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Home My WebLink AboutGREENBROOK BLK 4 LT 12 ) ,,..~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl.TH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELl. ~NSPECTION REPORT /D '7 UPGRADE LEGAL DESCRIPT]ONL/ ~ ~ C/ - LOCATION NO. OF BESOMS Dwelling DISTANCE TO: W~ ~*~/0' [Absorpti?~rea, PERMITNO. ~ Liq. ca/~ity~n gallons Inside length Width Liquid d~ /~ ~ ~ IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. =_~0 = < M~ ~ ~ Mater~ Liquid capac,ty ,n gallons N~lin~ ~ Le~ of e~chline~__ ~ ~-- Total lengtl~f I~ Trench width~s Distance ~~~ ~ ~ Top of tile to finish grade.~ , Material beneat~ tile ~ ,~. ........ Total effectivT~rp~n area Length Width Depth PERMIT NO. ~~ANCE TO: Well Building foundation Nearest lot line ~ C~~ Depth Driller Distance to lot Pine PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TE~T INST~ER . .' , D~ t DATE LEGAL 72-013~ v. 3/78) LJP_KI-li'".: I l'lb.r'4 I 825 264-4728 ':: 8'10-'::29 ) FIPPLICFINT HRF-:RISON CONST. SF.:R BO::'; .~.,'.:.R 99507 LOC:~ MUST BE WITHIN 25'" OF T. H..~ LEGRL L12 B4 GREENEF.'CCI< LOT SIZE 274--8651 40808 SF-:!LIRRE FEET -' "- DRR I NF ! ELD T't'F'E .-.IF SOIL RBSORPTION :..~=TEi'I IS: Iif', BEF L]F i"1RX I MIJM N_ 1 - .: E:EDF.:OOHS = 4 SOIL RFtTING ,::SQ FT,-.'"E:R>= '175 THE REC!UIRED SIZE OF THE SOIL RBSOF.:F'TION S'T'STEM IS: · E:, E F" 1- H == -:.'~ L I[£ t'-JJ ,_1~ 'T H =_'=,. :=:_ ,_3 F:: -F-~ ',.." E L [::, E F' T H == .=.'"'-:' THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFtINFIELD. THE DEF'TH OF Fi TRENCH OR PIT IS THE DISTFINE:E BETWEEN THE SURFRCE OF THE GROUND RN[:, THE BOTTOM OF THE ENC'R',/RTION (IN FEE]'). TP~E TRE~'-,~CH 1-4 ]: [:,]-H Z 2~; 5. t:Z~C~¢.E~ FEET. THE GRR'v'EL DEPTH IS 'THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRL. L PIPE RND THE BOTTOM OF THE E',,.,',CR',,,'RTION (IN FEET:-". PERMIT FtPPLICRNT HFIS THE F..E_-,FLNz, IE, ILIT~ 'FEI INFCRH ]'HI'--'.., [:,EPFIF.!TMENT _F)_tF.'ING '['HE INSTFiLLFtTION TNSPEI_-:TIONS nF FtNY WELLS FiD.~RF:ENT TO THIS FF.._FmE. 1 = FIND THE NUMBER OF RESIDENCES THFiT THE WELL WILL SER',?E. T_~--..~,O ,:. .... ~.' .':, INSPECT Z L,t'.t_.-- - ":-- RF--:E F."E(_::."U ~ E,H_.F. FILLING OF FtN'T' S'T'STEM WITHOU]' FINFtL INSF'EF:TION FIND FIPPROVRL E?'r' THIS DEF'FIF.:TMENT WILL BE SUBJEF:I' TO PF.']SE2LTI3N MINIMLIM DISTRNCE BETWEEN R WELL FIN[." RNY ON-SITE SEWRGE _F-"ISPOSRL. SYSTEM IS t00 FEET FOR Fl PRI',,"RTE WELL OR :~.50 TO 200 FEE'[ FROM R F'UBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM [:'ISTRNCE FROM Fi PRI","RTE WELL TO Fi PRIVRTE SEWER LINE IS 25 FEET FIN[:' TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY FIPPLY. SPECIFICRTIONS RN[." CONSTRUCTION DIRGRRMS FIRE R',/RILRBLE TO INSURE PROPER INSTFILLRTION. I CERTIF"r' THRT :.1.: I RM FRMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET F'ORTH B"r' THE MUNICIF'FILIT"¢ OF FINCHORFIGE. 2: I WILL INSTFILL THE S"r'STEM IN FICCORDRNCE WITH THE CODES. .3:: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMB. / ............................ FIPF'L I CFIN'F HRRRISON CONST. I SSI_~E[:, _,F .... ~ ---T~' "' ~ J ...................... ,:' CH FE ~_.~.~' 'v'4. 0 Block 4 Depth in Feet From TO 0.0 7.5 7.5 15.0 Bottom of Test' Hole: Frost Line: Free Water Level: · Table M we iiA19708 Date: 4/14/81 Logged by: To Krupka Soil Description F-4, Brown Si~ Sand, SM, silt to 40%, firm, moist F-3, Brown Gravelly Silt)![ ~_~, SM,' occasional cobbles, firm, moist, becomes saturated at 15' Set 3/4" perforated PVC pipe to run perc test and to monitor water table elevation. Measured Perc Rate = 3.4 minutes/inch. Recommended Desing Perc RAte = 10~0 minutes/inch. 15.0 Feet 1.0 Foot 3/14/81 - 15.0 Feet 3/18/81 - 2.8 Feet (Apparently from surface water intrusion) 3/23/81 4/09/81 4/16/81 7.8 Feet 7~8 Feet 8.5 Feet Second and Fourth Anchorage Limited Partnership · April 17, ~981 page Four seasonal high water. Lot 4, Block 4 The measured water level in the test hole at this site remained fairly constant and high. Saturated conditions were encountered at 12 feet while drilling on March 14. The water table elevation was found at 6.8 feet on March 23~ at 6.8 feet on April 9, and at 8Q'3 feet on March 16. The measured percolation rate was 40 minutes/inch. Because of the high ground water, a shallow mounded disposal system should be used. Lot 6, Block 4 The high water level at this site necessitates a highly mounded system} or using insulation to provide frost protection while maintaining the necessary separation between the di:~posal system and the seasonal high water. While drilling, saturated conditions were encountered at 13 feet° On April ~8, the water level was measured at 5~4 feet, then at 5.1 feet on April 23, th~ water level had lowered to seven feet by April 9, and then to 7.5 feet on April ~5. However, much of this water is probably from surface water and melting seasonal frost. The measured percolation rate was 3.8 minutes/inch, ho~ever~ we recommend a more conservative design value of 10~'0 minutes/inch~ Lot 12, Block 4 Again, the disposal system should be placed as high as possible ~s site The.~.w_~.er level in the test hole remained fairly · at tl ' ' ....... ~ ~ ~"~ .... ~-~ ~evel was measured at 2.8 feet ..... J~ ~stant at ~i~ht te~.g/ The w .... <~ . . o . "~ ~March 8, ~T~ appeared that th~s h].gh level wa= caused by infiltration of surface water, and was not the true water level at the time. The measured percolation rate on March 17 was 3.4 . minutes/inch, but it is recon~ended the more conservative value of ~0o0 minutes/inch be used, because of the high silt content of the.upper soils. Lot 13, Block 4 · -' ed near the center of the lot on April 7, ,?~:~il The test hole was d~mll .~ ....... ~ ~ no water was detected..~ ~ ~dA~ i~a~ e~ s~~ s~ ~ ~ 9t~e~ 1 ~u~/~ ~c~ ec t%~e t~'~ ~ recommend th P . ' ~ ~ ' avoid the surface silts. Lot 14, Block 4 No water wa's encountered while dril'ling, on April 7, or when 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 OSC25'1525 Parcel ID 017 -431-05 Expiration Date: Legal description GREENBROOK BLK 4 LT 12 Site address 12531 FREITAG CIR 3/17/2026 Current property owner(s) WOODALL MARK A& VERONICA M X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments N Original Certificate Date: 11/24/2025 This Cificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject syst (s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, De elopment Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other 1. GENERAL INFORMATION Parcel I.D. 017-431-05 Complete legal description Greenbrook, Block 4 'Lot 12 Location (site address) 12531 Freitag Cir Current property owner(s) Mark & Veronica Woodall Day phone 2. ON-SITE SYSTEMS SLED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well serving # dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage 0 Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: Fn� Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 6. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 17 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS FO -1 Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ 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 $ 5 � Waiver Fee $ Date of Payment I) 1 2,.,C> J,-;1'57- Date of Payment COSA # 0S (1-11 151? 5- Waiver # COSA Application AK025.doc COSA Checklist_May2025.docx COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA 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. 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 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade 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 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) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_May2025.docx E. SEPARATION DISTANCES From Well on Lot to:(Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’Yes if No ft Disposal Field on Lot > 100’Yes if No ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/Septic Line > 25’Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to:(Please enter distances if less than required) Tank to Foundation > 10’Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main/Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS 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 Phone Engineer’s Printed Name Date ARM Septic Services, LLC Maintenance Checklist. Advanced Treatment System Operational Checklist: Advanced Treatment System Legal Description: Street Address: i zl�3 I E tr -e itm Cie. Service provided on: Date: - 195 Time: ^'490 Ckm Service provided by: Company: f 171) Technician: Nafty,h ie Date of last service: I()— (6 , 2q By: (ro7 � Other. 1. Type of Aerocell Treatment System: Cat II -AeroCell Treatment System Cat III -AeroCell Treatment System p� (} L� 2. Conditions at media filter: [CAcceptable ❑ Unacceptable a. Evaluate presence of odor within 10 ft of perimeter of system: WNone ❑ Milo ❑ Strong ❑ Chemical ❑ Sour b. Source of odor, if present: 3. Manhole Risers and Pipe Caps: NAcceptable ❑ Unacceptable a. Cover/s intact: [XYes ❑ No b. Method of securing cover: 5*C4* W c. Insulation present on all lids? XYes ❑ No d. Any plumbing leaks or water intrusion: ❑ Yes WNo e. Surface water/infiltrations into components: ❑ Yes ?Sl No 4. Venting/Air supply: *cccepta le &Unacceptable rf P«lr. 'A a. Air supply unit operating properly. ❑ Yes LJJ Chs S ;-6 b. Venting appears operable. []Yes N(No 5. Media surface: 'Acceptable ❑ Unacceptable a. Biomat on surface. 9Yes b. Uniform spray pattern. Yes d. Ponding in/on media. ❑ Yes e. Plugging/clogging of nozzles. ❑ Yes f. Media appears to be settling. ❑ Yes g. Appropriate maintenance performed. LCJ`Yes h. Pest activity at surface. ❑ Yes 6. Effluent quality a. Effluent odor after passing through media filter: b. Effluent color after passing through media filter: M. L(None ❑ Milo ❑ Strong ❑ Clear Brown ❑ Black 17933 Old Glenn Highway *Chugiak, AK 99567 office/fax: (907) 688-9433 Email: ARMServicesAK@outlook.com (PAGE 1 of 3) ARM Septic Services, LLC 7. Tasks for recirculating/discharge flows: Acceptable Unacceptable a. If applicable, Jandy valve functioning: ❑ Yes ❑ No NIA b. If applicable, Jandy Valve basin dry: ❑ Yes ❑ No N/A c. Cleaned collection system in Aerocell unit: KYes ❑ No ONot Necessar'->�tti d. Design recirculation ratio: 80 : 20 e. Actual recirculation ratio (Estimated): 160 8. Pump System: Acceptable ❑Unacceptable a. Control panel in Auto1� Yes ❑ No b. Timer settings IFS Panel (No Override timer): ❑ Yes ON: `I - Wi OFF: kb 7 p[gm Override ON: 3 1M r, Override OFF: 5 (� L_ N/A C. Floats in correct placement: IXYes No d. Floats working properly: LVYes _i No e. High water alarm operational: 51'es ❑ No f. High water alarm count:.L4 261 g. Pump Run Counts: q 3101 h. Pump Run Time: I 7!90 i. Float Error Counts: En N/A j. Total Override Counts: 50 N/A k. Effluent Filter serviced: end Yes ❑ No I. Tank lids secured after inspection: Yes ❑ No m. Weep hole functional: XYes ❑ No 9. Primary Tank TEAcceptable ❑Unacceptable a. Sludge and scum level checked: FOYes ❑ No b. Sludge/Scum levels: 1st:�0 �� 2nd: y�, 3rd: N/A c. Tank needs to be pumped: ❑ Yes ® No d. Water softener backwash discharging on system? ❑ Yes ❑ No e. How many people live on the system?Ajlylc� f. Tank lids/caps secured after inspection: I Yes ❑ No g. Last Date Tank pumped 10. Drainfield: a. Type of Drainfield (circle one): Be 5 -wide Deep Trench b. Design Effective depth: Vo 7 inche est c. Checked Liquid Levels in Drainfield: ® Yes ❑ No MT#1 Liquid Level: 0 Inches MT#2 Liquid Level: 0 Inches MT#3 Liquid Level: Inches MT#4 Liquid Level: Inches d. Is there any surfacing effluent?: ❑ Yes K' No 17933 Old Glenn Highway *Chugiak, AK 99567 office/fax: (907) 688-9433 Email: ARMServicesAK@outtook.com (PAGE 2 of 3) ARM Septic Services, LLC 11. Is the remote monitorin a. Type ofMonrtorin g system functioning? gsystem: (if no, describe in co b. Phone line workicomment [�J Yes ng? ❑Yes4'`l►�o o ❑ N/A 12. Does this system receive an advisory notice/wa 13. Is the s ste rn►ng? Y (if so describe in comments min satisfactory condition/ pass i ) L Yes ANo 0�5— inspection? (if no, describe in comments) ( YeS L' No Other Comments: r SeNtceP[OVitle['. �� Date: �- L L � 179A,�d Glenn Highway *Chugiak, AK 99567 office/fax: (907) 688-9433 Email: ARMServicesAKCoutlook.com (PAGE 3 of 3) ATTENTION: Buyers and owners of a property served by an Advanced Wastewater Treatment System (AWWTS) ** TO AVOID SEWAGE BACKUPS** Prior to using the wastewater system, contact the service provider to ensure that regular maintenance is completed. Many of the systems require remote monitoring, the provider will tell you how to provide this capability. Who to contact: • AdvanTex: Anchorage Tank at 907-343-3704 • Quanics Aerocell: Garness Engineering at 907-337-6179 • Biocycle: Biocycle Alaska at 907-274-0314 • BioBarrier: Tim Ecklund at 907-250-0100 • Intermittent Dosing Sand Filter (IDSF): contact MOA onsite 907.343.7904 Please complete the attached document, Advanced Wastewater Treatment System Maintenance and Repair Agreement. When signing this document, you acknowledge that you are required to provide regular maintenance for your AWWTS. MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 1 `I "' Day of ni&VtMt3 t 9— of 20 ?-5 , by and between 6. K.S-t i 4g— , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Quanics system located at (legal description) Greenbrook, Block 4 Lot 12 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction. Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability.'. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWWR: ByI—�-(signature) Date: 11 l't 2dZ5 _ dei i •i�4°�`c� (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this i dayof 202,L by Jae— N TARY P03LIC FOR ALASKA My Commission expires:�3 //t -7 e) LORI OLSON LCoNotary Public State of Alaska mmission Expires Mar 16, 2027 Date: G Title: (rev. 05/18/2018) Page 3 of 3 � � _ Municipality of Anchorage • ; -- � On-Site Water and Wastewater Program ;T c..1 343-7904 OC �,� tu Di 1 c , Certificate of On-Site Systems Approval Parcel I.D. 017-431 -05 Expiration Date: ?— _r ' 1. GENERAL INFORMATION Complete legal description Greenbrook B4 L12 Location (site address) 12531 Freitag Cir. Current Property owner(s) Isaac & Melanie Paterniti Day phone Mailing address 12531 Freitag Cir. Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class A Well El Community ❑ Public Water System ❑ Public Sewer Cl WaiverNariance request for: Distance: Received b • OJT .111,‘ _ .'�l/lbA l I. ' .� Date: t 0 b/Nur I1 COSA to be released to the engineer,unless otherwise requested bit engineer. COSA Fee $ S! f Waiver Fee $ Date of Payment loll f i 1 Date of Payment Receipt Number 06161q6 6186 Receipt Number COSA# x-41 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 _ _ disposals ste i area safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify_that based on mutation 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. IrKpndkcjtny an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA giJilkitites:illgitfrhiitions.The reported results describe the performance of the system under the conditions encountered at the time of the test, and seatatitfiidist&nces measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 10/2/201 7 ��• Afro.. Y* . i\ * 06. DSD SIGNATURE JxSystem #1 Approved for bedrooms . . _ • •Sieven 13. Pannone . System #2 Approved for bedrooms 6�� . CE-8149 • Disapproved l�� `��•••••'ON t�'..~ ‘\\tom.`—' Conditional approval for bedrooms, with the following stipulations: e• Ltiv•-6,i it-tp if4��`�r� r f ON SITE WATER AND 1." WASTEWATER o PROGRAM • S€R� By: Original Certificate Date: ) Q — 20 --17 r The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue see f • 3 If more than 1 septic system is on the lot: COSA Checklist# 1 of Structure served by this system • Certificate of On-Site Systems Approval Checklist Legal Description: Greenbrook B4 L12 Parcel ID. 017-431 -05 A. WELL DATA Well type A If A. B. or C provide PWSID# 21 0346 Well Log (YIN) Date completed Sanitary seal (YIN) Wires properly protected (Y/N) Total depth ft Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample. Collected by: B. SEPTIC/HOLDING TANK DATA S.T.E.P./Steel Z(0 r -k• • 11/18-20/2008 Tank Type/Material 1�(�Y111 "mate installed Tank size 1 500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping 9/15/2017 Pumper One Stop Pumping C. ABSORPTION FIELD DATA • 11118-2D/20082 2 4 GPD/SF BED Date installed Soil rating (g.p.d./ftor ft /bdrm) System type Length 15 ft. Width 1 5 ft. Gravel below pipe .57 ft. Total depth 3.24 ft Eff. absorption area 225 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9/29/2017 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test C) in. Water added 61 5 gal. New depth t in. 600+ Elapsed Time: 1 •L-U min Final fluid depth U in. Absorption rate >= g.p d. N Any rejuvenation treatment (past 12 mo ) (Y/N & type) If yes, give date D. LIFT STATION Date installed 11/18-20/2008 Size in gallons 1500 Manhole/Access (YIN) Y "Pump on" level at TIMER in. "Pump off' level at TIMER in. High water alarm level at 44 in. Datum Bottom of Tank Cycles tested 3 Meets alarm&circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line rj+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS *Double clean out prior to septic tank. G. ENGINEER'S CERTIFICATION � � OF Aqkkki I certify that I have determined through field inspections and Ar ice . ti review of Municipal records that the above systems are in Ali • • I. ,I,...'••-y, \ *9 conformance with MOA COSA guidelines in effect on this date. r •••• IS4W'., •• •• f Steven Pannone _ f.... . Engineer's Printed Name .Sle;Fen •. •onnone 10/2/2017CE-81491 Date {i9 .4,\470 0R OFE59 ..4 COSA canary sheet_2-6-15.doc ��✓ ��'`` � 13 V� P i - o -------N-1::..41'22'Vy 2.:.32' � N. `r° I- .'.'..'..:.'.:........,..,.. <,. , v.., w .44'' f� EXISTING 'AP z 11. C.•s P HOUSE „J'fy� N elo 47_ Nc 11 M Z 'a C. 5 N IT N 1 trim 10' ° �T1L ES r 214'H7 `-- ___J 42.23' 589'56'10-E 3 NORTH PARK DRIVE b 1 UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSttING BOUNDARY DR FENCE UNES. THE SURVEYOR TAXES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABUJTY ONLY FOR THE COST Of THE SURVEY, USTED DISTANCES PREVAIL OVER SCALING REPRODUCTION MAY CAUSE ERRORS IN SCALE. ❑ LOT SUAwEY SURVEY TYPE SYMBOLS ❑ rouNoAii As-BIULT • SET ROAR 7 DRAINAGE ❑ FINK sTWUCTUPoE AS-BuLT o FOUND REBAR B—e. woof) FENCE 1•••:'�_:a.� CONCRETE ❑ PLOT PLAN . . . AS-e9IT. . .TOT S1ROET.. . TCP NY ASSUMED ELEV. it--x—X- METAL FENCE I7/■7/1 WOOD DECK ❑ As-ow . .. Na COOKERS SET El CERTFIGARA ILON S-PI-RWLT, . . NO CtsaI RS SET PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS. SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAT PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION Prepared by .•••'oF,44 , Robert E. Johns, Jr. & Assoc. PLOT PLAN 41P '\�.. .� Professional Land Surveyors h.rr meth*r P.t I r_ap+.+r.s.q..a Owlet F....d.4 here.Me eel 1�:' �. 1700 Mink Delve hew lead r wtdrr.�s d.a wt beers _J `) '. ANCHORAGE. ALASKA 99504 r....i n.M•.�...w Me Ire r we r "•.r.k..y ren...r enwr.new e_ ..arr`..ed....1 JR 9t. •:�.- $Cols: 1" 50' Rec. Lot S.F. Rec. Plat Fite No. FOUNDA1ON As-Bum M../C M.a....,..w, .M I ;.. ...�, Date Surveyed: 02/18114 Drag, by: RE Chocked e, MK ...........hew "..e.. 1. 0• .. ..Si me«e~".��wane. ♦ • Re:ERT E 7• �! Dote Draw,: p2119/14 Grid: 2839 '`".o. 14-44 a� r..n.hr • • da o •'' n c ' e FINAL 51RUCTURE AS-BUILT +•�� • �rf�''. 41 L S •�'J'� Legal Dcocriptlon: w r.r+,L 1010.1 Ir r�s.M .+ a.r.,Penny certify w 4�e ••'''...............••6°i 4P Lat 12 Block 4 *wow,...Q,.k4..e sr r.. f 9'P „...00 -.erre.tW wrm�r d..n home moo/ ! .:..w'.�:.m.".�«n”"e+. .�... ��"M11111iWe . GREENBROOK ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND Mark and Veronica Woodall THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this of 20 byMork and Veronica Woodall Day of ��' and between herein the"OWNER,"and the Municipality of Anchorage,herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein,the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Quanics Wastewater Treatement System located at(legal description). Greenbrook 112 B4 2. Definitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On-Site Systems Approval(COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit.An On-Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA,and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS,the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement,the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the municipality and the manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement,and any renewals thereof, at the owner's sole expense,to pay for any and all: (1)repair(s),(2)maintenance, (3) adjustment(s), (4)replacement costs,and(5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws,regulations,rules and orders for the AWWTS. C. Upon request by the Municipality,the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction,maintenance and repair of the Owner's AWWTS. I. Owner agrees to provide and maintain a telephone connection to the AWWTS as required by the AWWTS approval. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof,or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: Mark and Veronica Woodall a. Owner: b. Municipality: Director.Community Development or desixnated authority C. Any attempt to amend,modify,or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: �, l� ff By: �►/1'� (signature) • 4 't y � ( g ) Date: I • t t 1 Mak Woodall (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoin_ instrument was acknowledged before me this ra day of1 r2_ 201` b s � . r \\�111111111111/j/// NOTARY PUBLI $ ' ALASKA ,`�� Gomm..• e) My Commission expires: i-1 1512 alt _ `4-1/4'NorARr. \" �, pt/9L�G MUNICIPALI YL_ B . (signature) Date: 10 20 1 (print name) Title: ARM Services, LLC Quanics Maintenance Contract, Addendum A For the purposes of the contract, the term "owner" or "owner(s)" shall refer to the legal owner of the system, or the authorized representative. The term "ARM" shall refer to ARM Services, LLC. PURPOSE: As required in the MOA(Municipality of Anchorage), the Quanics Aerocell system requires a maintenance contract with a certified maintenance provider.ARM Services, LLC is a certified Quanics maintenance provider. This contract covers one year of Quanics system monitoring, inspections, and maintenance, which will start upon receipt of payment. This contract will include a minimum of one inspection per year, (which is covered under the $475 annual fee). SERVICES: The services currently offered by ARM for the purposes of fulfilling this maintenance contract include: • At least one inspection and servicing of the system per year. Service work includes (but is not limited to)filter cleaning, nozzle cleaning, inspecting of components and observing them functioning, checking drainfield liquid levels, and testing system operation. • Annual report, indicating the status of the system, and any required repairs. • Availability to respond to alarms or callouts. • Availability to repair system, make adjustments, and technical assistance. If any major maintenance or repair items are required (other than the minimum filter cleaning, nozzle cleaning and inspecting of the system) these items shall be completed at an hourly rate of $105/hour -4- material material costs. If ARM Services, LLC (ARM) responds to any alarm conditions or call-outs (or completes service work/ repairs), whether notified by the Quanics unit via phone line or from tenants/owners, a two hour minimum of billable time applies at $105/hour. If an alarm condition exists, ARM shall have 48 hours to respond to an alarm. If ARM responds to alarms from 6pm-11pm, time shall be billed out at $157.50/Hr (2-hr min.). If ARM responds to an alarm from 11 pm-8am, or during weekends or holidays, time shall be billed out at $210.00/Hr (2-Hr min.). If such an alarm or malfunction situation arises, the owner(s) should have a contingency plan which should include an emergency pumping of the system (via septic tank pumping service) and/or restriction of water usage, to provide relief until the system can be inspected by ARM during reasonable hours. The owner(s) phone number is required to be input into the remote monitoring system in the Quanics panel, and the owner(s) are responsible for being the primary responders to any alarm conditions, whether contacted via phone call from the Quanics, or by someone else reporting a problem or alarm. If the owners respond to an alarm, and ARM is contacted to provide technical assistance over the phone, this time shall be billed out at $105/hour, with a .5 hour minimum (For example, if during a peak flow event like a Christmas party, if the Quanics system cannot keep up with a large surge of water and goes into alarm, the system can easily be manually pumped down by the homeowner while receiving technical assistance from ARM via telephone call or text). Should the system require pumping (via pump truck)for emergency reasons or as part of routine maintenance, the pumping fees are not covered under the annual $475 fee. This contract shall renew automatically each year, unless the owner provides written notice with their intent to dissolve the contract. Payment is due at the beginning of each 1-year cycle, otherwise this contract has been broken, and ARM will not be providing any maintenance or monitoring services. FEES: • Annual maintenance contract fee: $475.00/year • Hourly rate (Mon-Fri, 8am-6pm): $105.00/hour • After hours rate (6pm-11pm): $157.50/hour • Hourly rate for weekends, night-time (11pm-7am), and holidays: $210.00/hour OWNER RESPONSIBILITES: The owner(s) have read and understand the Quanics installation manual and the Quanics owners/ operation manual, and agree to operate the system in accordance with those manuals (available from Garness Engineering in Anchorage,Alaska). The owner(s) of this system are required to be trained on 24738 Chugiak Drive*Chugiak, AK 99567 Ph: (907) 317-9433 office/fax: (907) 688-9433 Email: ARMServicesAKQoutlook.com ARM Services, LLC how to respond to alarms, how to identify potential problems, and how operate the system. Although ARM will be responding within 48 hours to potential alarms or problems, it is important for the owner(s) to understand the basic workings of the system, and to be prepared to respond to an immediate problem. This contract is absolutely contingent upon the system being maintained and kept in good working order. In short, if at any time the owner(s) put off any maintenance (or repairs) on this system, use the system in an abusive manor, or do not keep a working phone line hooked up to the panel (this includes maintaining a working remote monitoring system), this contract is null and void (ARM will not be providing a refund of the annual fee). See additional owner(s) responsibilities under "Disclaimer". DISCLAIMER: ARM is not responsible or liable for any damages to the system or the residence due to (but not limited to) the following reasons: • Performance of the septic system • Deferred maintenance • Abuse of the septic system • Workmanship associated with the installation of the system • Engineering design or inspection work associated with the septic system • Damages to the system • Failure of any of the septic components ARM is not associated in any way with the engineering of the septic system, or the corporation "Quanics". ARM does not offer or imply any warranty of the Quanics system components. Simply put, ARM is helping to monitor and maintain the existing septic system, solely at the direction of the owners. The owner(s) are fully (and solely) responsible for the septic system and its operation, the management of the system, its performance, and directing what is and what is not to be done by ARM regarding the system. Limited warranty: ARM does not offer nor imply any warranty of the workmanship or components of the existing septic system. Any issues with the system, components, and workmanship are not covered under a warranty by ARM. ARM does not offer or imply any warranty of the Quanics system or its components. ARM offers a limited 1-year warranty for workmanship associated with repairs made to the Quanics Aerocell system. By signing below, the owner or authorized representative of this system agrees to all of the terms of this contract, and authorizes ARM to provide annual services for this system. r '' Signature: '` 6, 1.—,16L, Date: To f Jl l Property address/site description: 12531 Frelfag Circle, Anchorage AK 99518 24738 Chugiak Drive *Chugiak,AK 99567 Ph: (907) 317-9433 office/fax: (907) 688-9433 Email: ARMServicesAK@outlook.com I~.) 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 De~j~.,tion (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name-~.~-~/-'Z)× /¢~/'Z'~r/,/¢ .W.C4. Telephone: Home Applicant Address ~'/¢ ~¢ . ~¢'~ (c) Applicant is (check one): Lending Institution ~; Owner/builder; Buyer ~; Other ~ (explain); (d) Lending Institution~ ~'~'~ ¢~7/~&j~ ~;~elephone -~ ~-- ¢¢¢¢ a.d Address ~ Telephone ~ ~ (f) Mail the HAA to the following address: . TYPE OF RESIDENCE Single-Family,' Multi-Family../[] Number of Bedrooms ~ / Other WATER SUPPLY [] Community,,,~ Public [] Individual Well Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~/ Public [] Community [] Holding Tank [] Note. If community well system, must have written confirmation'from the State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 72-025 (11/84} ENGINEERING FIRM PROVIDI "kl~r~ INSPECTIONS, TESTS, FILE SEARCH, D~A 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 Approva~ 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 disposat system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on Telephone the date of this inspection. Name of Fir~7/P Address Date %--/~ - ~'~ ADpHp::vAe: fPoRrO,~)/'/'~ bedrooms by ~'1 ~~_ ~2Date Approved ~/~ Disapproved Conditional Terms of Conditional Approval · ":'.i),~ CAUTION The Muncipality of Anchorage 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 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Well Log Prese%/N) ~ Date ~pleted ~/~ /~ield TotalDepth ~ Cased-to ~ Depth of Grouting ~ ~ Static Water Level ~ Pump Set At ~/~ Casing Height Above Ground ~ Sanitary Seal on Casing(Y/N) Electrical Wiring in Conduit (YIN) / Depression Around Wellhead (YIN) Separation Distances from Welt: .~ / ; On Adjoining Lots - ~¢~ To Nearest Sewer Service Line on Lo~ Water Sample Collected by / ; Date Water Sample Test Results To Septic/Holding Tank on Lot ..2%~-~ ~ ¢ of Absorption Field on To Nearest Edge ~,4.~,'/'L°tj~4:- To Nearest Public Sewer Line Cleanout/Manhole B. SEPTICL.__u,E~b,B,H~ TANK DATA Date Installed-~'~ /Z¢ --~-~/Size '~ ;'-~-~ /~,~-~ No. of Compartments StandpiPeS) /.t/.~-~ Air-tig~ap~)/]~ Foundation Cleanout(Y_~. Depression over Tank (Y~) /I/ ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) //~ ;for Holding Tank High-Water Alarm (Y/N) /¢///~/"¢ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: . !~ To Water-Supply Well ~,/~ -¢.-~ '~'¢ //f~¢¢~o Building Foundation '~-~='~ To Property Line ,,// ¢// To Disposal Field .~'/'¢¢ / To Water Main/Service Line '/-~/_' ¢ To Stream, Pond, Lake, or Major Drainage Course ~/~/~ /~' Page I of 2 72-026(1U84~ ABSORPTION FIELD DATA Soils Rating in Absorption Strata -/'.:~'-~ ,~-*-~---~--'~ ¢'~','Z-~ype of System Design Date Installed ~-5'~ -- ./j2 --~?/" Length of Field Width of Field ~ / Depth of Field Square Feet of Absorption Area Depression over Field (~'~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well _~'_/- ,4 .~_~ /, To Building Foundation To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness Standpipes Presert~_~) Date of Last Adequacy Test -~,.d-7'/_~ .~-~.4 ~ -7 ~.~ y / '-~ ~' ',~To Property Line ./.,~ To Existing ~r Abandoned System on ; On Adjoining Lots To Cutbank (if present) LIFT STATION Date Installed /J~ · Size in Gallons , "Pump On" Level at ~-/~.-'/~ , High Water Alarm Le~F.~' /t~'///~ Tested for Electrical Codes (Y/N)///, Comments /t/'/~/~ Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ~,ve check/ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed /~//~-,'_//~ Date ¢'--/~'- ,~'~--~' ,/ Company~Z:~ .~,z/,,¢',.~'~'4/ MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (~ ~/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE:. August 19, 1986 PWS 1.0.# 210346 To Whom it May Concern: According to records on file in this office the GREENBROOK S/D Water System is in compliance with the State Drinking Water Regulations Sincerely, ~ng,: PE District/Engineer ~vo~c~ N. 017321, ",¥a,~ ~= "~,a~,g~ CLEANING SERVICE ~ ~ ~,~" P.O. BOX 112688 PHONE 345-2513 ANCHORAGE, ALASKA 99511-2688 Job Address L ROTOR ROOTER SERVICE CALL HRS. STEAM THAWING HRS. TRIP CHARGE HRS. OVERTIME CHARGE HRS. ADDITIONAL LABOR CHARGE HRS. @ PUMPING SERVICE {,"'2")%{~(GAL) HRS @ HYDRO-JET SERVICE HRS CUSTOMER ORDER PLEASE PAY FROM THIS INVOICE TOTAL TOTAL FOOTAGE CLEANED OR THAWED BLADES USED PRO~BLE CAUSE OF STOP.~AGE //~X--X~,~_.,~_.O ~. [] JOB NOT GUARANTF-c'~D FOR FOLLOWING REASON WORKACC TED. Time ne Date Date -' Date Inspector Inspector Inspector Comments Conditional Approval Datl~ S(~wer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received ; Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Address ~,Li',.~f: -~ ~ , ~ Lending nst'tut'on ~ ~;~ ,., ~f, j?,:,?~ '~" i :Phone Realty 0o, ~ Agent t- Phohe Address Type. o~ Residence ~/ ~&'/ ~-~ Single Family ~ Multiple Family No. of Bedrooms ~ Other Water Supply ~ individual A~ACH W~LL LOG. A well Icg is required for all wells drilled since June ~ Community 1975. For wells drilled prior to that date, give'well depth (attach Icg if Q Public Utility available.) Sewage Disposal ~ Individual Year Individual Installed: / ~' ~ / ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE NSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.