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GREENBROOK BLK 1 LT 4
Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181141 PID Number: 017-023-54 Dwelling: 0 Single Family(SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New D Upgrade Name: ABSORPTION FIELD Donald & Daneen Barba Address ❑ Deep Trench ❑■ Shallow Trench ❑ Bed ❑ Mound 13001 Von Scheben Dr. Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 830-0073 4 1.2 GPD/SF 5.8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 3.8 Ft.2.0 Ft. Greenbrook 1 4 Fill added above original grade Gravel length Township Range Section 0.2 Ft. 20.0 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 5.0 Ft. Ft. To Septic AbsorptionHolding Sewer Total absorption area Number of trenches Dist.between trenches Tank Field Lift Station Tank Line From 170 Ft2 1 Ft. Well >100' >100' N/A N/A >25, TANK 0 Septic O S.T.E.P. 0 Holding 0 Other Manufacturer Capacity Surface Water >100' >100' N/A N/A Orenco/FAP 1500 Gal. Material Number of compartments Lot Line >5' >10' N/A N/ANA Fiberglass 2 Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Orenco 1500 Gal. Pump on level at Pump off level at High water alarm at Remarks 25 in. 13 in. 11 in. Pump make and model Electrical Inspections performed by PF2005 MOA PIPE MATERIAL House to tank ABS Tank to D3034 Installer drainfield Guaranteed Services Drainfield D3034 CO/MT D3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection 13' 7/19/18 2nd 7/20/18 Location and description dates: 3'd 7/20/18 4d' Bottom of siding on South wall. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp CF�4�,q`k Conditional Approval: Date �igNV. ''• `'it4,f9,� *: •49TH i\ • * 0,• • Benja• chiller 4-f..... CE 12592 �� 04�d} 7/23/1 8 ••c. Approve - v,.., I ' Date 7 Jg !�l\\ROFEs``�1, Inspection Report_9-1-12.doc GREENBROOK, BLOCK 1 , LOT 4 - 13001 VON SCHEBEN DRIVE PERMIT # 0SP181141 PID # 017-023-54 LOT 4 (Ili EXISTING SEPTIC Q ABANDONED IN PLACE 10'UTILITY EASEMENT \ SHED v TH#1 4-BDRM HOME • • • 0 / •.. ... ALTERNATE SITE .i--7,7‘;-.--: co+' 0• • FCO TH#2 • s% jMHS . u, • WATER SERVI E LINE I ..,...__ s% acofli A B (LOCATION APPROX) :/'- it. • s% • FCO 11.6 19.8 L — _ J• MH1 15.0 22.6 • TH#3 s�•• I MH2 23.4 29.6 2C0 20.4 31.0 20'LONG x 5'WIDE X C01 21.8 52.1 2'EFFECTIVE DEPTH 1,500 GALLON ADVANTEX MT 29.8 55.4 ABSORPTION TRENCH TREATMENT TANK w/AX20 CO2 31.7 57.2 FILTER POD _4.--;-�4 \k1 NOTE: LEGEND i�Q' 5�10, NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE PROPOSED SEPTIC SYSTEM CO-CLEANOUT A00).• '9 T 2C0-DOUBLE CLEANOUT *;49 7H , '*TA ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN.NO CONFLICTS WITH FCO-FOUNDATION CLEANOUT / ��••• 1� • :•• / WELLS OR SEPTIC SYSTEMS. MH-MANHOLE 0 ...�... ... / MT-MONITORING TUBE ,rl��^•• E t2592'I�r '���i/ 0 50 100 SV-SEPTIC VENT fa G .• N 1259 .•' i mi .. MI I♦ FEET ,it\�PPOFESSI4��+ .....9.E... 1•.50' TH-TEST HOLE GREENBROOK B1 L4 PERMIT # OSP181141 PID # 017-023-54 O N 0 0 I i 0 LL N x____ 99.4 _ _ ry 96.3 95.2 /li1500 GAL SEPTIC TANK V `------1 90.6 97.6 FINISH GRADE 0� 97.4 ORIGINAL GRADE o "3. :, 'sy ;rr+••x.� ,`!• -} �z:�` �'k�� � ...�.-_ aF'3t�;'',3,l`G ,d3y"'� 7�'"' �e�'';� rY�•��.'�?C e�w�; 93.6 — ' ;- 3 %•y.� :,E Fd ,;•:w�', ',x ,,,• � r Ri: i {?z�3',r� za.,, 93.6 Xt�• y;3ir ' e,...?.fia c7..11Kt�:.w..Y'DT.� t WIl...��, ••.t.;a:•.c.�..t.:•. �,j ` 91.6 91.6 I 20' 84.4 co NO GROUNDWATER 7/20/18 4t I F- OF A< \l i*:49TM 1' •* // PROFILE AS-BUILT /% �.' CE1 •`l�` •� ' ill Of1�`�`%r•,•��,Hp592 18 . �`.�� GE (NO SCALE) (k\�F' P•ROFESSIO "-. - 4 -,�O 4L k � MUNICIPALITY OF ANCHORAGE ,.. DEVELOPMENT SERVICES DEPARTMENT 'et)); �\ '9*++ 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 .. .•�/ SOILS LOG AND PERCOLATION TEST Benja•.• hiller . j ,�#04 . CE 12592 •. / GREENBROOK, BLOCK I, LOT 4 �,k'rlcc�...Jul 24.2018• ` i LEGAL DESCRIPTION: l‘ipROFESSI�W� PERFORMED FOR: DONALD BARBA \ANN\��' DATE: 7-20-18 PROJECT No.: Professional Engineers Stamp: PARCEL ID#: 17-023-54 TECHNICIAN: J. MILLETTE DEPTH TEST HOLE 3 (feet) 1 1' OB SLOPE SITE PLAN y:: 5 Y i...•+;,'�;! SEE SITE PLAN i'.•.e•';! 6 -.''�''' ' SAND W/SOME SILT 7 SP _.:;1 -,.:Ii,-,4....:•...W, 8 —°•'-•;:::f-.-' • 10 . •+r"' WAS GROUND WATER ENCOUNTERED'? NO "•:•:''<•^•;�• IF YES n WHAT DEPTH? - I I DEPTFI OF WATER AFTER MONITORING: _ �•'�''1',� DATE OF MONITORING: 12 c.“•'`.,.‘,._:, }=:==": DATE READING GROSS TIME NET TIME WATER NET DROP 13 (MINUTES) (MINUTES) (INCHES) (INCHES) 14 7-20-18 TEST HOLE PRESOAKED PRIOR TO TESTING: 15— 1 3:45/3:55 10 516/1116 5;6 16 2 3:56/4:06 10 516/ 1116 5,6 3 4:07/4:17 10 516/11 516 17 4 4:18/4:28 10 516/ 11 516 18 5 4:29/4:39 10 516/11 5* 19 6 4:40/4:50 10 516/ 11 516 20 - PERCOLATION RATE: 1.8 (MIN/INCH) PERC.HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 3 FT. and 4 FT. COMMENTS: PERCOLATION TEST ONLY. GROUNDWATER WAS NOT MONITORED. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program P0Box 1966o 470OElmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 Permit Number: OSP181141 Work Type: Septic Upgrade Tax Code Number: 01702354000 Site Legal Address: GREENBROOKBLK 1LT 4 G:2839 Site Mailing Address: 13001 VON SCHEBEN DR, Anchorage Owner BARBA DONALD & DANEEN E Design Engineer: FORGE ENGINEERING � This permit is for the construction of: Expiration Date: Lot Size in Scl Ft: Total Bedrooms: 6/15/2018 6/15/2019 2 Disposal Field 2 Septic Tank El Holding Tank [] Privy 171 Private '~ Well [l Water Storage All construction shall beinaccordance with: 1. The attached approved design. 3. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska VVeetavvoter Disposal Regulations (1 8AAC72) and Drinking Water Regulations (1 8AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 16.O5.Provide notification bycalling (QO7)343'79O4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Re_t4'se TS, p�~U Dr_� ` ���` m�i ^ �� \oV`. \ � \ ) C 1�'`L \^o\e ` 5 4-o o'm- Or\ �cf\cul. 2\S\�ne.y\ l `�-l����eJ � u . `'' 2 C�[\ � Cr -�~ �o*S\ v.ov\, Ck�� (�.�^o«^�� �e6Lk\4�. ^`/ ^/\��Q +`(}/� 4' - ^ ` � L -0 [ ` �� � _r� L�, [DVv� o� \o���L`�DM ��P0�\~_ t,L S//�]mA`f4+/� 0y` . .. xzr- \ Received By: Date: Issued By: Date: MUNICIPALITY OF AN - * RAGE . .(')O-C2.41101111141L.3'3 ti ' '1 Community Development Department/ ' •ne: 907-343-7904 Development Services Division a 3'JN 1 6 ." 3 ax: 907-343-7997 On-Site Water & Wastewater Program ti ON-SITE SEWER/WELL PERM '`A '�� .1'0 6 e Parcel I.D. 017-023-54 Property owner(s) Donald & Daneen Barba Day phone 830-0073 Mailing address 13001 Von Scheben Drive Anchorage, AK 99516 Site address Same Legal description (Sub'd.. Block & Lot) Greenbrook, Block 1, Lot 4 Legal description (Township, Range & Section) Lot Size 45,037 Sq. Ft. Number of Bedrooms 4 (Four) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) IX! (w/wo ADU) Septic Tank X Upgrade Ix] Duplex (D) Holding Tank Renewal I 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 property owner or authorized agent) Permit/Rush Fees: (P61 Waiver Fees: Date of Payment: (p —(3- Date of Payment: Receipt Number: o-15 Receipt Number: Permit No. CjQ1O Lit Waiver No. Permit App_:- I_ ,) GE ' ENGINEERING PO BOX 240773 ANCHORAGE,AK 99524 522-7773 677-7766(FAX) June 13,2018 Municipality of Anchorage Development Services Dept-On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage,AK 99507 Subject: Greenbrook,Block 1,Lot 4— 13001 Von Scheben Drive Septic System Reconstruction and Permit Application Dear On-Site Services Engineer: The septic system on the above lot has failed. We are submitting this permit application for the construction of a new septic tank and absorption field. The existing tank will be decommissioned in accordance with Municipal Code. The attached site plan identifies the location of the home, well, existing septic location and the proposed septic tank location and absorption system. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The subdivision is served by a community water system. The ground surface on the lot is flat in the area proposed for the absorption system with a slight slope to the west. There are no slopes greater than 25% within 50 feet downslope of the primary absorption site. Drainage arrows are shown on the site plan showing the grade and direction of flow. Storm water drainage will not impact this septic system. The new bed will be constructed parallel to the slope as much as possible. It will be a minimum of 100' from all wells and surface water, and more than 5' from the septic tank. The existing absorption trench will be abandoned in place. The water service line is located west of the house and more than 10' from the proposed septic system. Please refer to the attached test hole log and septic design. If this design is followed,there will be no adverse impacts to adjacent properties. Sincerely, (24- PSEOF A........�q � CO . .•..I Michael E. Anderson, P.E. ,;*: 4911.1 / '7 A AttachmentsMICHAEL E. ANDERSON I;:i•• CE-438] ; ; ; SS`; 11, •-+ LU Z 1 JF O Y F- U F in = W w v C-) OZ m ~ w a Q z O U W O U` 1- LU cn z F m Z CO x � UWW '' O � pJ OCO OO�w 2 J WUwOC:j O ZD p Z Z0 U= O w -- C) LL Q O w w w a w_ U3 U W U , .�� co I— Q w -i Ct) cnz U U Q O �� .W_I O N w LL :2i :2i Cl) H �IOUw 00 z nzo o¢ LU En c') w0 x N Cn 1` U r w H a w J U o Q3 U) z '^ F- oz O V J Q Z Z F U o Z W °wa w z O _ 0 0 F- O W n J m _ } I- LL. O (n J O � F - w _ Q w Q F- LL - a_ >- o F- ED LLJ� M �LU I �l O O �i I—w z = OO 0 LO LLo o O W oh - lit U)m w Q O J Z W 1 °, O F o X a 1 F Lei Li z z F< o oc)w 1Ni x�c=i ?D CO OJ U L W d ¢uWiai �� SwF- ¢ o zuj � z LO 1 r = xF-00 U Z Z w M I F- ""a = o U) W n w �WO U) / I O N- U c U _ a N Q] i p — 0 a N za w= O _ a w U) p F= 0 LU O ry N�_ F mLLI� 8 yps Z Z Q o o Q� Z 1Vp� \ J QLi U � A > w LL Of �n (1)W Z ��L. N ••�yJ���+l J0CU � ' U t�� 600 GPD PEAK FLOW 5' WIDE TRENCH SYSTEM PERK RATE: 8.15 MIN/IN 1500 -GAL ADVANTEX FAP TANK APPLICATION RATE: 5.0 GPD/SF W/AX-20 FILTER POD 6 600 GPD / GPD/SF / 5' WIDE - 0.7 (RED. FACTOR) = 16.8 LF TRENCH REQUIRED (20 LF SPECIFIED) BOTTOM OF TRENCH: 6' BELOW GRADE FLOW LINE ELEVATION: 4' BELOW GRADE TOP OF TRENCH: .5'ABOVE GRADE RFORATED PVC (HOLES DOWN) kINFIELD ROCK f nGiw€lk ING TYPICAL WIDE TRENCH SECTION (NO SCALE) DOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE SOF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY MUNICIPALITY OF ANCHORAGE ��G rip A1-.1, DEVELOPMENT SERVICES DEPARTMENT �'�kP••••• �4 • :F9,1 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 A*•••49TH I\ %*�� SOILS LOG AND PERCOLATION TES .-.J.4),, T .• Pi TA . Michael E.Anderson ri LEGAL DESCRIPTION: GREENBROOK, BLOCK I, LOT 4 1` F�PROfESS10��`\'� PERFORMED FOR: DONALD BARBA `\\����1'` Professional Engineers Stamp: DATE: 6-7-18 PROJECT No.: PARCEL ID#: 17-023-54 TECHNICIAN: J. MILLETTE DEPTH TEST HOLE 1 (feet) 1 1 �- 1' OB SLOPE SITE PLAN ••'•'i•yi L:.•w 3 >4;'= s; • : SILTY GRAVEL 5 •; !; �%;;} SEE SITE PLAN '. . .r 6 —, I `4 8 —.',..4":: .-. -.,.'.'': CLEAN SAND 9 %::,.-, SP ::;."•;!=.?:" ;• 10 •t•'•�•1,• :• WAS GROUND WATER ENCOUNTERED? YES ?!:::• ".....;:'• ' ,^• IF YES «.WI IAT DEPTII? 13' DEPTH OF WATER AFTER MONITORING: 6-14-18 ii.::A. DATE OF MONITORING: 11' 4.+:a=ii s . <1 Min./Inch }'=~ ' DATE READING GROSS TIME NET TIME WATER NET DROP 13 : i (MINUTES) (MINUTES) (INCHES) .,..- .;.: (INCHES) ' v 14 `"t�'•`.:. 2/21 TEST HOLE PRESOAKED PRIOR TO TESTING: 15 1 6:26 28-4/16 16 2 6:56 30 31-11/16 3-7/16 3 6:58 28-4/16 17 4 7:28 30 32 3-12/16 18 5 7:30 28-4/160 19 6 8:00 30 31-15/16 3-11/16 20 PERCOLATION RATE:8.15 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 3 FT. and 4 FT. COMMENTS: MUNICIPALITY OF ANCHORAGE �'.G 9 1419li� DEVELOPMENT SERVICES DEPARTMENT — 71•I �\ -1,I/ 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 0... 9T C ZaA SOILS LOG AND PERCOLATION TEST / : Michael E.Anderson . / 1 f k,-,-4-0 ���TA� 41 -1� ,. �� LEGAL DESCRIPTION: G REENBROOK, BLOCK I, LOT 4 k>t F0:***SSIONP� PERFORMED FOR: DONALD BARBA `\�������~ Professional Engineers Stamp: DATE: 6-7-18 PROJECT No.: PARCEL ID#: 17-023-54 TECHNICIAN: J. MILLETTE DEPT!' TEST HOLE 2 (feet) 1' OB SLOPE SITE PLAN 1 ,,::,..-.;;:,:••::-; 2 _„,,-.::‘...:?;:?;;:::.1,:.;:t 3 � ..i.'`� SILTY GRAVEL ..i?.i:i`. '� "`• GM °,.t4 r:,.tr/is:-Iif +'fi f::;:+ 5 ' SEE SITE PLAN fi 6 —•j al t 7 8 'I. .. r:._ ' :::; CLEAN SAND 3. 1 0 •i .•,.?•1:-. WAS GROUND WATER ENCOUNTERED? YES .!::::,a4.:.:,;;. :":.; IF YES a WHAT DEPTH? 13' ` DEPTH OF WATER AFTER MONITORING: 6-IL.-18 1 I c;•!.,;:r•;,"xR::I. DATE OF MONITORING: I I' :i=l ^;y. <1 Min./Inch t.=' %j: °1 DEPTH TO }`=?•i .: DATE READING GROSS TIME NET TIME WATER NET DROP 13 :.;5: ;.::::...y.-...; (MINUTES) (MINUTES) (INCHES) (INCHES) 14 .'-'~''"f"` TEST HOLE PRESOAKED PRIOR TO TESTING: 15 16 17 18 19 20 PERCOLATION RATE: (MIN/INCH) PERC. HOLE DIA. (INCHES) TEST RUN BETWEEN: FT. and FT. COMMENTS: Soils encountered are identical to TH#1. No percolation test completed. L.LJ ,,,,,.. ___ ,___, a N 7s -4 gi 2a 41• VI' 246-94 C1-) Lo w 0 N ,n M z 0 ,-, '''': ) • !( �„ C ti LLI cz- e e 00 C L CD ' I T e e .Z. ~ I Z N > , f o V I w N0 O _...W_i__—__ .J } b el Ns1 11. 66- w294.06 AS=BUILT SURVEY 1'° : 30? NO CORNERS SET THIS DATE •='''z''' ' oOF•04 A4� I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY �,,\� OF.q.....4 OF THE FOLLOWING DESCRIBED PROPERTY ,fgt.;?-../ �11� ''••��O LOT 4, BLOCK 1, GREENBROOK SUB. 49 w P\ (/ ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE Atti_ At /,� G VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN D o • /� `Q THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS DO SHANE A.HOLT .' �O CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS EXIST OTHER THAN NOTED. `°-0o P LS 6914 O� NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. DATED AT ANCHORAGE ALASKA THIS 3 RD DAY OF 9 1O EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN �p4a d p HEREON ( UNLESS INDICATED) MAY , 2018 Qp�e1essioOA�6o NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE �-"s- M Soo PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAPD SURVEYING ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW APD/OR ICE. 9309 GROVER DRIVE ANCHORAGE,AK 99507 13887, FB 188-14 345-5513 LEGAL DE,~CRIPTION LOCATION DISTANCE TO: Manufacturer Liq. caf DISTANCE TO: MUNICIPALITY OF ANCHORAGE '~. / DEPARTMENT OF HEALTH & ENVIRONMENTAl PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT / W ~ Width ' IF HOMEMADE: Inside length Well Dwelling No.DloSf iTinA~CE TO: Length of¢¥in~ Top of tile to finish grade ,y, Length Wid[ Crib diameter Well Material Foundation.,~--f~ Nearest IotT~ ¢,.2~.~ Total len~;l~ li~es Material ~eneath tile Depth Crib depth Type of crib Building foundation Trench v~l~'~)~ inches inches NO, OF BEDROOMS PER 7 7 No. of compartments Liquid'depth PERMIT NO. Liquid capacity in gallons PERMIT NO~?fl~d Distance b e~7~s Total e~.f~cd ve.abs o r ptio n&r e~ PERMIT NO, Total effective absorption area Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorpt on area(s) OTHER PIPE M~ EFJ IA.LS_~__ SOl L TEST RATI N G_,_~._ /?,5 NSTALL . / / // R EMAR KS A~ DATE LEGAL 72-013 (F~.. 3/781 [:,EPFIRTMENT ii ,HEF!LTH FINE:, EN'¢!F.:ONMENTRL , ~,CI]"EC't"I.F. IN F:25 '"_."' '}]TREE']'.'., 17.':~it.~F.': GE., FIK. ,_,~,....,,_=., ~r: T E FIF'PL z L. HN l HRRR ~ SON CONST C:O ............... LOCRT Z ON t ERR[ L4E:'I ISREENBRIqf'IK LOT SIZE 48511a SQM~FFT THE ~'E;' IF'ED SI2E OF TPE SOIL RE~SORF'TIC¢-~ S"r'STEM iS: / - ]'FIE LENGTN DII'dENSION IS THE LE:NGTH (IN FEET) OF THE 'TRENCH OR DRRINFIEL[:,. THE [:,EPTH OF R TRENCH OR PIT IS THE DISTFINC:E E:ETI.,iEEN THE SURFRCE OF'.' ]'HE GROUND FIND TNE BOTTOM OF THE E,',::CFI',,,'RTION (IN FEET). THE GRR',,,'EL [:,EPTH IS THE MINIMUM [:,EPTH OF GRRVEL BE'THEEN THE OUTFF:!LL PIPE RN[:, THE BOTTOM OF THE EXC:Ft',..,'RTION <IN FEET>. PERMIT RPPLIC:RNT HFIS THE RESPONSIBILITY 'TO INFORM THIS DEPRRTMENT DURING THE INSTF~LL. RTION IN'.SF'ECTIONS OF FtN'T' HELLS R[:,JRCENT TO THIS PROPEF.:T'¢ RND 'I"HEEi NUME~ER OF' RESIDENCES THF~T ]'HE HELL HILL SERVE. BFfCKFILLING OF" FtN'¢ S'?":;]"EM HITHOUT FINIAL INSPEE:'f.'ION FIND FIPPF:'.O',,,'FtL B'¢ 'THIS DEF'FIR'I'MENT I,.I ILL E:E SUE:.J'ECT "1"0 PROSECUT I ON. MINIMUM DISTRNCE 8ETHEEN FI. HELL AND FtN'¢ ON-SITE SE!.,.IRGE DISPOSRL S'?'STEM IS -tl2t~3 FEET FOR R PRI'¢RTE I.,.IEL. L OR :!1.58 TO 20t:~1 FEET FROM Fl PUBLIC HELL. DEPENDING LIPON THE T'.~'F'E OF F'UBLIC HELL. MINIMU.f'I [:,ISTRN£:E FROM R PRI',,,'RTE I.,.IELL'~TO Fi. PRI',,,'RTE SEI.qER L. INE IS 25 FEET RND TO Fl. COMMLIN!T'¢ SEi,.IER LINE IS 75 FEET. OTHER REQUIREMENTS MFI'¢ RPPL'¢. SPEC:IFICRTtONS FIN_F:, CONSTRUC:TION DI.FtGRRMS FIRE W,,,'RILRE:LE TO INSURE PROPER INSTRLL. FFTION. I CERTIF'.r' TNRT ±: I 8['1 FFIM!LIRR 1.4ITH THE REQUIREMENTS FOR ON-SITE SEI4ERS RND HELLS RS SEiT FORTN B'¢ THE MUNIC:IF'BLIT'¢ OF RNCHORRGE. 2: I WILL INSTRLL. TNE S'T'SI"EM IN RCCOR['.,RNCE HITH 'THE CODE'_--;. 3:: ! UNDr..F. RSTRND TI-iRT 'THE ON-SITE SE.WER S'¢STEM MFt'T' RE;;!UIRE ENL.A. RGEMENT IF' THE RESIDENCE IS REMODELE[:, TO INCLU-E:,E MORE THFIN 4 BEDROOMS. s · - - .................... ISSUE[:' B'¢. ........ [:,RTE ..... '¢4. IZ:I '- . 4040 "B" ~t~eet 'Anchorage, A~a~a 99503 W.O. " Second and Fourth Anchorage Li~ited p~rtnership 46~ %%usiness Park Blvd.. - . . Anchorage, .Alaska 99503 Attention: Mr. Les Pace Subsurface investigation ~or suitability of On-Site Sewage DiSposal, Lot 4, Block 1~ Lot 2~ Block 2; Lot 3, Block 2; Lot 8~ Block 2~ Lot 9~ Block 2; Lot ~0, Block 2; Lot ~7, Block 2~ Lot t9,. Block 2; Lot 26, Block 2~ Lot 3, Block 4; Lot ~t Block 4~ Lot B, Block 4; Lot ~2, Block 4; Lot 13, Block 4~ Lot ~4~ Block 4~ Greenbrook Subdivision' Dear Mr. Pace: -. During March and April of '~981~. we ~rilled a 15 foot boring on each of the above lots and placed a perforated, 3/4 inch PVC pipe -~ ~-~ monitored over a -in each hole so that ~-he water table couia m= - perioc~, of time and. a ~ercolatiOn test run in the hole. The holes were drilled using a Nodwell.mounted, Mobile B50 drill rig owne~ and operated by Denali Drilling, Inc. The drilling was supervised and. the test holes logged by Mr~ Ted Krupka, s~nior technician, an(~ b~r~ O~M. ~atch, geologist with Alaska Testlab. After the holes were dril. led~ our technician returned on several occasi~n~ and checke~ the water level in each of the test holes. After a perio~ of time the holes were saturated, left to stand overnight, saturate~'-again and a percolation test run~ The percolation .test %.~as ~un by monitoring the' drop in the wa'ter table elevation at 10 minute intervals for a minimum of one hour. The percolation rate listed in this report was computed using the s'lo%~est 20 minutes of that percolation test. Incluctecl with ~:his r~port is a test l~ole location sketch for each lot, anc:~ a lo(3 o~i the b6ri'ng placed: on each lot. ~'he results of this exploration ar~ describecl as follows: water table e~evation measureO in the test hole at this site remaine~ fairly constant at about ~2 feet. p~,~ percolation rate mea~Dlred on April ~5 %~as 6,0 ~inute~/inch. Because of the need to keep- %:he sy~ten~ sh~llow .~nd the high silt content~ we.recol~en~ a more conservative design percolat~on rate of ~0.0 minutes/inch. D__e.~th in Feet: To 0.0 0.5 0.5 7.0 7.0 15.0 Table A WO ~A19708 Date: 3/14/81 Logged by: T. Krupka Soil Descri~ption Peat F-3, Brown ~i.lt~ Sand~ SM, silt to ~0%,.moist F-2/F-3, Brown Si~h_~ Sand, SM, silt to 25%, saturated below Set 3/4" perforated PVC pipe to run perc test and to monitor water table elevation. aerc Rate = 6.0 minutes/inch. Recommended Design Perc Rate 10.0 minutes/inch Bottom of Test Hole: Free Water Level: 15o0 Feet 1.0 Foot 3/14/81 ~ 1210 Feet 3/18/81 - 1~.9 Feet 4/9/8~ ~ 12.5 Feet 4/14/81 ~ 12.0 Feet gas a 5 6 7,0 itostil' i. : li • ! ett409 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 Forge Engineering Phone (907) 522-7773 Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 7/23/18 OF&• q'kkt 7*.•4 9TH I *1 6. DSD SIGNATURE System #1 Approved for Lf bedrooms % �. Ben)ani9'Schiller er System#2 Approved for bedrooms �4 F 4• . 7/23/18 ••���t� Disapproved kk`VROFEss0.10' "' Conditional approval for bedrooms, with the following stipulations: <? " '( OF�illiCyG ON-SITE �t c WATER AND WASTEWATER oz PROGRAM &—.) 9,41f4%1 /7, c�.:r,\I\CC" fig, 0 By: �, Original Certificate Date: ^�b The Municipality 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 engineer's work. • 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheeti* .. c 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 B1 L4 Parcel ID: 017-023-54 A. WELL DATA Well type Community If A, B, or C provide PWSID# 210346 Well Log (Y/N) N/A Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. 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 colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material FAP / Fiber Glass Date installed 7/19/18 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping Pumper New Construction C. ABSORPTION FIELD DATA Date installed 7/20/1 8 Soil rating (g.p.d./ft2 or ft2/bdrm)1-2 System type 5 - Wide Length 20 ft. Width 5.0 ft. Gravel below pipe 2.0 ft. Total depth 6.0 ft. Eff. absorption area 170 ft2 Monitoring tube Y Depression over field N Date of adequacy test New Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed 7/19/18 Size in gallons 1500 Manhole/Access (Y/N) Y "Pump on" level at 25 in. "Pump off level at 13 in. High water alarm level at 1 1 in. Datum Top of pump cage Cycles tested Meets alarm&circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots >100' Absorption field on lot N/A On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout >100' Sewer/septic service line N/A Holding tank >75' Animal containment areas N/A Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: >10'Building foundation Property line >5 Absorption field >5 >10' >10' >100' Water main Water service line Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: >10' >10' Property line Building foundation >10' Water main 10 10' Water Service line >1 0 Surface water >100 Driveway, parking/vehicle storage > Curtain drain None NotedWells on adjacent lots >1 00' F. COMMENTS G. ENGINEER'S CERTIFICATION y�y.�`\L. '�°F Acgeyt I certify that I have determined through field inspections and se 411* •• review of Municipal records that the above systems are in j*•49 TM .i *y conformance with MOA COSA guidelines in effect on this date. / Ne —, i . . Engineer's Printed Name Benjamin Schiller, PE ...► .. .. ...... j Benja• chiller �_ te 7/23/18 9�c CE 12592 / Date g is6..• 7/23/18..:'�C�,� ,,klF�PROFESS\ ' ... COSA brown sheet 10-10-12.doc ,cJ _,, ,..., CI': ! d 78 24 41- .QS , 4 46.94 LI O N h • V L w T� S \ 5411 - 0 ` \ 44 �. Pati j .. J J 4'`'I 0 - �. p o'er J 0 6.1 Y LIQ S X vJ 4 I ; � vI W N 0 o I 1 0 q 0 .._—__ W • > OM.H. � ••OADVANTEX o POD '• 0i °M.H. !! 81 11. 56- 14 294.06 AS-BUILT SURVEY 1`" u 302 NO CORNERS SET THIS DATE Qo�-OF A� I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY � P�OF q�g4p OF THE FOLLOWING DESCRIBED PROPERTY . . TH %\ ��PO, LOT 4, BLOCK 1, GREENBROOK SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE 0 VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS �O�, SHANE A.HOLT ��Q CONFLICTS BETWEEN EXISTING STRUCTURES AN) PLATTED LOT LINES AND/OR EASEMENTS; AND IS EXIST OTHER THAN NOTED. QQ i. ' LS 6974 v 40 NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. DATED AT ANCHORAGE ALASKA THIS 22 HD DAY OF EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN 04°a .- .1A67 o HEREON ( UNLESS INDICATED) JULY , 2018 �QO�Ofessi°na‘�'a� NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE ODOO�ODo PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SURVEYING ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 GROVER DRIVE ANCHORAGE,AK 99507 13887. FB 188-14,189-36 345-5513 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the"AGREEMENT" made and entered into as of this 2..D Day of JU,.3 of 20 It . by and between _ 1?gP)1.1 , herein the"OWNER,"and the Municipality of Anchorage,herein the"MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as ADvAt.JTE)c. 'TtQ-i: `f rEt"i t located at(legal description) i3ZCt1K— P L.K- '1 CT 1i 67) . 2.55"1 2. Maintenance,Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs,and inspection costs. This includes an annual maintenance fee(typically$400 to $600). 0) Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drain field replacement. (rev.05/18/2018) Page 1 01'3 OWNER: I3ySs.- ..:JC-P (signature) Date: �© l Lt Cc �c�l t J ejE1 JAJ, lL /pI l V (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument`xas acknowledged before me this clay of �'l� V , 201b , byJmNwr (JYq in 7s¼iLIC W mri� N TARY P FOR My Commission expires: C6(.29(52(4 NOTARY PUBLIC JOHN L. HOWARD III STATE OF ALASKA MY COMMISSION EXPIRES May 29,2022 MUNICIPALITY: 1 r7 By: ' �1 / i / (signature) Date: / 2 3/13 Reeee4 (j,rra// (print name) Title: (rev. 05/18/2018) Page 3 of 3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # -((~ ~,.-~ - ("')¢::~ ,'~ ._~Z_~ HAA # ~ ~c~ / ('~ [ ~ GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Dayphone ¢~8-0oq~ ~ Lending agency ~ ¢~' ~ ,r-~- 0!, ~ ~ Day phone Mailing address ~, ~ ~' ~ ~/~ , /~'¢ ~'~¢'~r' Day phone Agent t~ 0~,¢ ~o ~' ~'~¢~ u.J'~'v~ / Address 2, NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. ~2-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and typeofstructureindicated herein, l furtherverifythat based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm¢ Phone Address [9 '~/~ /'~/'¢'¢" ~ Engineer's signature ~--~- ~ Date DHHS SIGNATURE ~' Approved for ~'~'~) Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~ ~'~' Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA/f21 Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LoT ~ ~V-.t ~H~,P_~o~ Parcel I.D. If A, B, or C, attach ADEC letter. Date completed Cased to Sanitary seal (Y/N) FROM WELL LoG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: B. SEPTIC/,%CLC;~;C TA~IK I~ATA 71 ~h'~'/~ Date installed z 8/ Cleanouts (Y/N) ~ ADEC water system number Driller Casing height Wires properly protected (Y/N) g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /'AL 3El~/I'LL'¥ hive5,0N MAy Collected by: Tank size /~6¢D Foundation cleanout (Y/N) ~' AT INSPECTION High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~,~ On adjacent lots To property line ~ .~O Absorption field Surface water/drainage Other bacteria g.p.m. 72-0~6 (Rev. 3/91) Front MOA 21 Foundation ~ D Water main/service line ~~ CONTINUED ON BACK PAGE Alarm tested (Y/N) Compartments Depression (Y/N) C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~ I Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating / 7~' System type \,¢,/i~ Gravel thickness .5 Total depth Cleanouts present (Y/N) ~ ~-~--~,~.t Date of adequacy test for ~/ bedrooms ~ If yes, give date SEPARA'I'ION DISTANCE FROM ABSORPTION FIELD TO: Welion lot__ 'fo building foundation On adjacent lots Surface water 1"-//,~, On adjacent lots hC//,A Property line G ~ -¢ To existing or abandoned system on lot Cutbank r'/,'/A Water main/service line Driveway, parking/vehicle storage area 0 Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guide!ir~e,s in effect on the date of this inspection. Signature Engineer's Name Date HAAFee$ / 7 (~ ~ Cfi Date of Payment ~,~/~'- ~'/' ", 72-026 (Rev. 3/91} Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 6NCHDR6GE, 6L6SK6 (~07} 24B-5095 LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: SEPTIC SYSTEM ADEQUACY TEST 13001 Van Scheben Joe Hodges S:i. ngle F'ami ly,, 4 Bedrooms []lass A Public Wa~er System 210:346 F:ROM MUNICIF'AL RECORDS: 4 Bedroom System TANK: Anchor'age T'ac~k. 1250 Gal. ]'wo Comparts. ABSORPTION SYSTEM: Trench ABSORF:'T'ZOIxt AREA: 700 Sq. I=t. SOIl_ F(A]" I NG: 175 I NSTAL..I_AT I ON DAT'E: Jul y 1981 DATE OF LAST PUMPING: Anch. Cess F'ool April 25~ 1991 DATE DF TEST: April 24~ 1991 TEST PROCEDURE: System. was inspected and measurecl. Tank was ~ound with 5 ~:eet c)~: c:over- and with a liquid level o.F 48 :inches. -I"rench mon:i, tor 'lube was 7.5 ~:ee't:. deep with 3:1. :i. nc:hes o~ water. 700 oallons o.F clean water was added tc, i:he t. rench while tl"le water levels in t. he tank and 'l:.he moni'L:or tube wer'e monit:ored. The water level in the tank did not change, while the level in the mor~itc)r" r"ose 4 :inches immediately, t]h(-:~,f] progress:i, wely 7 :i. nches. Duril")g the i'le).(t 30 minute~:~ the water ievel dropped 5 inches. A-[te)r 5 hours t:he wat:er level was back a'E 'El'le s'EartJ, nE~ poini::~ indic~t, ir~(.~] that al]. 700 gallons had been ai:)sorbed, TEST RESULT: 'T'h:i.s system meets the code requir'emerrEs o~: the Health and Social Services Depariiment o.F the Mun:i. cipaliiiy o.f Anchorage. NOTE "l"lae operat::i, onal 1 i~Ce o~ al. ]. sept:lc s'ysi:ems depends on t:he lclcal sol 1 corld:i, tier~s, groundwater levels t:hat may ~:lL~ctL~ate during the year~ and t:he water usaqle (:)'f the .~:am:i. ly be:i. ng ser'ved , .~/..>c~;.m. These cond:[tions are outside the cont:rol o.F the eva].uat:c)r" of '[:his sel]tqic systelll, ~ge cart t. herefor~, not: give any estimate o.F how long i:his system wil} function satis.Factory -For C:LIr'r'E'FV(:'. or -Ft.lI]ur'e }J \\ DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 April 29, 1991 WALTER J. HICKEL, GOVERNOR 563-6775 FOR: Mr. Tobben Spurkland PWSID -,-¢210346 Green Brook Subdivision My review of the records on file in this office reveals that the Green Brook Subdivision Class A Public Water System is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Keven K., Kleweno Lead Engineer MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORI~ APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner ~. P-/~ JJ~b~S°'~q Telephone: Home Mailing Address / "bOO / Business (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent '-7-'/~' Address "7 /'/Y Telephone (e) Mail the HAA to the followina address: or: Check here I-I, if hold for pick up. List contact person and day phone number below. .2. TYPE OF RESIDENCE Single-Family [] Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/86~ Front ENGINEERING FIRM PROVIDING ~NSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, t verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm '~iP~ &~ '~20'¥~/¢J Telephone Address ' ' ' ~v ~% ~ /,~/ Date ~ /// l~ Engineer's Seal DHHS APPROVAL Approved for /-'~.~z~ 0~-) bedrooms by Approved ,.._/"~. Disapproved Terms of Conditional Approval Conditional Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, Page 2 of 2 72-025 fRev 8/86} Back .,,c~C~8~IC.IPALITY OF ANCHORAGE (MOA) _,~/~.~f O~: ~'~'~ ~[Ol~-I AUTHORITY APPROVAL (HAA) 264-4744 Well Classification If A, B, C, D.E.C. Approved (Y/N) ~ Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height 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 Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments 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 Date Installed '7/5/ Standpipes (Y/N) Depression over Tank (Y/N) Size /~¢~:) No. of Compartments -'r ~(./o Air-tight Caps (Y/N) ~ Foundation Clear)out (Y/N) Y ~//'/--$I~/¢_..~ I~ Date Last Pumped ~'~ ~ Pumping/Maintenance Contract on File (Y/N) ~ ; for ~ Holding Tank High-Water Alarm (Y/N) ~ Temporary Holding Tank Permit (Y/N) ~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72~026 (Rev 8/86~ Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / Date Installed ~ U L'~/ Width of Field ,.~ Square Feet of Absorption Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ~k/~/N To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Date of Last Adequacy Test ~'//I / ,~ To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~' 5 To Cutbank (if present) D, LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level 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, verifie,~, or conformed to all~lOA~ and HAA guidelines in effect on the date of this inspection. Signed ~~/~¢'~// Date Company / MOA No. Receipt No. O Date of Payment ,~ ~ Amount: $ / ~ ~ ¢- ¢ ~ Engineer's Seal Page 2 of 2 72 026 fRev 8/861 ANCHORAGE. ALASKA 99501 ._ TELEPHONE: (907] 279-3916. . LOCATION: RESIDENCE: ~.~-~- -' ~ WELL: Class A Community System TEST Lot 4, Block 1, -Greenbrook Subdivision ~%-~ "~-: 13001 Van Scheben . ~.~-.. ..0 ~ George and A Harrison ~. ¢~'-~ ~ ...r. ~ ......... ~ ~J. . .. Single Family ~ ..~.~ ;'"~- ' DATE OF LAST PUMPING: ABSORPTION AREA: 700 sq. f~. INSTALLATION DATE: July 1981 March 12, 1988. Anchorage Cesspool '~,~;~.TEsT:'-P'ROCEDURE.i ~- ---~ System was inspected an~ measured. Tank was ~7,;~?~'~f..~'found.-~,-with five feet '0f' cover a~d a liquid depth of 41 inches. ~~'-~?~T~eh'~'~:.-'s~mp:. 'was found seven feet .deep and with a liquid level of ~-::~.:?~3.~_'i~:~s_,.: 55Q gallons of clean water was added to-the trench at ~/?'<~'-~::.a:'~S~'~ady rate of 7 gallons per minute While the water, levels in ~:?~-~;.~: .' the-'-tank and the 'trench were monitored. The water level in 'the ~-:~_~':~ ' ' ~'nk did not chan~e while the level in'the sump rose 11 inches ~"~3~.~_;3_-for the fi.rat 200 ~allons and 4 inches for the next 200. The ~'%~":~;'~-~- infiltration rate was monitored. Within 10 minutes the level in -_--- the sump dropped 3 inches. After two hours the level.· had dropped" ~.~-~' ~'~/ ~' 5 inches, ' i~dicating tnat~ more than 300 gallons had been _~_ _ ; TEST RESULT: ~" Th~s system m~ets the code requirements of ~---L--'~--~ ...... ; the Health and Social Services Department of the Municipality of ~_~----:_~??t~.~-,:..-local soil conditions, groundwater levels that may fluctuate ....~;~?~::~f-~f~_ ..... -during the.'year, and the water usage of the family being .served ~;;---_-~.~:~'~;~_:by..the system. These conditions are Outside the control of the ~;;"~-~/.-?:~:.;-;:eualuator 'of this septic system. We can therefore not ~iv~ ' any ---~r':- ' "' -.~_.--- _ estimate of how long this system will function satisfactory:,, for DEPT. OF ENVIR T ANCHORAGE/WESTERN DISTRICT OFFICE / 3601 "C" STREET. SUITE 1334 ANCHORAGE. ALASKA 99503 STEVE COWPER, GOVERNOR ~563-6775 DATE: 3-10-88 PWSID #: 210346 To Whom It May Concern: According to the records on file in this of{ice, the GREENBROOK SUBDIVISION Water System is in compliance with the State o~ Alaska Drinking Water Regulations. Sincerely, Ronald S. Klein Environmental Field O{tricer Alaska Mutual Sa ings Bank 5th & F STREET · P.O. BOX 1 ! 20 · ANCHORAGE, ALASKA 995 ~ 0 MEMO - LETTER TO ~ob Pratt Municipality of Anchorage ........ 825. L...Street Anchorage, Alaska 9~501 Dear Mr. Pratt, DATE .......... !2f!!f_79 . SUBJECT....~3 · .B% ,_. ~ree~b~pok .S~D ...... Health Approval Request Per phone conversation with you this date, enclosed is a request for a health approval from your office on the above legal description. This is a recently installed sewer system wJth a community weel. You have a f~nal inspection that indicates this is approved. You indicated no inspection fee was required to submit an approval to this bank. If any questJons, please call me at 274-3561. Cam you call and let me know when th~s will be ready so I can send someone over to p~ck it up? Thank you for your help. APPLI:,~.~NT FILLS OUT UPPER HA,'~_ ?ONLY Property Owner George Harrison Phone , SpA Box 373 R Anchorage Ak 99507 345-26r~ Mailing Address Zip Code Buyer Address Zip Code Lending Institution Secuirty National Phone Address Zip Code Phone Realty Co. & Agent Address Zip Code Legal Description Lot 4 Block 1 Gtmenbrook Street Locatic~ Type of Residence [~ Single Family [] Multiple Family No. of Bedrooms "~ [] Other Water Supply [] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975; {~ Community For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal 82 [~ Individual Year Individual Installed: [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: L.~t~ } APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDiTiONAL APPROVAL* DATE BY: _ Soils Rating Date ~wer Installed Weil To ~sorption Area Well Log Received Wetl to Tank Septic T~k Size 72.023 (3182)