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GREENBROOK BLK 2 LT 5
r'e nbrook Block Lot 5 #017-023-61 Municipality of Anchorage. On -S___ Water and Wastewater Program • (907) 3�_-T904 Page 'of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171165 PID Number: 017-023-61 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: BRAD LARSON & AMY HASTINGS ABSORPTION FIELD ❑ Deep Trench El Shallow Trench ® Bed 0 Mound Address 12940 VON SCHEBEN ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.5 GPD/SF 1 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 0.5 Ft. Gravel depth beneath pipe 0.5 FL Subdivision Block Lot GREENBROOK 2 5 Fill added above original grade Varies 2.2 — 2.9 Ft. Gravel length 60 FL Township Range Section Gravel width 15 FL Beds: Number of Lines 3 Distance between lines 5 Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field TankrN:A ne 900 Fe -- Ft. Well 200+ 200'.}. 200'+ NA TANK ® Septic ® S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface water 100'+ 100'+ 100'+ NA Anchorage Tank 1 1250 Gal. Material ! % Number of compartments 2 Lot Line 5'i- 10,+ 5'+ NA NA .51coe Foundation 5'+ 10'+ 5'+ NA LIFT STATION Manufacturer Capacity Curtain Drain NA *50'+ NA NA Anchorage Tank 1250 Gal. Remarks None known. Existing field decomm. Pump on level at 44 in. Pump off level at High water alarm at 42 in. 48 in- nMounded in place per code. STEP & Field insulated. Mounded113 side Slope. Pump make and model Franklin 24450401 17 —1/2HP Electrical In,Ispections performed by Installer Mike Anderson PIPE MATERIAL Housetotank 3034 Tank to 3034 drainrield Drainfiield 3034 comT 3034 Inspector ARCTERRA BENCHMARK (Assumed elevation) 100 ft Ins dates: 1ctiot 11/27/17 2na 11/27/17 Location and description 3d.1 1/28M 7 011/28/17 Garage Slab COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin Conditional Approval: ' ��, OF AL�q pate * 9TH *# fX13 KEMETH M DUFF , Approved gr Date 3/Y ' ����G~� \ sslo .® AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP171165 GREENBR❑❑K SUBDIVISI❑N LOT 5 BLOCK 2 PID# 017-023-61 p � F MT B—C=19.0' I PANEL NEW 1250 -CAL\ Q e \ STEP TANK NEW BED 01/10/18 GRID: 0 2�0' A o c „ ELEC. o MH CO co MT C TH17-1 A—E=56.0' nip O c .0, 10 1O oN 22 CO Cos Z Z I '� 0,�, B cf, O titi2O 0 0' �pFOk 220 BM O �p APPROX. LOC. O PER MNA rT1 N LOT 5 w :At BLK 2 CD l 45"W iN 674g � 29 9 W 9' 4g� 299.59' 752.2, m R X SCALEi 1' = 40' A—C=42.0' DRAWN: B—C=19.0' CHECKED: M A—D=44.0' 01/10/18 GRID: B—D=25.0' JOB No.: OR A—E=56.0' A B—E=35.0' ti A—F=104.5' I zr B—F=92.5' 100,4 r g W z U U {J Z S 1� FINAL GRADE 1250—GAL STEP 0 ®® 2 ® OF Alf . m J ® 9TH *.� KE s. CE CL 1 ��wA f,��,s® J e p�F'ESSIOt�' 3_ ®\® FILTER FABRIC L DWLATIDN SEWER ROCK I, GUM WATER a 93.7 98,70 98,70 ON 6/15/17 1' MDA SAND 87 70 Bml 60' SCALEi NTS PREPARED FOR: BRAD LARS❑N 12940 VON SCHEBEN DRIVE ANCHORAGE, AK 99516 FIELD BOOKS BOUNDARY: N /A STAKING STAKING: N/A ASBUILT: SLS DWG. FILE AGAD FILE: FILE COMPUTED: DRAWN: BMW CHECKED: KMD DATE' 01/10/18 GRID: SW2839 JOB No.: 17-156 g o� " p `� rpt M 52 00 . q -. h c4- Nil~ oZ. OR `n Q " two 1` 0 iz j CD o a ° `N° c N82°20'04"W 290.28' (290.45' R) `n °° �' `° ° ' o r y C BASIS OF BEARING OD m 0 N° bow°tea I 0 3F a' a� � �' a- r'' a• � , I 0 a CD ��MMU\\` p, 20.0' • • C� -' iLTT (A �6aa' :5�`� I� C 180•Z�wC t7l o o O k AN a O O Opp r r 8 y 1p p• w 22_ p. N x �C 0' mHE'D N by FI r :� I O c1� I �1 2Q0. C, DE 22. p. Dew 00 Z OD i cK W K W Oo N mom: tti� O I Oi `r or. r 5CHULL E6 152.2' o X o �� - PROF�s�' N76°53'45"W 299.46' �• w N N a s0 (N76°46'09"W 299.59' R Imp, 0-19 30' 30' 12-2- CD Nto CA rA 0PV °to m� ��� co oui Zn azZ ,","°""'`a, MUNICIPALITY OF ANCHORAGE ; On-Site Water&Wastewater Program is::' , a......IPO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax.(907)343-7997 http://www.rnuni org/onsite Wil' I)erattment 4~CNON;.GE On-Site Wastewater Disposal System Permit Permit Number: OSP171165 Effective Date: 7/7/2017 Work Type: Septic Upgrade Expiration Date: 7/7/2018 Tax Code Number: 01702361000 Site Legal Address: GREENBROOK BLK 2 LT 5 G:2839 Site Mailing Address: 12940 VON SCHEBEN DR, Anchorage Owner: HASTINGS AMY R & Lot Size in Sq Ft: 49598 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Field d Septic Tank D Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: "71 / Date: 7—/e9 — / _ QQ�, ,,Issued By: ri �l'.t'+ca, CuC • fel Date: f 07 0 MUNICIPALITY OF ANCHORAGE /C1* Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-023-61 Property owner(s) BRAD LARSON & AMY HASTINGS Day phone 907-375-2578 Mailing address 12940 VON SCHEBEN DRIVE, ANCHORAGE, AK 99516 Site address 12940 VON SCHEBEN DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) GREENBROOK BLOCK 2, LOT 5 Legal description (Township, Range & Section) Lot Size 49598 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field 12!] Initial ❑ Single Family (SF) [ (w/wo ADU) Septic Tank Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of pro,- • owner or authorized agent) Perm. Rush Fees: Waiver Fees: Date of Payment: (a h301/i Date of Payment: Receipt Number: 028, Receipt Number: Permit No. 0501 11 L5 Waiver No. Permit App_9-1-12.doc �nC 'ERRq t c ARCERR. , '' CONSULTING, INC ¢`f � SNTING 212 E. 5151 Ave,Anchorage, AK. 99503 "'°" Office(907)868-3791, Fax(907)868-3793 June 26, 2017 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit—Greenbrook Block 2, Lot 5 It has been determined that the absorption field of the subject property is saturated. Subsequently, the owner has requested we proceed forward to obtain a septic permit to upgrade the septic system. The general slope of the proposed septic area is flat. On June 8, 2017 a testhole was performed to investigate soils and groundwater. The results of this test are attached for your review. The proposed upgrade will serve the existing 3- bedroom single-family residence. We propose to install a pressurized bed. Groundwater was encountered at 8' during excavation and at 6' at monitoring. The property and adjacent lots are served by a community water system. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868-3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. 40411re Kenneth M. .E. Attachments: On-Site Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test 20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793 WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN GREENBR❑❑K SUBDIVISI❑N LOT 5 BLOCK 2 1.25' PVC / / a. FLAT + ;) 0 `D FLAT 1 MT INSTALL NEW 1250-GAL STEP TANKS MT Coil I /e CrJ t-, 4 �O' CO FLAT T1117-1ti . t" O o$O 2 w FLAT ?•ii �U CJT � "0'67 10 . '`"2? Fco + TING 5'S z 7 Z-4- P. �.. 49.0.° c.: 0' DEGo►eM15S10N ods-ns 2 o c- a 3-BR k_ 1)1 .Z110' 4 w APP • • //////A o D4 APPROX. LOC. WATER UNE O O mr rr;f I WATER UNE LOCATION IS TO BE REVERIFIED & STAKED PRIOR TO CONSTRUCTION ty7' Ce CP N w O (O b • �N�,6S34S"W J 6' / 0 46'p9.,w 299 5,, 152.2•,59x /0. u FLAG PROPERTY LINES , WATER LINE Scale: 1•= 50' & EASEMENTS PRI❑R PAGE 1 OF 3 TO C❑NSTRUCTI❑N AREA SERVED BY o li DESIGN DETAILS PUBLIC WATER N 3 BDRM X 150 GPD = 450 GPD Y 450 GPD/0.5 GPD PER SQ. FT. (1' SAND FOR SEPARATI❑N) = 900 SQ. FT 0 (900 / 15' W x (0.5' GRAVEL) = 60 FT. BED USE 1 BED - 60' (L) X 15' (W) X 0.5' (ED) 0 TOTAL DEPTH OF SYSTEM IS 1' FROM ORIGINAL GRADE. 0 INSTALL 1' MOA APPROVED SAND AT 1-2' FROM GRADE PRI❑R TO ADDING SEWER ROCK a2 COMPLETELY DECOMMISSION EXISTING SEPTIC SYSTEM PER CODE. U u NO PUBLIC WELLS WITHIN 200' OF 5 PROPOSED SYSTEM. NOTES: /�6_ Gam' ' NO PRIVATE WELLS WITHIN 200' OF li PROPOSED SYSTEM EXCEPT AS NOTED. 1, INSTALL GAL STEP & INSULATE TANK IF <4' COVER. >, 200' OF PROPOSED VELLNO SEPTIC SYSTEMS E CEPTHIN AS NOTED. 2. INSULATE BED WITH 2' HD BURIAL FOAM IF < 3' OF FILL. MIN. 2' FILL WITH INSULATI❑N, >3' COVER NO INSUL REQ. I` 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INT❑ SEPTIC TANK. I 4. CONTRACTOR WILL ENSURE ALL SEPARATI❑NS TO ADJACENT F WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... OF ALS t FP AO. W /c��� <Q 1 PREPARED FOR: gCTE �/� BRAD LARSON ti rs / l 12940 VON SCHEBEN DR. ��/���kk\ ' o 00 *' /� • TH g . * ANCHORAGE, AK 99516 I in \ �� t„so ,,,,..,„, I • �� ii 3• , FIELD BOOKS cauPurFn: I/6i���I1�11 x 4 '� BOUNDARY: • DRAW: Z A• r CE 18 �w I N/A BMW m ���� CLrr "'1 N V �' , STAKING: CHECKED: KMD F NSA • �i A'' �$ a A• ///i e/ ASBUILT: SLS DATE: 05/26/17 -�F !LI VIA'', \ D . FILE. GRID. SW2839 �(e C'\-�,�,/�yC 0�1 `���48` ACRD FlLE: JOB No.: 7- 56 R�pf.,s11I.T I NG .x.56`9 FILE AK. 99577 WASTEWATER ABS❑RPTI❑N SYSTEM DESIGN DETAILS GREENBROOK SUBDIVISI❑N LOT 5 BLOCK 2 4 Au I< ►ti..o wed, a 4(eA S l cj°`s s 114111:1 15e, 3: 1 w G "vf54a--4 .5 tildt77. /7 ill 4 1- F Jed• . •not GNI. Ce 0 ll" 0 F *1'p�Q �4 I'S 1 X FINISHED GRADE (ADD UNCLASSIFIED FILL) ?below 0..Ci H 2'+ FILL / COVER W/ INSULATION ! 1 x FILTER FABRIC >° '1/ f �-- — — § _ /INSULATION I l'e o SEWER ROCK 7 a r A" _J1250 GAL`-�� MIN. 1. SAND. FILTER :. vorl.. (U S.T,E.P. . . 0 , I. OJ Lift Stotler 6A BELOW GRAWTERD t _ IMIN. 5'._I MIK 5'._d 60' BED I . 12' 2.5'(tyP) \I CAP ENDS OF PIPE \ M.T. ° T I 55 LF 1 1/4' PVC W/3/16 HOLES cn @ 5.5' SPACING (TYP) 1 1/4' PVC FROM TANK TO FIELD — 1 1 1/4' PVC FOR MANIF❑LD U1 1 .--r 2.5 ut 1 J t 0 wd a F M.T. O c 4 .$ InF= Nv50o 60' CJ Oo U 4' SOLID FROM HOUSE Fw� PAGE 3 OF 3 Ar < , • 4,s r PREPARED FOR: RCTER I BRAD LARSON I,�� 1 �; 7y t 12940 VON SCHEBEN DR. yl' �� r\ * .49TH . * / ANCHORAGE, AK 99516 / ''� ` 06 \ � �T g / FIELD BOOKS COYPurm: ; E' 4 % _ I wry BOUNDARY:N/A DRAIMI: BMW Z �! ��' ��! yti$ sruaNQ N/A aiECKED: KMD % \• ^p :`,1 n°' 1 lot p�4 IN �,/` 10�y,`t� , ,LLT: SLS DAA 06/26/17 �'.'....�.. ' E5510P ! �� tbli ` DWG. FILE: GRIM SW2839 c & C �1 \�_� e44k 4'SUI.TI NG • 1x' AC'"D p.r. FILE Joe No.: 17-156 FR 4K.99577_ /Volumes/Perrone snor.d/Ston .fW -L at SEPIK - Filed by /Gr..nbrook Subd/Blk 2 Lot 5/2017 Upgrade/5.p0: D..ign.deg WASTEWATER DISP❑SAL_ SYSTEM DETAILS GREENBR❑❑K SUBDIVISI❑N LOT 5 BLOCK 2 / g2`20'04„w .61111111290.28' FLAT »..�■ BASIS OF (290.45' R ) / 10iii BEARING 1.25” PVC + 0i' u, FLAT `� FLAT , 1 M T r /, INSTALL NEW C' 1250—GAL STEP TANK MT coil Al; 0 p . CO FLAT TH17-1 ,, 80' c; 0 • S CY/th = FLAT k0 8 0• �C co • • G TO:MI:ATER Z n� o_p• 2FCO ON EXISTIN " Z0. c_ 7ap• ° DECOMMISSI0CP Gs; 20 w w3—BR titi APPR•p - 22 . p OX N -4, 0. �FL'kOIII� ° Oj0 LINE 0 �" o '44* csi WATER LINE LOCATION IS TO BE r N REVERIFIED & STAKED PRIOR TO CONSTRUCTION aj Y m C� 00 .0 :A (J N 0 ( o 0) O �/J o - L a PRESSURIZED DISTRIBUTI❑N SYSTEM HOLE SPACING DESIGN 0 , 1. RESIDUAL HEAD = 5' co 2. HOLE SIZE = 3/16' = 1.00 GAL. PER HOLE @ 30 PSI 3. 30 GALS CPUMP DELIVERY)/1.00 GALS./HOLE = 30 HOLES m 4. 165 LF LATERAL/30 HOLES = 5.5' SPACING PER HOLE Lz 13 5. ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS. Scale: 1'= 30' LJ 40:1111 _\N PAGE 2 OF 3 w / �� �F <Q'•t PREPARED FOR: gcTER NI- �`S� `�� � BRAD LARSON *oti �����\\\`I 4s�� E /* . A 9TH iN * V 12940 VON SCHEBEN DR. �, 111111 �f�._ ANCHORAGE, AK 99516 _ Sc° KE �, •GE e E3 FIELD BOOKS COMPUTED: ; Ri" ' › , ` f ��� / BOUNDARY:N/A DRAWN: BMW > 1 4 "Apr STAKING: N/A CNECKED: KMD = s •j'ln°' , 444, t� �p�,�/ /0 y / ASBUILT: SLS DATE 06/26/17 `' •�+� .• \11( 6af aqi , "OFESSIO�A DWG. FILE: GRID: SW2839 9C! (' C' 11 E \ +� Fop 1� qo Z `` ACAD FILE FILE Joe No.: 17-156 R`FR,S4K 99577— �36 l oL t, cTERR� ARCT��z�Z:� �-A� , OF AL4t01 CONSULTING, INC a 212 E. 51s1 Ave,Anchorage,AK. 99503 • TI( "7 i • Office(907)868-3791, Fax(907)868-3793 `' AIM"`sem/ �`'' AO y`;SkriHo.> ..#s" 4 •P KENNETH 'us a SOILS PERCOLATION TEST I "� 0, )) y 1 F;- i p oEssiost& As. Performed for: BRAD LARSON Date Performed: 6/8/2017 *\�. 1"f Project: GREENBROOK BLOCK 2,LOT 5 TEST HOLE# TH 17-1 Depth (Feet) SEE ATTACHED SITE PLAN 4''.a • 4Org/OL FOR HOLE LOCATION (II Was Ground water encountered? YES What depth? 8' D Depth to water after monitoring? 6' Date? 6/15/17 -I 0 till1it.N1 Reading Date Gross Net Depth of Net C' Time Time Water Drop (> 1 6/9/17 1:00 - 6" - 2 1:30 30 min 3 5/16" 2 11/16" 8 3 1:31 - 6" - 9 4 2:01 30 min 3 4/16" 2 12/16" Io 5 * 2:02 - 6" - I I 6 2:32 30 min 3 4/16" 2 12/16" 12 7 13- HOLE PRESOAKED 8 PRIOR TO TEST 14- 9 15- 10 16- 11 17- 12 18- -1: Water Added 19 Percolation Rate 11 (min/in) Perc Hole Diameter 6" 20- Test Run Between 3 feet and 4 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. F-~MUNICIPALITY OF ANCHORAGE~ He~ .h and Environmental Prote ion Fourth Floor West 825 L Street Anchorage, Alaska ,99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE /% · FROM W~_LL ._%~t~xt~ MAr~UFACIURER ~ IN$1gE LE~'IOTH INSIOE WIDTH __ ~MATE RIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY_LQ GALLON[ TILE DRAIN FIELD: L _~_1,?_ TOTAL LEI'JGTH DISTANCE FROM V,'t:L ~L~_.-_FOUNDATION_~:~"~NEAREST LOT LII'IE"~<::) OF LINE ~ :~ of Lines I DISTANCE BETWEEN Lli',IES TRENCH V,'IDTH~_~:~_ IN. TOTAL EFFECTIVE A[;SORPTIO,"4 ,%f~CA _~.._"~-__ SQ. FT. LENGTH OF EACtl Lli'IE DEPTII Of FILTER O."'PTIh TOPOF TIL['IO FII',H$1tG;'~ADEL/~'T"' MATERIAL[;ENEATHTILE_~-~~' IN. ABOVE TILE._.~ IN. SEEPAGE PIT: Log Crib Rings BUI LDtl':G FOLJi,tDATIO~'I __ DIAMETER OR VIIDTtt LENGTN DEPTH Crib Size: CIAk'IETER_,.__[3EPTll DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE . ABSORPTION AREA WALL AREA) SQ. FT. Well Class:~v~. Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials:~%~ ~ of Bedrooms: ~ Installer: ~ ~ Remarks: ;!i -i DATE P~,~"'~APPROVED PERMIT NO I C ] . ~l~ll_ I T~r' OF I---II'~lm~F.~-ml~.l~m_~E DEPART~IENT OF HEALTH AND ENVIRONP~ENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 995A± 0~--~'~ I TE ~E;EWEF~ PER,'1 I T 771A~4 ) APPLICANT LOCATION LEGAL LES PACF LAi'..KI,IC~.nD HOI'IES V'ONSCHEBEN DR L5 B2 GREENAROOK SUB/D 1~01 E DIPIOND LOT SIZE ~4 8588 44450 SQUARE FEET T~'PE 0~ SOIL ABSORBTION SYSTEM IS: TREHCH 1,18XINUI,1 NUMBER OF BEDROObIS : 3 SOIL RATING THE REtQUIR~D SI~E OF THE SOIL ABSORPTION SYSTEH THE DEPTH OP fl TRENCH OR PIT IS THE DISTANCE BE)WEEll T~ SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN TH~R~ IS NO SET WIDTH FOR TRENCHES. , THE GRAVEL DEPTH IS TH~ ,MINI~IUM DEPTH OF GR~¢E~STWEEN THE OUTFALL PIPE ----~ ..... ' PACK~GE ~--~T OPTION ....... ~ PA~KA~E PLANT ~l~V ~E INST~LLED AT~HE.P~MITTEE~S OPTION SUBJECT TO THE FOLLOWING CONDIT]OIIS: ~ . ~ I. EITHER 8 CLASS I OR II ~ASF n~'~'~D PLANT ~I~Y BE INST~LLED. 2. A CONTINUOUS ~I~IN~EN~N~ ~GRE~-IT I5 REQUIRED. IF ~ MAINTENANCE ~CKFILLINm] OF ~NY SYSTEM WITHOUT F ~L INSPECTION 8ND ~PPROV~L BY THIS DEF'~RTMENT WILL BE SUBJECT TO PROSECUTIO~I. I'IINII'IUi'I DISTANCE BETWEEN A WELL FIND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS IE1Kl FEET FOR A PRIVATE WELL OR 200 FEET FOR FI PUBLIC WELL. OTHER REQUIREMENTS %'IF~Y APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PIS_RId ]' T EXP~. I RE'~. DECEt'IBER _~I , '1977 I CERTIF~ THAT ~l: I BPi FAhlILIAR WITH THE REOUIREMENTS FOR ON-SITE SEWERS F)ND WELLS AS SET FORTH 8V THE NUNICIPFILITV 0~' ANCHORAGE. 2: I WILL INSTALL THE SVSTEM IN ACCORDANCE WITH THE CODES. ~: I IINDERST~NI) THAT THE OH-SITE SEWER S~/STEM I'lA'~' RE(QUIRE ENLARGE~'IENT IF THE RESIDENCE IS REMODELED TO INCLLI~E I'IORE THAN ~ BEDRO0)'IS. Municipality of AnchOrage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 C__,ERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-023-61 1. GENERAL INFORMATION COSA# ©% II ~uC"] L~ Expiration Date: / / -g - i2-- Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent " Mailing address GREENBROOK S/D; BLOCK 2, LOT 5 12940 VON SCHEBAN DR. *ANCHORAGE, AK 99516 CHUCK STILWELL Day phone 771-808.3 12940 VON SCHEBAN DR. *ANCHORAGE, AK 99516 Day phone Day phone Unless otherwise':.{equested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 5 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 On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water sUpply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 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 afl applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 557-6179 Address ,5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, G£G, 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 repo~t is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any DSD SIGNATURE '~/Approved for Disapproved. Conditional approval for other person or party is not authorized, nor will it confer any legal right whatsoever. · ~ bedrOoms. ~'_~. ' AND bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report. Other ~~ Original Certificate Date: /3-/i Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST LegaI Description: GREENBROOK S/D; BLOCK 2, LOT 5 Parcel ID: 017-023-61 A. WELL DATA provide 210346 Well Log (Y/N) Well type A If A, B, or C PWSID# Date completed Sanitary seal (Y/N) Wires properly protecte~ Total depth ft. Cased to ft. Casing ~~round) in. FROM WELL LOG ~~;~CTION , Date of test ~- ~ ~-- ft. ~ Static water level ~~:,,,~/' "~ Well production _ / .... g.p.m. ~-- g.p.m. WATER SAMPLE Coliform ,,/~colonies/100 mi. Nitrate mg./L. Collected by. ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL 1/20/1978 Tank size 1250 ..gal. Number of Compartments 2 ._ Foundation cleanout (Y/N) YES Date of pumPing 'l O/ (~/I I ABSORPTION FIELD DATA Depression over tank (Y/N) NO [*BELOW EXISTING GRADI:J Date installed Length 36 ...ft. Total depth * 10.12 ft. Date installed Cleanouts (Y/N) YES · High water alarm (Y/N) 1/20/1978 Soil rating (g.p.d./ft2or~ 140 Width 3 ..ft. Eft. absorption area 432. ft2 Monitoring tube *YES Results (Pass/Fail) PASS Date of adequacy test 11/4/11 _ Fluid depth in absorption field before test 31.5. in. Water added 768. ga1. Elapsed Time: 120 min. Final fluid depth 63.5 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date ~NEW MT INSTALLED TO BOTTOM OF DRAINROCK. DRAINROCK LOOKED CLEAN. System type TRENCH Gravel below pipe 6 .._ft. Depression over field NO For 3 .bedrooms New depth 67.5 in. 450+ g.p.d. D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at__ in. "Pump off" level~. High water alarm level at in. Datum J Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots ~~' ~eanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5' + Water main Water service line 10'+ Surface water. 100% Wells on adjacent lots 100'+ PRIVATE/ 200'+ PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN Building foundat on. 10'+ Water main 10'+ Surface water 100'+ Driveway, parking/vehicle storage Wells on adjacent lots 100'+ PRIVATE// 200'+ PUBLIC 10'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $ L~ O~ D ~ Date of Payment Receipt Number (~c~L~ ~ (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number. Dec 07 11 04:27p FrantzHildonen 27~B68B p.1 [. ~99. 59 ' $ 7~* 4~'0.9"~ Lot 5 ,Block ~2 Anchorage Recording Precinct, Alaska LOT SURVEY CERTIFICATION I hereby certify tho~ I have surveyed fha property shown and described I~reon,and that the improvements situ~ed thereon ore within the prop- arty lines and do not overlap or encroach on adjacent property and that no improvements on adjacent property overlap or encroach on the premises in question and that there ore no roadways, utility lines or other vlslble easements on said property excep~ os indicated hereon, Ref, _LEGEND ~: Brass copped monument recovered o : Won pipe and/or rebar recovered a : 2x2 hub ~ tack recovered · = 5/8"x 50" reb~r sef this survey Prepared by: R 1, BUTTON (907)279- e£o0 519 W, £/ghth Ave. Anchoroge' Alaska, 99501 Property of: /?/,- / I 12705/~011 07~2 8686770 ~PLU$ HOME SERVICES , INC. CUSTOMER · 7501 E. 140th Avenue Anchorage, Alaska 99516 345 - 1890 An:Tm'va Co~mtting INVOICE # P~GE 01 41133 Anchorage, AK Block Lot DATE DESCRIPTION AMOUNT 10-06-1 1 lhtmp_Sq~, ie for ~?,a~.a~ ~_ !2~@ x~c~_~_~ r~.~-..,.= . $165.~ .. ,~_dx ,,,~, kG~' .. '7: .. :, '~,,, . ,, h ' RE~ARKS ' : " ...... ' '",,, Gallons Septic ~ Leach Area ~ Holding Tank i Standpipes ~Time ~ PROBLEM AREA-- CALL FOR MORE I~FORM~IION NEEDS TO BE ~NE AGAIN IN 6 MONTHS Good Shape ~ Sludge buildup on bosom ~ Floater on top ~ Jim cap missing or ~ Cut standpipe to 1' above ground ~ Needs Septictrlne needs replacing ARcT ERRA CONSULTING, INC 212 E. 51~ Ave, Anchorage, AK. 99503 Office (907) 86g-3791, Fax (907) 868-3793 ON-SITE WASTEWATER INSPECTION GREENBROOK LOT 5, BLOCK 2 12940 Von Scheben Drive, Anchorage, AK October 25, 2011 ~ CONSULTING, INS .'~',?¥ 212 E. 51a Ave, Anchorage, AK. 99503 '.'.~ 4' O~ce (907) 868-3791, F~ (90~ 868-3793 October 25, 2011 Eric J. Neeld Account Manager Fidelity Inspection & Consulting Services RE: GREENBROOK SUBDIVISION LOT 5, BLOCK 2 12940 VON SCHEBEN DRIVE, ANCHORAGE ALASKA · ON-SITE SEPTIC SYSTEM INSPECTION Dear Eric, Per your request, on October 7, 2011 we inspected the on-site wastewater system of the above referenced 3-bedroom property in accordance with current Alaska Department of Environmental Conservation (ADEC) and Municipality of Anchorage (MOA) protocols for private septic systems. Thi~ investigation was based on observations of the day in which this inspection was performed and according to available documents. Record Documents Record MOA documents of the 1978 septic system were obtained and reviewed prior to conducting the septic adequacy test. Per those documents, the 33-year-old .3-b.e.droom. septic _system_ c,o, nsists of a 1250-gallon septic tank and a thirty-six toot long leach tield with 6 of effective sewer rock depth and 4' of cover. There were two other adequacy tests conducted in the last ten years as follows: 1) August 4, 2003 - a septic adequacy test was performed and it noted that the monitoring tube extended only 28" below the lateral and that the last 135 gallons caused a rise of 2.5". Prior to testing the documents indicate that the effluent level in the monitoring tube was at 6" and that it rose to 23" (within 5" of the lateral) after injection of 510 gallons of water and the level subsequently settled back down to 18.5" (within 9.5" of the lateral) after 69 minutes. This information would indicate that the field was 69.4% in failure and operating in the top 30.6% of its operating c_apadty. The tank was pumped prior to running the test and although the field was not monitored after the required 24-hour period the fluid drop was extrapolated to assume that it returned to its original level based on the observations at the time. The derision to extrapolate data vs. monitoring after 24 hours is at the discretion of the engineer and can be questioned by the reviewing agency depending on the situation. 2) June 7, 2006 - the most recent MOA Certificate of On-Site Systems Approval (COSA) and septic adequacy test performed before ours 12940 Von Scheben Drive October 25, 2011 Page 2 of 4 noted that the system was 65% in failure and that the monitoring tube extended 29" (1' different than the previous testing) below the lateral. Prior to testing the docmnents indicate that the water level in the monitoring tube was 1" and that it rose to 14.5" during testing (within 14.5" of the lateral) after injection of 487 gallons of water and subsequently settled back down to the 1" level after 24 hours. This information would indicate that the field was 61.1% in failure and operating in the top 38.9% of its operating capacity. Although there were no receipts that indicated pumping prior to testing that we found, the COSA indicated that the'system was pumped on June 6, 2006. It should be noted the monitoring tube was designed to extend six feet (6') or 72" below the lateral to the bottom of the leach field and not the 28" - 29" observed in both these inspections. Methodology Prior to starting the septic adequacy test the septic tank is pumped by a MOA certified pumping company to verify tank capadty and safeguard the residence from septic backup if the system fails. A site inspection of the septic standpipe(s) is preformed to establish the current condition of the equipment and_any discrepancies with record information on the system are noted. A mechanical water meter attached in4ine to a hose is attached to an outside spigot. The water is drained into a Septic lea. chtield standpipe and the water level is monitored for absorption or backup. Once the required water volume, currently 150 gallons per bedroom, is injected into the system the water is turned off and the system is monitored for rate of absorption. If the system does not absorb the prescribed water volume within a twenty-four hour tPheriod, or if the water begins to flow into the lateral distribution line and tank, e system is deemed in failure. ' Findings A+ Pumping removed 1250 gallons of effluent out of the septic tank prior to testing. Four septic standpipes were noted in our investigation and appear to be a foundation deanout, septic tank deanout, post-tank deanout and a monitoring tube / sump at the end of the field. Prior to testing, we noted that the monitoring tube extended only 28" below the lateral (similar to the August 4, 2003 test), fluid in the monitoring tube was measured at 13.6" (14.4" below the invert), rather than the 1" indicated in the previous test. After injecting less than 300 gallons of water into tl3,e septic field, fluid began to back into the septic tank and the septic adequacy test was aborted. Observations after 20 minutes indicated the effluent levels were still visible above the lateral. MOA~ Municipality of Anchorage, Certificate of On-site Systems Approval, Guidelines for Approval, revised '?~e system must be able to absorb I$0 gallons per bedroom per day. DSD reserves the right to require field data of the adequacy test. Adequacy tests shall be performed with effluent levels in the 12940 Von Scheben Drive October 25, 2011 Page 3 of 4 and ADEC requires that a 3-bedroom system be able to inject and absorb 450 gallons below the lateral, which this test failed to showptherefore, this system does not meet the minimum code requirements. Additionally, this information would indicate that the field was 80.0% in failure prior to testing and that during testing the effluent level rose above the level of the field and back into the tank negating its ability to operate at its designed level. Although this doe'§ not mean that the system Would not operate under a low-usage, operating environment, it fails to meet the requirements to receive a COSA at this time. Conclusions & Recommendations In order to obtain MOA approval for the septic system, the system must be .able to absorb the required amount of water, in this case 450 gallons as indicated above. In order to achieve this requirement the system can be modified through several means including rejuvenation treatments or installation of a new leach field. Due to the ndmber of unknowns and costs assodated with rejuvenation methods, home sales typically opt to have a new septic system installed. Unlike some engineering firms who are also in the business of installing septic systems, ArcTerra does not install septic systems--we design and test. We strive to bring peace of mind to both buyer and seller, and when construction is necessary we'll help the owner obtain competitiv, e, fair bids from reputable excavators. We are happy to provide information and quotes for our services in the areas of design and construction inspection services. If you want to consider a new field, outlined below are the necessary steps you would need to take. We are also happy to discuss the other options regarding rejuvenation of a septic field. I would also note that due to the age of the tank and its material it is highly likely it also would need to be replaced although there is no indication of this from our procedures. Septic System Improvement Requirements · New soil test holes, with utility locates, will need to be excavated to determine the soil and ground water characteristics for the design, of a new leach field. This includes hiring an engineer to conduct soils' logs, ercolation tests and water monitoring and an excavator to dig the test oles · An engineer to design and provide stamped drawings of the new absorption field below the top of the distribution pipe. A wastewater disposal field is considered failed iff The effluent level prior to the test is at or above the distribution line invert. Less than the prescribed rate of water (150 gallons per. bedroom per day) is absorbed below the top ofthe distribution line in 24 hours. Groundwater is found to be less than 4 feet from the bottom of the absorption field. Drain fields filled to 90% of capacity or greater at the time of inspection shall receive an advisory notice on the COSA." 12940 Von Scheben Drive October 25, 2011 Page 4 of 4 system, submittal of the design to the municipality for permitting and approval of the design for construction. · Selecting an excavator for construction of the system and an engineer to conduct the inspections. · Having an engineer complete and stamp an inspection report and COSA documents, submission to the MOA for approval and receipt of the COSA. While we do not believe in having our own construction company, as we believe it conflicts with our duties to our client, once a design has been completed and permitted by the MOA we can send the design out for competitive bids to reputable and MOA approved contractors. Final selection always rests with our clients. Limitations The assessment of the condition of the septic applies only to the conditions as of the day tested. The absorption rates may change due to subsurface conditions that may not be,observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the' family being served by the system. The operational life of all septic, systems is subject to these various and dynamic characteristics and is outside the control of the evaluator of the 'septic system. Therefore, ArcTerra cannot give any estimate of how long a system will function satisfactory for current or future occupants nor can ArcTerra guarantee that no unseen encroachments, defidendes or discrepandes exist. Please advise us on how you wish to proceed or if you need any additional services. If you or any of your clients have any questions regarding the adequacy of this system or the methods and/or procedures employed during our inspection or evaluation, .please feel free to contact .me at (907) 696- 6111/Fax (907) 868-3793. Respectfully, ArcTerra Consulting, Inc. Kenneth M. Duffus, P..~ Cc: file Parcel I.D. Municipality o.f Anchorage Development Serv,ces Department 7/~/C~ Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 wvw.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date:, '7- ~- C~) 7 t. GENERAL INFORMATION Complete legal description Lot 5 Bk 2 Greenbrook S/D Location (site address) 12940 Von Scheben Dr., Anchoraqe, AK 99516 Current Property owner(s). Katha~ne Melaine Walters Mailing address .12940 Von Scheben Dr., Anchoraqe, AK 99516 Lending agency Mailing address Real Estate Agent Sallie Nickerson/Jack White Real Est. Mailing Address 3801 Centerpoint Drive, Anchoraqe, AK 99503 Unless otherwise requesled, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Day phone 561-4001 · Day phone · Dayphone 229-1148 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class _A. Well Public Water System D [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On*site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On*Site Systems Approval are required for the transfer of title (except between spouses) for properties sewed by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells er 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 vedfy 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 vedfy 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 Enqineerinq Semices, LLC Phone 272-8218 Address P.O. Box 102954, Anchoraqe, AK 99510 Engineer's Pdnted Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious cnglnccfing analysis of thc system in accordance with MOA DSD Guidcllncs & Regulations. The reported results describe thc performance of thc system under thc 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 thc local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the conU'ol of the evaluatur ofthls system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any wa'rarity for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the 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 ix'tson or party is not authorized nor will it confer any legal fight whatsoever. 5. DSD SIGNATURE ~ Approved for .~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: .... ., : . WASTEWATER . = Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw ~treet P.O. Box 196650 Anctmrage, AK 99519-6650 www. munLorg/onsite (go7) 343-7g04 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot fl Block 2 Greenl~r99t~ Parcel ID: A. WELL DATA Wall typeA IfA, B, or C provide PWSID#210346 ~ ~mpleted __ Sanite~ seal (Y/N) .~,Wl~s property p~ (y/N) Co 00 mL D. SEPTIC/HOLDING TANK DATA Tank Type/Material OmerSt~t Number of Compartments Depression over tank (Y/N) Pumper A+ Home 8ewlc~l Date installed Cleanoute (Y/N) Y High water alarm (Y/N) I~A Tank size t250 gal, Foundaljon c~anout (Y/N) Y Date of pumping .MIt20~ C. ABSORPTION FIELD DATA Date instelleq 1/20/t978 Soft rallng (g.p. cl./~ m ~/Ixlrm) 14(I System type DeeoTmnch Width ~1 ft. Gravel below pipe ~ ft. Total depth .U. ft. Eft. absorption area 432~ Monitoring tube_Y Depmesion over field N Date of adequacy test ~/7/2506 Results (Pass/Fail) Pa$~ For =~ bedrooms Fluid depth in absorption field before test t* in. Water addeq487 gal. New depth14.~ in. Elapsed Time: 1~4~1 min. Final fluid depth .~ in. AbeorptJon rate >= 4~ g.p.d. Any rejuvanatlontmalment (pest 12 mo.) (Y/N & type) N9 If yes, give date D. bI~TION Date instalil~ "Pump on" level at~'~ in. Datum ~ E, SEPARATION DISTANCES Size in in. at Meets alarm & cimuit requireme~s? in. SEPARATION DI TO: Septic tank/lift station on lot Absorption field on lot Public sewer n Sewer adjacent lots On adj'~ Public sewer m~nl~e~nou~ Hok:ling tank ~ Manure/animal excrete storage area.~--... SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main ~ Wells on adjacent lots Property line Water service line Absoq~n field Surface water Water Service line 25+ Curtain drain None Obsented F. COMMENTS Monitor Tube only extrude 29' below inv., G. ENGINEER'S CERTIFICATION SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1~ Building foundation ~ Water main ~* Surface water ~JlX~' I:)fi~lWay, parking/vehicle ~orage t1~ Wells on adjacent lots 200+ I ce~ify that I have determined through field inspec~ons end review of Municipal mcon~ that the above systems are in ~onformance ~ MOA CO.SA guidetines in effect on this date. Engineer's Printed Name ~teven R, Pannone. P.E. Date COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) ~ '"- Waiver Fee $ Date of Payment. Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wast·water Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. t. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR SINGLE FAMILY DWELLING 017-023-61 HAA~ ~ ~ Expiration Date: / ~-.-/-~,. Complete legal description GREENBROOK SUBDIVISION; LOT 5, BLOCK 2 Location (site address or directions) 12940 VON SCHEBEN~ · ANCHORAGE~ AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address · 99516 · ALLEN LEE Day phone 345-3542 12940 VON SCHEBEN ROAD · ANCHORAGE, AK · 99507 Day phone DEREK' SUITER W/ PRUDENTIAL WSTA Day phone 4241 B STREET · ANCHORAGE, AK · 99503 273-7285 Unless otherwise requested, HAA will be held by DSD for plckup. 2. NUMBER OF BEDROOMS: 3 3. TYPE O~: WATER SUPPLY: Individual Well ~E] Individual Water Storage Community Class ^ Well ~ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 wast·water disposal and/or water supply system. DSD also issues HAAs upon request to homeov, mers. 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 by my seal affixed hereto and as of the validation date shown below, I vedfy 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 forthe number of bedrooms and type of structure lndicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage tiles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with alt applicable Municipal , and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone Address 3701E. TUDOR ROAD. SUITE 101 * ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A. CARNESS. P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to pmvfde e thorough, conssientious enginee#ng analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The mporfed results described the performance of the system under the conditions encountered at the time oft he lest, end separation distances measured to readily identifiable features. 3'he 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. Satisfactoq/ test results do not guarantee future performance of the system, nor do they guarantee that there ara no hidden defects or enccoachrnents. AKWWC, Inc. can therefore not provide any warranty or future estimate of howlong the system wfil continue to meet the operational requirements of the ADEC or MOA DSD. The contenI 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 autho~fznd, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE V'"" Approved for ~> bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ,~ ~, WASTEWATER: : ...... Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewster Program 4700 ~ou~l Bmgaw St. P.O. Box 196850 Anchorage, AK 99519-6650 w~w.ci.enctx~rage.ak.us (9O7) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal D~on: GREENBROOK SUBDIVISION; LOT 5~ BLOCK 2 Parcel ID: A. WELL DATA *PUBLIC WATER 017-023-61 Weld type A If A, B, or C provide PWSID~ 210346 Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires pmpedy protected ~..~.. Total deqlh lt. Cased to fl. Casing he__round) in. FROM WELL LOG AT I.~ISPECTION Data of test Well production ~.-~ g.p.m, g.p.m. WATER ,,~J~ PL ~ ~ ~~'"'"~: ' C.~ltform ~ ~loni~8/lO0 mL Ni~reta m~./L. Olher bectari8 ~31oni~'lO0 mL ~ m~.lt. Deta of ~m~le:, C~lll~:ted I~: SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 1/20/1978 Tenk$ize 1250 gal. Number of Comp~tmonta 2 Cleonouts(Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) N,O High water alarm (Y/N) N/A Data of pumping 8/4/2003 Pumper A+ HOME SERVICES ABSORPTION FIELD DATA I.I~LOW rxl~n~ Data installed 1/20/1978 Soilraflng(g.p.dJit20n~140 Systemtype 0£EP TRENCH Length 36 It. Width 3 .it. Grovel below pipe 6 ft. Totaldepth "'6.75 .it. Eff. absoq3flonerea 432 It2 Mo~itoringtube°'YES Deprassionoverfleld NO Data of adequacy test 8/4/2003 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 6 in. Water added"'~l°gal. Now depth 23 in. Elal~ed Time: 69 min. Final fiuid depth 18.5 in. Abeofption rata >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - '"'MT ONLY EXTENDS 2B" BELOW INVERT ="'~'LAST 155 GALLONS ONLY CAUSES A RISE OF 2..~" D. LIFT STATION Date in'tailed Size in gallons ~ 'Pump on" level at in. ~?~_oj~..l~~ High water alarm level at .in. ~ -/~ Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 'PUBLIC WATER Septic tank/lift station on lot Absorption field on lot Public sewer main On adjacent lots ~~ Public sewer ma~ Holding tank. SEPARATION DISTANCES FRoM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Properly line 5'+ Absorption field Water main 10'+ Water service line 10'+ Sudace water 5'+ 100°+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water sen/ice line . 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ Water main. 1 Driveway, perking/vehicte storage 10'+ __COMMENI~, ENGINEER S CERTIFICATION I certify that I have determined through field in~pecgons and review of Municipal records that the above systems are in conformance agth MOA HAA guidelines in effect on this date. Engineer's PrintiK} Na~e JEFFREY A. GARNESS Date ~O.~ Receipt Number L.t( C.~q(:~ c ~ Waiver Fee $ Date of Payment Receipt Number HOME SERVICES, INC. CUSTOMER 7501E. 140~ Avenue Anchorage, Alaska 99516 345-1890 ..,,~.~=. ........... .~,~,LsultanL~,Imc. 3701 E. Tudor Road, S,~tc # i 01 TO: 33S,3~zlG P: 1'1 INVOICE# 25626 Block Lot DATE ' DESCRIPTION AMOUNT ,' ~ 'x~..;... ~.s~.~. ..:: . RE~RKS ,.. .'.. I~ Gallons Septic ~ Leach Area Holding Tank ) S~ndplpes ~me ~ PROB~M AREA ~ CALL FOR MORE INFORMATION ~ NEEDS TO BE DONE AGAIN IN 6 MOTHS ~ Good Shape ~ sludge buildup on bo~om : ~ Roster on top ~ Jim mp missing or ~ C~ standpipe to 1' above ground ~ Nee~ Septictfine needs replacing 12/09/2003 09:48 FA/ 907 261 2201 ~'ffT-TITLE "~ DEC. 9. 2003 9:D2AM LAED TITLE C~VPAEY ~002 ~0, 264 P. 2 ,, . ,I * l · 12/09/2003 'I'L~ 09:34 [TX/R,T ~o 5598] ~002 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA gg501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Addre~! 274-Z533 DATE: July 2r 1986 PWS l*f)*#21034t~ To Whom it May Concern: According to records on file in this office the Oreenh~oo~ ~h~(v(R(nn Water System is in compliance with the State Drinking Water Regulations Sincerely, OF ANCHORAGE : ...... D~'PARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION - l ...-.- DIVISION OF ENVIRONMENTAL HEALTH .. ':;i "..- ~'~'; :il :~.[ CEF~TIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ': .~ ~.~; ~ ' ..... ;'- ., ~- ,, , ON-SITE SEWER AND WATER FACILITY 1. GENERAL INFORMATIoN --. (a) ' ~e~al Description (include lot, block, subdivision, section, township, range) (b) .~pplicant' Name - · ,. _ Telephone: Home ~ Business (c) APplicant:is (check 6ne):'Len~'ihg institution~; Owner/builder ~; Buyer ~; Other ~ (explain); (e) , Re:;I Estaie 'COml~any :and Agent : ....: · Address '. ' '~ ;Telenh~n;~',~ ~'.'', -' ; · ' ' -* ': .. · ;' .:(f); Mail the HAA to the followin address: .,i~,,..' ':-;'. · ' ,~ ':' . : '. "..:' '. , ,-.':'- ;-'., . ::, ; ' ',.~.~:.':". . / ~, . . ~ . ,~ * . ~ .. .~, ,. ~,~; ,., , ~ ;: '' Numl~rbfBedrooms:::..~""""'~-' ','i~:¢J,,':',i";:~'.:,i' ' ': ':-, ' ' ' ' 3 ' WATER SUPPLY . .' · ' ~ ',~. - ~ ' .' 'individual Well ~ ~ Commumty~ .~ Public D '~'*,,,-" ~'..~ ~ ': ~* ~;.. ~,/~ ~ '~''~ ? -~. . ~. ~ .. ;`~NOte:~fc~mmun~ty.we~system~mUsthaVewr~ttenc~nf~rmat~nfr~mtheStateDepa~ment~Enwr~nmenta~C~nsewah~n '~" -, : ~, attest ng to the ega tyandstatus~:..,:',"-..,... ~h,.,,: ......... , ..-...,~,.. - .... * .,, . ~ ..... :.~. ~ + . .,:~ ~ : ...... : .. ~,~,~: , ~ ,,:~:'"'.. .~ /.,' :.;,,. ; .,.~ · : ; . . ,. . .~ .........,.. ~. .,, ~.-~..,.. . 4. SEWAGE DISPOSAL. : ,.-, · ' " ' ' ' ~. ?' o~site ~.~. Public ~ *~ ~community ~ · "'T~nk ~ .-' Holding · - ' ' ~ ; . attestmg to the legality and status. :.:~' ~,,,., ,-' ' ' ",:' ., , ' . - ,. *..~, *:' ,, 5,~' ENGINEERING FIRM PROVIDING INSPECTIONS,,TESTS, FILE S~RCH, DATA AND INFORMATION ";, "-" ~ce~ifiedbymys~alaffixedher~toandasoftheval'dationdat~shownbelow verif~lhatmy nvestigationofthisHealth:': ' : ~ ~ ~r tho number oI bedroom~ ~hd t~¢ o~ ~tructuro Indicated he~i~l luther ~eri[~ that b~d o~ th~'ln~ormation obtained :~;' [rom the Municipaflt~ o[ ~nchora~e file~ ~nd ~rom m~ Investigation ~nd In,poetion, tho on-,ito ' wa,tewator disposal ~stem i~ In complianco with ~fl Municipal 8nd gtato eode~, ordinances, ~nd re~ulalion~ in effect on th~ dato o[ thi~ In~peclion. . NameofFirm ~ ~~ Telephone qoT-- ,. . ~ ~ '~, . ~?,._~ , ..~,, ,:,,.,.~--~;'-.. ,~:,,~,, z,,...,~ ., ,., , '-'.:?. ..:r .,".' , ' '.:':- · ', ' Approved for ~ bedroom ~ ' Approved ~ Disapproved ' Conditional - ~ ~erms of Co~dillofl~l Approval, The Muncipality of Anchorage Depa~ment of Health and Environmental Protection (DHEP) i~ues Health Authority Approval ce~ificates based solely upon the representations given In paragraph 5 above by an independent professional erie near rag stared n the State of Alaska. The DHEP does this as a cou~esy to purchasers of homes and~their lending , .- .'- nstatutlons In order to satlsfy~e~mq federal and s~te requlre~ents.'Employe~s o[ ~,EP do ~t~ond~t [~spectl~nq or., ~.,~ ,~.-, ,. - :-. ~;' analyze data before a ce~flcate is issued..The Mumcipnhty of Anchorage is not responsible for errom or om~ss~ons m the .,......., OT£CTION JLa!. 0 lg86 , EL, .¢EiVED--- . Well Classification ~'~ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 : Legal Description: ~, or" If~) B, C, D.E:C. Approved (Y/N) Y Well Log Present (Y/N) Total Depth Static Water Level Casing Heigl~t Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line CleanouVManhole. Water Sample Collected by · Water Sample Test Results Comments ._.C,0~_ A.b. Cased to Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Air-tight Caps (Y/N) 7 Date Installed Standpipes (WN) ~/ ' Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) · N Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ~ r To Water Main/Service Line Course .__...~_~M _&Z~,~_~,..,~ Comments Size ~ No. of Compartments ~ Foundation Cleanout (Y/N) ,Y' ~ Dat6 Last Pumped ~,./~0/~ (_~ ~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation ~ ;~ To Disposal Field I.~ · TO Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11,84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /9 ?R Width of Field ,.-~ Square Feet of Absorption Area Depression over Field (Y/N) Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test .'~. ~.~.~ r., Separation Distance from Absorption Field: To Water-Supply Well '~O~ ~ TO Building Foundation ~' ~' Lot ~lOki ~ TO Water Main/Service Line ~ ~ ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway. Parking Area, or Vehicle Storage Area Comments To Property Line ..~ / To Existing or Abandoned System on ; On Adjoining Lots /00' To Cutbank (if present) ,,Vo?- D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Levet at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request *° I certify that I have checked, verified, or conformed to aTI MO.~ ar~l HAA guidelines in effect on the date of this inspection. signed -Oate yzl Company~'~f '"' '~ ~&A,(.,,- MOA No. Receipt No. ~ Date of Payment ~,,_~,~ Amount: $ Page 2 of 2 72-026(11,84) Engineer's Seal INVOICE N. 014989 ",~'~ ~ '7~v.~.~ CLEANING SERVICE P.O. BOX 112688 PHONE 345-2513 ANCHORAGE, ALASKA 99511-2688 ROTO,R ROOTER SERVICE CALL HRS ' (~ STEAM THAWING HRS ('~ HRS (~ TRIP CHARGE OVERTIME CHARGE HRS (~ ADDITIONAL LABOR CHARGE HRS (~ PUM.,NG SERV,CE/~ ~(GALI HRS ¢. HYDRO-JET SERVICE HRS (g~ MATERIALS PLEASE PAY FRGM THIS INVOICE TOTA CUSTOMEROflDERe TOTAL FOOTAGE CLEANED OR THAWED BLADES USED PROBABLE CAUSE OF LINE CLEANED WORK ACCEPTED RNCHORRGE 401 ERST FIREWEED LRNE RNCHORRGE. RLRSKR 99503-2197 (907) 276-3770 DRTnFnX NO. (~07) 279-5092 · JUNEAU · BETHEL · FFIIRBANKS July 3, 1986 Ms. Check 12940 Von Scheben Drive Anchorage, Alaska 99516 Subject: Health Authority Approval Lot 5, Block 2 Greenbrook Subdivision Job No. 6-42.07 Dear Ms. Check: Attached are the completed forms necessary to obtain }Iealth Authority Approval on your septic system. Total cost of our services is $300.00. Please submit this amount when pickup up the forms. Sincerely yours, Michael E. Anderson, P.E. MEA/jb Attachments