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HomeMy WebLinkAboutGREENBROOK BLK 4 LT 2�rM. ' �� �� ••► Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 3 of ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231409 PID Number: 017-431-15 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New N Upgrade Name ERIC & MARIE OCHALDEUS A ORPTION FIELD Site Address Z 6800 TERESA CIRCLE, ANCHORAGE, AK 99516 ❑ De Trench ❑ Wide Trench ❑ Bed Phone 907-717-4881 Number of Bedrooms Other Soil Rating Total depth f original grade 3 LEGAL DESCRIPTION /SF Ft. Depth to pipe invert from odg• vel depth beneath pipe Subdivision Block Lot EXISTING GREENBROOK 4 2 Ft. Township Range Section Fill added above original gr Gr I length Ft. Ft. Gravel width Beds: Number of Lines Dist a between lines SEPARATION DISTANCES To Septic From Tank Absorption Field Lift Station Holding Sewer Ft. Total orption area - Ft. Number of trenches Dist. between ches Tank Line Ft2 Well NI EXIST. j�J�A /-� _ 2�,+ TANK El Septic ❑® S.T.E.P. El Holding El Other Manufacturer Capacity Surface Water 100'+ EXIST. 1 QQ'+ _ INFILTRATOR SYSTEM 1530 Material Gal. Number of compartments Lot Line 5'+ EXIST. 51+ - NA PLASTIC 2 Foundation 1 Q'-I- EXIST. Q'+ _ LIFT STATION Manufacturer Capacity Remarks *2ND COMPARTMENT OF INFILTRATOR TANI INFILTRATOR SYSTEM *-500 Gal. Alarm location Electrical installed by ='n INDOOR RISING SON ELEC. Installer PIPE MATERIAL House to tank D3034 Tank to EXIST drainfield Ai b r 1 z�Y\ LIZ Drainfield EXIST. Co/MT D3034 Inspector E BENCH MARK (Assumed elevation) 100.00 ft Inspection 1st 2/21/2024 _ dates: 2nd Location and description P 3'd 4th - BACK DOOR THRESHOLD ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional �06o p Approval: Date fl -� •--.-9 � �. .... .......... Septic System Op =. e y Gor ess: Approved Date 3 S SLY 3 r 23 Note: this approval does not include well permit requirements. p0' Ofess900°\ IRev 05/02/18) #AECCas4 �OpoOo�� PERMIT NUMBER: OSP231409 j —APPROXIMATE LOCATION WATER LINE LOCATION BASED UPON LOCATES PERFORMED , BY NORTHERN UTILITIES EXISTING 3-BEDROOM HOUSE NOTE: OLD TANK WAS EXCAVATED, PUMPED, COMPLETELY REMOVED, AND DISPOSED OFFSITE t PER THE CONTRACTOR 7-FOOT LOT LINE WAIVER GRANTED 7-FOOT LOT LINE WAIVER REQUESTED- 4 NEW IM-1530 INFILTRATOR PLASTIC STEP TANK —APPROX. LOCATION OF OLD DECOMMISSIONED DRAINFIELD PARCEL ID NUMBER: 017-431-15 } EXISTING DRAINFIELDI i PRESSURIZED SEWER LINE A B MH1 1 32.9 30.3 MH2 1 25.3 1 38.8 NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN AUTOCAD. It -FARNESS ENGINEERING Q SALES - CONSULTING 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE. ALASKA -PHONE (907) 337 6179' WEBSITE: w .gamessongineedng.00m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ERIC & MARIE OCHALDEUS 907-717-4881 2 OF 3 PROJECTILEGAL DESCRIPTION: DRAWN BY: GREENBROOK; BLOCK 4, LOT 2 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF NEW STEP TANK 2/27/2024 1Wsxtjj i 1a �......1... ...........3 ..........,... i�?. �e rey AEG mess : v AY '7 'p . ... .... LICENSE 44®'WFESJ� �® #AECC884 rAaYlk"'v PERMIT NUMBER: PARCEL ID NUMBER: OSP231409 RECORD DRAWING 017-431-15 RE -USED RE -USED EXISITNG EXISTING DEMAND DOSE INTERIOR CONTROL PANEL - ALARM TOP OF MANHOLE LID (MH1) = 100.32• TOP OF TANK @ INLET = 95.67- INVERT OF INLET PIPE = 95.08J FINAL GRADE = 99.01-99.06• IM-1530 GALLON TWO COMPARTMENT INFILTRATOR TANK- 2" OF INSULATION BAFFLE WALL BAFFLE HOLES GOULDS PE51M PUMP OR EQUIVALENT--/ TWO (2) CINDER BLOCKS FOR PUMP STAND (SUPPLIED BY CONTRACTOR; PROPOSED PUMP TANK FLOAT SETTINGS INFILTRATOR TANK MODEL IM-1530 TOTAL CAPACITY 1787 GALLONS WORKING CAPACITY 1638 GALLONS INLET INVERT 47" HIGH WATER FLOAT 33" "41" START FLOAT 32^ •40^ STOP FLOAT 32" •40" FLOAT LEVELS ARE FROM BOTTOM OF PUMP ('MEASUREMENT FROM BOTTOM OF TANK). NOTE: MEASUREMENTS ARE WHERE THE FLOAT WIRE ATTACHES TO PIPING WITH A 3.5 INCH TETHER FROM PIPING TO FLOAT (PROVIDES 3- OPERATING RANGE), ALL FLOATS MUST BE NARROW ANGLE FLOATS. TOP OF MANHOLE LID (MH2) = 100.30 MH1 TOP OF TANK @ OUTLET = 95.65 WEEP HOLE TO DRAINFIELD -- -------- HIGH WATER FLOAT t STARTFLOAT STOP FLOAT koxARNI SS El II � I ul® Ltd = ENGINEERING SALES CONSULTING/� - 3701 E. TUDOR ROAD, SUITE 101 - ANCHORAGE, ALASKAPHONE (907) 337-6179' WEBSITE. www.gamessenglneeringmm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ERIC & MARIE OCHALDEUS 907-717-4881 3 OF 3 PROJECTILEGAL DESCRIPTION: DRAWN BY. GREENBROOK; BLOCK 4, LOT 2 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF IM-1530 INFILTRATOR STEP TANK 2/27/2024 OF ao ' o o.......... :.... ....�.0 op f � ....:� � ...,,, ,..,.r........... ...O J�ffre yGarness : e ♦1 J, Ar C -7953 _�® ♦ F, ��A, AV AW LICE©4 444% FESS� #AECC884 Itlwa Rising Son Electric Services LLC. 10007 Lee St. Eagle River, AK 99577 (907) 622-6777 February 26, 2024 Re: 680o Teresa Circle Anchorage, AK 99516 Two whom it may concern: The lift station at the above referenced address has been wired in accordance with NEC and State/Local codes and is wired to the manufactures standards. Please contact Dakota Keller with Rising Son Electric Services LLC with any questions or concerns at (907) 622-6777. Thank you for your business. Sincerely, Dakota Keller, Owner Administrator License Number 2065 Specialty Contractor license Number 38497 (907) 622-6777 U) o0- 0-0 wz O `n f- ED 0�1 s 0 C" M N I— O J a3H5 M ,vu uqZ 196.9.gV Z M '189,60°09 s n •! UJ J Q = w �> e' a : W i o0 0S a ;cn; ;w;, N ._ W W O Cl) N W _ ,0'ZE 313 N L__ 3nV3 - 'pl g�,� N �65'OZ6 �-OO,O V• U -- -- -----310�110VS3�131-- -- o : T: : ' :V) ; : o% :L: It C/)' i c� '//� �: : � Q •• Qom.' \C:) m w w O a II O�O Cn !ZV N C -0£ II I I I I W 0 z W m W U U) z O z � W �w> U W W OHO J Q O X Q 0 >_a0 Z m0-z LL, 0 O N 0 MUNICIPALITY 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: OSP231409 Effective Date: Work Type: SepticTank Upgrade Expiration Date: Tax Code Number: 01743115000 Site Legal Address: GREENBROOK BLK 4 LT 2 G:2839 Site Mailing Address: 6800 TERESA CIR, Anchorage Owner: OCHADLEUS ERIC J & MARIE A Lot Size in Sq Ft: Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: This permit is for the construction of: �I r Department 12/14/2023 12/13/2024 42548 ❑ 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: 3�5 5u eck -fe, G G Date: Issued By: �d, Date: 3 1 Municipality of Anchorage � Ur. partmenr P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV231061 COSA#: Permit#:OSP231409 PID#: 017-431-15 Legal Description: GREENBROOK BILK 4 LT 2 Engineer: Garness Engineering Group Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 7.0 feet. This waiver applies to both the North and Southeast property lines. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: I ZZI y�Z3 Approved by: l/(/ Name of Reviewe **** VARIAN C E/WAIVER REVIEW **** MU[ UP Y OF AN-NCA=AOR. GE qqq . Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-431-15 Property owner(s) ERIC & MARIE OCHADLEUS - Day phone 907-717-4881 Mailing address 6800 TERESA CIRCLE, ANCHORAGE, AK 99516 Site address 6800 TERESA CIRCLE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) GREENBROOK, BLOCK 4, LOT 2 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ Septic Tank El Upgrade Upgrade ADU) Q Holding Tank E] Renewal (D) ElRenewal ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: DRAINFIELD TO LOT LINES Distance. 7' 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:.- ?_2.5- Waiver Fees: 22� Date of Payment: Date of Payment: Receipt Number: Receipt Number: Permit No. Waiver No. 05U 23 1 Oti 1 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Appiication.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231409, Deb Wockenfuss, 12/14/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231409, Deb Wockenfuss, 12/14/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231409, Deb Wockenfuss, 12/14/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231409, Deb Wockenfuss, 12/14/23 s �TILITY,� OOo LOT 3 POLEO OCA a 0� LOT 3 v\\ UTILITY PEDESTAL �Q' CJ SEPTIC STANDPIPES \ Cp p LOT 2 40 45,548 sq. ft. O CIDP �p N 25' FENCE o ' GRAVEL h DRIVEWAY C) to I °O LOT 1 UN ASPHALT IY r' DRIVEWAY co U w Q _ r w 44.0' C/)O w w w w - wi z N 2 -STORY ° FRAME SEPTIC I— 00 54.4' 14.0' 1 00 HOUSE �S,i MANHOLE I LU 2.0' Z o M cli 1 06 I 25, 32.0' GREEN- HOUSE 45,0, wnTErz N ItO p KEY BOX 00" 38.39' A79.00 REBAR N 56OFq< 00'00" W R280.00� _ `�� `� o � 1''', - - —VON SCHEBEN DRIVE _ �•' �i� *: 49 TH ........ .... ............, NOTE \ i ��'� B u Saliz : o DRIVEWAY LOCATION IS 0 20' 40' �1 S LS -14837 APPROXIMATE DUE TO �/ 4 ' • 4 = SNOW AND ICE COVER. tilt iO I OFE S . rl*�­�p -:", EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT (74-147) ARE NOT SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE BOUNDARY SURVEYAND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION SURVEY STANDARDS. THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR ISA VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. JOB # 23182 I NO CORNERS SET THIS DATE I SCALE 1" = 40' AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 2, BLOCK 4, GREENBROOK SUBDIVISION ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST EXCEPTAS INDICATED. DATED THIS 4th DAY OF DECEMBER, 2023, AT ANCHORAGE, ALASKA. FIXED HEIGHT, LLC C.O.A.122554 Land Surveying Services 907.290.8949 225 W 23rd Ave., Anchorage, AK 99503 WWW. FIXEDHEIGHTCOM Environrnent~,l Health Oivi.ion 7 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES F:ALikii .~ j,~ ]~ ,L~. ~ Tn SEPTIC ABSORPTION ~"&~FRO~ TANK FIELD WELL Phone{s) Permit No. No. ~edroom~ WELL ~_(:Us' '~'' ;~ O~"~ ' '+ LEGAL DESCRIPTION LOT LINE / Township, Range, Section AS-BUILT DIAGRAM (Show Iocabon of well, septic system, property lines, foundahon, TANKS /t~,~ ~~O' ~.~C [~:?(' N 1~-~,..1, . '~ ~ i ,z :7o TYPE OF SYSTEM I-d' ~'~'~ , ', ,~ .~ ,, ~ ~ ~i J Depth to pipe bottom from Total depth from original grade ~ Fill added above original grade Gravel depth beneath pipe / .:': FT FT Gravellenglh ~.~i FT ~ravel~wldth~ / F~ ~ Numberolhnes~~~IS°drat'n9 ..~/~AJP,pematerial % ~% Installer (;.,~ Oj~ IOatelnsta ed / ~ -<~: " WELLS ~ ~" ~ PRIVATE /~ OTHER (Identify) j Classdicahon (A,B,C) Total Oepth ET Cased [o Instaflel Oa~e Installed: ~'T; / REMARKS: - - /~ j J/ Q~(~(? ~)(/(~ ~()0( Incpections Pedgrmed by: ,' ~//~~J;il ~ . * cedilylhatJhisinspectionwaspeflomedacc0rdingl0all H~~proval:/ ~ ~ (/ ~ ' ¢~ ~ ' Date: . .. / ¢~ / 72 013 F:'(~z, r' m i ?.. ?...!uml::~ r...?i~ ~ 9()0()(],"4 tJp (:,1 i" a.d ~-:.:~ Da'L(:.:! J] s!i~iu(.:.!d ~ 0 :I i,:.)Ui/iii9 EnO :J. F:' a P (::: ,,~):, ii. ][ (::J ',~ ,'..i) ~!, i,' '...41]:!i :t. -... 15 Lc?l:. ~:~:~.x~,::.~ ..xl2. Uj.q~{j (sql, (L,, c:~p SI~?.F.-q']~C i"ANK','~ ?'t :J i'! :J mL.ul~ 'Lcd'La]. s~.?ptic: b.~d'lJ.:: capac:~.'Ly: i~0()0 gallc~ns,, Each s~.~'..:,pt:Lc 'Lank mu~:~;!;., h?[~v(.? at i~:.::,as'{' 2 cc::,mpaPtm~z~r'YLs. D~pt.h to, top ,:::,f' sept:i.c 'Lank (s) < 4,,O ~]J::J:::]~l'~]~!~] J"J~]U?.~}]J~, l'.]]~:}lJ...C Z~;.q.3"'"46EI:L AND L.,.J}~]ag~]~] a C;C)h.j~3'J'j::;ZL]CI" A J"J]ZN]:jvJLJivJ (])F: A :7: J:::~])[]T ~3AN]} ~:;]]L'J'J~]::~'. }3J~}~]~-IJ~}~ATH THE F:'IER~'~ ]; J V~I.. ]] D F:'C)R A S ii. Jxl~]'..)l....!~J~] F:'AM ]] LY HOME AND E X I:::' I RES :L2/3 :i./90 M U N I C I P A 1_ I T Y O F:' A N C H O R A G E Depat"tn-.~rrL of I,--lealt. I] ~:~ I-,tumar'i Sei'~vice~ E!25 L St, l"ee:t.: Anc:hcmage~ Alaska 99501 34.3.-4720 19219 NORTH 13TH PI_ACE i:::'!"'l(:)l~:N i X, AR 85024. D,9, y Ph(:}r'le: 602.-.5!3 !-2033 l:::'a i- (z <.:::, i I d: () :1 '7- 431-'-' J. 5 I...ot. i....ega 1: .'.:!i;ub d i v :i. s i ,:::)n: GREENBRO(]K SUBD ,, I...ot. Lcd:. S:i.z~-z, 4:;:::5Zl-8 (sq,, ~'t.,, c)r' ac::r'es) Max Bedr. oc, ms: This Pei"mi'L:: 3 Total Capac:i.'Ly B loc k: 4. SEP]'IC TANK: Min:i. mumt. ota! sept. it 'Lank c:al::~ac:ity~ i,000 gai]~c)ns, l:~i:a,::::h s~:.:,pt.:i.c t. ank must. have at least. 2 compar'tment, s,, L),z.~pt.h 'Lo top of sepLic '~..ank(s) < 4,,0 i'R~E,'i.'. I"E~CiL.lil"(.)?!~i; insu!a'Lion ove~" 'Lank (s) ~ i NI:::[)RM !) ,, H ,, H ,, S. 1:::'I::;,' I OR 'T'C~ :I. ST &. 2ND I IqSPEC]" :!10NS BY EIqG I NIEER, I F' AI::TE~:I::~ OI:::'I:::'ICI~: I...IOUI::~S, CAI_L. 343-4681 AND L. EAVI~: A I"IIZSSAE'iE~ CONST'RUCT I:::'i~:1::~ El~!G]:NE~:I~:RS ATTACHED AF:'F:'R[iVED THIS PiZRMI"I' EXF:'IRI~:S 12./:51/89 AND VAL..ID F::'OR A SING!_E FAMIL..Y HQME~ ]: i::::EF~T ! F:'Y 'T'HAT: :ii wi Zi.] inst. all '!'..he syste~m :i.n acc:cn'~clanc:e~ ~,~it.h all I~IOA c'.c~des and 3,, I w:i.l! adhe~e t.o all MOA and St. at.e o{ Alaska r'equir, ement, s {of t. he s~t. bac:k d:i. st. arJc~:~s ir'cml any ex:i. st.:Lng ~,.,.,el]., t,;aste~a'Le:,P dispos.a], sys'Lem c:)r' p~ud::~lic: se)weH"a{iie system' on this or' .:'any Y~id.jg::~c(,::)Fit. (:)P Fl~:,:~aP[:)y Ic)t.. ZJ.. [[ i..U"IE}()i,!"E.t.~i:U"iQ ~t. his peJ'mi'L is valid f'or" a maximum of 3 bedi"ooms,, a.l.~:::.,..) u~h...~l s'~"-~:l t.~al..~2,~...:~ c,::q, haL.,. ,..'x O~ Lb,.:,, ~..,.~!...a.I .... ? ...... e~J .~ .......... L,,.:... ......... (.~l ...... and aRE . RO0 SUbDiVISION / SERVED BY CO.UN TY [~LL , ~T~C SWT~HS-~ PROPOSED: BED ~ X J ~ Construct Bed ~F~M k/s~ Verify integrity of exist. ~anki-~m~. ~[',6~b: ~..... Supply and.Install 500 gal STEP ' ][[ i ~ ~'o~<;'~o Systera. M.O.A. Approved. ~ ' - Insulate STEP System and Pressure ~ jo~ z z f[ Main IF necessary.~ ~ ~{~ ~0~ Install GEO Fabric over sewer rock. ~ 4' Install 2" of Styrofoam Insulation ~ ~ ~____~ over GEO Fabric ~[. ALL CONSTRUCTION TO MEET M.O.A. SPECIFICATIONS. NOTE: )0' ~ All Dimensions ~d Locations Must Be Field Verified Prior To Construction 85W5 SYSIEM'kOGAIION PLAN LOT J 8L~K J '~ '*~ ~ ........... ~ : ~ S26 T12N R3W  DRAWN BY, ' ' ' ~* NORTH JERRY ~ESS Indlcat~ Ilave ~eo ~te~in~ By Use Or' Cloth "??:~?'"~<~'t~">'~¢.~'>"'< tf~"g*~!?~2S'.?g'%"'"'?~>[['. ':'!'"?~ -, Surveying ~ FA~IE ~ AT,AS~ · ' , L* ' '~,*. MuniciPality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST HOLY_ CER¢ORmEO ¢OR: I~A.h,l'kl I E LEGAL OESCRIPTION:.LoT' Z 2 4 5 6 7 8 9 10 12 13 14 20- ,sur:. 4- 5/,4- /,4~ DATE PERFORM Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUm-EReO~ . OEPTH~ Oe~, w~i 4 '~ :~ Readi~jDate' Gro~s Net Depth to Net · . ~ . Time ~ime Wa(~ Drop ~ ~ '"' I1.:~ " C--?,~' .0'7' ~ 3 " I I :dd " ~, ~.~' . o '7 ' . ~4 " 1i: ~ " O, ~3 ' . O'n ' TF..ST RUN BETWEEN . Cercouat~oN ~ate Z3,. (¢ I (.~i;~n~ ¢~c HOLe OIAMETER ~ '~ ~RTIFY THAI ~lS TEST W~ P~FORMED IN A~ORO~CE WITH ALL STA~ AND MUNICIPAL GUIOELIN~N//'EFF Tom Fink, Mayor A unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 9, 1989 Ken Dennison 19219 North 13th Place Phoenix, Arizona 85024 Subject: Lot 2 Block 4 Greenbrook Subdivision Permit ~880169, P.I.D. 90t7-431-15 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, ~.9..8,8 .... ~- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES p.Q Box 196650 Anchorage. Alaska 99519-6650 On-Site Services/Water Quality #502 No such of [ce ;n sf~fo ..... Ken Dennison 19219 North 13th Place Phoenix, Arizona 85024 It h I,,{l,:, ,,{, ,Iii Daniel J. Roth Acting Program Manager On-site Services Section DJR/ljw enc: Copy of Permit ] unicipality of.Anchorafle Department of Health and Human Services 825 "L" Street Tom Fink Mayor P.O. BOX 196650 Anchorage, Alaska 99519-6650 343-4744 January 9, 1989 Ken Dennison 19219 North 13th Place Phoenix, Arizona 85024 Subject: Lot 2 Block' 4 Greenbrook Subdivision Permit #880169, P.I.D. ~017-431-15 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1988. Permits are issued on a calendar year basis by authority Of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the orginal as-built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. When applying for a new permit, the fees are: $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, Daniel J. Roth Acting Program Manager On-site Services Section DJR/ljw enc: Copy of Permit M LI N :1: C :1: F:' A L.. I T ¥ 0 F A N C; H 0 R A G E 825 L S'Lreet~ Anchc~rage., Alaska 995():[ 343-4720 iD N .... S I T E S I,:,]: W E R I::' E R M I T r m :i. t Iqumb 6..~r: 880 :L &9 Date Issued,~ ()E-II2:Z!;188 Up g r ad e Eng i n~,~er Designed !::h,,~rl~:~.r~ Name: KIEN DEI'qNISOiq t:)wner, Ach::lr'es~_~: 19219 I',I[)R'T'H :1.3 'T'H F:'LACE F::'HOI!i]qI X, AZ 8,50:~4 Day I::'hone: 6()2-511~1 ;t. I....c)t Leq a ].: Sur.) d i v :i. s i cln: GI:~I~[ElxtBR[IL].K L. ot: 2 B 1 oc k ~ 4 Sect :i.c~n: 26 Tc:w,u~sh :i.p: :i21q Range: (~;W L.ot S:i, xe 42.54E! (sq,, ft,,, or ac:res) lfiax Bedrooms: ]']"lis I:::'er'm:i.t: 3 Total Capacity: SIEI:::'"t':!:C 'l"Atql<: Min:i. mum to'Lal septic tank c:apac:i, ty: I,()00 gallons,, Each sept:i,c tank mus'L have at ].eas't:. 2 cc:)ml:)ar, tm~.'-n{s. Depth 'Lo top ¢:iF septic rani.:: (s) < 4.() INSTAL. I_ PIER EiqGi'NEIERS DESIGN :1.5' X 45' BED WI'TH LIFT STA"F]:OI~I USIE SAND FI. LI,,.. AS NEIEDED. THIS PERHIT ]:S ISSUED FCIR A SINGLE I=AM]:LY RESIDENCE ONLY AND EXPIRES 12/3]./88. NO'TiI="Y DHHS PRIOR "1"0 EACH INSF:'ECTION, CAL..L :];43-46E1:1. AFTER ,HOURS,, ]: CIERTIF:'Y "I'HA'I'~ :[. :1: am !'am:i.:l. iar' with the requirements For ¢~n-site se~,;ers and we].].s as set ¢or'th by the Murl:i. cit:~ali'Ly of Anchorage (MOA) and 1:.he State o¢ Alaska. 2.,, :[ t,~:i. 1], :i,t"lstall the system in ac:condance ~,~i'l:.l"i all MOA codes and r'egu:t, at.:i,c)c~s, ar'id J.l"i compli, anc:e ~,¢:i.'f..l'i the design c:~iteria ~¢ this penmi'L,, 3,, ;[ will adhere to all Id[IA arid State of AIasl<a ~equipemerrLs for- the se'L back dis{ances from any exist.:i.r~j well, ~.,~ast, e~'¢at, en dispersal syst. em of public scwel"a(;!6~ system on this or any adj.acen'L op nearby t understarld that this permit is valid ~'of a maximum oF a].s~ t..tr]d(.;)H"~tarid that',, the capacity o¢ the total], sy~tem :i,s 3 bec!poc)fn~ and SiqH'~6'cl'ar~y en].ar'c:lemerlt ~¢~¢~~ ¢¢~ DA"r'E:will ~'eqLtire afl add i'Lionat permit,, ~.,,,, ~, i/)~i~IC~PALJ'~,,,OF ANCHORAGE ALASKA erlUlROllmerlTAL CONTROL ..... 1~ ~ ~71R'O'N M E!i411~,~L PROTECTION ~n§in¢¢rin§ ~, ~nuironmcntaJ SlucJies 'AU6 1 8 1988 BLOCK 4, GREENBR00K SUBDIVISION 1.0 1.1 1.2 1.3 1.4 1.5 2.0 2.1 2.2 2.3 2.4 2.5 GENERAL The drawings, sheets i r. hrough 4, shall be part of this specificatiou. All materials and workmanship .shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services (DHHS), the couditions of tile permit, and all applicable rules aud regulations currently ~n effect. All excawitions and depths are advisory, and are to be verified or modified in tile field by tile Engineer or inspectiug age.,:cy. IL is the responsibility of the owner or installer to adhere Lo approved design for tile installation, to maintain the specified separation distances and to have the appropriate inspections. If the installatiou is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at AECS should be consulted prior to construction, to determine the number of inspections that will be required and to explain what these inspections will involve. SEPTIC TANK If there zs an eKJ. st.Ln~ septic tank it may be used if it meets ~he capacity requirement for the residence. The structural integrity of the tank must be verified. The septic tank shall be a UPC-Approved two-compartment tank, constructed of 12-gauge steel with bitumastic coating and set level on undisturbed soil. If the tank is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation. The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 5 feet from the absorption area. Tile septic tank and bed shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class C wells, and 200 feet from Class A or B we!]s, un]ess otherwise specified. Less than the required separation distance must have prior approval or waiver by DHHS or Alaska Department of Environmental Conservation (ADEC). Pipiag shall be fitted with a mechanical watertight calder coupling oa the outlet and inlet of the septic tank. Piping sha!] be 4-inch solid PVC ASTM D3034 or cast iron, sloped a minimum of 1/4 inch per lineal foot. If the piping is buried at a depth of 4 feet or ]ess, it must be insulated 2.6 2.7 3.0 3.1 3.3 3.4 3.5 3.7 3.8 ,,,.zJth an overlying layer of 2 inch bnria] type polystrene rigid hoard insulatio.,t. Cleanouts shall be instal!ed as designated and csppe¢, with air 'tight rain caps. (Jim caps or equivalent), and extend a minimum of ! foot above ground level. If a lift station is required it shall be a combination lift station septic tank per Anchorage Tank and Welding, Inc. design. See attached specifications. SEEPAGE BED The gravel for the bed shall be 0.5 'to 2.5 inch, screened rock with less thau 32 passing the #200 sieve residual. Ali. substitutes must have prior DIIHS approval. The bottom of -the excavation shall be !evei and raked with the backhoe blade to insure that the bottom has not been compacted durlng excavation. Sand, :for leveling, shall have a size distribution which meets the requirements of MOA code !5.65.077. The distribution pipe shall be perforated 4-inch rig.id PVC with a minimum crust strength of 1500 pounds and sbal! meet the approval of DHHS for use as drainfield pipe. Ail ,pipes shall be laid level, and spaced according to the drawings. Monitor standpipes shall be placed as shown in 'the drawings. They shall be 4-inch rigid PVC ASTM D-3034, or cast iron. The section shows with holes may be either drilled 0.5 inch holes on 6 inch centers on opposing sides of the pipe, or a section of regular perforated sewer pipe may be clamped to the solid section with a no-hub coupling or solvent joint. Perforated section shall be located in gravel only. The portion of pipe above the sewer rock stall be solid. A rubber raincap (Jim Cap or equivaleat) shall be placed over the top of the pipe. Insulation is required, using burial type polystene rigid board insulation. There shall be ! inch of insulation for every foot of soil less than the required 4 feet of cover, but 'there must be at least 24 inches of soil even though insulation is used. The solid pipe extending from the septic tank to the drainfieid shall also have 4 feet of cover or an equivaleut layer of insulation combined with soil. The side slope of the mound shall be sloped ! foot vertical to 3 foot horizontal. The the bed shall be planted with a white clover and red fescue mix or blue grass. 4.3, 4.4 INSPECTIONS This bed will require a minimum of three inspections. The first inspection will be of the open excavation, to assure that the system is installed in the proper soil strata, correct depth and meet minimum specified desiyn parameters. The second inspection w:lil be after placement of gravel, monitor standpipes, and distribution pipe, to verify proper installation and position of pipes prior to backfill. The third inspection will be after final backf_~l and yrading to ensure that adequate soil cover, has been provided over the bed. The inspection of the septic tank or lift station installation can be iucorporated with any oae of the above listed inspections. CONTROL SERVl~;m-~, ir~. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 CALCULATEDBY Z~ /~/C~/ DATE CHECKEDBY DATE SCALE .......... ~...~> ~,.~ ~-.-?...~ ~ ~ / ..... . --, ...... ~ ............ ~ .... ~ ~ ~.? ~ ..... ~ ~ : ~ ~ .... ~ ~' ~ :, ~ , ...... ~ ....... : ~ ........ : ...... ~ ~ :: ~ : '~ :- ,, -~ ~ .... ~ ......... ~ ...... : ........ ~ ......... : ..... : ~ ~ .: ........... ,:......., /y . .: j ~ ~ .........( ........... (.......~.: ; ) ..... ~ ~ ~;.-..) ....~ ~ .... ~ ......... ~ ~ ~ ~ ....... ) ...... ~ ........... } ~ ..~ .......... { ..... ~ ......... ) ..... ...... ~ ........ , ..... ~...,., ~ ............ , ...... Z.....~ ~ ~., ~ ...... , · ,,-~ ....... ~ ~ ~---'~ ....... ~' '~" "'~"' ~ ..... ~ ~ .... ~.~ ~ ~~.~/~..~.~.?~.'.~-~-+ ~,'~?~ ~ ~ ..~ ~ ~ ~ .......... ...... ...... ............. ..... :~ ~, ~ ~ ......... ~...~ .... :,.~...~ ~ t ......... ~..;~. ....... ~ , ..~ .......... ~ ~ ~ ,~ .~-:~/,~ ~:~. ......... ~ ~ ........ ~ :~ ........ ~ .... ~ ....... ~ ~ ~:....~ ..... ~ ........... ~. ~: ........... ~ ~ ........ ~ ..... , ~ ~ ..... ~ ~ ,:~ ~, ~ :~.~.L:~:~:........../~:.~.?..:~ ~.........~ .......... ~ ........ [ [~: ~.~ ,: .:.~:.:?.:~. [ ~ .... : ~ ....... : ~ ..... ~ ......... : ~ ........... : ', ......... ,, ......... ~ ........... ........ ~ ...... ~ .......... ~, ~ , ~'. , -~ ..... ~ ~ ~: , ..~ ..... .. : ~ , ,' ,, ....... ~, .......... , ~, '"~, ........... ~'. .: ............. .......... ..... CONTROL SERVICES, 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO, C~ CALCULATED BY CHECKED BY. OF ~'~ DATE. DATE PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST TOwnship, Range, Section: ~'/,~,4/ 1 2 3 4 5 6 7 8 9 10 11 12 13 !4 15- 16- 17- 18- 19- 20 COMMENTS ~J SLOPE SITE PLAN I-z ~ WAS GROUND WATER ENCOUNTERED? ! S L IF YES, AT WHAT ~.. '/ O DEPTH? '7 P E Depth to Waler After/j/,,, · · ' ' .orHor n§? ~'/.~'~/ Date: Gross Net Depth to Net Reading Date Time Time Water Dro PERCOLATION RATE . . TEST RUN BETWEEN ~- (minutes/inch) PERC HOLE DIAMETER __ FT AND --~ FT PERFORMED BY: }'~'~/'~'~'/q' I ,~, ~/ ,,'~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) NOTE SUBDIV15ION IS SERVED BY A PRIVATE WATER SYSTEM. ~1~ '[er h I,~OY C: REID, x , %/ xk \ / __p:le -I- NOTE: This As-built shall not be used for any purpase other than financing requirements. Under no ci rcu,~stances should any data hereon be used for construction or for est~blishlng boundary or fence lines. ' . ' ' ' - I h~eby cert~ ~at I have ~ey~ the "g .... :~_~ ~ro~ert~. ~-I ~ ~ ~ - ~chorage ~ecordmg Preclnc~ imnrovements situated thereon ~e ~th~ ~;~; ~.a ao not overlay or en~oaen on me prop~y '-~ a~]ac~nt thereto, t~at no improvements on. prop- ques~on and tha~. ~here ~e Vo lines or other visime easemen~ on as ~cated hereom Dated at ~chorage, Al~ka this_ I&~a ._d~ or ~~~' ~ED WA~ & ASS~IA~ Engineers and S~veyo~ .~ ~ .... . ' . ,.. · ... !"':,~< :...',.'.~ . · ... . MUNICIPALITY OF ANCHORAGE, BUILDING S~F~Tg'DIVi'S'ION . ;] . .,~ .' ,.. : · . LOT BLOCKt . , . .:'...". ., . . . FOOTING El' FOUNDATION I"-I BOND BEAM ~' [~ FRAMING [] ELEC, FINAL INSULATION [] OTHER SHEETROCK ~ [] STRUCT. FINAL [] FIRE FINAL. OTHER [] "ZONING '. IONCOMPLIANCE OBSERVED COMMENTS AT NEXT INSPECTION [3 GO N~T CONCEAL. ON'I' "..' : '-"?. 'il · · ".'"~'~/':.,": '"-' ..... · ?.,,~ .. ....:. ,: /,'. .:'. ..~ / '" ,"~ /,~ . . .':: ." :L:,:,'"""'V"''. ,''.. .'" / ,! :'~ : ,, . .... ': ..... ,~ .' , ,/ INSPE(~T~R' ~,..:" ' ' ' ' DATt= . · WHEN CORRECTIONS ARE' ,~DE, PLEASE CALL FOR INsPEC' (~N':"'i DO' NOT REMOVE THIS No¥icE .'..':'-:: ".. "' ~'w, 11/87) ..' .. :.... ,.../ 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 NAME MAI LING ADDRESS LEGAL DESCRIPTION PHONE ~'NEW [~]UPGRADE LOCATION Well DISTANCE TO: ~t,~ ~J,~ Manufacturer ~ Liq. capacity in gallons [ .~ u~ DISTANCE TO: [Well Manufacturer ] Well I DISTANCE TO: I -- -- No. of lines Length of each line ~ngth Width ~ Crib diameter ~ell icl Bepth Buildino foundation DISTA~C~ TO: Absorption ar Dwelling ~Z &ela Material Inside length Width Dwelling NO. OF BEDROOMS PERMIT NO, No. of compartments Liquid depth PERMIT NO. Material Liquid capacity in gallons Foundation ~_.~ Nearestlotline ~ ~ PERMITNO. '7 ~)~-'~10 Total length of I~nes .Tr.~ench. w~id~h ~r.~,,~,,'~- Distance between lines ~.~ I Material beneath tile Depth Total effective absorption a~e,a~ PERMIT NO. ~ Crib depth Total effective absorption area Building foundation Nearest Pot line Driller Distance to lot line PERMIT NO. Sewer Jine Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) SHEET NO. OF I::I&t'W CONSULTANTS, INC. CALC BY DATE CHKD BY DATE :. ........ ~ ............. .~ .... ............... .~P e;~ ~ o ,':¢: g,'% ~.~..'R ~.~ ................: ....... ~OL)..~2~ ....................... .o..,~., ~ .'. i:::::::::::::: :G" ,--, ....... ~_~j~,~' 'o-~-'~c~v.^~' ~" :ii!! ~: ....................... i ...... ' ............................ I ..... .-' .......... : .... ' ..... i ...... :' ! .......... ! .... I .... i .........: ..... 'f:~:F.~.'~A3'~--tx ............... :::::::: ~::: ...:: :: g, ::: i o.. · '' ........ : ......... : ............ : ........ " c.) " .......................................... ;L~ 4 ¢¢; 7o;q, 'P.T,: :I ' ' ' i 2: ' ' .......... ~ ...................... ~ ......... ,. ........ ~ ......... : ......... ---:.--.--..-''-~''''''.''' ........ !.. ' ..... i;;;.-,-~-,,. ~ ,-,.~.?. · ,.~.~. ~--:~'~-' '~-~'~",' ........... ' ................... ~ ...... ' ..... .:.i~..i. :..:~:~:.~':..~i..:~..:...~!~:~::~:.~ ~ ............................ :: ...... ' .... ~' '¢0,,~_:~ ~;N ¥%~ O .3 W~ ' ~- I--,-~ .............................. i' .____.____... ______.. . ?~,J i~'_.]-¢. .: ................... :... i: :A~c. fio~A:c~Cz:i: :::::: :: ,-~ .... ........ ! ......... [ ...................... LC''!-- ' ~ · ' : ~ ......... i ........................... i ......... i ....... ,"~:1 ? ........ ~ ......... ! ........................... ",- ~. · ....... i...:. ..... i ................. i ......... i ......... ~ ......... ~ .........~ ......... ~ ......... ! ......... i ........ i"T'T"FT"FT'T"F'21'":":":"TT'T'T'T'T'T"T'FT'T'T"F':'"TT'T'T' ':"':'":'":'":'":'":'":"T":' ":'"~ ~ A'~:~;:'":~'¢'~:L~'EL-T '::' ~"F "-:: ' ';?V ;~",;~ .......................... ': ....................................... .......... ~ ......... ~ ......... ~ ......... i ......... i ........ ~ ......... ~ ........ -: ......... ~' ' ....... : ......... : ......... ~ ......... i ......... : ......... : ......... : Ci~'-4~ SITE PERMIT NO. ( 78~'~97~:.~ ) 8PPLICBNT 9ERN' DENNISON LOCFtTION DE~IRMOUN RDZVON SC:H. IJESON LEGI:IL L~J~ B ,~, GREENBROOK S,."D DEPBRTMENT OF HEBL.]'H 8ND ENVtRONMENTBL PROTECTION 825 '"L'" STREET., 8NCHORBGE, BK. 99501 264-4720 S,E~,-~ER F'ER~I I T 462? OLD SEWBRD HWY LOT SIZE TYPE OF SOIL 8BSORBTION SYSTEM IS: DRBINFIELD 2]~2 4625 54000 SQURRE FEET MBNIMUM NUMBER OF BEDROOMS SOIL RBTING (SQ FT/BR)= 205 THE REQUIRED SIZE OF THE SOIL 88SORPTION SYSTEM IS: [)EF-1-H= ;~ LFZ[-4GTH= :t24 GF-:FIV[£L [:, E F"F [-~ = [5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINF'IELD. THE DEPTH OF B TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURF8CE OF THE GROUND 8ND THE BOTTOM OF THE E::.:',CB;.,'BTION (IN FEET). THE TE:E~L-:H b~ ]] [:,TH I S 5. ElkZl~-_l FEET THE GRBVEL DEPTH IS THE MINIMUM DEPTH OF GRR',,,'EL BETWEEN THE OUTFBLL PIPE 8ND THE BOTTOM OF THE E~'.',CBVBTION (IN FEET). PERMIT BPPLICBNT HBS THE RESPONSIBILITY TO INFORM THIS DEPBRTMENT DURING THE INST8LLBTION INSPECTIONS OF 8NY WELLS 8DJBCENT TO THIS PROPERT'.~' FIND THE NUMBER OF RESIDENCES TH8T THE WELL WILL SER°,,,'E. ....... Tk~Zg (2) I BBCKFILLING OF 8NY SYSTEM WITHOUT FINBL INSPECTION 8ND 8PPROVBL BY THIS DEPBRTMENT WILL 8E SUBJECT TO PROSECUTION. MINIMUM DISIBNCE BETWEEN 8 WELL BND ANY ON-SITE SEWRGE DISPOSBL SYSTEM IS ±00 FEET FOR 8 PRI9BTE WELB OR i50 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS MBY 8PPLY. SPECIFIC8TIONS 8ND CONSTRUCTION DIBGRBMS ~RE 8VBILBBLE TO INSURE PROPER INSTBLLBTION. F'E]F,.:'F1 I T E)..::F' I REs, C-,EC:Er-IBEF: 3-t_, ~1.:.-7~?:E: I CERTIFY THRT i: I BM FRMILIBR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS RS SET FORTH BY THE MUNICIPBLITY OF 8NCHORBGE. 2~ I WILL INSTBLL THE SYSTEM IN 8CCORDBNCE WITH THE CODES. ~': I UNDERSTBND THBT THE ON-SITE SEWER SYSTEM MBY REQUIRE ENL8RGEMENT IF THE )RING NUMBER i Date Completed: SOIL DESCRIPTION of T.H. ORGANIC SILT dark brown 1.5r SILT (~) gLay~ and brown mottled, moist SILT W/TRACE SAND AND GRAVEL (~L) occasional angular cobbles, sand mostly in discontinuous lenses containing some water 8' A.B. ---iO.0'T.D. Groundwater encountered at 8' LOCATION SKETCH No Scale HOUSE UNDER CONSTRUCTION NOTE: DISTANCES SHOWN ARE APPROXIMATE AND HAVE NOT BEEN MEASUREO BY SURVEYING METHODS. EXPLANATION ~ ..,. ORGANIC MATERIAL Little Visible Ice O:-IO' V× -- "': ~ ICE DESCRIPTION ~-~f.. ~Ss,72 5z~% ,85.9pcf 5~": I I ~WATWR CONTENT .s- ~ I ~ows/roor  ~0~ STRATA CHANG~ ~ _ BEDROC~ TYPICAL SOILS LOG''i-] Ss Id"SPLIT SPOON WITH 140 L~ HAMMER $ z L 4" SPLIT SPOON WITH $40 LB. HAMMER Sh ~5" SPLIT SPOON WITH ,.~'~0 LB. HAMMER ~7~ SILT ~ BEDROCK SAND ~ lC~' M,~3SIVE Lot 4 Block 2 Greenbrook Subdivision Anchorager Alaska GRID. PROd. NO. 85115 DWG.NO. A-01 J ELAPSED TItlE TIME 9:29 0 9:30 1 9:32 3 9:34 5 9:39 10 9:49 20 9:59 30-= 10:09 40 10:18 50 10:29 60 Table 1 PERCOLATION TEST R&M No. 851151 INCHES DROP IN INCHES 8 3 8 4 84 8 6 8 6 8.8 8.9 9.0 9.1 0o 3 inch in 30 minutes 100 minutes per inch Test performed within test pit at a level 5.5 ft. below original ground surface. BORING NUMBER 2 Date Completed: SOIL DESCRIPTION ORGANIC SILT SILT (ML) 1 ight tan 3.0~ SILT W/TRACE TO SOME SAND AND GRAVEL (bLL) occasional cobbles, gray and brown mottled, moist 5' --SAND G~AVSL ----y---- -- W/TRACS SILT (GM- GW) .-- __g r__ay~_ m~is_q_ --7. SILT (ML) occasional cobbles, ~ moist, tan 14.5' T.D. No groundwater encountered LOCATION SKETCH No Scale [ Backhoe ?est ]Pits F I House Under Construction NOTE: DISTANCES SHOWN ARE APPROXIMATE AND ItAVE NOT BEEN MEASURED BY SURVEYING METHODS. EXPLaNaTION ORGANIC MATERIA~-- / Little Visible Ice OLIO' Vx  BEDROCK TYPICAL SAMPLER TYPE SYMBOLS SOIL SYMBOLS ~[)WN. L,:..A_L.':j<?: [[~'"' SOILS LOG ]J Lot 4, Block 2 Greer~rook Subdivision Anchorage, Alaska [ 1 GRID, £,~O,tNO. 85 l'tS z_ J DWG. NO. A-01 fl PERCOLATION TEST TABLE 1 R&M NO. 851151 TIb~ 12:©3 i2:04 12:06 32:08 12:23 ].2:33 12:43 i. 2:53 1.:03 ELAPSED TIME 0 1 3 5 10 2O 3O 4O 50 60 INCHES 9.5 9.7 10.2 10.8 11.8 12.8 13.6 14.3 DROP IN INCHES 0.3 0.2 0.5 0.6 1.0 1~0 0.8 0.7 0.3 1,8 inches 16.7 minutes per inch October 6, 1978 R~I No. 851151 Syren & Sons 2330 East Tudor Road Anchorage, Alaska 99507 Subject: Soil Investigation for Sanitary Sewer System, Lot ~, Block ~,~ ' Greenbrook Subdivision, Anchorage, Alaska ~ Gentlemen: At your request of October 5, 1978, we conducted a subsurface soils investi- gation at the proposed location of the sanitary sewer system on the subject lot. The investigation complied with those procedures required by the Municipality of Anchorage Department of Health and Envirorm~ental Protection. This investigation, which was accomplished on October 6, 1978, consisted of a test hole excavated to a depth of 10 feet below the existing ground surface. The test hole was dug prior to our investigation and its location is shown in attached Drawing A-01. Excavation was accomplished with a backhoe. A sample was taken at the depths shown on the soils log in Drawing A-01. The sample wii1 be held in storage at our lab for approximately six months. The topography at the excavation site is generally horizontal. At the time of the investigation the site had been stripped. The top of the test hole was located approximately 1.5 feet below original ground surface. The soils encountered in the excavation are shown in the test hole log in Drawing A-01. This log displays specific conditions encountered at the test location. However, subsurface conditions may vary in other parts of the lot ~ithout any apparent surficial evidence of the change. Groundwater was encountered in the test hole at a depth of 8 feet. At the time the hole was excavated seasonal frost was not present and permafrost was not encountered. An offset pit was excavated for the purpose of performing a percolation test. The pit was dug to a depth of-5.5 ft. and offset from Test Hole No. 1 a distance of 45 ft. Soils encountered in the offset hole were similar to those encountered in Test Hole No. 1. The percolation test was performed in a 2 ft. deep hole within the offset pit at the depth shown in the attached Table 1. All depths were measured from the top of the hole. The data in Table 1 show average infiltration from the depths indicated to the bottom of the hole. The measured percolation rate was 100 minutes per inch. October 6, 1978 Syren & Sons Page --2- We appreciated this opportunity to be of service to you. Please contact us if you have any questions concerning this letter or if we can be of addi- tional service. truly yours, R&M CONSULTANTS, INC. /~ gary Smith ~,' .... ~enior geologist GS/kah/12-V October 11, 1978 Rfbl No. 851151 Syren and Sons 2330 East Tudor Rd. Anchorage, Alaska Subject: Soil Investigation for Sanitary Sewer System, Lot~, Block Oreenbrook Subdivision, 3a~chorage, Alaska Gentlemen: At your request of October 9, 1978, we conducted a subsurface soils investi- gation at the proposed location of the sanitary sewer system on the subject lot. The investigation complied with those procedures required by the Munic- ipality of Anchorage Department of Health and Environmental Protection. On October 6, 1978 a test pit and percolation test proved the area just north of the partially completed house to be inadequate for the installation of a septic system. The purpose of this investigation was to explore subsurface conditions in other areas of the lot and to locate a suitable site for the septic system. The locations of the seven additional backhoe pits are shown in attached Drawing A-01. The site selected for the on-site system is at the location of Test Pits 2 and 3. The soils log of Test Pit 2 is shown in Drawing A-01. Test Pit 3 encountered the same soil conditions as in No. 2 and was dug to a depth of 515 feet for the purpose of conducting a percolation test. Other test pits encountered silts with minor sand and gravel generally in thin discontinuous / lenses. These lenses are water bearing below about 8 feet in Test Pits 1 and/ The 'topography at the excavation site is generally horizontal. At the time of the investigation the site had original vegetation consisting of brush, birch and large spruce. The top of the test hole was located at original ground surface. A percolation test was performed in a 2 foot deep hole at a depth of~.5..~£eet within Test Pit 3. All depths were measured from the to~~.e~h~ole. The data in Table 1 show average infiltration from the depths indi~a[~ to the bottom of the hole. The measured percolation rate was 16.7 minutes per inch. Ps, ge 2 We appreciated this opportunity to be of service to you. Please contact us if you have any questions concerning this letter or if we can be of addi- tional service. Very truly yours, R&M/~, ONSULTANT~, INC. r't ~ ,' Gar~/ /~. Smith Senf~r Geologist GAS/djb/18-D MEIVIORAIMr~UM TO Syren & Sons 2330 E. Tudor Rd.' / Anchoraqe, Alaska 9~07/j~-- ~ROM Gary A. Sm~// SUBJECT Soil Investigation for Sanitary Sewer syste~ Lot 4, Block 2, Greenbrook Subdivision, Anchorage~ Alaska DATE [PROJECT NO. October 12, 1978 851151 Site visit was made this date to inspect excavated area for seepage bed in the SE corner of the lot. The excavation (approx. 20' x 30') is located at the site of the earlier percolation test. The excavation was extended to the top of the sand and gravel zone (5.5') where the percolation test was performed. Although it appears to thin on the north end, the sand and gravel was exposed in the entire floor area of the eXcavation. The excavation is considered suitable for installation of a seepage bed. XC: Municipality of Anchorage Dept. of Health and Environmental Protection 001650 MUNICIPALITY OF ANCHORAGE o ,fit Development Services Department a p P � Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-431-15-000 Expiration Date: 6/30/2024 Legal description GREENBROOK BLK 4 LT 2 Site address 6800 TERESA CIR Anchorage AK 99516 Current property owner(s) OCHADLEUS ERIC J & MARIE A The On -site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: ✓ w T- 14-1k t s 7 ,q LL-r� blvC �S�' I`-D �-v l S 5 �-'I� ►7 0 Original Certificate Date: 1 /2/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovWjune 2022 MUNMPAUTY OF Am HO RAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-431-15 Complete legal description GREENBROOK; BLOCK 4, LOT 2 Location (site address) 6800 TERESA CIRCLE, ANCHORAGE, AK 99516 Current property owner(s) ERIC & MARIE OCHADLEUS Day phone 907-717-4881 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units 0 Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: FNI Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel N Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS 0 Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee Date of Payment COSA # U l G Z >/ -! lD Waiver Fee $ Date of Payment Waiver # COSA Applicatlon June2022 Legal Description: GREENBROOK; BLOCK 4, LOT 2 Parcel ID: 017-431-15 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 LL DATA SERVED BY A CCJMMUNITY WATER SYSTEM ❑ Well log i with Onsite (or attached) Well production at time of test gpm Date drilled I depth ft Water storage tank v gallons Cased to ft Well disi for coliform test? ❑ Yes I'm ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) _ °® Date of flow test for COS Static water le eginning of test ft. B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 2/1990 ❑ ALL standpipes present per record drawing Total measured depth from grade 3•1 ft (max) Measured depth to pipe invert from grade 2.9 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 4.4" ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) N/A If yes, enter date • o form bacteria is Negative mg/L ❑ Nitrate less than MRL (ND) ug/L ❑ Arsenic less than MRL (ND) Collected by Date C. LIFT STATION ❑ Required maintenance completed Age of lift station NEW years Lift station material PLASTIC Comments: Adequacy test date 12/5/2023 Results ❑ Pass Fluid depth prior to test 0 in Water added 657 gal New fluid depth *2 in Elapsed time 150 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 1.6 in Effective depth remaining 4.4 in Comments/Deficiencies: *2" IN DRAINFIELD AFTER INTRODUCTION OF 305 GALLONS AND REMAINED AT 2" THOUGHOUT THE REST OF THE TEST. COSA Checklist June 2022 E. SEPARATION DISTANCES VP0m.ez1vate Well on Lot to: (Please enter distances if less than required or if community well on lot) .� Septic Tank/Li on Lot > 100' Community Sewer Man eanout > 100' Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes i _ ft a e Sewer/Septic Line > 25' F] Yes if No ft Absorption Field on Lot > 100' ❑ Yes if ft Tank > 100' ❑Yes if No ft Neighboring Absorption F _ 0' Animal Containm _ ❑Yes if No ft Yes if No ft �.�F1 Manure/Animal Excreta Storage > nity Sewer Main > 75' ❑Yes if No ft (> Yes if o ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' n Yes if No ft Tank to Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No *71* ft Private Wells > 100' Cj Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' n Yes if No ft Water Service Line > 10' FBI Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *WAIVER GRANTED (WAIVER #OSV231061). G. CERTIFICATION & 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, indicates that the on -site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Gamess Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances to identifiable o�6o0©O o� O� A QUO were measured readily features. Hidden defects or encroachments may exist that were not identified during the . . 95�0 evaluation. The operational life of all wells and septic systems depend p ` _ S, upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate Q p 0) during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing * 4. TH ••7 the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not :. ........... .. ............ 3uarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the currents stems fail to perform Y P adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG e �0 ....... ......... r y .Gar ess.= to perform the evaluation. Reliance upon the information provided in this report by any other person or party 9 ., Q d, �4{e�e E_79 •• �G (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. •..... • COSAChecklist—June 2022 �o°o uCENSE� q rofes -%of% � NAECce84 2 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 01 7-431 -1 5 ' HAA # ' ¥;::~ ~c-~ -~ -~, 1. Gi=NERAL INFORMATION Complete legal description Lot 2; Block 4; Greenbrook Subdivision Location (sit,e address or directions) 6800 Teresa Circle Anchorage, AK Property owner Mailing address Lend!rig agency Mailin_g address Agent Address C~ndRn~ Mobility Services Dayphone C/O Jack White Real Estate 3201 "C" Street Anchoraq~-, Day phone Patty Seymour/Jack White Day phone 762-31 52 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 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: XX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) F¢ont 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 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 is inspection. Wat Wa t Name of Firm ~-~ --~=~=~ ~? / ASdress 7320 C cle n,,.eeCs i . ture ALASKA WATER & WASTEWATER CONSULTANTS INC. IS TO BE PAID ~//00 ~ AT CLOSING FOR ENGINEERING SERVICES PERFORMED. DHHS SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with th-e following stipulations: Additional Comments By: ~¢__-¢/./~/q ~ /X/, /4~ 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 DH HS 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#21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343z~ Health Authority Approval Checklist A. WELL DATA Well type Log present (Y/N) Total depth IfA, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to -- Casing height (above ground) Sanitary seal (Y/N) FROM WELL LOG g.p.m. Wires properly protected (Y/N) AT INSPECTION Date of test ,, Static water level Well production g.p,m, WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~L~C~© Tank size Foundation cleanout~) Y'~q~ Pumper /~ '/-' ~7/~/~Number of Compartments /~ Cleanouts(~)2 Depression (Y/I~ /,O,5 High water alarm ~N) ~)/~ - ~/~ ~x:~/o,~ Date of Pumping C. ABSORPTION FIELD DATA - Fluid depth ,~y (ins) Minutes later: I~...~e,~uo. Absorption rate = Peroxide treatment (past 12 months) (Y/I~ ~'~? & r-~y/ If yes. give date 72-026 (Rev. 3/96)* ~ ~I~R~O ~/~ ~CO~ O~ q~5 'J- g.p.d. Date installed ~1~[c~0 Soil rating or ff~/bdrm)~-~ ~ System type ~ Total depth ~ /~Y ~'~ ~'~' Length ~,~ Width ~ Gravel thickness below pipe ¢~ ~ffective absorption area I~ MonitoringTube present.N) .~ Depression over field (~ Dateofadequacytes, Results(Pass/Fail, %~ For ~ bedrooms Fluid depth in absorption field before test (in.); ~ Immediately after gal water added (in.): LIFT STATION Date installed Manhole/Access (~N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size "Pump on" level at* *Datum '-~ "Pump off" level at* Septic/holding tank on lot Absorption field on lot Public sewer main SEPARATION DISTANCES FROM WELL ON LOT TO: Sewer/septic se~ice line ~/~ Lift station SEPARATION DISTANCES FROM SEPTIC/~ TANK ON LOTTO: Foundation ~ t,~ Prope~y line ~ ('~ Absorption field Water main/se~ice line JO ~.t Sudace water/drainage /~ *¢ Wells on adjacent lots On adjacent lots On adjacent lots Public sewer manhole/cleanout SEPARATION DISTANCE FROM AB.S_QRPTJON~FJELD ON LO]' TO: ...... D4-?'E/) PropeNy line /0 ~ ~/~ Building foundation lo ~'~ Water main/se~ice line lo'~ Sudace water /OO ~ Driveway. parking/vehicle storage area /O Cudain drai ~o~ ~. Wells on adjacent lots F. ENGINEER S CERTIFIC&TION ~ / I '/ ,co,ffy*atl¢¢d~,ih~fi~ld,nspoctionsandroviewofMunicipalrocor,~,~~ ,sara in conforman~e ~ith/~4~A~guide~nesin effecton this date. HAAFee $ ~ ' ~ Date of Payment /////:'~/~:~( Riot..ece..__ Number - . 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 GENERAL INFORMATION Complete legal description Lot 2; Block 4; Greenbrook Subdivision; Location (site add'ress or directions) 6800 Teresa Circle Property owner Mailing address Lending agency' Mailing address Lang & Sarah Sprague 6800 Teresa Circle~ Anchora,q e~ Day phone 345-8588 Alaska 99516 Day phone Agent Vince DeFil~ips VISTA/BETTER HOMES & GARDENS R~ ~T~ 344-9603 mobile- 244- 6038 Address 621 West Dimond Blvd. Anchoraqe~ Alaska 99515 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: 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: XX Public sewer 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 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 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 Address Engineer's signature S & S ENGINEERING 17034 ~.~n I~, EagJe River, AJasl(a 99577 Phone Date DHHS SIGNATURE / Approved for / Disapproved. bedrooms. Conditional approval for 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. 1/91] Sack MOA #~1 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type ~ Log present(Y/N) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number '~[1~"~-'~ Date completed Driller Total depth Cased to Casing height Wires properly protected (Y/N) AT INSPECTION Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level we, f~oTM Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot ~(-Jr' ; On adjacent lots ;On adjacentlots Public sewer main Sewer service line Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed '~ ~:~ ~ L~ Clean°uts~N) y Collected by: Tank size \~.~'--~ ~---~,'~,~-','~, Compartments '~- F~jU.~dati°n clean°ut~:~N) 7 Depression (Y~]~ /A Alarm tested (Y/N) High water alarm (Y/N) Date of pur~ping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lOt To property line Surface water/drainage On adjacent lots '~5;~ l"~ Foundation Absorption field ,~ I .~ Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent ~)N)T "Pump on" level at High water alarm level ~ Meets MOA electrical codes ~N) ~/ Manufacturer ~__.~1~. M an h o le/Access dEE:TN) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ~-3L~f..~ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed "-~.~ ~ ~'~ Length ,E3¢~. Width Total absorption area Depression over field (Y/~ Results~fail) Peroxide treatment (past 12 months) (Y~ Soilrating "~'~"-c~--z~/'¢-'~z~ Systemtype ~..?-.~,, ~.~¢'¢~ '~c;;>~ GravelthicknessUU-L)~ ~¢~Totaldepth/./~22,~-~ /~ ~11 Cleanouts presentd~N) Date of adequacy test for ~-~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~--~;Pr~ On adjacent lots ,'~g;:c>I 4-- Property line To building foundation \ ~ To existing or abandoned system on lot On adjacent lots '"~2c;> ~ J¢ Cutbank b-~p r.~ Water main/service line Surface water \ ~;:~:>~ J~ Driveway, parking/vehicle storage area Curtain drain b--~:. ~-~,.~--~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec~t..~.~t~.e~r~te of this inspection. S gnature 17034 Eagle River Loop Road N~. ~ ~/~ ~'4 ~) l H*;~ Engineer s Name ____ HAAFee$ /~ Waiver Fee: $ Date of Payment / - ¢ -~' , Date of Payment DEPT. OF ENVIRONMENTAL CONSERVATION WALTER J. H/CKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 (907) 563-6775 December 27, 1991 FOR: S & S Engineering PWSID Cf 210348 My review of the records on file in this office reveals that the Greenbrook Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer BR/cf ~/ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Business (c) Applicant is (check one): Lending Institution []; Owner/builder; Buyer []; Other [] (explain); (d) Lendinglnstitution,,,,~_.~_--_'_~',-~-?~' ~ Telephone (e) Address ,_._~ / Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family'~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY individual Well F"J Communityj~ Public [] Note: If community well system, must have written confirmation from !he State Department of Environ mental Conservation attesting to the legality and status. 4. 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. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 ~--~////,,~4'~ ¢ ..'~ ¢.~c~',,~--~ Telephone ~ ~ ~- ~ ~ ~ ~ Address ~ ~~ ~ /~ ~ ~/2~ .~ ~ ~ Date ,~/~--~ Engineer's Seal Approved ,...k~ Disapproved Conditional Terms of Conditio~l. Approval CAUTION The Muncipality of Ancl~orage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level MUNICIPALITY OF ANCHORAGE (MOA~) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ~ If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Cased to Depth of Grouting 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 Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adj$'ining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~-~ j~';27 Size ,,/~4.~ O NO. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) '/~/ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Welt /'~../~," ~ ~ ¢ To Property Line ~'~ ~ / To Water Main/Service Line ¢~?,~'" ~ ~ Foundation Cleanout (Y/N) Date Last Pumped --~---------------~'~ ,/¢-~;"~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation d_,:, ' To Disposal Field ~ · To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ..,,~/ ~..--¢.~-3v~ Width of Field /,¢,;2/ Square Feet of Absorption Area (-., 4 ~=' Depression over Field (Y/N) ./V' Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well _/r-~,..?¢~.-. ~ To Building Foundation ~--~' Lot -- To Property Line ~ · To Existing or Abandoned System on ; On Adjoining Lots -- LIFT STATION To Water Main/Service Line .~'O' ¢' To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course r To Driveway, Parking Area, or Vehicle Storage Area ~,_.~-,¢" .~"~::~ ~ Comments /'~.,~.--'/,'¢,~/ ~,,/~..2,¢,_.,.. /,,,'¢-~ ~'~-~¢~ '-J'4~,~" ,~'~" ~>,.~--,,~.~-.~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sig ned~~~",'~~ Date Compan~'_~-~/~J~-~-?~';$'-~ ~'~ ~OA ~o. Beceipt ~o. ~ ~~ Date of Payment ¢--/¢~ ~& ~ ,~ ,, .~.. - .. --, .. Eng neers Seal 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 'IE" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE: To Whom it May Concern: According to records on file in this office the ~~,~ c~//~ Water System is in compliance with the State Drinking Water Regulations Sincerely, MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF }:,~ALTH &  825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ?~OTECTJON DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten {10) days for processing. 1. PROPERTY OWNER PHONE PROPERTY RESIDENT (If different from above} PRONE 2. BUYER -- MAILING ADDRESS 3. LENDING INSTITUTION ~ PHONE MAILING ADDRESS ~. REALTOR/AGENT ] PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION ;TREET LOCATION 6. TYPE OF RESIDENCE [~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five ~ Three [] Six [] Other 7. WATER ~UPPLY ' ~ INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ~[~J' COMMUNITY since June1975. For wells drilted prior to that date, givewell [] PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM **If individual/on-site, give installation date tq'~)-~[~?'2 [~-~'1N DI VI DUAL/ON-SITE** 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. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVE~' INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE E~ THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED E3PUBLIC UTILITY Connection Verified INSTALLER Size: J E~'~' If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line 1 WELL TO: Absorption Area to nearest-Lot Line 5, COMMENTS [~-- APPROVED FOR -~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany cCficate) [] DISAPPROVED DATE BY (Title)/~ // 72-010 (Rev. 3/78)