number of Holes: 360 Hole -Spacing: SHALLOW BED DETAIL (NO SCALE) NOTE: Grade Area to Drain Away. Maintain 6' Separation From Bedrock. Provide 3' of Cover or 2" Insulation and 2' Cover. Maintain 4' Separation From Groundwater. Maintain 100' Separation From Well and Surface Water. 1 w� OF At o 11 .r {'� .MICHPEL E. ANDERSON• c . CE _ 4381 Sent By: A18sKa Vfater d Vlastewater Consu; 9C7 338 3246; Ju1.31-00 13:15; Page 10/20 ALASKA WATER & WASTEWATER CONSULTANTS, INC. OF 690rE (i07j�i-6179 B104 rNf hC(907) 33e-72� 1146 �: •'' •• SOIL LOG - PERCOLATION TEST 7 LEGAL DESCRIPTION: CREENBROOK SUBDMSION, LOT 10, BLOCK 2 """' ' ' .. ""' """' PERFORMED FOR: RICK HAGEN ••..• 5/13/2000 i1. N6 DATE PERFORMED: P•b •, -7953 g 97 TEST HOLE 1 •^ 1 ORGANICS (PACE 1 OF 2) •��Pof•••bn� E 2 SM SOIL CLASsinCATIONS \ ':? A•o;' GW _C _ ORG SIT PLAN TN)3>Hla 3 r.::+: GP ML ��� KLY GM CL 4 GC OL SW MH 5 • • SP CH 5M OH 8 SC T4 TESLOCARE 7ML ROUNDWATERDATE12' 5/15/20DO 7HI111' 5/22/2000_1row 10 11 DATE READING CLOCK (MINUTES WAR�LtJ�G EL `ETCHES) 12 B.O.H. 5/16/00 PERC. HOLE WAS PRESOAKE7 4+ HOURS PRIOR TO TESTING 1 2:58 6- -- 13 2 3:06 10 2 1/2' 3 1/2' 3 3;06 — 6' — 14 4 3:18 10 3 1/4' 2 3/4' '5 3:15 — 6' 1S 8 3:26 10 3 1/4' 2 3/4• 7 3:26 — 6' — 16 8 3:38 1 10 4' 2' 17 9 3:38 — 6' 10 3:46 10 4 1/8' 1 7/8' 16 11 3:46 — 6' 12 4:08 10 4 1/8' 1 7/8' 19 PERCCLATION RATE s.3 (MIN.lINCH) FERC. HOLE DIA. &,(INCHES) 20 TEST RLN BETWEEN 1.5 FT. AND 2.0 FT. COMMENTS: TEST HOLE #1 AND #2 LOCAMONS ARE GENERAL. _ PERCOLATION DATA ON THIS PACE AOR UPPER BENCH PERC• HOLE ONLY. PERFORMED BY ALASKA WATER do WASTEWATER: 1, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFQRMEP IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE Sent Ey: Alaska Water Q Wastewater Consu; 907 338 3248; Jul -31.00 13:18; Page 12120 ALASKA WATER & WASTEWATER CONSULTANTS INC.C QF A PICNC (e0 SS'7-617e • FA28 6-X (e0 -SIH n '`1. .•••••••• , J` SOIL LOG —PERCOLATION TEST LEGAL DESCRIPTION: CREENBROOK SUBDNISION: LOT 10. BLOCK 1 "" t PERFORMED FOR: RICK HAGEN �.. .. . DATE PERFORMED: 5/15/2000 7953 ` TEST HOLE #11 '^ '. 1 (PACE 2 OF 2) S311 CI ASSIFlCATIONS 2 GW ---� ORG SITE nya �S 3 a? GP ML i¢r x Lmlm GM CL tH/a 4 GC OL . •° q SW MH 5 SP CH i SM^i OH 6 Sc 11002 TEST HOLE LOCATIONS 7 w ARE GENERAL. DEPTH TO DATE GROUNDWATER 8 1 1 61500 ` 11' 6/22/00 9 I� 10 T TIME WAREADING EL ET t 1 F DATE READING ul� (MINUTES) (INCHES 6/15/00 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 12 13 1 y 4:05 30 5 1/4• 3/4• 14 3 4:05 — 5 4 4:35 30 5 1/4' 3/4- 15— 5 4:35 — 6• — 0 5:03 30 5 1/40 3/4• 10 W 17- 7 16 13 19 PERCOLATION RATE (r11N./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.5 FT. AND 5.0 FT. 20 COMMENTS: PERCOLATION DATA ON THIS PACE FOR LOWER BENCH PERC. Hd.E ONLY. a] 02 !ZAL- IMIL-HIIIII PERFORMED BY ALASKA WATER do WASTEWATER. I. JEFFREY A. GAR4ESS, CERTIFY THAT THIS ON WAS PERF M _ )N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT DATE c� Sent By: AlasKa Water 6 Wastewater Consu; 807 338 3246; Jul -31-00 13:17; Page 11/20 DATE 16- 17— Is- 19 READING ALASKA WATER & WASTEWATER CONSULTANTS, INC. F s 22/2ooD •,� pr&fw[ 0a S>!7-e12t • FAx 114& 5/16/00 FERC. HOLE WAS SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: GREENBROdc SUBDIVISION. LOT_ 10, BLOCK 2 •• • ' ' "" ••.... PERFORMED FOR: RICK HAGEN .. ...... fr A. DATE PERFORMED: 5/15/2000 ' -7053 r',t d DEM =__ TEST HOLE 2 '•.'' •••......••'•E *dp�of&&&1•"+ 3:26 ORGANICS 3 S/6' 2 3/6• 3 3:26 SOIL CLASSI%ICT•.TIONS �y 2 b.�¢_ GW == ORG 16111 trp . sc r^ sM�s 4 .o-;.•• GP � ML Kcr soar 4' GM CL 1H/4 �E 4 GC OL — 6' SW MH 5 SP CH ism 30 4• OH 6 Sc • TH02 7 ML DEPTH TO PATE (�I GROUNDWATER I 6 74#1 DRY B.O.H. POND 10 it 12 13 14 13 18 17 18 1D PERCOLATION RATE 15 Q1 ANCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 1S FT. AND 2.0 FT. 20 COMMENT'S: TEST HOLE #1 AND i2 LOCATIONS ARE GENERAL. *SOMEONE REMOVED TH PIPE. OW BENCH DEPTH _ COULD NOT MONRORBn _ PERFORMED BY ALASKA WATER k WASTEWATER: 1, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PER RM IN ACCORDANCE WITH ALL STATE AND MUNICIPAL CUIDEUNES IN EFFECT ON DATE: DATE 16- 17— Is- 19 READING s/ts/�� *s' s 22/2ooD (INC�� 5/16/00 FERC. HOLE WAS PRESOAKW 4i DATE 16- 17— Is- 19 READING CTIA MIHUTE�S WA�lDILPVEL (INC�� 5/16/00 FERC. HOLE WAS PRESOAKW 4i HOURS PRIOR TO TESTING 1 2:56 — 6• '� 2 3:26 30 3 S/6' 2 3/6• 3 3:26 — 6• 4 3:56 30 4' 2• S 3:56 — 6' 6 4:26 30 4• • 2- Sent $y: Alaska Water 6 Wastewater Consu; 807 339 3248; Jul -31-00 13:18; Page 13/20 ALASKA WATER & WASTEWATER CONSULTANTS, INC F AC f ca aif-e,7e •.,� dub ys'f- SOIL LOG - PERCOLATION TEST �.' 491y' •:; LEGAL DESCRIPTION. CREENBROOK SUBDIVISION, LOT 10, BLOCK 2 ................................ PERFORMED FOR: RICK HAOEN ....................... Jeffrey A. Com Comm; DATE PERFORMED: 5/15/2000 CE -7953 (fed) S 1/Y TEST HOLE #2 ....... 3 -_-c-= ORWI S ProfeesW^d 4 4:J6 2 t SOIL CLASSIFICATIONS S 4:38 `'' GW __ ORG SITE LAN .a`. n,» . sCyE 3! GP ML \ utr aoxGM 30 5 1/2' CL n+/4 4 GC OL SW MH ism 5 SP CH OH B SC Tn1] _ HOLE 7 ML DEPTH DATE LOCATK*4 ARE GROUNDWATOER BCENEPAL LLLLU DRY 5/15/2000 r'21 •5• 5/22/2000 9 B.O.H. / POND 10 DATE READING CLOCK I NET TIME WA�ApIN�G L I tt � NUTES) (INCHES) 12 5/18/00 PERC. HOLE WAS PRESOAKI>7 4+ nouns PRIOR TO TE3TIN0 13 1 3:]e — S. 14 15 16 17 10 19 CH FERCaATION RATE (MIN.JINCH) PERC. HOLE DIA. 6 ONES) 20 TEST RLN BETWEEN 4.5 FT. AND 5.0 FT. CENTS: *SOMEONE REMOVED TH PIPE COULD NOT MOWTOR BELOW PERK HOLE DEPTH. PERFORMED BY ALASKA WATER do WASTEWATER: I. JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: 2 498 30 S 1/Y 1/2• 3 498 — 8• 4 4:J6 JO 5 1/2' 1/2' S 4:38 — 8• �- 8 5:08 30 5 1/2' t/2• PRESSURE DISTRIBUTION CALCULATION Elevation at Highest Discharge Point Pressure at Highest Discharge Point Liquid Level in Tank (Elevation) Diameter of Holes in Distribution Line Diameter of Distribution Line Hole Spacing In Distribution Line Length of Transport Line Diameter of Transport Line Q =12.4a h/= 12.4(.1875)(.1875)V5— = 2.4(.1875)(.1875)V5_ .9748 GPM/Orifice _ .9748' 30 = 29.2 GPM TDH = (109-94) + .0192(29.2)(29.2) + 15 + 16.4 36.0 Therefore 30 Orifices @ 6' Spacing ,.SS .000995(29.2) (65) (1.5) *-W 4.6 104' 5' Head 94' .1875" (3/8") 1" 6' 65' 1.5" ��ff"fo LL. 200.00 150.0c LJl 0=4 if —4 -1 EFFLUENTPUMPSI -t-r I E FFLUE TPU' lowi 1/2 Hp to 11/2H p I:- I If '2 Hp I if it if I ;W I mi I i it iiij I U I SINGLE PHASE, 60HZ 1 SINGLEPHASE, I I JIS IN 115 p VOL If" .1 44- 115/230 VOLT if PC#2 PC#2 IrH I 4 1. -.20 OSI 15 HHF - 9 stage fill it 05/9 2 it 05/92 it; 1- !1— if Ili ii;i 1, 11 it I it Ill iiii il" ii; 11: - fill ill !;if if fill fill -LLL j -LL lizi It -LL 4 - fill i it if . +-Li -UL -;it it iiii I! izil I it !it 1-11 it 20 stage- of 11 ij !!I fit, +-jj- — + it it it I I If I ;III si'l I if i,jj .1 If: !- 1 ; t . --;! I I: If I I I if it 4 i it fit list T7 T41 -L ift Jig fit J 1+ 4 r i!;l I if fit :it isit fill I if its +41 s 4 -4 2—i A—L 4% 0 05 5 it if; if ++L It Tt ! it:% ;it it: i it If 171 if sg:; #.A if if I I it i!s i's 11 fit .1. i i it it if It 4 I I i1i fill Ili :1 —11111" XL s if - I fit 1: 7ff ill fit TE LT. u; it 400SI05HH-2 Stage it .,!1 4 —V � - - "isit'll ji I It it I +4 It ---73 T- 200SIOSHHF-5stage wJ114 "finwcontroller 1+ -4 -d rONYI-- 6 we 11 5.00 10.00 15.00 20-00 25-00 3100 35.00 40.00 45.00 50-00 1 7-cl. 7 - NET DISCHARGE, GPM �ENCO SY��26ZfiCOLONtWL-ROADROSEBURTO�R97470 �W)673-0�165 I ONSITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 10, BLOCK 2, GREENBROOK SUBDIVISION GENERAL: 1. The scope of this project includes the procurement and placement of a new 1,500 -gallon combination septic tank and lift station and pressure distribution system. Work also includes the construction of a 60' long x 15' wide absorption bed at the location shown on the attached Site Plan. The new bed distribution piping shall be constructed .5' below existing ground level to provide a minimum of 4' separation from groundwater. Direct bury insulation may be required to provide the minimum coverage required over the new bed. In lieu of insulation 3' of cover may be placed atop geotextile fabric over the new trench. Leveling of the existing ground with coarse sand may be required to provide a smooth even surface for the new bed. The sand must meet the Municipal specification for absorption beds. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANKILIFT STATION INSTALLATION 1. The 1,500 -gallon septic tank/lift station must be constructed by certified tank manufacturer. Construction shall include an 18" manhole to provide access to the lift station. 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. 4. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 'Lot 10, Block 2, Greenbrook May 2, 2001 Page 2 of 3 5. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drain field. 6. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAIN FIELD CONSTRUCTION: 1. The drain field shall be constructed to the dimensions shown on the design. The bottom of the bed shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drain field rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drain field rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drain field are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drain field rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. The lift station must be constructed by a municipally approved septic tank manufacturer. An Orenco 20 OSI 05 HHF-5 pump is recommended. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 'Lot 10, Block 2, Greenbrook May 2, 2001 Page 3 of 3 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the Installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. m Municipality of Anchorage George P. Witerch, Mayor Btd1dind, Safety Division P.O. Box 1JG650 • 4700 S. Bragaw• Street Anchorage, Alaska 99519-66 )50 • (907) 343.8301 h ltp://wl%�v.cl.anchorllgc.ak.us July 3, 2002 John Laverty 12640 Von Scheben Dr. Anchorage AK 99516 Subject: On -Site Water and/or Wastewater Permit. Permit Number: SWO10378 4Legal Description: Greenbrook Block 2 Lot 10 Dear John Laverty: An On -Site Water/Wastewater Permit, number SW010378, issued by this office for a single-family system, will expire on August 11, 2002. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee of $100.00 if the renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $400.00 for a wastewater permit and $150.00 for a well permit. If you have any questions, please call this office at 343-7904. Sin el , �' 4 ztv Jir{Cross, P.E. Manager On -Site Water and Wastewater Program Enc: Copy of permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Renewal Date Issued: Aug 11, 2001 Expiration Date: Aug 11, 2002 Permit Number: SWO10378 Parcel ID: 017-431-18 ,Legal Description: GREENBROOK BLK 2 LT 10 Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 012640 VON SCHEBEN DR Owner Name: John Laverty Lot Size: 60589 SQ. FT. Owner Address: 12640 VON SCHEBEN DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516 - This permit is for the construction of. Disposal Field f✓ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Date: 8 "// _0/ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-43 —Permit Number SW 0/0378 Property owner(s) .TON./ LAIMPETY Day phone Mailing address (1) 12640 VOA/ SCAIDUA/ DRIVE Mailing address Zip Code 995-/6 Legal description (Lot, Block & Sub'd.) OUe 2 L oT /O Legal description (Section, Township & Range) Lot Size 60589 Acre Sq.Ft. . Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ' ` ❑ Water Softening Unit ❑ Therapy Pool ❑ nation is correct. I further certify that this application is being made for a is in accordance with applicable Municipal Codes. C' . authorized agent) Permit Fees: 320 Ee__ Waiver Fees: Date of Payment: 7-28-0-0 Date of Payment: Receipt Number: 0 (p S'7/ Receipt Number: (Rev. 12100) 9ENEWAL ALASKA WATER F& WASTEWATER CONSULTANTS, INC. July 27, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: On Site Septic System for Lot 10, Block 2, Greenbrook Subdivision (Bottomless Intermittent Sand Filter-ISF) To whom it may concern: <LCEIVEU JUL 28 2000 MUNICIPALITY OF ANCHORAGE —111, Art ITAL SERVICES CP"' The proposed 4 bedroom house will be served by a private septic system. We are proposing that a 1500 gallon S.T.E.P. tank and a Bottomless Intermittent Sand Filter (ISF) system be installed. Comments regarding the proposed upgrade are summarized as follows: 1. GENERAL: Two test holes were excavated south of the proposed house to determine an arra suitnhlr for a arntin cvctrm tmorade Rnth trcthnlrc wpm fnnnd to he cnitahle. fnr nn nn -cite MUNICIPALITY OF ANCHORAGE Department of Health & Human Servicesn'- �Wl- On-Site Sewer/Well Permit Application _Q17 — 1131 S NOTE: Application must be fined out completely SINGLE FAMILY DWELLING Parcel wrimmoon Number/ Property Owner Name Tol e t/Pr i Day Phone Mailing Address Vao1 ;2,0W L C� Rel. AnA, Ak Zip Code 99,2ilb Legal Description Z G reenbroo k Lor 8100 Subd, w 6.C. s.aa if%�f Q ,n Lot SizeAcres . Ft. Number of Bedrooms � To p /...//�! 1lcEAl /�JvE5rm"9 0 -�-5 L5r& Inspections will be conducted by: ffiApproved Engineering Firm ❑ Municipality (permit fee included) Does your house contain any of the following: ❑ Hot Tub ❑ Swimming Pool ❑ Therapy Pool ❑ Jacuzzi ❑ Water 901ftener Unit This application is for: aSewerOnly ❑ Sewer and Well ❑ Sewer Upgrade ❑ Well I certify that the above Information is correct. I further certify that )11 this application is being made for a Single Family Dwelling andyjc,, jjj!^ in accordance with applicable Municipal Codes. Property ,vyell Drily Feesr 3 C20 • Receipt M ldr�% / o I �� Permit Waiver Fe 72-012 (Rev. 4198)' Receipt 0 Waiver # J W O/0370 I r—/ e. Minimum Absorption Area: 30OR2 f. Effective Depth below pressure pipes: 2.5+ g. Effective Depth: 2.5+ inches IL Width: 18 ft. i. Length: 20 ft. k. Effective absorption area = 360 ft2 j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank". k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank". L Sand material: In accordance with M.O.A. latest standards in. Pea Graves: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than 1% passing the 48 sieve. We are proposing to excavate down to a depth of 3.0 feet (maximum), place a minimum of 6 inches of sand, install the air supply line, and cover it with 18 inches of sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 4. SURFACE WATERS: The ponded area shown on the site plan is to be back filled. 5. TOPOGRAPHY: As can be seen on the attached topography site plan, we are proposing to install the bottomless ISF on a bench that is gradually sloped down to the east, west, and south; these slopes should not de a concern 6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the construction practices will comply with DHIIS' "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction Copies are available at the Municipal Onsite Services office (5th floor, 9th & L St.) 7. CLOSING: I am open to any suggestions from your department, which would be an improvement to the proposed design I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank yo}1 for your assistance. ., M.S. NOTE. Attached is a site plan drawing, a design drawing, a detail drawing, two soils logs, a topography drawing, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B • Anchorage, AK 99504 Ph: (907)337-6179 • Fax: (907)338-3246' akwwc.com QV•I GR2. EENBROOKCS/D SERVED BY A COMMUNITY WATER SYSTEM 609 LOT 0. BLOCK 4, GREENBROOK S/D SERVED BY A COMMUNITY WATER SYSTEM \ 21 LOT 5. BLOCK 4. •\y�N GREENBROOK S/D SERVED BY A COMMUNITY \• (�^ WATER SYSTEM Vl• F F TH/3 \•�/�F �(v� KEY BOX •\ / i PROPOSED FOUR BEDROOM HOUSE KEY BOX PROPOSED NEW SEPTIC SYSTE LOT 9. BU GREENBROi �+ SERVED BY A � ♦` -UPRC AlfA WATER SY POND TO BE FILLED I � �IW J U U Z � U CREENBROOK S%o' LOT B. BLOCK 2. SERVED BY A COMMUNITY CREENBROOK S/D WATER SYSTEM SERVED BY A COMMUNITY WATER SYSTEM 7 ALASKA WATER R �'VASTEWATER scALE CONSULTANTS, INC. f 1' = 100 • ............ 6" DEBAFIR RW m i•• REPARED FOR PHONE NUMBER: 'ACE NUMBER: `, ,`•,,,,, ,,,,,,, RICK HAGEN (907) 229-8400 1 OF 1 tit 91:1 f A ,Co�ness. EGAL DESCRIPTION: �4,�� •��• E-7953 GREENBROOK SUBDIVISION; LOT 10, BLOCK 2, �'�„ ...........4` YPE OF WORK:�yV�ae�P/ofeefloT•df—�'�, SITE PLAN FOR NEW SEPTIC SYSTEM (BOTTOMLESS ISO ..:�=�' PROPOSED 1500 GALLON S.T.E.P. TANK 1.25 INCH DIAMETER HOPE UNE— INSTALL UNE SO THERE IS POSITIVE DRAINAGE BACK TO S.T.E.P. TANK. ALTERNATE SITE \ THJ2 T TH/1 PROPOSED FOUR BEDROOM HOUSE —AIR UNE (SEE NOTES) -PROPOSED 18, BY 20' BOTTOMLESS ISF (SEE PROFILE DRAWING) AIR COMPRESSOR SHALL BE ATED WITHIN THE CRAWL SPACE OR GARAGE. THE CONTRACTOR SHALL VIDE A 0-I0 PSI PRESSURE GAUGE A LOCATION WHICH IS READILY ESSIBLE FROM WITHIN THE HOUSE. E, A 30 PSI GAUGE WILL NOT WORK. 7/24/2000 �'LYAloIA•I�r� •ssa�+•nw�+v DRAWN BY: ALASKA WATER & WASTEA)VATER i'W'M' CONSULTANTS, INC. yam' o®ARR Ran 12 • c AK 9"" • • FAX 1 = 30' 'RLPARLD FOR: PHONE NUMBER: 'AGE NUMULR: RICK HAGEN (907) 229-8400 1 OF 1 LLGAL CLSCR:PIION: GREENBROOK SUBDIVISION; LOT 10. BLOCK 2 DESIGN DRAWING FOR NEW SEPTIC SYSTEM (BOTTOMLESS AIR COMPRESSOR SHALL BE A MAS INDUSTRIES MODEL 5070, AS PLIED BY ANCHORAGE TANK. THE LINE SHALL BE 1/2 INCH DSA. HDPE 'IECE), INSULATED WITH 1/2 INCH M PIPE WRAP (R3 VALUE). INSIDE A VCH SCH.40 PVC JACKET. THE LINE LL BE BURIED TO A MINIMUM DEPTH 3 FEET. CONTROL PANEL FOR THE S.T.E.P. SHALL BE INSTALLED WITH A BLE/VISUAL INDICATOR ON THE .IDE OF THE HOUSE WITH A REMOTE '.M INSTALLED INSIDE OF THE CONTRACTOR SHALL INSURE THAT THE NEW WATER UNE SHALL BE GREATER THAN 15' AWAY FROM THE STEP TANK \ & SEWER SERVICE UNE OF k/W...... Uc—inoo � c�(*� MOD EX PEA FLUSHING VALVE AND COVER— ORIGINAL 2.0 FEET MINIV.IM M.OA APPROVED SAND FILTER— MONITORING TUBE [INAL GRADE INSULATION SCH 40 i FILTER FABRIC INSTALL NR UNE 6* FROM BOTTOM OF SAND FILTER. 7 VALVE DSURE h PLYWOOD BOX AS REQUIRED. ALASKA NVATER & WASTEWATER O,'f S. INC. CkLL N.T.S. 1 DESARR ROM N • AK 99N4 • MCNE r • PAX (007MM-uml'REPARED FOR: PHONE NUMBER: PAGE NUMULR:.RICK HAGEN (907) 229-8400 1 OF 1 A. .EGAL DESCRIPTION: -7 GREENBROOK SUBDIVISION; LOT 10, BLOCK 2,�•.., IYPE OF WORK: Di''odProfa, DETAIL OF BOTTOMLESS INTERMEITTENT SAND FILTER (ISF) ki Ol ORIGINAL Y�::y'^ju in n3 GRAVEL U ALASKA NVATER & WASTEWATER O,'f S. INC. CkLL N.T.S. 1 DESARR ROM N • AK 99N4 • MCNE r • PAX (007MM-uml'REPARED FOR: PHONE NUMBER: PAGE NUMULR:.RICK HAGEN (907) 229-8400 1 OF 1 A. .EGAL DESCRIPTION: -7 GREENBROOK SUBDIVISION; LOT 10, BLOCK 2,�•.., IYPE OF WORK: Di''odProfa, DETAIL OF BOTTOMLESS INTERMEITTENT SAND FILTER (ISF) ki Ol owroups O LOT . BLOCK 4, OR K D ERVED BY A OM UNRY WATER ` LOT 3, BLOCK �P SERVED BY AOK MMUNITY G 0 N 4 t LOT 71, BLOCK GROK S/ // ri SERVEDD BY BY AA COM UNITY V C1 ; WATER SYSTE ppb �'p� BEDR MDHO SE w K BOX v PROPOS NEW SEPTIC LOT 9, OCK GREENB K S 5 BY A OM M RY C AR WATER POND TO FILLED Z U � S V LOT t BLOCK 2. CR BROOK S/D SERVED WA A COMMUNITY R SYSTEM LOT B. BLOC 2, CRE NBROOK /D SE BY A C MUNIIY WA EM DATE: 7/ 0/20 0 DRAWN K D.W. SCN E: V = DD - 001 B TE 28 NONAGE NE M 99504 • FHO90773 7-0179' FAX (907)338-3246 F PHOt NUMBER: PAGE UMB J Y 1 1 CALCRIP R RO SUBDIVISION; LOT 110. BLOCK 2, TYPE 0 WOR . TO G APHICA DRAWING ALASKA WATER & WASTEWATER CONSULTANTS, INC. _p00F�000 6901 OEBARR ROAD. SUITE 2B • ANCHORAGE. AK. 99504 O• • �p PHONE (907) 337-6179 • FAX (907) 338-3246 SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: GREENBROOK SUBDMSION. LOT 10, BLOCK 2 ....... ' ' .. ""' ........ PERFORMED FOR: RICK HAGEN .• .••.•••. r A. Gayness: DATE PERFORMED: 5/15/2000 QQQ e —7953 (f -- TEST HOLE #1 O��' nor°°.. Quo (feet) 0 ORGANICS (PAGE 1 OF 2) 4o��04ppO�po 2 SM SOIL CLASSIFICATIONS ION SITE PLAN .? GW = —= ORG I' = 100' KEY BDx \ Sc\ 1 �R 3 `iia.'+ GP ML F GM CL THJ 4 GC OL No SW MH 5 SP CH SM OH 6 Sc TM,2 TEST HOLE LOCATIONS 7 DEPTH TO ARE GENERAL ML GROUNDWATER DATE 8 (soNDaD) TM/1 12' 5/15/2000 TH ' 11' 5/22/2000 9 l POND 10 1 11 12 B.O.H. 13 14 15 16 17 18 19 PERCOLATION RATE 5.3 (MIN./INCH) PERC. HOLE DIA. _(INCHES) 20 TEST RUN BETWEEN 1.5 FT. AND 2.0 FT. COMMENTS: TEST HOLE #1 AND #2 LOCATIONS ARE GENERAL. PERCOLATON DATA ON THIS PACE FOR UPPER BENCH PERC. HOLE ONLY. PERFORMED BY ALASKA WATER do WASTEWATER: I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERF ME IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: 0 DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 5/16/00 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 1 2:56 — 6' — 2 3:06 10 2 1/2' 3 1/2' 3 3:06 — 6' — 4 3:16 10 3 1/4' 2 3/4' 5 3:16 — 6' — 6 3:26 10 3 1/4' 2 3/4' 7 3:26 — 6' — 8 3:36 10 4' 2' 9 3:36 — 6' — 10 3:46 10 4 1/8' 1 7/8' 11 3:46 — 6' — 12 4:06 10 4 1/8' ALASKA WATER & WASTEWATER CONSULTANTS, INC. 0000Copo Or• �40 CLOCK TIME 6901 DE94RR ROAD. SUITE 2B • ANCHORAGE, AK. 99504 PHONE (907) 337-6179 • FAx (907) 338-32464� P •• 0 NET DROP (INCHES) 6/15/00 SOIL LOG — PERCOLATION TEST ��r y*p1 HOURS PRIOR TO TESTING LEGAL DESCRIPTION: GREENBROOK SUBDMSION: LOT 10, BLOCK 1 PERFORMED FOR: RICK HAGEN 0....... .. ..... ....... ft a ss•:�O DATE PERFORMED: 5/15/2000 QQ a 7953 O Di (feet TEST HOLE #1 DOp�edP' "aFo�� 5 1/4' 3/4' 3 1 — (PACE 2 OF 2) �o(sesio� c. �DOpppoo� 2 4 SOIL CLASSIFlCATIONS Gp N 5 1/4' 3/4' SITE PLAN v �o' -==� RG I' = 100' i \Sc\FN 4:35 — GP M Ker eox 6 GM CL pR n1/4 4 3/4' GC OL `• • o o SW MH 5 " •'• : SP CH SM OH 6 SC ro12 TEST HOLE LOCATIONS 7 < ARE GENERAL DEPTH TO DATE a GROUNDWATER 8 z 0 TH/1 12' 6/15/00 41s 11' 6/22/00 9 pPOND 0 10- it 11- 12 Nz z 0 13IZ 14 5U 15 0 16 in H 17 18 19 PERCOLATION RATE 40 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 20 TEST RUN BETWEEN 4.5 FT, AND 5.0 FT. COMMENTS: PERCOLATION DATA ON THIS PAGE FOR LOWER BENCH PERC. HOLE ONLY. TEST HOLE 11 AND 02 LOCATIONS ARE GENERAI. PERFORMED BY ALASKA WATER do WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFO ME JN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: l� DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 6/15/00 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 1 3:35 — 6' — 2 4:05 30 5 1/4' 3/4' 3 4:05 — 6' — 4 4:35 30 5 1/4' 3/4' 5 4:35 — 6' — 6 5:05 30 5 1/4' 3/4' ALASKA WATER & WASTEWATER CONSULTANTS, INC. F 690UWE (07) 756179 0 FAX( 07) 1 ANR3h-32469504 �j�.`• •��0 SOIL 1013 - PERCOLATION TEST LEGAL DESCRIPTION: CREENBROOK SUBDIVISION. LOT 10, BLOCK 2 PERFORMED FOR: RICK HAGEN•• ••••••• •J fr A. Go ss; DATE PERFORMED: 5/15/2000 0 9 —7953 TEST HOLE #2 a��ti`• "......•''��oa�' ORGANICS �ilppo lo d\ SOIL CLASSIFICATIONS r'0 2 SITE PLAN ni/3 S\ d= o' GW -- ORG I• = 100' HF 3 s :'•t GP ML Ker Box SM GM CL TH/4 itg 4 GC OL °• • SW MH 5 ' ' • • SP CH SM i OH 6 SC TH12 7 ML DEPTH TO DATE MOWED) GROLMINATER B DRY 5/15/2000 THg1 +5' 5/22/2000 9 B.O.H. POND 10- 111— 12 13 14 15 16 17 18 19 PERCOLATION RATE 15 (MINANCH) PERC. HOLE DIA. 6 (INCHES) 20 TEST RLN BETWEEN 1.5 FT. AND 2.0 FT. COMMENTS: TEST HOLE #1 AND 42 LOCATIONS ARE GENERAL. *SOMEONE REMOVED TH PIPE. COULD MONITOR BELOW BENCH DEPTH, BELOW BENCH DE� PERFORMED BY ALASKA WATER do WASTEWATER: I, JEFFREY A. CARNESS, CERTIFY THAT THIS WAS PERF RM IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: c DATE READING CLOCK NET TIME TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 5/16/00 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 1 2:56 — 6' — 2 3:26 30 3 5/B' 2 3/B• 3 3:26 — 6' — 4 3:56 30 4• 2' 5 3:56 — 6' — 6 4:26 30 4' 2' ALASKA WATER & WASTEWATER CONSULTANTS, INC. I SOIL LOG - PERCOLATION TEST I LEGAL DESCRIPTION: GREENBROOK SUBDIVISION, LOT 10, BLOCK 2 PERFORMED FOR: RICK HAGEN DATE PERFORMED: 5/15/2000 E TEST HOLE #2 lee 111T1TiI✓I ORGANICS 1 1 EII'lll'II1m 10 11 12 13 14 15 16 17 16 DATE DRY ;5' DATE READING I CLOCK TIME I NET TIME I (MINUTES) WATER LEVEL READING GW qw-aiIIIIIIIII •- PRESOAKED 4+ HOURS PRIOR TO TESTING 1 3:36 — I — n�lUlSSW ilii. CO LLHHH 30 5 1/2' 1/2- 3 4:06 /_% T-ML 6' — 4 4:36 30 5 1/2' IIIlillll 5 4:36 — 6' — 6 • %//% 30 5 1/2' 1/2' !tlitll 4'.6.� • C�•i'SC EII'lll'II1m 10 11 12 13 14 15 16 17 16 DATE DRY ;5' DATE READING I CLOCK TIME I NET TIME I (MINUTES) WATER LEVEL READING NET DROP (INCHES) 5/16/001 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 1 3:36 — 6' — 2 4:06 30 5 1/2' 1/2- 3 4:06 — 6' — 4 4:36 30 5 1/2' 1/2' 5 4:36 — 6' — 6 5:06 30 5 1/2' 1/2' 19PERCOLATION RATE 60 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 20 I—�—JI TEST RUN BETWEEN 4.5 FT. AND 5.0 FT. COMMENTS: 'SOMEONE REMOVED TH PIPE. COULD NOT MONITOR BELOW PERK HOLE DEPTH. PERFORMED BY ALASKA WATER do WASTEWATER: I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: • Municipality of Anchorage r On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 017-431-18 Expiration Date: I I o� 0 13 1. GENERAL INFORMATION Complete legal description Greenbrook Blk2 Lt10 Location (site address) 12640 Von Scheben Dr., Anchorage Ak. 99516 Current Property owner(s) Kelly Glllllan-Gibson Day phone Mailing address Real Estate Agent 12640 Von Scheben Dr., Anchorage Ak. 99516 2. TYPE OF DELLING: 0 Single amily (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex). 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class A Well Q Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNadance request for: Received by:Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ qc- O 1 Date of Payment I I I Receipt Number 01`S�1c6G COSA # C7 -Z) L1 Waiver Fee $ Date of Payment Receipt Number Waiver # 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 Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE J� System #1 Approved for Z-/ bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 272-8218 Date 12-1100 Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: 1 bd &,-) of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet r ... c Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Greenbrook 13I1<2 Ltl0 A. WELL DATA Well type Public Date completed Total depth ft. If A, B, or C provide PWS ID # A Sanitary seal (Y/N)_ Cased to ft. Parcel ID: 017-431-18 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform co1onies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Date installed 6/14/01 Tank size 1500 gal. Number of Compartments 3 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping 4/9/12 Pumper A+ Home Services C. ABSORPTION FIELD DATA Y Date installed 6/15/01 Soil rating (g.p.d./ftz or ft2/bdrm) 0.7 gpd/sf System type Trench Length 60 ft. Width 15 ft. Gravel below pipe 0.5 ft. Total depth 3 ft. Eff. absorption area 900 fe Monitoring tube Y Depression over field N Date of adequacy test 10/30/12 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 624 gal. New depth 0 in. Elapsed Time: 120 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed 6/14/01 Size in gallons 250 "Pump on" level at 43 in. Datum Bottom of Tank E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot _ Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas "Pump off"level at 43 in. Cycles tested 3 Manhole/Access (Y/N) Y High water alarm level at 45 Meets alarm & circuit requirements? Y On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 110+ Water Service line 10+ Curtain drain 50+ F. COMMENTS G. ENGINEER'S CERTIFICATION Surface water 100+ Wells on adjacent lots 100+ I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R Pannone Date 12t11 r COSA brown sheet -1 0-10-1 2.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ in. 74-147 GREENBROOK SUBDIVISION LOT 10, BLOCK 2 60,589 S.F. FINAL STRUCTURE AS -BUILT GASTALDI LAND SURVEYING JEFF A. GASTALDI, R.L.S. 4726 WEST 88TH AVENUE ANCHORAGE, ALASKA 99502 PHONE 248-5454 GRID DATE 2838 7/10/2000 F.B. JOB NO. 01-13 GS102 I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. R IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA NOTE: NO CORNERS SET THIS DATE. BUILDING DETAIL SCALE: 1"=20' O>F■A �'•. yy Ar *: 49TH.........::.; ■ i .,....... A u:.4........... 'I............40 0 L-; � 0 ♦., �. Jeffery A. Gastaldi: - ♦. sf '•. LS -6091 ��' • C-AlEa, Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program S. [ 1 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING,/ Parcel I.D. 017.431.18 HAA # fJ o- o 10 b 1 ' Expiration Date: I ;--- to " O 2- 1. GENERAL INFORMATION Complete legal description + Lot 10 Block 2 Greenbrook Subdivision Location (site address or directions) 12640 Von Scheben Drive Current Property owner(s) Hagen Investments LLC Day phone 229.8400 Mailing address P.O. Box 240186 Anchorage AK 99524 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well ® Community On-site ❑ 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 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 _Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 1214101 5. DSD SIGNATURE Approved for� bedrooms. Disapproved. Ry v y 4e��p—ENGINEER'S' �"• �s 4 ttJ�,r. C_ 4-12 Orf:S'•Cy�� Conditional approval for bedrooms, with the following stipulations: Additional Comments WATERANn : ! Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Y�^� �Tl ���� Original Certificate Date: 2 - (0 — 0 (Rev. 12100) Municipality of Anchorage y ,,•• ••,�+ • .. Development Services Department Bonding Safety Division :. ... Onsite Water 3 Wastewater Program 4700 South Brag" St. P.O. Box 196650 Anchorage, AK 99519-66W www.ci.anchorage.ak. us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST LegaiDescrip0on: Lot 110, Block X GreenbrookSubdivision Parcel ID: 01743WB A. WELL DATA Wen type — Date completed — Totai depth ft. Date of test State water levet Wen production If A. B, or C provide PWSID # A Sanitary seal (YM) Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: Date of sample: B. SEPTIC/HOLDING TANK DATA ft. g.p.m. Nitrate mgA. Collected by: Tank Type/Materiat STEPISteel Tank size 13M gal- Number of Compartments 3 Foundation cleanout (Y" Y Depression over tank (YIN) N Well Log (YIN) Wires property protected (YM) Casing height (above ground) in• AT INSPECTION fl g.p.m. Date installed m4r= Clearwuls (YM) High water alarm (YIN) Y Date of pumping Pumper New Construction c. ABSORPTION FIELD DATA Date installed 6!15@001 Son rating (g•P•dJff or 1P/bdnn) .l GPDISF system" Shallow Bed Length 60 ft. Width 15 ft. Gravel below pipe .5 ft. Total depth 4_2 ft. Elf. absorption area 900 IF Monitoring tube Y Depression over Reid N Date of adequacy test Results (Pass/Fan) For — bedrooms Fluid depth In absorption field before test — in. Water added— gal. New depth— kr. Elapsed Time: — min. Final fluid depth — in. Absorption rate '' g.p.d. Any rejuvenation treatment (past 12 mo.) (YM 6 type) N If yes, give date D. LIFT STATION Date installed 611412001 Size in gallons 250 Manhole/Access, (Y/N) Y 'Pump on' level at 43 in. 'Pump ofr level at 43 in. Datum Bottom of Tank Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot Absorption field on lot Public sewer main Sewer /septic service line High water alarm level at 45 in. Meets alarm b circuit requirements? Y On adjacent lots On adjacent lots Public sewer manhde/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >S Property line >S Absorption field >S Water main WA Water service line 21o, Surface water mw Wells on adjacent Iota >200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 210' Building Mundafion >10' Water main >10' Water Service line Mr Surface water >100' Driveway, parkingNshide storage >25- 2SCurtain Curtaindrain None Noted Wells on adjacent lots >200' R COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined tivough field Mspecttm and review of Municipal records that the above systems are in conformance With MOA HAA guldbkos in efiect on this date. Engineer's Printed Name Michael E. Anderson P E Date 1214101 HAA Fee $3coc) 1 Waterer Fee $ Date of Payment 196 H o o t Date of Payment Receipt Number Receipt Number (Rev. 12/00) Or .A/ +e L' c THr o , r� fns'. .•'�: v