HomeMy WebLinkAboutGREENBROOK BLK 4 LT 13Onsite File
Greenbrook
Block 4
Lot 13
#017-431-04
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211399 PID Number: 017-431-04
Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade
Name
Rhonda Mcleod & David Stranger
AORPTION FIELD
El De Trench ❑ Wide Trench ElBed ❑ Mound
Site Address
12503 Freitag Circle, Anchorage AK 99516
Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
4
JTotal
/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original g e Gravel depth beneath pipe
F . Ft.
Subdivision Block Lot
Greenbrook 4 13
Fill added above original grade Gr I length
Ft. Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Dista a between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between t ches
From
Tank
Field
Tank
Line
Ft2
Well
>100'
>1 00'
N/A
N/A
>25'
TANK R] Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1250 Gal.
Surface Water
>100'
> 100'
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>10'
>1 0'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
EI ical installed by
Installer
PIPE MATERIAL House to tank D3034 drainfield Tank to
D3034
Hiland Excavating
Drainfield D3034 CO/MTD3034
Inspector L.Tidwell
BENCH MARK (Assumed elevation) 100 ft
Inspection
15` 9/30/21
Location and description
nd
3`d 4m
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
OF•449,,�1
DateAk
Amp, •<<G
49
�/
Septic System
Benjamana5chiller
�f ���'•
Approved ` Date ICS 'g-2�
CE 12592 • Sill
4� ��jFq•
..10/1/21 , •F�C�e
Note: this approval does not include well permit requirements.
ilj® pROFESS10N1'�a
PERMIT # OSP211399
eNciHeeaiNc
i
PID # 017-431-04
Vu.V
PROFILE AS -BUILT
(NO SCALE)
FOAM INSULATION
Rol
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HOUSE DETAIL
Scale: 1"=20'
2.0'
POST & RAIL FENCE
(SEE NOTE 2)
/ 300•11�/
O
0 10 25 50 100
SCALE: 1"=40'
NOTES:
1) THE LOT IS SERVED BY A COMMUNITY
WATER SYSTEM.
2) THE POST & RAIL FENCE ENCROACHES
INTO THE RIGHT-OF-WAY.
3) THE CURVE DISTANCE ON THE ORIGINAL
PLAT DOES NOT MATHEMATICALLY CLOSE.
(C) = COMPUTED
R = RECORD
10.2'x10.0' SHED ON
13.3'x11.3' DECK
UTILITY EASEMENT
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211399
Work Type: SepticTank Upgrade
Tax Code Number: 01743104000
Site Legal Address: GREENBROOK BLK 4 LT 13 G:2839
Site Mailing Address: 12503 FREITAG CIR, Anchorage
Owner: MCLEOD RHONDA L &
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
�1�zent
llepartinent
9/17/2021
9/17/2022
51'1'•
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Veronica Pope
GE 2021.09.17
Received By: 09:58:50 -08'00'
Issued By: _ eaxtou
Date:
Date: 1 t 1 10� 1 f
4
MUNICIPALITY F
Community Development Department .
Development Services Division
On -Site Water & Wastewater Program
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 017-431-04
Property owner(s) Rhonda Mcleod & David Stranger Day phone
Mailina address 12503 Freitag Circle, Anchorage AK 99516
Site address 12503 Freitag Circle
Legal description (Sub'd., Block & Lot) Greenbrook B4 L13
Legal description (Township, Range & Section)
Lot Size 49,096 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
x❑
(w/wo AD U)
Septic Tank
❑x
Upgrade ❑x
Duplex (D)
❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES
A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: Z -r,
Date of Payment: q 5 A0.2 1
Receipt Number: `{ 9 0 y-6
Permit No. 0S,PZ 1 1399.
Permit App__- : , _..:c
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
September 10, 2021
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
9/10/21
Subject: Greenbrook Sub B4 L13- 12503 Freitag Circle
Septic Tank Replacement
Dear On-Site Services Engineer:
The owner of the above lot intends to sell their home and the septic tank on the property has
reached its end of useful life. We are submitting this permit application for the replacement of the
septic tank. The attached site plan identifies the location of the home as well as the existing septic
location. The home is serviced by a community well that is greater then 200’ from the septic
location. The exact location of the water service line is unknown; however, based on the adjacent
lots its location will not impact the proposed tank replacement location.
Please refer to the attached plan for the septic design. If this design is followed, there will be no
adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211399, Rebecca Carroll, 09/17/21
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~J MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE I NEW
LOCAT~O~ NO, OF BEDROOMS
~ DISTANCE TO: ~7----¢ ~__~ Absorption area Dwelling .ERMIT¢/oNO.
~¢~Z : Manufacturer ~ *~ Mat eria,~ ¢ No. of compartments
Liq.~apacity in gallons Inside length Width Liquid depth
/Z.~ IF HOME~DE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O z ~ Manufacturer Material Liquid capacity in gallons
D Well Foundation Nearest lot line PERMIT NO.
~ DISTANCE TO:
No. of lines Length of ea Total length of lines Trench width Distance between lines
-- ' ~ inches
~waterial beneat tile Total effective absorption area
~ ' 7 ~ inches N~
Length Width Depth PERMIT
~ ~ 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 PERMIT NO,
Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOl L TEST RATING
REMARKS ~ t'Z
APPROVE~~ DATE LEGAL
72-013 (Rev. 3/78)
PERmiT' NO.
R. PF'L I CRNT
LOC:RT ! ON
L. EGRL
FIRNOL. D POLRNCHEK BOX 292'i_
FREITRG CIRCLE
LOT ::L}:-': BLK 4 GREENBROOK S,-"D
L, OT SIZE
TWPE OF SOIL FIBSORF'T!ON S'T'~'TEM IS: TRENCH
MRXIMU.r,! NUMBER OF E:EDROOMS = 4
2'2'9 9992
49096 SQL.!RRE FEET
SOIL RWFI.NG ,:.'SQ F]'/E:R)=
THE REQUIRE[.', SIZE OF THE SOIL. RBSORPTION S?STEM !E;:
]'HE L.ENGTH DIMENSION IS 'THE LENGTH -'.'.'IN FEET) OF' THE TRENCH Of;.: DRR!NFIELD.
TFIE C, EF'TF! OF' R TRENCH OR PIT !S THE DISTRNCE BE'FNEEN THE SURFRE:E OF THE
GROUND RND THE BO"rTOH OF ]"HE EXCRVRTiON (IN FEET),
THERE tS NO SET N!D'f'H FOR TRENCHES.
TFiE GRW,,,'EL DEF'TH IS THE MINIMUM DEPTH OF' GRAVEL. BETNEEN THE OUTFRL. L PIPE
RND THE BOTTOM OF THE Ei:.,',(]RVRTION <IN FEE'I').
PERMIT RPPLICRNT HaS 'THE F.:EBPONS!B!LIT? TO iNFORM THIS DEPRR'TMEN'f' DURING THE
iNSTRLL. RTION INSPECTIONS OF RN'¢ P.!EL.LS 8DJRCENT 'TO THIS PROPER]"? aND THE
NUHBER OF RESIDENCES 'THF!T THE NELL. NILL !SERVE.
BRCKFII. LING OF RN"¢ B'¢L:;TEM WITHOLFF FINRL iNSPECTiON aND .~PPROVRL B'¢ "r'HzS
[.',EPRRTMENT .WILL BE SUBJ'ECT TO PROSECUTION.
MINIMUM DtSTRNC:E BETNEEN R WELL. RN[.', RBFr' ON-SiTE SENF4GE DISF'OSRL S'T'STEM :ES
!00 FEET FOR R PRtVF4TE P.IEL. L OR i5¢ TO ;;~'.~0 FEET FROM R PUBLIC NELL DEF'ENE:,ING
UPON THE 'T'¢F'E OF PUBL.!C P.!ELL
MINIMUM DISTANCE FROM a PRIVATE NELL TO R F'RIVRT'E SENER LINE IS 25 FEET FiND
TO R COF1MLINtT"r' SE!,IER L. INE IS 75 FEET.
OTHER REQUIREMENTS M~"r' RPF'L~'. SPECIFICRTIONS RND CONSTRUCTION [:'IF!GRP, ME; BRE
~V~!LRE,'LE TO INSURE PF::OPER. IN~;TBLLFITION.
! CERTIF"? THRT
i: I RM F:RHILIRR W!TFI THE REQUIREMENTS FOR ON-SITE SEWERS RND .NEL!_S RS SET
FORTH B'¢ THE MUNICIPRLIT'¢ OF' RNCHORRGE.
2: I klILL INS'TFILL. THE S"?STEM IN RCCORDRNCE WiTH THE CODE'S;.
3: I UNDERSTRND THRT THE ON-SITE SENER S'¢STEM MRL'r' REQUIRE ENL. RRGELMENT IF 'THE
RESI[:'ENCE IS REMODELED TO INCL_UrPE MORE THRN 4 BEE)ROOMS.
RPPLICRNT RRNOLD POLRNCHEK
........................... ,:. .......
ot 13, Block
Table N
WO #A19708
Date: 4/8/81
Logged by: O. Hatch
Depth in Feet
From To
0.0 1.0
I .0 2.0
2.0 8.5
8.5 11.0
11 .0 16.0
Soil Description
Brown Peat
F-4, Brown Silt, ML, moist, stiff, NP
F-4, Brown Gravelly Sandy Silt, ML moist,
stiff, 6" maximum, NP
F-2, Brown Silty Gravelly Sand, SM, moist,
medium dense, poorly graded, 2" maximum
F-4, Brown Gravell~ Sandy Claye~ Sil~, ML,
moist, stiff, 2" maximum, PL- to NP
Set 3/4" perforated PVC pipe to run perc test
and to monitor water table elevation.
Perc Rate = 9.0 minutes/inch. System should
be placed between 5.0 Feet and 11.0 Feet.
Bottom of Test Hole:
16.0 Feet
Frost Line:
Free Water Level:
1.5 Feet
4/7/81 -None Observed
4/9/81 - None Observed
MUNICIPALITY OF ANCHORAGE
Development Services Department ""
P p Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 017-431 -04
1. GENERAL INFORMATION
Expiration Date:
Complete legal description Greenbrook, Block 4 Lot 13
Location (Site address) 12503 Freitag Cir, Anchorage, AK 99516
Current property owner(s) Rhonda Mcleod & David Stranger Day phone
Mailing address 12503 Freitag Cir, Anchorage, AK 99516
Real estate agent Jeff Schroder
2. TYPE OF DWELLING:
FEEI Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone (907)242-3450
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: Distan
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 950
Date of Payment /04zzz I
Receipt Number 05h5SD
COSA # 0.5r,-2
Date:
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 Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 9/15/21
/*:49TH /
6. D7 SIGNATURE :� �j ...........
System #1 Approved for 4 bedrooms
Y pp oms r BenjaneSchillerCE 125
/
System #2 Approved for bedrooms ���s'• 10/4/292 �``�•�r�
1rF9F�p•....•p�F��
Disapproved kl ROFESSlO�
Conditional approval for bedrooms, with the following stipulations:
z
o WAST`�-V'ATER o
J PROUKAM J�
h ��
7LT Rv�Oc
' ))))))111''.
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 Checklist blue sheet
• K -
Legal Description: Greenbrook Sub, Block 4 Lot 13
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
is filed with Onsite (or attached)
Date dril
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 COMMUNITY WATER PWSID 210346
B. TANK DATA
Age of tank(s) <1 years
Tank type/material Septic/Plastic
Measured operating fluid level in septic tank New
0 Standpipes/foundation cleanout per record drawing
Date of pumping New Tank
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 9/18/81
0 ALL standpipes present per record drawing
Total measured depth from grade 8.6 ft (max)
Measured depth to pipe invert from grade n/a* ft (min)
❑ N/A — pressurized field
Q Monitor tubes go to bottom of effective. If not, state
depth into effective
Q Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies: `Original installation only includes monitor tube
COSA Checklist yellow sheet
Parcel ID: 017-431-04
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)
n i c ug/L ❑ Arsenic less than MRL (ND)
Collected
Date of Sample
STATION
❑ Require aintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 9/13/21
Results 0 Pass For 4 bedrooms
Fluid depth prior to test 39 in
Water added 800 gal
New depth 69 in
Elapsed time 1440 min
Final fluid depth 37 in
Absorption rate >600 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
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'
0
Yes
Community Sewer Manhole/Cleanout > 100'
0✓ Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' M Yes
if No
ft
Private Sewer/Septic Line > 25' ✓M Yes
if No ft
Absorption Field on Lot? 100' ❑✓ Yes
if No
ft
Holding Tank > 100' 0✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' 0✓ Yes
if No ft
0 Yes
if No
ft
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Yes
if No
ft
r✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' r-71 Yes if No ft Surface Water > 100' Q✓ Yes if No ft
Property Line > 5'
0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100'✓Q Yes if No ft
Water Main > 10'
✓1
Yes
if No
ft
Community Wells > 200' 0✓ Yes if No ft
Water Service Line > 10'
R
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'
✓1
Yes
if No
ft
Private Wells > 100' 0✓ Yes if No ft
Water Service Line > 10'
R
Yes
if No
ft
Community Wells > 200' U✓ Yes if No ft
Surface Water > 100'
✓❑
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that l 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.
COSA Checklist yellow sheet
OF
V
•`49 T-"
... ..;::.. ........
BenjantrySchiller
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�F9F� pROFE SStONt`� �,aw
MUNICIPALITY OF ANCHORAGE
DEI~ARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ~\'-~- Li-~ - ~L.~
1, GENERAL INFORMATION
Complete legal description
HAA # ~"1 ~:~c~ %t'~
Lot 13; Block 4... Gr6~n§rook S~Sdivi~ion
Location (site address or directions)
12503 Fr~ita~ Cirel~
Anchora96, AK
Day phone
Anchorage, AK
Day phone
Concord, CA 94524
Property owner
Mailing address
Lending agency
Mailing address
Arnold and Janic~ Polanch~k
12503 Fr~itag Cir~
~I~n~FOHITV
P.O. Box 4039
345-7029
99516
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup·
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well
Community well XX×
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOAtf21
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'9
Municipality of Anchorage /~
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LoT IS ~ ~r ~Eg~J~' ~'//~ Parcel I.D.
A, WELL DATA
Well type A
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
I(A,~, or C, attach ADEC letter.
Date completed
Cased to
FROM WELL LOG
ADEC water system number
Driller
Casing height ~:~;
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
(~__.0'~/'f-") ; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank /~J~,~:
WATER SAMPLE RESULTS: ,,~, J~. E,~, £E77'EF&. o¢ ~o.-t4¢c/~¢-f'-~ 15 /477',~1CHE~
Coliform N it rate Other bacteria
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~//~¢/
Cleanouts ~.~N)
High water alarm (Y/~_~
Date of pumping .~/~/~
Tank size //~ .CO Compartments ~
Foundation cleanout ~) ~¢,,f Depression (Y~) ,/,Jo
Alarm:tested (.Y./N)!'" '?/,~ ' ....
Pumper ~+ /~O/P'/~ .~"~'74'd~'lC-~_~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot d--o"~'~u/'~'rT'~/~° ~O~nadjacentlots
To property line ~ r Absorption field
Surface water/drainage /OO r ·
Foundation __/O ,,~
Water main/service line /~ ~
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Manufacturer
Size in gallons~ Manhole/Access (Y/N) ~
Vent(Y/N) "~.~ ~ ~-'"~level at
High water alarm level ~~ye~s tested _
Meets MOA electrical codes (Y/N) ~ ~
SEPARA~IFT STATION TO: ~
We~tJ~"f-lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed ~::~//~/°¢/
Length ::~'~ ! Width
Total absorption area ~/'~ ~
Depression over field (Y~_~
Results ~/fail) //~/4r £ .~-
Peroxide treatment (past 12 months) (Y/N)
Soil rating
/
Gravel thickness
Cleanouts present (~N)
Date of adequacy test
for /-iL '
/~O ¢"//~_/~/,~0¢,~ System type
Total depth
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ("_.¢,,¢~.~1~T' C~/.~ On adjacent lots
To building foundation ~O f
On adjacent lots ~O
Surface water /
Property line
To existing or abandoned system on lot
Cutbank ,~)a-~ /'~E,~O-~Watermain/serviceline
Driveway, parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of th/s inspection.
Signature fi & S ENGINEERING
17034 Eagle River Loop Road No. 204
Engineer's Name--.,~ ~.'.~-
Date
HAA Fee
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
WALTER J. HICKEL, GOVERNOR
(907) 349-7755
May 4, 1993
Mr. Scott Swenor
S & S Engineering
SUBJECT: Lot 13, Block 4, Greenbrook Subdivison
Class "A" Public Water System, PWSlD 210346
Dear Mr. Swenor:
I have completed a review of this office's files concerning the monitoring status of the
above-referenced Class "A" Public Water System and found the following:
The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on April 1, 1993. This does meet the provisions of 18
AAC 80.200(a), of the State Drinking Water Regulations.
The last inorganic Chemical Contaminants Sample results were submitted
to this Department on November 10, 1992. This does meet the provisions
of 18 AAC 80.200(a), of the State Drinking Water Regulations.
The last Radioactive Contaminants Sample results were submitted to the
Department on December 11, 1992. This does meet the provisions of 18
AAC 80.200(a), State Drinking Water Regulations.
The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC)
were submitted to this Department on November 12, 1991. Based on
analysis of the previous VOC samples results have been satisfactory. This
does meet the provisions of 18 AAC 80.200(a), State Drinking Water
Regulations.
Issuance of this letter does not imply that the above-referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations. This
letter is valid for 30 days and is for the specified legal description noted above only.
If you have any questions on the above information, please do not hesitate to contact this
office at 349-7755.
Sincerely, ,
Michael Lu
Environmental Eng. Asst. II
STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS
PROPERTY DESCRIPTION
Block & Subdivision or U.S. Su~ey
Lot 13, Block 4 Greenbrook Subdivision
12503 Freitag Circle
Anchorage, AK 99516
[ Car ti fi;~; ;;; f ° rBA(~)P icat;n~N;:3 46
This approval does not constitute a guarantee of any kind, explicit or implied, as to the performance
of the water supply and wastewater disposal systems.
WATER SUPPLY
A recent water sample was tested and found to meet Department of Environmental Conservation drink-
ing water standards for total coliform bacteria.
Title . =ir ;ate ~
Env. Eng. Assr May 3, '9
WASTEWATER DISPOSAL
The domestic
system was:
[] inspected by the
applicable
~artment of Environmental Conservation and fou to be in compliance with
~ts of 18 AAC 72;
[] inspected by a Engineer who certifies that
quirements of 18 AAC 72;
complies with applicable re-
[] installed by a Certified Install. certifies
of 18 AAC 72; or
system complies with applicable requirements
[] tested by a Professional Engineer ifies that the performance of the system is satisfactory
and that the system complies the lum separation distances specified in 18 AAC 72.
This approval is valid for/~ single family []
Name ~
unit with atotal of
bedrooms.
Date
18-0404 (Rev. 8/85) DISTRIBUTION: WHITE--BANK/LENDING INSTITUTrON; CANARY--APPLICANI~ PINK--DEPARTMENT
MUNICIPALITY OF ANCHORAGE
DEPARTMENT Oi: HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date October 29, 1986
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 13, Block 4, Greenbrook; Section 26, T12N,
R3W Seward Meridian
Location (address or directions)
(Intersection of Freitag Drive and Frei,Fa§ Court)
(b) Applicant Name Arnold Polanchek Telephone: Home 345-7029 Business
Applicant Address P.O. Box 102921, Anchoraqe, AK 995'10
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); Owner
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
(f)
Telephone
Mail the HAA to the following address:
Mr. Arnold Polanchek
P.O. Box 102921
Anchorage, AK 99510
2, TYPE OF RESIDENCE
Single-Family [] Multi-Family [] Other
Number of Bedrooms Four (4)
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legclity and status. (Letter Attached)
4, SEWAGE DISPOSAL ·
· Onsite [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
5.~ EN,GINEERING FIRM PROVIDINGk~SPECTIONS~ TESTS, FILE SEARCH, DAT~'~ND INFORMATION :
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of t.~is Health
Authority ~pp, roval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adeq u'~'te
for the n~mber bf b'~drooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm R. F. Black Consulting Enginee~elephone (907) 562-0238
nc
Address 4794 Business Park Blvd., ~ul~e 6
Date October 29~ 1986
EXCEPTED CONDITION:
REQUIRED STANDPIPE CONNECTED TO DRAINFIELD PIPING WAS
NOT FOUND. IN OUR OPINION, THIS CONDITION WILL NOT
SIGNIFICANTLY IMPAIR SYSTEM PERFORMANCE AND SHOULD BE
CORRECTED WHEN DRAINFIELD IS REPLACED.
Engineer's Seal
Approved for ~&~ ~edrooms by ~ ~ _ .
Approved ~' DisapDroved Conditional ~~
Terms of Conditional ~.
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 (11/64)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Lot 13,
Legal Description:
Greenbrook Subd.
RECEIVED
Block 14
(Plat 74-147)
Welt Classification Class A-Community ICA, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) N/A Date Completed N/A ~ Yield
Total Depth
Static Water Level N/A
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
N/A Cased to N/A
N/A
N/A
See Attached Letter
N/A
N/A
N/A
Depth of Grouting N/A
Pump Set At N/A
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots Over 50 feet
Over 50 feet
To Septic/Holding Tank on Lot Over 200 '
To Nearest Edge of Absorption Field on LotOver 200 ' ; On Adjoining Lots
To Nearest Public Sewer Line N/A
Cleanout/Manhole N / A
Water Sample Collected by N/A
Water Sample Test Results N / A
Comments N/A
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Date N / A
B. SEPTIC/N~)I4(~[I~G' TANK DATA
Date Installed9 / 18/81
Yes
Standpipes (Y/N)
Depression over Tank (Y/N) No
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) N/A
Separation Distances from Septic/M~]~Tank:
To Water-Supply Well Over 200 ft.
Over 10 ft.
To Property Line
To Water Main/Service Line Over 7.5 ft,
Over 100 ft.
Cburse
(R)Size1250gal(R) No. of Compartments Two (R)
Yes Yes (Note 1)
Air-tight Caps (Y/N) Foundation Cleanout (Y/N)
October 22, 1986
Date Last Pumped
N/A · for N/A
Temporary Holding Tank Permit (Y/N) N/A
To Building Foundation Over 10 ft.
Undeterminable
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Note 1: CLEANOUT PRESENT IN BASEMENT WITHIN 4 FT OF EXTERIOR
Comments
WALL. Note 2: (R) denotes information of record obtained from
Municipality of Anchorage File Review
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Datelnstalled 9/18/81 (R)
WidthofField 36" (Ri
2
Square Feet of Absorption Area 648 ft (R)
Depression over Field (Y/N) No
Results of Last Adequacy Test Acceptable
Separation Distance from Absorption Field:
To Water-Supply Well Over 200 ft.
To Building Foundation Over 10 ft·
Lot 14, Over 50 ft.
To Water Main/Service Line Over 75 ft.
'Fo Stream/Pond/Lake/or Major Drainage Course
min/inch (R) Type of System Design Deep Trench (R)
Length of Field 54 ' (R)
Depth of Field 4.5 ' (R)
Gravel Bed Thickness 72" (R)
Standpipes Present(Y/N)No (See Note 1)
Date of Last Adequacy Test October 24, 1986
To Property Line Over 10 ft.
To Existing or Abandoned System on
; On Adjoining Lots Over 50 ft.
To Cutbank (if present) N/A
Over 100 ft.
ToDriveway, ParkingArea, orVehicleStorageArea N/A
Comments Note 1: System has an observation well but lacks standpipe
at end of trench piping. This deficient condition should not
significantly impair system and no repair is recommended·
lIFT STATION (NONE PRESENT)
Date Installed N/A
Size in Gallons N/A
"Pump On" Level at N/A
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
N/A Vent (Y/N)
N/A
N/A
N/A
N/A
N/A
N/A
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that havec, hecked, verif ed. or conformed toa MOA and HAAgu de nes in effect on the date of this inspection.
Signed " '-'-'¢ '.., Date October 29, 1986
ST 86-303
Company R.F. Black Cons. MOA No.
Engineers, Inc.
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Engineer's Seal
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: October 28, 1986
PWS I.D.# 210346
To Whom it May Concern:
According to records on file in this office the Greenbrook Subdivision
Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
~pervisor
