The URL can be used to link to this page

Home My WebLink AboutGREENBROOK BLK 2 LT 6Greenbrook Block 2 Lot 6 #017-023-60 Municipality of Anchorage /Development Services Department Building Safety Division On -Site WaterProgram, and Wastewater P ram, 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 2 www.ci.enchorage.sk.us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWSWO50341 PID Number 017-023-60 Noe Wastewater System: ❑ New ® Upgrade Paul RiChartiSnin A0°"" Schehen SA5ABSORPTION FIELD in Rey. NurEe, of Bedroom o Deep Trench O share« Trrrh 17 Bed ❑ mo," O Doer Sod Rating Taal Depth ham &VOW pads. LEGAL DESCRIPTION Block. La &ea"aero Depth W proe Doran from agnil Wade Grovel depth bream pros ToavalupRW90 Baden Fr added Steve ogwl 7aaa Gravel Legh Ft Grovel vnah: Nu of "rice. Delrea belrnM tree Well: ❑ New ❑ Upgrade GWxrraien(Pmre.AB. Gk Class A TOW Depen: F, Caaadlo Tole abeorple,✓ea, F? Pros Material 3�l W Drew Dale DrNled' SW4Waler Level helaW Dole installed + Above a.la YWd Para Bel r. Cauq NrpC. M 06-45DS TANK Ft. GPM FI SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other. Septic Absorption Lift Holding ubiiUPrfvate Manulwt a Anchor, eTank c,oeaa 1000 Gr Tank Field Station Tank SewwLine Mrerei Novice, a Carputm0 S 200+ 200+ 100+ Steel 2 100+ 100+ LIFT STATION Sao Man/eduer RF*und~ 25+ 10+ Gel 'pWVor?WvMM 'Pump ce'lavelr Nqh wee, elarmM 7.9 6.1 WW Perp Make a wW Electrical Inepecovne Pwt-Od be, 50+ 50+ BENCH MARK Insulationover new tank 8 post tank lines. Local n and Deeupoon: Garage Slab Anuned Elevren. 100.0 FL Engineer's Stamp • OF �• .• .,,... �i Inspections performed by: PES, LLC Dates: 1"9/2112005 .• 4q TM �i .....r ... ............s.....0 2nd09121120050 00 Development Services epartment approval ..................... Steven R. Ponnonef / °PA Reviewed and approved by: Date: �� J '•. No. CE 8149 ♦ � � �� ••'•a,• (Rev IM) . .•`• ••♦ LSSt�� PERMIT NO:SW050341 RECORD DRAWING P.I.D. NO: 017-02360 WASTEWATER DISPOSAL SYSTEM LOT 6, BLOCK 2 GREENBROOK NEW 12508 REA SERVED BY COMMUNITY I SEPTIC TANK WATER SYSTE I ADD 4' R.I.OVER NO WELLS WITHING 200' TANK AND LINES OF NEW TANK EXISTING 3 I EXISTING 1250g BEDROOM HOUSE SEPTIC TANK EXISTING WATER CRUSHED AND SERVICE LINE I HAULED TO DUMP ' LOCATION A I OF SHOP T1 7.9' ASPyAULTDRIVEWAY EXISTING SAS NOTES: MT TO REMAIN �2 1) All work shall be performed in accordance with AMC15.65. 2 2) Materials used shall be in accordance with those specified In AMC15.65, Wastewater Disposal. 3) Maintain 10'separation to all lot lines and water lines, unless noted otherwise. 4) Lots served by community water 1 06, systems. No wells within 200' of proposed system. NEW 1250 g 4' RIGID 97'0 SEPTIC 6.6' INSULATION TANK , �� •(� �.....• ••. •♦♦♦ DESIGN CALCULATIONS: �P,,.••""• . 1♦ TANK REPLACEMENT ONLY ;•' ♦ BEDROOMS: 4 {3 ! TM i i}�1. MIN SIZE TANK.1250g , PREPARED FOR: PANNONE ENG. SVC, LLC ♦♦�°:Steven R. Pannone Paul Richardson P. 0. BOX 102954 ♦j:J%:,_ CEj4«<i 12900 Von Scheben Drive ANCHORAGE, ALASKA 99510 6��D1 l ,..•: Anchorage, AK 99516.3206 227-3522 P, 272-8218 Fax ♦♦♦ 1i�� DATE: 11-11-05 ,,, • SCALE: 1'=40' PLAN CO A B T1 19.2 17.5 T2 27.1 16.55 DC 41.7 23.9 MT 76.6 49.7 MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO50341 Legal Description: GREENBROOK BLK 2 LT 6 Design Engineer: 0062 Pannone Engineering Services Owner Name: PAUL RICHARDSON Owner Address: 12900 VON SCHEBEN DRIVE ANCHORAGE. AK 99516-3206 Date Issued: Sep 12, 2005 Expiration Date: Sep 12, 2006 Parcel ID: 017-023-60 Site Address: 012900 VON SCHEBEN DR Lot Size: 50043 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. - (EMERGENCY TANK REPLACEMENT) - SEPTIC TANK INSTALLATION MAYBE LOCATED NO LESS THAN FIVE FEET FROM ANY PROPERTY LINE OR BUILDING FOUNDATION; TEN FEET FROM ANY WATER SERVICE LINE; ONE HUNDRED FEET FROM ANY SURFACE WATER; AND ONE HUNDRED FEET FROM ANY PRIVATE WELL; AND THE SEPARATION DISTANCES REQUIRED BY 18AAC72 FROM WATER SUPPLY WELLS. -NO PART OF THE SEPTIC ABSORBTION FIELD OR THE SEPTIC TANK MAY BE UNDER THE DRIVEWAY. HOWEVER RIGID INSULATION NEEDS TO BE PLACED OVER LINES UNDER DRIVEWAY. Received Date: dSD Q/Z Issued Byf Date: I Municipality of Anchorage • Development Services Department Building Safety Division _ On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-023.60 Permit Number SW Property owner(s) Paul Richardson Day phone 2401022 Mailing address (1)12900 Von Scheben Drive Mailing address (2) Anchorage, AK Zip Code 99516 Legal description (Lot, Block & Sub'd.) _Lot 6, Block 2 Greenbrook Legal description (Section, Township & Range) Site Address: 12900 Von Scheben Drive Lot Size 50043 Acres q.Ft. THIS APPLICATION IS FOR: Number of Bedrooms 3 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Mupicipal CDdgs. . _ _ (Signature of property owner or authorized agent) Permit Fees: Waiver Fees: Date of Payment: Date of Payment: Receipt Number: 01 Receipt Number: (Rev. 12/00) PO Box 102954 (907) 272-8216 Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (907) 272-8218 (907) 272-8218 Fax September 12, 2005 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lots 6, Block 2 Greenbrook S/D EMERGENCY Septic Tank Replacement Permit Request Ladies and Gentlemen: 1 am writing to request that a permit to install a new septic tank be issued for this property. The system currently serves an existing four-bedroom house. The lot is currently developed and is served by a private water system. Tank Replacement. The original 1250 -gallon septic tank was installed in 1978. The tank was damaged during excavation for the new driveway. The top of the tank was ripped off.Currentiy the top is covered and the system is working. The lot is served by a community water system. See the attached site plan. A better drawing will be developed during the record drawing phase of this project. The existing drain field was inspected and found to be dry and operating properly. Surface Water: There is no surface water within 100 feet of the proposed system. Topography: The average topography in the area of the proposed septic system is approximately 1 percent. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 2273522 or 272-8218 Sincerely, Steven R. Pannone, P.E. Civil Engineer Attachments: C:\Work\Letters\6-2 Greenbrook.001.doc Ual"14003 UD.'ZU 2014a02p.* mus -c, 112100 SrlPT.G'YAAIL IkTike�N:rA/qz�L4u—g L'YlST'A SAS ` v R! I .AI/V. rw u[ Ro i It ' Tl M,♦ pe\l I0' Urn.. r.4. `•r.�. T• Ma' l�tiEMILr f ICL>Y i LOT &LOCK 2 - pp Sea,oyS b.F. aw, �� Date All work sl*l he di plot plan. Approves :f'211 not be Chop i•4(a'40Nlhou! Iket obtein inA• V Ct.. i .•.r y ZONE COVED ,Y COMMV,,pSy` W Jt-R�2_ . W STtz.•�i • � W�7C.i /Y�Zpp, SAS UBMI` 0rj Oci 1 ; 204 E IrIS 23.�-Crec) Ra4gEd,Q' VAN • �_ `» iCA�) 4o,I'([CL) DRi .: F A •.:°c VE a 71l�*IOC, l� ... .. ... ............OF �( •..•... •• • •.............•../ w. nf. .• V '. •1 SIEVEENN �;L PPAANNONEGL 4 4 ftu too G•+•7 (nr. I.ow • • • '� � •�. ar�,j`f.•.`: W•4�w��.l G't7 +NO J7Y wCC � �� (J\Un . II � b s. 1w � P�OFESS;^•da�' v , St3'TtL TA N tL i as shown on this T_ Imsand wp 15atln Apllvr.Alnl ymocild avail C!oranere:t a rand tRinge ordl! ! Foen A L Fat, A- e'll �� At�t, Jrc• ^ `niNt � uNa rl; p 1,370 n ,Y COMMV,,pSy` W Jt-R�2_ . W STtz.•�i • � W�7C.i /Y�Zpp, SAS UBMI` 0rj Oci 1 ; 204 E IrIS 23.�-Crec) Ra4gEd,Q' VAN • �_ `» iCA�) 4o,I'([CL) DRi .: F A •.:°c VE a 71l�*IOC, l� ... .. ... ............OF �( •..•... •• • •.............•../ w. nf. .• V '. •1 SIEVEENN �;L PPAANNONEGL 4 4 ftu too G•+•7 (nr. I.ow • • • '� � •�. ar�,j`f.•.`: W•4�w��.l G't7 +NO J7Y wCC � �� (J\Un . II � b s. 1w � P�OFESS;^•da�' v , HeE,, h and Environmental Prote` on .+ r• `� Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 ------------ INSPECTION REPORT ON -SITS: SEWAGE DISPOSAL SYSTEM NAME __is _-�1�-�---------- n,inlLlNc ADDRI-Ss-u=I)xn�5�Q+ �..Qimon,if-IoraE.3`a-4-�58e�, LOCATION _vot�__Sc �6 N__ _ ----_ LEGAL L>L SCRIP-1ION _---- SEPTIC TANK: C6MMUN(Tq �li'tUR... N'UiJ�SoER OF DISTANCE / Nom\ -� FROM WELL __- _ MAF,'UFACIURER__\_` _ .__._Mi\F1 RIAL_._. J�_+__I---._.--_--COfs1PHf2Ti:1EfJT5__ -_.- �,1 r INSIDE I_ENCdTfi_,V-.1____-_- INSIDE VJIUTI-i_-I __-- LIQUID DEPTf1 N�_. __ LICiUID CAPR.CH"Y �,_ GALLONS. TI[ -E DRAIN FIELD 11 k TOTAL LENGTH 1 DISTANCE FROM VAiLI_ __._._...._----FOUNOA]ION._r;�),_- .__NEAREST LOT LINE_1--_3C7-_-__.-OF LINE-- # Of Lines j ©tr-_ DIST AFICE L3ETVJE EN LIh1E-S � ____TRF 1`ICII W1 ifi6d- IN. TOTAL EFFECTIVE ABSOPPTION AREA _.- _- ..- -__.-- SO. FT. LENGTH OF EACH LINE------- Fi DEPTH OF FILTER U[PTtI: TOP OF TILE_ LO FIfdlSll G12ADE _.--._.-MAILRIAL f3ENEAIH TILE_____IN. A13OVE.TIL_[ ____ _._-_It`-l. SEEPAGE PIT: DIAMETER — -- OR WIDTH ___-, LENGLH_, DEPTH ____ _____-__--____-• Log Crib _Rings_ Crib Size: DIAiAETL.R____DEPrfi_—DISTANCE FRO. -M: WELL TOTAL EFFECTIVE BUILDING FOUNDATIOFl.. _ ... NEAREST LOT LINE -___-__ " AP. SORPTION AREA (WALT- AREA) -._SQ. FT. Well Qpmm�iJ�- �jl IC i I Class: Depth. I I I i j -Well Distance To: Lot bine ; i I N j i " i - � �. C D ii --- Bldg: Sewer Line: Pipe Materials - # of Bedrooms: ; Installer Remarks: �6l L5 2 lel I 4'21s; i I C;ATE_\ N �'J"_�(F� APPf2OVF. T�PE QF SOIL HBSORBTION SYSTEM IS: TRENCH MF�XIM||M NUMBER OF BEDROQMS SOIL RATING (SQ FT/BR)m2 125 THE REAUIRED SJZE OF THE SOIL HBSORPTIQN SYSTEM IS� DIMENSION 'IS THE LENGTH (IN FEET) OF TFIE TF?.EN(_1'H OR T 1-1 F OF A TREN04 OR PIT IS THE DISTANCE BE 'WEEN THE SURFRCJ:�' CIF THF GROUND AND THE BOTTOM OF' THE EXC.,AVATIJIN MA FT--_- T). THERE IS NU SET WIDTH FOR /RcnuncS THF- GRAVEL DEPTH IS' THE MINIMUM DEPTH OF GRA%.11-_ BF,.TWFF'N '!'HE OUTFAL.I... F,TF`E ANC, 'THE BOTTOM OF THE, E-`CAVATTCIN (IN FEFT''11. ~~_ F CA L.C.)WING CONDITIONS: z. EI/HER n CLASS I OR ^^ ."S. 2 H CUN�1NxnV� n��m/�w�m .`E"� '. .. QUIRED TO ENLHRGE THE SOIL AGREEMENT IS NOT KEPT CRE SORPTION SYSTEM SUBJECT TO PROSECUTI8N� HB Ax��__��~��~��_��~~�� K�J 1�� ~~---~ BF�CKFILLING OF ANY SYSIM-ILL INHL INSPECTION AND APPROVAL, BY THIS DEPFfRTMENT WILL BE SUBSECUTION. MINIMUM DISTHNCE BETWEEND HNY ON-SITE SEWHQE DISPOSHL SYSTEMi00 FEET FOR H PRIVHTE 0 FEET FOR H PWBLICWELLREQUIRENENTS MHY HPPLYSPECIFICATIONS HND CONSTRUCTION DIHQRHMS HRE HVHILHBLE TO INSURE PROPER IN' TFiLLHTION 1 7- If I " if lf.3 IEEE F -P. J_~ I CERTIFY THAT I HM -A11' 1- WITH THE R�QUIREMENTS FOR ON-SITE SEWERS AND WELLS HS SET FORIH BY THE MUNICIPALITY OF, HNCH8RH13'E. 2� WILL INSTHLL THE SYSTEM IN HCCQR[��CE WITH THE CODES` UNDERSTHND THA THE OP-4--SITE'.FEWERSY��TEM MAY REQUIRE _J'41 IF THE ORE THAN ] BEDROOMS RESIDENCE IS R�R SIGNED� * ~~ �� '�� r- ^ ^ ~ ,u DFPHRTMENT QF HEHLTH HND ENVIRQNMENTHL PROTECTION +J/l STREET/ ANCHORAGE, HK. 99501 264~4720 K�Ip_J U= ILIR F.E. ��F:E If -1 Awl u' PER|�IT NO ( 7710]5 ) HPPLICHNTLLES F1 |'OCKWQOD HOMES 1601 E DIMOND ]448588 iACHT7ON VON SCHEBEN ` SUB LOT SIZE 44450 SQUHRE FEET T�PE QF SOIL HBSORBTION SYSTEM IS: TRENCH MF�XIM||M NUMBER OF BEDROQMS SOIL RATING (SQ FT/BR)m2 125 THE REAUIRED SJZE OF THE SOIL HBSORPTIQN SYSTEM IS� DIMENSION 'IS THE LENGTH (IN FEET) OF TFIE TF?.EN(_1'H OR T 1-1 F OF A TREN04 OR PIT IS THE DISTANCE BE 'WEEN THE SURFRCJ:�' CIF THF GROUND AND THE BOTTOM OF' THE EXC.,AVATIJIN MA FT--_- T). THERE IS NU SET WIDTH FOR /RcnuncS THF- GRAVEL DEPTH IS' THE MINIMUM DEPTH OF GRA%.11-_ BF,.TWFF'N '!'HE OUTFAL.I... F,TF`E ANC, 'THE BOTTOM OF THE, E-`CAVATTCIN (IN FEFT''11. ~~_ F CA L.C.)WING CONDITIONS: z. EI/HER n CLASS I OR ^^ ."S. 2 H CUN�1NxnV� n��m/�w�m .`E"� '. .. QUIRED TO ENLHRGE THE SOIL AGREEMENT IS NOT KEPT CRE SORPTION SYSTEM SUBJECT TO PROSECUTI8N� HB Ax��__��~��~��_��~~�� K�J 1�� ~~---~ BF�CKFILLING OF ANY SYSIM-ILL INHL INSPECTION AND APPROVAL, BY THIS DEPFfRTMENT WILL BE SUBSECUTION. MINIMUM DISTHNCE BETWEEND HNY ON-SITE SEWHQE DISPOSHL SYSTEMi00 FEET FOR H PRIVHTE 0 FEET FOR H PWBLICWELLREQUIRENENTS MHY HPPLYSPECIFICATIONS HND CONSTRUCTION DIHQRHMS HRE HVHILHBLE TO INSURE PROPER IN' TFiLLHTION 1 7- If I " if lf.3 IEEE F -P. J_~ I CERTIFY THAT I HM -A11' 1- WITH THE R�QUIREMENTS FOR ON-SITE SEWERS AND WELLS HS SET FORIH BY THE MUNICIPALITY OF, HNCH8RH13'E. 2� WILL INSTHLL THE SYSTEM IN HCCQR[��CE WITH THE CODES` UNDERSTHND THA THE OP-4--SITE'.FEWERSY��TEM MAY REQUIRE _J'41 IF THE ORE THAN ] BEDROOMS RESIDENCE IS R�R SIGNED� in ('''� L70nitTuctlon 9F -.1t "Opts test is worth a thousand npinions" 2204 Cleveland Anchorage, Alaska 99503 CPerformed For Les Pace Date Per formed___V25 7-fi— _._. Lenal Oescrintion: Lot 5 Block 2 Subdivision Greenhrook This Form Renorts Soils Loo yes Percolation Test ____• nenth Feet Soil Characteristics 2 — Silt (ML) 4 Interlayered coarse Sands and 6 — Silts (SP -ML) 8— Coarse Sands and Gravels 10 —<--:: (SP -GP) 12 - 14 -a=. ------ Bottom of Test Hole 16 — C 18- 20— Was Ground Water Encountered? No IF Yes, At what Denth? I P a d i n q Date Gross Time Net Time Den.th to H2O flet Cron Percolation Rate ttinute Prnrosed Installation: Seenaae.Pit - Drain Field �. Oenth of Inlet Depth To Bottom Of Pit Or Trench_ rnm,'ENTS: 140 square feet drainage area required per bed ro, No �drock or ground water encountered. Test Performed By ,0 971 Data Certified By:_CONSTRTJCTION TES �- James D Mack Date: 8/25/76 _ L CVAI 10 uon:ibtucgcon �e�¢ -z-a "Ont t" is worth a thousand npinions" 2204 Cleveland Anchorage, Alaska 99503 Performed For Les Pace Date Performed 8/20/76 Lenal Oescrintion: Lot 6 Block 2 Subdivision Greenbrook This Form Renorts Soils Loq yes Percolation Test— Den th est_ Denth Feet Soil Characteristics OpSO1 4— Slightly Silty Sandy Gravels 6 — (GP+) n 10- 12 0-12 — 14 Bottom of Test Hole 16- 6- 18- 20— 1820— Was Was Ground !dater Encountered? No If Yes, At what Denth? No bedrock encountered.. Ieadinq Date Grnss Time Net Time Depth to H2O Net Dron Percolation Rate tlinute Prnposed Installation: Seenaae Pit Drain Field Depth of Inlet Depth To Bottom Of Pit Or Trench rnMWENTS: 125 square feet drainaaa__L.jLea__rei��._nPr hndrnmn. -qu Test Performed By -fG�o �__,�'��- Data Certified Ey: CONSTRUCTION TEL= 7� n M� , Date: -8/20/76- Sq Id v ^- Sq Id 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 1. D. # C,C) - r-)2 n - InC 1 2. 3. 4. GENERAL INFORMATION HAA# k)Q61 QL)Ir,'1G1 Complete legal description �- oT [,,LOC -r_ ?_ Location (site address or directions) `roti S714V r9Q\-,' '1)21Vtr d \ o� q— - t PC, Property owner 17 t), L C Day phone 2(2-3 Mailing address pOr &X M_Cubto6 Nti 99sk l- %(;3,) Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: 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 Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Fiev. 1/91) Front MOA #21 vE, 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 1—tLASV-A 2, Address t�>6x Engineer's signature 6. DHHS SIGNATURE Approved for r?c . bedrooms. Disapproved. Conditional approval for Additional Comments 0 Phone NQS-ozz Z_ —Date *?� �a aaMAaa.y L�v�e 0 � Oa Waw l9! .ice R. a n Ad', bedrooms, with the following stipulations: DateZ)4-y Ile 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 N21 Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L -or 65 Wk?_ Parcel I.D.`7`623—e O A. WELL DATA Well type Log present(Y/N)_ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ADEC water system number Post N P-161 G Date completed Cased to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Driller ing height Wires properly protected (Y/N) AT INSPECTION On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria e B. SEPTIC/HOLDING TANK DATA /-; 3 28 Date installed (` Tank size Compartments Cleanouts (Y/N) yes Found lation cleanout (Y/N) 7�� Depression (Y/N) NO High water alarm (Y/N) N` Alarm tested (Y/N) . N /A i Date of pumping- © Pumper NLOiNf, 43LPTIC SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: f Well(s) on lot N ) A On adjacent lots ii N 1A Foundation les To property line 6G 5 ,-Absorption field I Water main/service line 1-60 t Surface water/drainage I4CtJA Icu 4 tjS 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at Cycles tested Surface water _ z Date installed � ' g Soil rating RS Wi �fZ2 System type V F' I (Zo �h► e A v , Length �� Width .� n,o� (w(a�. Gravel thickness Total depth Total absorption area "'r /Zo� Cleanouts present (Y/N) rte Depression over field (Y/N) NC Date of adequacy test�____� Results (pass/fail) c r, for `' bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lotOn adjacent lots �' � ) r�-i I A Property line To building foundation 2 4�s To existing or abandoned system on lot l�C� 4 0 On adjacent lots ^� Cutbank ftJ � 1�4 Water main/service line Surface water Driveway, parking/vehicle storage area Curtain drain tV I R E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. r � ' 6 Signature r"11, Val ,, � fir, �G � � z Engineer's Name Jotl+v ` 4�ZL�ritiv ,av< dr; a 61 Date �0- HAA Fee $ /Z 6l) Date of Payment _�0_ s 2 -- Receipt Number - 7c.� r4q Faros to"� A/011 nac4 Mnn 91 Waiver Fee: $ Date of Payment Receipt Number ADEQUACY TEST FORM LOCATION Lat C 131-i'< A2 NO. of BEDROOMS: 3 DATE!, INSPECTOR : , P TANK SIZE : WORK ORDER: ?,2-16Q ZO TEST RESUL(S PASSED; FAILED; ... - rnnnnrl.At•..IY0 ADD IN IKIPLICQ CFPTIf NO. of BATHROOMS'. CALC. PEAK LOAD: CALC.PEAKTIME CALC. PEAK FLOW RATE ° rl.. .` n t e -K= MEAS. AVE. FLOW RATE 5bOG I0 ", f TANK I Inuln I FVEL=--- TIME METER READING CUMULATIVE VOLUME FLOW RATE RELATIVE SEPTIC TANK LIOUIDLEVEL SEPTIC TANK RELATIVE S. A. S, LEVEL 0 i S.A.S COMMENTS 16" �� err " O n: 19- q 5 cid" TOTALS REVIEWED BY: "� �` � DATE : 10-1(-1 (- LOAD = 150 GALLONS X NO. OF BEDROOMS TIME = 25 MINUTES X NO. OF BEDRMS +N0. OF BATHROOMS �l �E i _ ((t 11 J. -i DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 October 15, 1992 Mr. John Felton Alaska Rim Engineering P.O. Box 2749 Palmer, Alaska 99645 SUBJECT: Greenbrook Subdivision Class "A" Public Water System, PWSID 210346 Dear Mr. Felton: WALTER J. HICKEL, GOVERNOR (907) 349-7755 I have completed a review of this office's files concerning the monitoring status of the above -referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on September 10, 1992. This —e meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 2. The last inorganic Chemical Contaminants Sample results were submitted to this Department on November 8, 1989. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 3. The last Radioactive Contaminants Sample results were submitted to the Department on September 11, 1992. This dopes-.me,.eLthe provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were submitted to this Department on November 12, 1991. This doesmeet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above -referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II p�;c� printed on rccVdcd piper b act MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 STREET LOCATION - ENVIRONMENTAL ENGINEERING DIVISION - Telephone 264-4720 6. TYPE OF RESIDENCE REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEVVO,,FwnTA-15 _ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Lockwood Homes -Les Pace 278-4606 MAILING ADDRESS 7. WATER SUPPLY PROPERTY RESIDENT (If different from above) PHONE _-_—chorag - = - 7 KI COMMUNITY 2. BUYER - PHONE Larry E. and Milagro C. Kammerer 344-7824 MAILING ADDRESS E]q INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date SRA Box 373 L Anchorage, Alaska 99507 If system is over two (2) years old an adequacy test is required 3. LENDING INSTITUTION PHONE The First National Bank of Anchoracfe Z061 L 279-0622 xdC�-1 MAILING ADDRESS P.O. Box 4-2090 Anchorage, Alaska 99509 4. REALTOR/AGENT PHONE Area, Inc. Realtors -Barbara Kole'mlainen 278-4606 MAILING ADDRESS 4611 Business Park Blvd. Anchorage,_ Alaska99503 5. LEGAL DESCRIPTION Lot 6, Block 3, GREENBROOK SUBDIVISION STREET LOCATION - Na4 Von Scheben Drive, Anchorage, Alaska 99507 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other X:l SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY EA Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled KI COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM E]q INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. copy of inspection enclosed 72-010 (3/78) c THIS SIDE FOR OFFICIAL USE ONLY e INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE Ll PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic/IT,`anlbor ❑ Holding Tank Size:, If Tank is homemade give dimensions: SOILS RATING a S� TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL �--�^ 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line _ Absorption Area to nearest Lot Line 5. COMML=NTS APPROVED FOR 3 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 16 BY (Tittle LEGAL DESCRIPTION 72-010 (Rev. 3/78)