HomeMy WebLinkAboutGREENBROOK BLK 4 LT 5Greenbrook
lock 4
Lot
017-431
-12
Municipality of Anchorage
Development Services Department
Building Safety Division .
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak, us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND]OR WELL INSPECTION REPORT
Permit Number: OSPllll09 PID Number: 017-431-12
N .... JOERENE M. HOUT Wastewater System: [] New [] Upgrade
Address:
6801 Teresa Circle~ Anchorage~ AK 99516 ABSORPTION FIELD
Phone: Number of Bedrooms:
3 I~ Deep Trench [] ShallowTrench [] Bed [] Mound [] Other:
LEGAL DESCRIPTION Soil Rating: Total Depth from original grade:
1.2 GPD/Ft2 11 Ft,
Block: Lot: Subdivision:
Depth to pipe bottom from original grade: Gravel depth beneath pipe:
4 5 Greenbrook 5.52 Ft. 5.48 Ft.
Township: Range: Section:
Fill added above original grade: Gravel Length:
- 0.4 Ft. 38 Ft.
Well: [] New [] Upgrade Gravelwidth: Numberofli .... I Distance between lines:
3 Ft. ]I -' Ft.
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Class A Ft. Ft. 416 Ft2 D3034 / F810
Driller: Date Drilled: Static Water Level: Installer:
Date Installed:
Ft. Mike Anderson ~
Yield: GPM Pump Set at: Casing Height Above Ground:
Ft. Ft. TAN K
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
To Septic Absorption Lift Holding ~ublic/Private Manufacturer:
Capacity:
~ Tank Field Station Tank Sewer Line Anchorage Tank 1000 Gal.
Well 200'+ 200'+ SA NA 25'+ Material: Number of Compartments:
Steel 2
Surface Water leo'+ lOOt+ NA NA ~ / LIFT STATION
Lot Line 5~+ 10~+ NA NAA Size: Manufacturer:
Gal.
Foundation St+ 10T+ NA NA "Pump on" level at: "Pump off' level at: in. High water alarm at:
Curtain Drain NA * 50'+ NA NA Pump Make & Model Electrical Inspections performed by:
Remarks:
· None known. Existing septic tank was decommissioned BENCH MARK
per code, Location and Description:
Bottom of siding
Assumed Elevation:
100 Ft.
Engineer's Stamp
Inspections performed by: ArcTerra Dates: 1sT & 2ND 6/22.23/201!
Devel°pment,,/__Services Department Approval
Reviewed and approved by: Ff~..//'.~ £~,~ ~-">c-~ Date: ~ ~ r__{~
AS-BUILT SYSTEM DETAILS/SITE PLAN
GREENBROOK BLOCK 4, LOT 5 / / .x/w~
Permit 0SPl11109 / / ,///W
PID# 017-431-20 NE~ 1000 ~A~. S.T. ~ 3~-~-~.~-~-~.~.~
i / ~'/ ~~ EXISTING
~ / ~:/ /~a HOUSE .'~.v.v.v.v.'.v.'.v.v.v.v
~ ~ - ~. v.v.v.v, v
~ SCALE: 1" = 30'
A-D=17.1'
B-D=10.8' < ~ < = ~=~
5B-E=43.6' i~ FINAL GRADE
o I
.0-.:36, ,
B-F=5~ .5 ............. ~
5 -~ ~000~ IX
~ ~ SEWER ROCK
~ TANK I
~%OF ~.~ SCALE: NTS
* 6801 TERESA CIRCLE
~~ T~~e~ ANCHO~GE, AK 99516
eou~o~: BOUNDARY ~: BMW ~
~% ~/=M/t.[, ¢~ A~UILT: REJ D,m: 6/15/11 't..~ .....
, ~. 99577-~
PINAL (3MADE
SEWER ROCK
Permit Number:
Tax Code Number:
Work Type:
Permit Effective Dates:
Design Engineer:
Subdivision:
Site Legal Address:
Owner/Address:
Site Mailing Address:
On-Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
OSPl11109
O1743112OOO
Septic Upgrade
June 20,2011 to
ARC TERRA CONSULTING INC
GREENBROOK
June 19,2012
GREENBROOKBLK 4 LT 5 G:2839
Depar tm. eh t
ARC TERRA CONSULTING INC
20441 PTARMIGAN BLVD EAGLE RIVER AK 99577
6801 TERESA CIR, Anchorage
Lot Size in Sq Ft: 47444
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y Septic Tank
N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with: 1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017-431-12
Property owner(s) JOER EN E HOUT
Mailing address6801 TERESA CIRCLE, ANCHORAGE, AK
Site address 6801 TERESA CIRCLE, ANCHORAGE, AK
Day phone
Zip Code 99516
Zip Code 99516
Legal description (Sub'd., Block & Lot) GREENBROOK BLOCK 4, LOT 5
Legal description (Township, Range & Section)
Lot Size47,444 Sq. Ft. Number of Bedrooms 3
THIS APPLICATION IS FOR ([] all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
ARCTERRA
(Signature of propert~er or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
CONSULTING, INC
212 E. 51st Ave, Anchorage, AK. 99503
) 868-3791, Fax (907) 868-3793
June 14, 2011
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Upgrade Sewer Permit - Greenbrook Block 4, Lot 5
The owner has requested we proceed forward to obtain a septic permit to
upgrade the failed leachfield on the subject lot. The general slope of this lot is
from east to west at a grade of approximately 3-7%.
On June 4, 2011 a testhole was performed to investigate soils and groundwater.
The results of this test are attached for your review. The proposed upgrade will
serve the existing 3-bedroom house. We propose to install one 38' long deep
trench. Groundwater was not encountered at during excavation or at
monitoring.
The property and adjacent lots are served by a Class A community water system.
There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect
on adjacent lots by the development of this system. If you have any questions,
please contact me at 868-3792 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
Attachments:
On-Site Sewer Application
Wastewater Absorption System Details / Site Plan
Soils Log/Percolation Test
Owner/Contractor Specs
20441 PTARMIGAN BLVD · EAGLE RIVER, AK 99577-8736 ° PH (907) 868-3791 ° FAX (907) 868-3793
WASTEWATER DISPOSAL SYSTEM DETAILS
GREENBROOK BLOCK 4, LOT 5
3 PROPERTY
WATER LINE & EA
PRIOR TO
3
ON
PROPERTIES SERVED
BY CLASS A WATER SYSTEM
Scale: 1"= 100'
PAGE 2 OF 2
PREPARED FOR:
JOERENE M HOUT
6801 TERESA CIRCLE
ANCHORAGE, AK 99516
FIELD BOOKS COMPUTED: --
BOUNDARY:BOUNDARY ~-BMW
ST*K,Ne STAKING ~ --~'~"D-
ASSUILT: REJ ~ 6/13/11
^CAO riLE: FILE ~oB No.: 11-056
WELL & WASTEWATER DISPOSAL SYSTEM
GREENBROOK BLOCK 4, LOT5
REMOVE EXISTING S.T. PER CODE
& INSTALL NEW 1000 GAL. S.T.
W/2 POST TANK COs &
NSTALL NEW 38'L x 3'W x 5'D
12' MAX DEPTH
LOT 6
EXISTING
3-BP
HOUSE
TH11-1
DETAILS/SITE PLAN
FLAXQI~-.ROPERTY L1NE$ ~4/
WATER L~N.E & EASEM--~E~TSO/~/t.
PRIOR TO C~:~STRUCTION~ v~,
DESIGN DETAILS
3 BDRM X 150 GPD = 450 GPD
LOT 5
KEY BOX
450 GPD/1.2 GPD PER SQ. FT. (2.8 MIN/IN.)= 375 SQ. FT Scale: 1"= 40'
(375 / 2 x (5' GRAVEL) = 37.5 FT. TRENCH
USE 1 TRENCH - 38' (L) X 2' (W) X 5' (D) PAGE 1 OF 2
NO PUBLIC WELLS WITHIN 200' OF Total depth of system is 12' max from odginal grade.
PROPOSED SYSTEM. Total depth of gravel below distribution pipe is 5'
NO PRIVATE WELLS WITHIN 200' OF '
PROPOSED SYSTEM EXCEPT AS NOTED. NOTES:
NO SEPTIC SYSTEMS WITHIN 200' OF
PROPOSED WELL EXCEPT AS NOTED. 1. INSTALL NEW 1000 GAL & INSULATE TANK IF <4' COVER.
2. INSULATE TRENCHES WITH 2" HD BURIAL FOAM IF < 3' OF FILL.
MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ.
3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK.
4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
~~'~,~, WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC...
JOERENE M HOUT
6801 TERESA CIRCLE ~'~
ANCHORAGE, AK 99516 ~
FIELD BOOKS COMPUTED:
BOUNDARY: BOUNDARh
STAKING: STAKING CH~C~: KMD '~-
'-,.j.,
^c^9 mE: FILE Joe Ne.: 11-056 ~/~, AK. 9957?
Performed for:
A ¢TERRA
212 E. 51 st Ave, Anchorage, AK. 99503
(907) 868-3791, Fax (907) 868-3793
SOILS PERCOLATION TEST
Joerene Hout
Date Performed: 06/4/11
Project:
Depth
(Feet)
11-
12-
13-
16-
17-
19-
20-
Greenbrook Block 4, Lot 5
Org/OL
GM-SP/GP mod dense, trace of silt,
sand increasing w/depth
w/cobbles to 1'
B.O.H.
TEST HOLE # TH 11-1
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? NO
Depth to water after monitoring? NO
What depth? NA
Date? 6/13/11
Reading Date Gross Net Depth to Net
Time Time Water Drop
1 6/4/11 1:00 6"
2 1:10 10rain 25/16" 3 11/16"
3 * 1:11 6" _
4 1:21 10min 25/16" 3 11/16"
5 * 1:22 - 6"
6 1:32 10 min 2 6/16" 3 10/16"
7 * 1:33 6"
8 1:43 10 min 2 7/16" 3 9/16"
9 * 1:44 6"
10 1:54 10 rain 2 8/16" 3 8/16"
11 * 1:55 6" _
12 2:05 10 min 2 8/16" 3 8/16"
· Water Added
Percolation Rate 2.86 (min/in) Perc Hole Diameter 6"
Test Run Between 4.5 feet and 5.5 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State
and Municipal guidelines in effect on this date.
c TERRA
~ CONSULTING~ INC
212 E. 51 st Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS
LEGAL DESCRIPTION: GREENBROOK BLOCK 4, LOT 5
GENERAL:
1. The scope of this project includes the installation of a septic tank and or
drainfield to serve a single-family residence on the referenced property as
delineated on the attached Municipality of Anchorage (MOA) permit and site
plan. Construction shall be in accordance with the approved site plan and
design drawings; MOA permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
2. ArcTerra Engineering & Surveying, Inc. (ArcTerra) assumes no responsibility of
the accuracy of the as-built survey provided by the owner or owner's
representative.
3. The owner or contractor is responsible to notify the engineer of any discrepancies
noted on the design plans or drawings prior to commencing work. These
discrepancies could be, but not limited to, possible encroachments, surface water,
varying soils, unplatted easements, types or use of dwellings on or adjacent to
property, nearby public wells, etc.
4. The contractor shall be responsible for locating any necessary underground
utilities, easements, property lines and surface water. The owner and/or
contractor shall ensure, if deemed appropriate, that a registered land surveyor
prior to construction flags all setbacks. The contractor shall be responsible for
verifying all pertinent separation distances and component layout.
5. Unless specifically agreed otherwise, the property owner shall be responsible for
final grading areas subsequently depressed from soil settling. On all leachfield
mound systems, the property owner shall be responsible for ensuring a
satisfactory vegetation growth over the mounded area.
6. The MOA Development Services Department On-Site Water & Wastewater
Program must certify contractors installing wastewater disposal systems.
Owners installing their own systems must also receive prior approval from said
MOA Department.
SEPTIC TANK / HOLDING TANK [ LIFT STATION INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded with proper material and compacting
to prevent damaging, settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches above the
final grade.
4. Septic tanks installed with less than 4 foot of cover shall be insulated. The
contractor will ensure that the fill over the tank does not exceed the burial depth
rating.
5. A foundation cleanout shall be installed one to four feet from the building
foundation. In the line between the tank and the leachfield there shall be two
adjacent cleanouts (unless an effluent pumping system exists within the septic
Greenbrook B4, L5
June 13, 2011
Page 2 of 3
tank). These cleanouts shall be located on undisturbed soil not more than 10 feet
from the tank. The second cleanout, in line, shall be to clean toward the septic
tank.
6. Final grading over the septic tank shall be such that a positive slope exists away
from the septic tank.
7. All H.D.P.E. tanks shall have a vertical length of 4-inch perforated drainpipe
besides the tank extending to the bottom of the tank to above grade to monitor
ground water.
8. All tanks shall be anchored when there is not enough adequate soil cover to
resist buoyancy forces in high-groundwater areas.
9. All holding tanks and lift stations shall have an audible and visual alarm inside
the residence.
10. All lift stations shall be wired in compliance with the Uniform Electrical Code
and all MOA guidelines.
11. The contractor shall remove the old tank, or abandon it in compliance with the
Uniform Plumbing Code. The contractor is solely responsible for the
abandonment procedure.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the sidewalls of the
excavaction become smeared, they must be raked or scratched (roughed-up)
before gravel (sewer rock) placement.
2. Once the sewer rock is installed, the distribution pipe is installed level with the
perforations facing downward. Gravel is then to be placed over the distribution
pipe to provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel layer and the native soil
backfill. Ensure the silt barrier covers the entire gravel surface before placing
backfill.
4. Monitoring tubes shall be four- (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending through the gravel shall be
perforated from the bottom of the trench to the invert of the distribution pipe.
This is equivalent to the effective depth of the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four inches.
Insulation must be installed when the backfill depth is less than thirty-six (36)
inches. The finish grade over the trench must be mounded to prevent the
formation of a depression after settling.
6. All advanced technology waste water disposal systems (Advantex, Biocycle,
Intermittent Dosing Sand Filter, etc...) shall be constructed, installed, maintained
and monitored per manufacturer's specifications and MOA requirements.
MINIMUM MATERIAL SPECIFICATIONS:
1. A MOA approved septic tank manufacturer must construct any septic tank
proposed for installation.
2. The following pipe materials are MOA approved for use in septic system
installations:
_Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
20441 PTARMIGAN BLVD · EAGLE RIVER, AK 99577-8736 · PH (907) 868-3791 ° FAX (907) 868-3793
Greenbrook B4, L5
June 13, 2011
Page 3 of 3
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder,
Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be
installed between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than
3% passing the #200 sieve. If deemed necessary, a sieve analysis should be
performed.
7. When sand is being used as a filter material, its gradation specification must
conform to current MOA or ADEC requirements.
INSPECTIONS:
Typically there will be three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the sewer rock,
distribution lines, standpipes, and cleanouts, but before the placement of the silt
barrier, insulation, or any other backfill.
3.The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required, especially with the
installation of multiple trenches, sand filters, pressurized distribution systems, etc. The
inspecting engineer is to be contacted at least 24 hours prior to the start of construction.
If necessary, a pre-construction meeting will take place on-site. The inspecting engineer
will not coordinate, direct or control in any way the contractor's activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and attached plans and in accordance with the attached MOA permit. All
materials, components, and construction practices shall comply with the MOA's and the
State of Alaska's latest ordinances, regulations, or policies regarding wells and septic
systems. The failure of the inspecting engineer to notice a material or construction non-
compliance does not relieve the contractor of his/her responsibility to correct such
deficiency. There will be no contractual arrangement existing between the contractor
and ArcTerra. ArcTerra shall be the owner's representative and will inspect the work as
stated above to document the contractor's activities. Final acceptance of the contractor's
work rests with the owner and the MOA.
ArcTerra shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these construction documents.
ArcTerra's inspecting engineer will not be responsible for the construction means,
methods, and techniques, sequence, procedures or the safety precautions incident to this
project.
BY PROCEEDING FORWARD WITH THE INSTALLATION OF THE WATER
AND/OR WASTEWATER SYSTEM (S), THE PROPERTY OWNER, CONTRACTOR,
AND WELL DRILLER ACKNOWLEDGE HAVING READ AND ACCEPTED THESE
SPECIFICATIONS.
20441 PTARMIGAN BLVD · EAGLE RIVER, AK 99577-8736 · PH (907) 868-3791 ° FAX (907) 868-3793
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENI'AL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~AME
2i9'7 /;7 / r i, k
LEGAL DESCRIPTION
lot ;f-/ l ck g
PHONE [] NEW
LOCATION
DISTANCETO: J Well . L//)~' '~ ~YD'f/¢' Absorption
Manufacturer~r
Liq. capacity in gallons
DISTANCE TO:
IF HOMEMADE:
Well
Inside length
Dwelling
Manufacturer
Well/
DISTANCE TO:
NO. of lines/ Length of each
Top of tile to finish grade
Foundation /1~!
Total length of
Material beneath tile
Dwelling '7
Mate'ia'yfeH
Width
Material
Nearest lot line /.~--- *'
Trench width/,-)
/¢,& nches
inches
NO. OFBEDROOMS~..~
PERM'TNO' 20¢¢7
No, of compartments 2
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERM IT NO.(~2 0 ~/4 7'
Distance between lines
Total effective absorption area
400
Length Width Depth PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line
DISTANCE TO:
Building foundation
Sewer line
Septic tank
OTHER
PIPE MATERIALS p F~
SOIL TEST RATING
INSTALLER
6'er, e
REMARKS
PERMIT NO.
Absorpt on area(s)
APPROVED
DATE
LEGAL
72-013 (Rev. 3/78)
PERMIT NO.
E)EPRRTMENT ~ HERLTH RND EN, ~ENMENTHL ~./.0TEE:T~0N
825 "L" STREET~ RNCHORRGE, RK. ~950i
264-4720
,],~-~--S I TE 5E~qEF: F"EF:f4 Z T
( 820947 )
RPPLICRNT
LOCRTION
LEGRL
GENE FOWLER
L5B4 GREENBROOK
2157 FRIRBRNKS ST 99505
LOT SIZE
268-8845
999999 SQURRE FEET
TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS
SOIL RRTING
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
[:.EF'T.' ," .... 8. 5 LE~-4i_3TH= 45 i3F-:R%."EL [:.EF'TH= 4
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF 'THE
GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
F-:Ei_i!L! IRE[:. '_--]EP]- I C: TR~-4P-: $ I ZE= i£~¢_-~O
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
T~.J,], (2) I ~4'_:.PEE:TI,]~5; R~:E RE~]LIlRED
BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
i00 FEET FOR R PRIVRTE WELL OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO 8 COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS WRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
F'Ei~:f.1 I T F.'--:-"F' I ~:ES [:,E,::Ef. IBER ~e-l..
I CERTIFY THRT
±: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF 8NCHORRGE.
2: I WILL INSTRLL THE S'T'STEM IN RCCORDRNCE WITH THE CODES.
5: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS~L~,~U_IDE~' MORE THRN 5 BEDROOMS.
RPF'L I CRNT G~NE FOWLER
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVl RONIVIENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
[] SO~'LS LOG"
[] PERCOLATION
TEST
8
SLOPE
10
12
13
14
15
16
17
18
19.
2O
WASGROUNDWATER [
ENCOUNTERED? O
P
E
IF YES, AT WHAT
DEPTH? ~
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE --~, ~ (minutes/inch)
,TEST RUN BETWEEN '~ FT AND ~-~ FT
72-008 (6/79)
DATE:
TO:
FROM:
SUBJECT:
M c pa ity Anch° g
MEMORANDUM
January 19,
Laura Crow
1983
Sewer and Water Program
Request for Refund - Account #2460
Please make the necessary arrangements for the following
refund. A private engineering firm has performed the
inspections in lieu of this department.
Thank you.
Gene Fowler
2137 Fairbanks Street
Anchorage, Alaska 99503
Lot 6 Block 4 Greenbrook Subdivision - 20°00
Lot 5 Block 4 Greenbrook Subdivision - 20.00
Total: $40.00
Receipt # 205966
Laura J. Ward
Senior Office Assistant
attachments
91-010 (5/78)
MUNICIPALITY OF ANCHORAGE
Development Services Department:. Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 017-431-12 Expiration Date: S -3 —2-0 Z3
1. GENERAL INFORMATION
Complete legal description GREEN BROOK BLOCK 4, LOT 5
Location (site address) 6801 TERESA CIRCLE, ANCHORAGE, AK 99516
Current property owner(s) DAVID SMITH
Mailing address
Real estate agent
Day phone
6801 TERESA CIRCLE, ANCHORAGE, AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
®
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ $550
Date of Payment Sr r?
Receipt Number. S (j d Q 3
COSA # OSC211088
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 3/4/2021
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the or—
system and maintenance. The operational life of all well and septic systems are subject to i
these various and dynamic characteristics and are outside the control of the evaluator of the e�P•
well and septic system. Therefore, any estimate of how long a system will function satisfactory rg••• •� ��
TM
for current or future occupants or guarantee that no unseen encroachments, deficiencies or % *. ` �•*
discrepancies exist can be given by First Water Consulting & FWI.S . • • • • • .. • • • • •
r
6. DSD SIGNATURE Curtis Huffman
d' C3 1 .1..,
• ���/
K System #1 Approved for 3 bedrooms rF •. �� r
�,l SSONA4.�
System #2 Approved for bedrooms \\� PROFi * lI
Disapproved
Conditional approval for bedrooms, with the following stipulatioRT,(((((rf(((
TY OF
�J yon
WAT
RR AN
J P T !:V.'arER z-
�- �-
,,JiJJ1J SERVlG�?,
t^�I Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklisp
Legal Description: GREENBROOK BLOCK 4 LOT 5 Parcel ID: 017-431-12
If more than 1 septic system on lot: COSA Checklist # _of
A. WELL DATA — CLASS A WELL
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth _ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) _in.
Date of flow test for COSA
Static water level at beginning of test _ft.
Comments
B. TANK DATA
Age of tanks) 10 years
Tank type/material SEPTIC /STEEL
Measured operating fluid level in septic tank 50"
® Standpipes/foundation cleanout per record drawing
Date of pumping 3/3/21
Structure served by this system _
Well production at time of test _gpm
Water storage tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate _mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/22/2011
Adequacy test date 3/3/2021
® ALL standpipes present per record drawing
Results M Pass For 3 bedrooms
Total measured depth from grade 11.5 ft (max)
Fluid depth prior to test 40 in
Measured depth to pipe invert from grade 5.0 ft (min)
Water added 860 gal
❑ N/A — pressurized field
New depth 62 in
® Monitor tubes go to bottom of effective. If not, state
depth into effective NIT DEPTH IS 6.5' BELOW INVERT.
Elapsed time 1320 min
® Code -required soil cover over field
Final fluid depth 34 in
❑ System presoaked
Absorption rate 450+ and
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons
If yes, enter date
Fes,
Comments/Deficiencies:
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
❑ Yes
if No *5
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑ Yes
if No
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No
Neighboring Absorption Fields > 100'
Water Service Line > 10'
® Yes
Animal Containment > 50' ❑ Yes
if No
❑ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑Yes
if No
ft
0 Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No *5
ft
Surface Water > 100' ® Yes if No
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100' ® Yes if No
Water Main > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*PER CODE AT INSTALLATION.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
a.
AW
Awl
TM xv
• * ��
�._ Curtis HuffmanCE •:
Fo 3(4/20�11•������,�
ft
ft
ft
ft
ft
ft
ft
ft
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
017-431-12 ,.., HAA# :~:-1~'~'~.~,%i' ...... :~.~'~" \
1. GENERAL INFORMATION
Complete legal description
Lot 5; Block 4; Greenbrook Subdivision
e
Location (site address or directions)
Property owner
Mailing address
Gene Fowler
C/O Prudential
6801 Teresa Circle
.Anchorage, AK
Day phone
Vista REal Estate
Lending agency
Mailing address '
Agent Gl~ia Ho]f]~ch/Vista Real EStat~
Address ' 4241 "B" Street Anchorager AK
Unless otherwise requested, HAA wi//be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
%j
XX
NOTE:
Day phone
Day phone
99503-
273-7335
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 ) 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.
Ala~k~ Wa~er & Was~ewaSer
Name of Firm ~ .......a+~.,~.a I,~e0 Phone
Address 7320 E~s~ Chester ~:~s. C~rcle
A~ch.orage, ~aska
Eaginee(s signature Date
ALASKA WATER & WASTEWATER CONSULTANTS,
IS TO BE PAID $900.00 AT CLOSING FOR
ENGINEERING SERVICES PERFORMED.
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms,
Conditional approval for
INC.
bedrooms, with th-e following stipulations:
Additional Comments
By:
'fil'li[']l
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) ~¢k MOA ~21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907),'3a¢34¢48'44
Health Authority Approval Checklist
A. WELL DATA
Well type
I(~ B, or C, attach ADEC letter. ADEC water system number
~1 (y/N.,,~)t (Y/N) Date completed
Sanitary se _ Cased to____ WireC~iir~gp~ri~ilo(t~bctO~ (g~/o~ic)
AT INSPECTION
Date of test ~ __
Static water level ~__
Well production .... g.p.m. -'--~_ g.p.m.
WATER SAMPLE RESULTS: ~
Coliform Nitrate Other bacteria %
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed H/9 ~. Tank size
Foundation cleanout (Y/N) ¥
Date of Pumping /O/~ ¢//¢/t~
JO0~ Number of Compartments ~- Cleanouts (Y/N)
Depression (Y/N) ~J-O High water alarm (Y/N) /'J
Pumper /~ '~
C. ABSORPTION FIELD DATA
Date installed ~ / / (~ ~-'
/
Length ~ Width
Effective absorption area .400
Date of adequacy test /o/2-3
Soil rating (~l~:d:YfF or fF/bdrm) / 2~O System type
/ / /
~'. ~' Gravel thickness below pipe '~ Total depth
Monitoring Tube present (Y/N) y Depression over field (Y/N)
Results (Pass/Fail) /~r~.~ For ~ bedrooms
depth 'n absorption field befpre test (in.); D¢-~ Immediately after 102. 7'
Fluid gal. water added (in.): ~'
Fluid depth ,~¢'7~-~;~ '~(ins) Minutes later: ~4,0 Absorption rate = ,~-~'E) ~ g.p.d.
Peroxide treatment (past 12 months) (Y/N) /~ ~ ~.~O,.,a.,,J If yes, give date ~/A
72-026 (Rev. 3/96)*
EIF.T-STATIO N
Manhole/Access (Y/N) .~P~el at* 'Pump off" level at*
High w~ *Datum~'~'-'''~'~'~
C,.~cle~tested .
E. SEPARATION DISTANCES
S~ES FROM WELL ON LOT TO:
Septic h/olding tank on Iot~ On adjacent lots
Absorption field on 1et -~-~.-- ~~~4~~_
Public sewer main _ anout __
.~ service line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~' /
'~" Property line ~'/¥- Absorption field
Water main/service line /'0 t.~ Surface water/drainage /0~/'~
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /O/+' Building foundation /0/Y- Water main/service lin /~ /'/-
Surface water /00 l'/-
Driveway, parking/vehicle storage area
Curtain drain AJc~-/~_-- l~,JOt.~J~) Wells on adjacent lots
ENGINEER'S CERTIFICATION2
I certify that I ha~ de,~mi..~hr~( field inspections and review of Municipal r,c~"~il}~,~;'~.'~i;b~ are
,nconforma th dellneslnefeotonthlsdate.
Date i ~
HAAFee $ ~)D-
Date of Payment
Reoe,pt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
7320 East Chester Heights Circle ~ Anchorage N Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
October 25, 1998
Gene Fowler C/O
Prudential Vista Real Estate
4241 B Street
Anchorage, Alaska 99503
Attn: Gloria Hoflich
Subject: Septic System Adequacy Test. Lot 5,
Circle.
Bk 4, Greenbrook S/D. 6801 Teresa
Dear Gloria:
Per your request we performed an evaluation of the subject septic system. Our findings are
summarized as follows:
A. ADEQUACY TEST (10/23/98): The drainfieM is a 3.5 foot wide trench that is 50 feet long,
and has an effective depth of 48 inches. Prior to starting the adequacy test, the monitoring tube
was dry. Over a period of 2 hours, 1027 gallons was introduced, causing the liquid depth to rise
to 37.5 inches, which corresponds to approximately 27.4 gallons per inch. The recovery was
monitored 4 hours later and the level had dropped 24 inches, indicating an absorption of 658
gallons. Based upon this data, it was concluded that the absorption rate of the drainfield meets
the Municipality of Anchorage requirements for a 3 bedroom house (450 gallons per day).
NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not
limited to, seasonal surface water infiltration, groundwater variations, septic system
maintenance (frequency of septic tank pumping, usage of biological additives), condition of
drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age),
type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects),
and the amount of water being introduced on a continual basis. Consequently, the results of this
adequacy test are only valid for the specific day of the test. Furthermore, because of the limited
nature of this investigation, it is possible that there are hidden defects which may not have been
detected. No warrantee is made regarding the future performance of this septic system.
B. SEPTIC TANK: The septic tank was installed in 1982. It has two compartments, a capacity
of 1000 gallons, and is made of steel. Steel septic tanks typically have a structural life of 20-25
years. No warranty is made regarding the life of the septic tank.
Throughout the test it was noted that there was approximately 6 inches of liquid in the post septic
tank clean-out. It is probable that the line at the outlet of the septic tank is separated from the
tank and the pipe has settled. This condition does not appear to have adversely effected the
operation of the septic system.
If you have any quest
Sincerely,,
Je .
~ns, please contact me at 337-6179, or 244-9612.
3arness, P.E., M.S.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division ....
825 L Street. Room 502 · Anchorage. Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
A. WELL DATA
Well type ~
v
resent (Y/N) Date completed
Total ~ Cased to Casing height (above ground)
Sanitary sea~ · '- . Wires properly protected (Y/N)
Date of test . ~....FR~.~.~
AT
INSPECTION
Static.water level. _
Well production -
WATER SAMPLE RESULTS:
Nitrate
Coliform .
Date of sample:
I~ B, or C, attach ADEC letter. ADEC water system number
B. SEPTIC/HOLDING TANK DATA
Collected by:
Date installed ti / ~ ~''''' Tank size
Foundation c e~tnout (Y/N) Y Depression (Y/N)
Date of Pumping JO~;I./~ Pumper.
A+
g.p.m.
Numberof Compartments ~-- Cleanouts (Y/N) ~
High water alarm (Y/N) /d ~
C. ABSORPTION FIELD DATA
Date installed I//~..* Soil rating (~e~:/ff2 or ffa/bdrm)
! /
Length ' ~ Width ~..~ Gravel thickness below pipe
Eff~tive absorption area ~OO Monitoring Tube present ~/N) y Depression over field ~)
Date of adequacy test Io/~ Results (Pas~Fail) P~ For ~ bedrooms
' 10~7 (in.):
Fluid dep~h~n absorption field before test (in.); ~ ~mmeaiately after gal water added
Fluid dep[~ (ins)Minutes later: ~ ~orPtion rate= +~ * q.p.d,
72-026"er°xid' ,roatmen%2 months),/N)(Rev.,96,. ' ~ /''~ "~4N~ ~0' ~s' give date
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Parcel I.D.
017-431-12
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DVVELLING
Expiration Date:
1. GENERAL INFORMATION
Complete legal description
GREENBROOK BLOCK 4, LOT 5
Location (site address) 6801 TERESA CIRCLE, ANCHORAGE, AK 99516
Current Property owner(s) JOERENE M HOUT Day phone
Mailing address 6801 TERESA CIRCLE, ANCHORAGE, AK 99516
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
LES BAILEY & ASSOC.
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
TYPE OF 'WA'~ER'SUPPLY:
~' Individual Well ;;.:'; -
Individual Water ::
, , . Stol'area
Community ClaSs ~ Well
PUbli~ Water System
3
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site ~]
[] Individual Holding Tank r-~
[] Community On-site E~]
[] Public Sewer ['--]
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
DSD SIGNATURE
~/"/ Approved for ~3
Disapproved.
Oonditional approval for
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date. 06/24/11
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The
assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow
and absorPtion rates may change due to subsurface conditions that may not be observed from the surface,
changes inland use, local soil characteriStics, groundwater levels that may fluctUate dudng the year and the
water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these vadous and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a ~ ~;_~,~i ~'
system will function satisfactory for current or future ~'~ :: ~.'.;~:..~ ~,
occupants or can ArcTerra guarantee that no unseen ~,~.,;~-~ ~ :.
encroachments, deficiencies or discrepancies exist. ~ ~:.i ':... ::.~ ~."?~i ~
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
'.
0N-SITE
= · WASTEWATER . :
Arsenic Adviso~
Maintenance Agreements
Supplemental Engineer's Repod
Other
By:
(Rev. 11105)
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: GREENBROOK BLOCK 4, LOT 5
A. WELL DATA
Parcel ID: 017-431-12
Well type COMMUNITY - A IfA, B, or C provide PWSID # 2 1 0346 Well Log (Y/N)
Date completed Sanitary seal (Y/N)
Total depth ft. Cased to ft.
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100mL Nitrate
Arsenic: __rng/I Date of sample:
SEPTIC/HOLDING TANK DATA
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
g.p.m, g.p.m.
mg/L
Collected by:
Tank Type/Material Septic/Steel Date installed 6/22/11 Tank size 1000 gal.
Number of Compartments _2 Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~ Depression over tank (Y/N)
High water alarm (Y/N) N Date of pumping NA-NEW TAN~K Pumper
C. ABSORPTION FIELD DATA
Date installed 6/22~1 Soil rating. (g.p.d./ff~ or ~/bdrm) 1.2
Length 38 ft. Width --3 ff. Gravel below pipe 5.48 ff.
Eft. absorption are~ 416 ~ Monitoring tube Y
Date of adequacy test NA-NEW SYSTEM
Fluid depth in absorption field before test __ in. Water added__ gal.
Elapsed Time: __ min. Final fluid depth __ in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (YIN & type) _If yes, give date __
System type Deep Trench
Total depth 11 ff.
Depression over field N__
Results (Pass/Fail) __ For
New depth __
bedrooms
in.
g.p.d.
D=
LIFT STATION
Date installed
"Pump on" level at __
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at
Cycles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Animal containment areas
Manhole/Access (Y/N).
High water alarm level at in.
Meets alarm & drcuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation $% Property line 5'+
Water main 10'+ Water service line 10'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation ;to'+
Water Service line ;to'+ Surface water ;tOO'+
Curtain drain 50'+ (None Known)
COMMENTS
Absorption fi.eld 5'+
Surface water ;tOO'+
Water main 10'+
Driveway, parking/vehicle storage 10'+
Wells on adjacent lots 200'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DIYFFETS
Date 6/24/2011
COSA Fee $250.00
Date of Payment
Receipt Number
(Rev, 11/05)
Waiver Fee $
Date of Payment
Receipt Number
CONSUL~I~ING, INC
212 E. 51a Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793
]~ly l, 20:1.1
Mu.nicipai:tty of Anchorage
'Development Services 'Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Lot Line Waiver - Greenbrook Block 4, Lot 5
The asbuilt $'rtrvey conducted after construction of the new septic leach field wiflx
a diverter valve to 'the existing leach field show the original line is approximately
8' from the property line. The new trench is iff from the property line. We are
therefore requesting, a lot line waiver to 8' of property line be granted for future
use of the original septic trench. W'e do not expect there to be any adverse effect
on 'the subject or adjacent .lots by granting this waiver.
If you have any questions, please contact me at 868-3792/FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, inc.
Attachments:
On-Site Inspection Repo:rt
~0/~0 39~d EBLE89SLOB g§:PI ~0~/~0/L0
Municipality of Anchorage
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997
,,http://www.muni.orfllOn$ite
Development Services Department
On-Site Water and Wastewater Proqram
Department
**** VARIANCE/WAIVER REVIEW ****
WR#: 111141 HA#: 111218 Permit#: 111109
PID#: 017-431-12
Legal Description: Greenbrook Block-4 Lot-5
Engineer: ArcTerra
Applicant: Joerene Hout
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 8.0 feet.
This waiver approval applies to the existing absorption field to property line separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
Waiver is Granted: X Waiver is not Granted:
Rec#: 7-1-11 Amount: $200.00 Date Paid: 7-5-11
**** VARIANCE/WAIVER REVIEW ****
UNDER NO CIRCUMSTANCES SHOU~ AN AS-BUILT BE USED FOR CONS~UC~ON OR FOR ESTABLISHING BOUNDARY OR ~NCE UNES.
~E SUR~YOR TAKES RESPONSIBILI~ FOR ~E INI~AL ~ANSAC~ON ONLY AND ASSUMES FINANCIAL LIABIU~ ONLY FOR ~E COST OF ~E SUR~%
LIS~D DISTANCES PREVAIL O~R SCALING. REPRODUC~ MAY CAUSE ERRORS IN SCALE.
~ cOT ~.~Y SURVEY TYPE SYMBOLS
~ nN~F~NOA~SmUC~REAS-~'LTAs-BU{LT " SET REBAR ~ ~ DRAINAGE~ ASPHALT
O F~ND REBAR O C C WOOD ~NCE I:m::av:'~.l CONCRE~
PLOT P~N , . . AS-~UiLT , , , LOT ~R~Y .
~ AS-BUILT , , . N0 C~NERS ~T ~ RE~R~RCA~ AS-BUILT. , . NO C~$ ~T ASSUMED E~V. % ~ X METAL FENCE ~ WOOD 0ECK
PLOT PLANS & LOT SURVEYS NOTE:
IT IS THE RESPONSIBILITY OF THE BUILDER OR O~ER, PRIOR TO ONLY ~OSE IMPROVEMENTS ABO~ GROUND AND ~SIBLE ~LL BE
CONS~UC~ON, TO ~RIFY PROPOSED BUILDING GRADE RELA~ SHO~. FENCES, ~LLS, SEP~C C~ANOUTS, SIDEWALKS. DRI~WA~,
TO FINISHED ORADE ANO UTILITY CONNECTIONS AND TO DE~RMINE ETC., ARE SHO~ iN ~EIR APPROXlMA~ LOCA~ON, ONLY, SNOW
~E EXISTENCE OF ANY EASEMENTS, CO~NANTS OR RES~IC~ONS MAY PRE~NT SOME IMPRO~MENTS FROM BEING SEEN AND LOCA~D.
~ICH GO NOT APPEAR ON ~ RECORDED SUBDI~SION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURLY CERTIFiCATiON _~~, ~repored by
Robert E. Johns, Jr. & Assoc.
~ ~x~ ............. ~ ~, ~
.~,~,~ ...... ~.~ ~... ~...~.~ Professional Land Surveyors
~ ~ ~ ~, ¢~ ~ t~ m* b~t ~¢ my ~ *~ ~7~'~ ~ORAGE, ALASKA 99504
~ md ~ ~ ~* ..~ ~~ ~ ~~ Rec. Lot S.F. ~Rec. Plat File No.
"~ ~ ......~~~~ ...... : ..th ., ~ ~ sc,~: 1" = 60'
F~NDA~ON AS-BUILT ~. '""
~. ,~ [. ~n~ ~.. ~y ~fy m~t ~ ~ ~ ~ ~ Date Surve~d: Drown b~ Checked b~
"~ ~ ' ~" ~'" ~'~~~= ~ ........ ~ 6/27/11 REJJMK
FINAL S~UC~RE AS-BUILT
Legol
Description:
~ ~* Lot 5 Block 4