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HomeMy WebLinkAboutGREENBROOK BLK 2 LT 11MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241259 Work Type: SepticTank Upgrade Tax Code Number: 01743119000 Site Legal Address: GREENBROOK BLK 2 LT 11 G:2839 Site Mailing Address: 6726 NENANA PL, Anchorage Owner: KOSINSKI CAROL A Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: Dk-partmcttt 8/29/2024 8/29/2025 83320 ❑ Disposal Field Q Septic Tank ❑ 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: `? CA TO Date: _ Issued By: Date: cj �� 4 MUNICIPALITY OF Community Development Department ------------ Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON -SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-431-19 Property owner(s) Carol A Kosinski Day phone Mailing address Site address 6726 Nenana Place, Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Greenbrook Block 2 Lot 11 Legal description (Township, Range & Section) Lot Size — 83,320 _Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial EJ Single Family (SF) RX (w/wo ADU) Septic Tank R Upgrade RX Duplex El (D) Holding Tank R 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. wzm" (Signature of property owner or authorized agent) Permit/Rush Fees: Z 5 Waiver Fees: Date of Payment: Date of Payment: Receipt Number: Receipt Number: Permit No. c) Waiver No. Permit App_'-'- : - , Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Mailing: P.O. Box 1807 Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska Subject: Greenbrook Block 2 Lot 11 Septic Tank Upgrade Permit Request This is a design narrative for a permit to install a 1500-gallon S.T.E.P. tank to replace an existing 1500-gallon S.T.E.P. tank to be issued for this property. The existing tank is 30 years old and is likely perforated and leaking, it will be abandoned per code. Currently the lot is developed. The proposed replacement will be connected to the existing drain fields. This lot and the surrounding lots are served by a community well. There is currently no water service lines within 10’ or private wells within 100’ of this upgrade. 1. Upgrade Tank Design. The tank will be located: 5’+ from any property line. 5’+ from any deck/stair support. 10’+ from building foundation. 10’+ from any water line. 100’+ from any surface water. 100’+ from any private wells. 200’+ from any public wells. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at (907) 745-8200. Sincerely, Steven R. Pannone, PE, F. ASCE Owner/Civil Engineer 14 August 2024 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241259, Curtis Townsend, 08/29/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241259, Curtis Townsend, 08/29/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241259, Curtis Townsend, 08/29/24 Municipality of Anchorage Page ~__.L_. of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~YV~ ~$¢.~7~' PID Number: ~ r~ ~ ~/ Wastewater System: ~w D Upgrade Address: ABSORPTION FIELD Phone: No. o~drooms: ~ Deep Trench ~llow Trench ~ Bed D Mound ~ Other L E G A L D E S C R I P TI O N soi, Rating: /~ GPD/Sq. Ft. Total Depth~,from original grade: Subdivision: 0epth to pipe bottom from original grade: G ravel depth beneath pipe ~o,: /I ~,o~: ~ ~~ ~. ~ ~. ~- ~ ~t. Township: Range: Section: Fill added above original grade: Gravel length: ~. ~ Ft. ~ Ft. WELL: ~ D New D U pg rade Gravel width: Num her of lines: 0istance between lines: ~ Ft. / ~ Ft. Classification (Private. A,B,C): Total Depth:~ ~To: Total absorption area: Pipe materiah~ ~ / Ft. FL ~ SO. Ft. ~/~ ~ ~/-~ : Driller: ~ Date Drilled: Static Water Level: Installer: / DateiGstalled: PM Ft. Ft. SEPARATION DISTANCES D SeD~io D ,o~i.~ ~.E.~. TO Septic Absorption Liff Holding Dublic.~rh'2te Manufacturer: Capacity in gallons: F~o~ T~,~ Fi¢~ S~io~ Ya,~ Sew.,Li..~ ~C~ F~ I Material:~ ~ Number of Compa~ments: Surface >/~' >lo0' ~ >/00' LIFT STATION ~,~ Water Lot ~ 7~ ~ ~ ~ , ~ / Size in gallons: Manufacturer: / ~ "Pump on" level at: "Pump off" I~vel at: ~ High Water alarm at: Foundation ~/ ~/~7 I ~ - ~ ~" ~ '*I Pump Make & Model Eiectrical~nspecti~ns ~erformed by: Curtain Drain ~ ~ ' ~/ ¢~ Remarks: BENCH MARK Location and Description: /  Assumed Elevation: /~ Fh Inspections performed by: ~ DateS:2ndlSt/~/~/)~;;.':;:~ [~~o 0 ~~ ......... ~ ~ .... Department of Healt~ Hu ces approval '"~.: <'"~-.;, ~.~ ~,,o.~¢,*~:¢.x,. ,..~ Reviewed and approved b ate: . ./ ~,,~.,,s~.¢~ 72-013 (Rev. 9/91) MOA 25 Permit No. ~Vv/'c)~"J~' Page. ¢'" of ~' Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: I,-II. ~¢- ,,~K~I~ ~ I ' PID NO.: / / Permit No. -' -¢' '" Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: bllI ,~'~ ~'l~-I',l~ .'-J.llY~. PID No '~'~1 ~r¢~ll) ......... PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930375 DESIGN ENGINEER:POLARCONSULT OWNER NAME:SAUL BRYAN N & JOANN L OWNER ADDRESS:18906 CITATION ROAD ANCHORAGE, ALASKA 99516 DATE ISSUED: 9/21/93 EXPIRATION DATE: 9/21/94 PARCEL ID:01743119 LEGAL DESCRIPTION: GREENBROOK BLK 2 LT 11 LOT SIZE: 83320 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 (iSAAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. DATE: DATE: polarconsult alaska, inc. ENGINEERS * SURVEYORS · ENERGY CONSULTANTS September 10, 1993 DHHS, Environmental Services, On-site Services P.O. Box 196650 Anchorage, Alaska 99519 2ECEIVED SEP 1 0 lgg ~,.;i~ c~c~h[y of Anchorage Oept. Health & Human Services Attn: Dan Roth Re: Design and Construction Approval for On-site Sewer System at Lot 2, Block 11, Greenbrook S/D. Dear Mr. Roth: We have redesigned the system based on the current topography. We have designed a sqUare bed system because it will be possible to keep as much of the bed as possible away from the slopier areas of the surrounding ground. We have been monitoring the water level in the excavations over the past 4-6 weeks and the water table has remained at the same depth as when you first observed it, even after the heavy rains we have been experiencing. It is extremely unlikely, therefore, that the water level will rise appreciably from where it is now. Furthermore, based on the elevation of the road in relation to the current ground water level, the level will not rise, otherwise the road would be flooded. Also, the current vegetation in the low-lying areas doesn't support the conclusion that the water table will rise, or that whole area would be submerged. Assuming the water table rises two feet, for example, in the high-season, a system is still feasible, provided that enough fill be used. Because of these reasons, we are requesting the design permit be granted according to the attached pages. Although our topographic asses~sment is only an approximation, it should serve as an 1503 WEST 33RD AVENUE · SUITE 310 * ANCHORAGE, ALASKA 99503 PHONE (907) 258-2420 · TELEFAX (907) 258-2419 poiarconsult Sincerely, Matthew Korshin POLARCONSULT Attachments: Site Plan, Sheet 1 of 3 Topographic Site Plan, Sheet 2 of 3 System Design Calculations, Sheet 3 of 3 polarconsult alaska, inc. ~1503 West 33rd Avenue · Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 SHEET NO. '/ c^,cU~TEO 8¥ ,'~' CHECKED BY. oF ~ !c polarconsult alaska, inc. 1503 West 33rd Avenue · Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 s,E~,o. 2.- o._ -~ CHECKED DY. DATE /"-/0' SCALE P polarconsult alaska, inc. 1503 West 33rd Avenue · Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 SHEET NO. ~ OF. CHECKED BY, SCALE ,/ /'~ '~', DATE PERFORMED FOR: LEGAL DESCRIPTION: © 1 2 4 14 17 18- :20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: Township, Range, Section: %/-// SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED7 IF YES, AT WHAT ]/-~t DEPTH7 Depth to Water A Monitoring? Dale: Gross Net Depth to Net Reading Date Time Time Water Drop P~r~o~¥ ~/tz .... l' aA~ c) o /" - z ~,4~ ~ .'.,~, ' ~,~ / ~/~" ~" :~ e~ z ~,~ ~ ~i~ ~" ~" 5~fiz q ~,~ ~ zW' ~ ~ PERCOLATION RATE '-~" '~ (minutes/inch) PERC HOLE DIAMETER ~ // TESTRUNBETWEEN 5 FTANC (-o FT COMMENTS CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-005 {Rev. 4/85) PERFORMED FOR; LEGAL DESCRIPTION: 2 4 10 12 13 14 15 16 17 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST D~TE PERFORMED: ~1~'. 2-:,/~o/' ///! ~r~,~f~/.(Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Alter~ Monitoring? *'\? . Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop s , PERCOLATION RATE '~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND 7 FT PERFORMED~Y: /~'/q'//,/."/ /~/~ry,~/r) , .~.,/-/~',w/~ CERT,FYTHATTH,STESTWASFERFORMEO,N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: (~)I~/~ 3 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~L,~' ~. O 1 2 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18- 19- 20- COMMENTS ~,~c-~-~,J~;r~,s~ip, Range, Section: SLOPE WASGROUND WATER ENCOUNTERED? S DEPTH? p E Depth to Water Alter ~//~ , MonitorinD? /v//~ Date: /V/,~ SITE PLAN Reading Date Gross Net i~Jll~J Depth to Net Time Time Water Drop p~,~-~oAl,(, ,~/ I_~ $,,~; ~ ~ -)q'/i ~ ~ PERCOLATION RATE '~"~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '~"'~:~-- FTAND "~' ~ FT PERFORMED BY:~i?t&U I L~ 'f-k~J 5 f~4~,J~ I ~,~..r/X,,..~, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOR~^NCE W,TH ALL STATE AND MUN,C~PAL ~U,DEL,NES ,N EFFECT ON TH,S D^'~E. D^~E: ~ ) ~ l ~,~ 72-008 (Rev. 4/85) polarconsult alaska, inc. 1503 West 33rd Avenue · Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 SHEET NO. CALCULATEO BY CHECKED BY DATE. polarconsult alaska, inc. 1503 West 33rd Avenue · Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 SHEET NO 3 cHECKEO BY DATE polarconsult alaska, inc. 1503 West 33rd Avenue · Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258.2419 S,E~,O. 2..- o~,..-~ O."'-C'~'~"EDE¥ ,¢.A OA'"~ ~/~/?~ CHECKED BY DATE polarconsult alaska, inc. 1503 West 33rd Avenue · Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 SHEET NO. /~ OF. ~' CHECKED BY DATE polarconsult alaska, inc. 1503 West 33rd Avenue · Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 FaX (907) 258-2419 S,E~O. Z 0~. Z CHECKED BY DATE Polarconsult alaska, inc. ENGINEERS · SURVEYORS ° ENERGY CONSULTANTS August 13, 1993 BRYAN SAUL 18906 Citation Road Eagle River, Alaska 99577 Re: Septic Design for Lot 11, Block 2, Greenbrook S/D Dear Mr. Duffy, In accordance with our proposal, Polarconsult has completed the percolation tests and system design at the subject property. Attached are the soils percolation logs, design drawings, and a letter of transmittal to the MOA. .~ Based on the site investigation, the property appears suitable for the installation of the on-site waste water disposal system provided the subsurface conditions encountered are representative of the general area. The design is also contingent upon investigation of your property by a DHHS inspector to determine whether or not the proposed system is feasible. The total cost for this work is $1,340, as agreed to previously. Thank you for giving us the opportunity to be of service and if you have any questions, please give me a call. POLARCONSULT 1503 WEST 33RD AVENUE · SUITE 310 · ANCHORAGE, ALASKA 99503 PHONE (907) 258-2420 · TELEFAX (907) 258-2419 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING O l '7 ~Y ~ l l ~7 HAA# GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone D~y p~one Pg~'oD Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well Community well Public water 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 (Rev, 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm F'/,~/-/-~? 7-~c/~/ ~-~';~- Phone ~ ~/j-- 1.7.~-$- Address ! 5/.5'- } O ~'c4~ _C/,.~ /~,~ cAo,',~c;/,~j /¢-~ ~').~-/4' Engineer's signature %~u¢.-~-¢/_~<_ ~ ~ Date ~/I/~ ~ DHHS SIGNATURE '~ Approved for Disapproved. Conditional approval for bedrooms. . .. ~,(~.~.4,. ~ - bedrooms', with the following stipulations: Additional Comments 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. 1/9~) Back MOAi¢21 t~ut~c~P^urr o~ ENVI~ON~mT^~ SERVtCES D~VlS~Ot~ Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICES AUG 0 7 Environmental Services Division 825"L" 8treat, Room 502. Anchorage, Alaska 99501. (907)343-4744 R E C E~ Legal Description: A. WELL DATA Well type ~Ja££ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Health Authority Approval Checklist If A, B, or C, attaCh ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG g.p.m. Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Nitrate Collected by: Other bacteria Date installed I 0 / c] Foundation cleanout (y/N) Date of Pumping 7/3° / ~ ~ C. ABSORPTION FIELD DATA Date installed I O ! Length 76?' Width Effective absorption area ~'EO Date of adequacy test ~ / t [ 90" Fluid depth in absorption field before test (in.); Fluid depth lb- ~'~' (ins.) Minutes later: Peroxide treatment (past 12 months) (y/N) I~lo,a¢ Tank size 1,5-O0. c/a I Number of Compartments __ Depression (y/N) Pumper /~ ~' N ~ Cleanouts (Y/N) y High water alarm (y/N) V' Soil rating (g.p.d./ft2 or ft2godrm) h ~ qp~4'~ System type ~' ~,,de Gravel thickness below pipe ~. E ' Total depth ~ Monitoring Tube present(y/N) Y' Depression over field (y/N) Results (Pass/Fail) /~a.O' For ~ bedrooms Immediately after/~$~9 gal. water added (in.): 16' Absorption rate = > ~oO g.p.d. /~r~oo,,r~ If yes, give date N- ,4, D. LIli'r STATION Date installed tO ttg~ Size in gallons 13-oo ~ol ~T~P Manhole/Access (Y/N) Y' "Pump on" level at* ~ I t 3" "Ptmlp off' level at* - II 7 '~ High water alarm level at* -Itl" *Datum SEPARATIONDISTANCES bee.~ r'ece,~ bi7 SEP~ON DISTANCES ~OM ~LL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line ; On adjacent lots N, At, ; On adjacent 10ts N- A, Public sewer manh01e/clean0ut N. ~-. Lift station N, 31 F4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation q 3' Property line ~ ?~" Absorption field ~e9 ' Water main/service line ~, Ig/~ Surfacewater/drainage ~ too' Wells on adjacent lots ~, 2oO' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation I Z 7 ~ Property Line 25 ' ~ .Water main/service line ~> tO ' Surface water '~ tOO ' Driveway, parking/vehicle storage area ~' ~io r-oact /'~,6Lto' Curtain drain ~o,q¢ 5 ~£,0 Wells on adjacent lots '~> ,'P. OO ' ~ I..ok [~t~e t.c, at~,er t.l.r~e~ Z/Iq~gq ENG~ER'S CERT~CATION I certi~ that I h~e determined thru field inspections and review of Municipal recoeds' 'that. tn conformance with MOA H~ guidelines in effect on this date ,." . ? " ,0~ '~,: ~ ..c~/'~'~: ~ :' % ~'; ¢5. En~neer's Name ~ore ~, ~oo~ ¢~ t, Date_ ~ ~ l~9~ q%.,.~.:57~,~ HAA Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number Parcel i.D. # 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 GENERAL INFORMATION Complete legal description Location (site address or directions) _;, '~-, Property owner . ~:.~'-...:.: ·, , -.'...% ...:...' Mailing'address Lending agency Mailing address Agent Add ress Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~:;)O ~._. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site )4y._ 34 Holding tank ' ..~ .~'.i~..- - Community on-site Public sewer. ' ' '- ' NOTE: community weft system, provide written confirmation from State ADEC attest- If community Wastewater system, pyOvide written confirmation from State ADEC attesting to the legality a~d statUs of system. 72-025 [Rey. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER .... As certified by my seal affixed hereto and as of the validation date shown below, I verif~ 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 r 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. DHHS SIGNATURE ~ ~. Approved for // Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 p?ofessional engineer's work. 72-025 (Rev. 1/91) Back MOA ~1 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~m-/l ~-oq~ Z/ ~--~,~7:~J J~o~)~ Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height A. Well Data Well type C.0/Y'~,L)~ ~7'~ Log present (Y/N) FROM WELL LOG Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main /',J//~ Sewer service line zlo s ¢L, Wires properly protected (Y/N) AT INSPECTION g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /,J IA WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed /0 Cleanouts (Y/N) Y' High water alarm (Y/N) Date of pumping Tank size /~'0~ ~,,~a.. 5'T'/5'P Compartments Foundation cleanout (Y/N) Y' Depression (Y/N) Alarm tested (Y/N). ~ A~.~ ~)~ s-,-~co,--co,J Pumper ~ J~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /',J )/~ On adjacent lots To property line '> 70 Absorption field Surface water/drainage > ~ Z9 Foundation Water main/service line 72-o26 (3/93)* 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) Y Manufacturer Manhole/Access (Y/N) off" "Pump Level at Cycles tested ~ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /'~t/A On adjacent lots Surface water /~0 ~J6 '~ 10~) ) D. ABSORPTION FIELD DATA Date installed /¢,/Z-~ / Length 7 O/ Width Total absorption area Date of adequacy test /~-~.) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Cleanout present (Y/N) Results (pass/fail) O Soil rating (GPD/Ft2) /~ Gravel thickness Z, Z- / /'~ Depression over field (Y/N) ~::>"~ £J for After test If yes, give date System type (.z.)~ 0 6' "-F-~ ~¢ Total depth ~.. '7... t Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /k]/A- To building foundation On adjacent lots Surface water Curtain drain On adjacent lots I / Z'7 ! '~ Z-OO Cutbank Property line To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION Engineer's Name Date ~"~/t I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in e?je~ on thedate:bf this inspection. HAA Fee $ Date of Payment Receipt Number 72-026 (8/93)' Back Waiver Fee $ Date of Payment Receipt Number Tom Fink, Mayor Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 14, 1994 Michael E. Anderson, P.E. Anderson Engineering PO Box 240773 Anchorage, Alaska 99524 Subject: Waiver Request for Lot 11 Block 2 Greenbrook Subdivision Waiver Request #WR940009, PID #017-431-19, HA940109 Dear Mr. Anderson: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is end of the trench to the east property line of 3 feet. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sinc~ ly, Robert W. Robinson Civil Engineer On-site Services ljw#7 ~j MUNICIPALITY OF ANCHORA~ Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ WR940009 PID9 017-431-19 HA# HA940109 Permit # SW930375 Date Received: March 1, 1994 Applicant: Legal Description: Lot 11 Block 2 Greenbrook Subdivision Engineer: Michael E. Anderson, P.E., Anderson Enqineering PO Box 240773, Anchoraqe~ Alaska 99524 Z~KXI~X~X~X~X~X~X~X~X~X~M~XK~K~MXX~X Waiver Requested: Lot line waiver of 3 feet from the east property line to the end of the trench. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: o 3. Other: Waiver is Granted: Waiver is NOT Granted: List QQnditions or Reasons ~or above: Date: ~//~/~ ~ o~f ~eviewer Rec #: 25697/3038 ~ount: $ 115.00 Date Paid: March 1, 1994 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 March 1, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: RECEIVED i AR 1 1934 Municipality o~ Anchorage Dept, Health & Human Services Lot 11, Block 2, Greenwood-Subdivision Lot Line Waiver Dear Onsite Services Engineer: The septic system designed for the subject lot was placed in the extreme northeast corner. This is the only area on the lot with satisfactory soil conditions and the necessary separation distance from groundwater. The east end of the drainage trench is 3' from the lot line. It was necessary to place the trench at this location to take full advantage of the suitable conditions and to provide the necessary separation distance from surface water. This subdivision is served by a community water system and placement of the drainage trench within 3' of the lot line will have no impact on the surrounding lots. We hereby request a waiver be granted allowing placement of the drainfield trench with 3' of the lot line. Sincerely, Michael E. Anderson, P.E.