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HomeMy WebLinkAboutGREENLAND BLK 1 LT 1Greenland
Block 1
Lot 1
#015-172-19
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP221121 PID Number: 015-172-19
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
JOSEPH ZIMMERMAN
ABSORPTION FIELD - EXISTING
❑ Deep Trench ® Wide Trench ❑ Bed ❑ Mound
Site Address
4970 E 112TH AVE, ANCHORAGE, AK 99516
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
2 GPD/SF
6 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2 Ft.
Gravel depth beneath pipe
4 Ft.
Subdivision Block Lot
GREENLAND 1 1
Fill added above original grade
VARIES 1.13 —1.32 +/- Ft.
Gravel length
2 X 20' 40 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
*285+ FtZ
2
10 Ft.
Well
*50'+
__
251+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ® Other ADVANTEX
Manufacturer
ORENCO / ANCH. TANK
Capacity
1500 Gal.
Surface Water
*50'+
__
Material
COMPOSITE PLASTIC
Number of compartments
2
Lot Line
51+
__
NA
Foundation
10'+
__
LIFT STATION
Manufacturer
ORENCO
Capacity
1500 Gal.
Remarks `AX SYSTEM SEPARATIONS & ONLY USED. ZED FOR
ASBSORBTION = 285+ SF OF SAS. NEW FIELDS INSULATED
Alarm location
1ST FLOOR
Electrical installed by
RISING SON
EVEN THOUGH THERE WAS ADEQUTATE SOIL COVER.
Installer NORTHERN EXCAVATION
PIPE MATERIAL House to tank 3034 dra rifled 3034
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspectionddates: 1s' 6/27/2022 2nd 6/28/22
Location and description
3'd 6/28/22 4" 6/29/22...
TOP OF ADVANTEX POD
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
• • ` `'' ��$
Conditional Approval: Date
.W I •.ig
BTH
•
•• ••"•••• •••••••:••
Septic Syste
Approved
�� �•,Curtis Huffman
-
�` CE 128991
Z
Date �' '�Z
¢
�����', �•,?/15/22 •�����
�k�FOPROFESSIO�V
Note: this approval does not include well permit requirements.
�'���,,,�-��-®..
PID:015-172-19PERMIT:OSP221121
FIRST WATER CONSULTING
GREENLAND BLOCK 1, LOT1
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 /T Day of JA UVY
of 20 ? , by and between
_j_05_e5'N JA:.vcs csu , 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 ADVANTEX
located at (legal description)
-GREENLAND BLOCK 1 LOT 1
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
T3 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.
Z'S 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).
TA 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.
TT 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.
-TI Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
S'S Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
aJ 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.
T 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
OWNER:
By: (signature) Date: j4,4j � GLI
�,t; (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this 1-P+day of
20n, by _TAiQP
N sWosoAn��
,y Commission expires:
NOTARY
MUNICIPALITY•flO1111
By:OJ (signature) Date: I/ Z
Cc / M"1 S 7t, r,..D (print name) Title: G (V(-
1.
Vr-
(rev. 05/18/2018) Page 3 of 3
MUNICIPALITY OF ANCHORAGE
ti
Development Services Department 1 Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 015-172-19
Certificate of On -Site Systems Approval
Gf Z (0/-10 Z_3
1. GENERAL INFORMATION
Complete legal description GREENLAND BLOCK 1 LOT 1
Expiration Date
Location (site address) 4970 E 112TH AVE, ANCHORAGE, AK, 99516
Current property owner(s) JOSEPH ZIMMERMAN Day phone
Mailing address
Real estate agent
4970 E 112TH AVE, 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
4. TYPE OF WATER SUPPLY:
Day phone
Private Well
®
TYPE OF WASTEWATER DISPOSAL:
Water Storage
❑
Private Septic
Community Well
❑
Holding Tank ❑
Public Water System
❑
Community ❑
Public Sewer ❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 1� M
Date of Payment 7�6/Z2
Receipt Number _ 1140q6'
COSA# aSCa�13-Z
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 6/30/22
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
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & FWCS
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
E
System #2 Approved for bedrooms
Disapproved
~' OFAi8111
*: 49 7H ....:* r�
/jj . ' • Curtis Huffman j
Ir+ �F67 CE 128991
PROF 0( ONPX�
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date: Z 11 _�o2
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
Legal Description: GREENLAND BLK 1 LT 1 Parcel ID: 015-172-19
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA – PUBLIC WATER
Well log is filed with Onsite (or attached)
Date drilled CIRCA 8/17/1971
Total depth 150+ ft
Cased to 40+ ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 5/2/22
Static water level at beginning of test 59 ft.
Well production at time of test 5+ gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 0.51 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample 6/16/22
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) NEW TANK years
Tank type/material ADVANTEX FAP / PLASTIC
Measured operating fluid level in septic tank NEW
Standpipes/foundation cleanout per record drawing
Date of pumping NEW TANK 6/27/22
C. LIFT STATION
Required maintenance completed
Age of lift station NEW LIFT STATION years
Lift station material PLASTIC
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) NEW 6/29/22
ALL standpipes present per record drawing
Total measured depth from grade 7.32 ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective ED 4’ TOTAL DEPTH
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date NEW
Results Pass For 3 bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
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 *50+ ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No *50+ ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/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
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Property Line > 5’ Yes if No ft
Absorption Field > 5’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No *50+ ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ 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
Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No *50+ ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No
F. ENGINEER’S COMMENTS
*THIS IS AN ADVANTEX FAP SYSTEM AND MEETS ADVANTEX SEPARATIONS FOR SUBJECT & ADJ LOTS.
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.
7/15/22
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ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
GREENLAND SUBDIVISION
LOT i BLOCK 1 PLAT P-268
SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance shout(
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: DATE: SCALE: E—MAIL:
JULY 9, 2022 1 "=40' schuller0ok.ne#
22-070 DRAWN BY: CHECKED BY GRED NUMBER: B04K/PA{
JLS SW2636 220247
* = FND 5/8" REBAR
, - -q!
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9 .......... . ...........
o •.Jyj _; 0 - - HN L. SCHULLER.• o
` s • LS -10408 qj
•.
0 . • ' ���� / 1831 Talkeetna Street
o�• : ,,,r Anchorage, Alaska 99508
.Nvk�,C�o
fe a� L „�, (907) 227-1455 office
L®` ssio®�,�•.... (907) 274--4992 fax
MUNICIPALITY OF ANCHORAGE
On -Site 411atg F& WasWisatar Program
M Elm 19615350 4740 Emma Reed
ArchoraW, AJeatoa X3819-fi55p PMM,�. (907)343.7904 Fax= (M) 343-799,
h 11 p , A'w*tiw jm rt i , wq kwr5 i to
n -Site Wastewater Di p0$a18 ystem Permit
Pc rm it Number: OS P221121
lhtark Type; Septir- Upgrade
Tnx C -ode Number: 015172190DO
-5ite Legal Address: GREENLAND BLK I LT 1 G:2636
Site Mai li ng Ad d rens, 4970 E 112TH AVE. Andhorage
Owner: ZIMMERMAN JOSEPFr W
Design Englnear= FIRS7WA7ER CONSULTING
This permit is forth* constniction cyF;
Effective Dates
Expiration Date:
men r
a
n
rt n
t1S' lart11 ant
Lot Size in 3q Ft:
Total Bedrooms-
V3V2022
W31
2716
Q Disposal Field RI peptic Tank ❑ Holding Tank Q Privy ❑ PrIvato 11%rell ❑ Water Storage
All conotruai on s hal l be 1 n accordance with:
1. The attached approved design_
. All mquirements speelfied in Anchorgige M unicipal cads Che laters 15.55 -end 15,$5 and the State of Alaska
Wastewater Dlspossil Regulations (IBAAC72) and Drinking Vater Regulations (1 C-80}
3, Tho wastewater code requires Inspl2di !� EiLuinq the i R1r-t11mHnn 7hiR L-rboinaAr Rh -q11 n"Ify iM* Dq'v.sl4Pm-�-nt
Services Department per AMC 15, 55, Provide noiif!cation by Galling P07) 343-7 (240).
4. , From Odober 15 to April 1-5, a aubaurface sail ab3orption "am under can5trtictlon during freeing weathlar
ah JI be either:
a_ Opened and Glased on the same day. or
b. Covered, sealed, arta heated to prwerrt framing
Special Provisions; Ploase note, the ML layer was not perk tasted so cannot be utilized for iirc- required
absoipiion area.
Fk,"VOd By,
Issued P:
Date: 5l 31T
D -ate- 5-,
MUNICIPALITY OF ANCHORAGE
Development Services Department r' Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I. D. 015-172-19
Property owner(s) JOSEPH ZIMMERMAN Day phone
Mailing address 4970 E 112TH AVENUE, ANCHORAGE, AK 99507
Site address 4970 E 112TH AVENUE, ANCHORAGE, AK 99507
Legal description (Sub'd., Block & Lot) GREENLAND 131, L1
Legal description (Township, Range & Section)
Lot Size 27,153 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
0
Initial ❑
Single Family (SF) El
(w/wo ADU)
Septic Tank
El
UpgradeX
(D) El
Holding Tank
❑
Renewal ElDuplex
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A 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: 595
Date of Payment: (D - 24 ,Z
Receipt Number:
Permit No. 2--2-112, 1
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
May 13, 2022
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: GREENLAND B1, L1
The property owner has requested we obtain a permit to upgrade the failed septic system of the
above referenced lot. We propose to install two shallow trenches and a 1500-gallon Advantex
FAP 2.0 plastic tank to serve the existing 3-bedroom residence. The design is based on the
recent test hole conducted on May 2, 2022. No groundwater was observed at test hole
excavation or monitoring.
The slopes are moderate at 5% at the proposed upgrade location. The lot and area are served by
private water. The design will not impact any of the neighboring properties. Please contact us if
you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221121, Rebecca Carroll, 05/31/22
FIRST WATER CONSULTING
GREENLAND BLOCK 1, LOT1
DESIGN CALCS:
NO WELLS WITHIN
50' OF PROPOSED
SEPTIC AX SYSTEM
NO SLOPES >25% WITHIN 50'
OF PROPOSED FIELD.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221121, Rebecca Carroll, 05/31/22
FIRST WATER CONSULTING
GREENLAND BLOCK 1, LOT1
DESIGN DETAILS:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221121, Rebecca Carroll, 05/31/22
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: GREENLAND B1 L1
PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 5/13/22
DEPTH
FEET OG
SOILS
1
ORG/OL
2
3
ML
4
5
6
7
8
GM/sm-ml
9
10
11
12
13
14
15
16
17
BOH
18
19
20
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
5/13/22 30 min 6 1 2/16
30 min 6 1 1/16
30 min 6 1 1/16
PERCOLATION RATE 28.4 (MIN / INCH)
TEST RUN BEWTWEEN 4 & 5 FT
PERC HOLE DIAMETER 6
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: NA
DEPTH TO WATER AT MONITORING: DRY
DATE: 5/13/22
TESTHOLE # 22-1 DATE PERFORMED: 5/2/22
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: JOE ZIMMERMAN
5/13/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221121, Rebecca Carroll, 05/31/22
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 �2 (; Day of JMav
/ of 20�, by and between
,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 Svstems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as AN ADVANCED ADVANTEX SYSTEM
located at (legal description)
GREENLAND BLOCK 1, LOT 1
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
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.
IJ 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
OWNER-
By: 5' nature) Date:
t name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this _ day of
20_, by
NOTARY PUBLIC FOR ALASKA
My Commission expires:
MUNICIPALITY:
By: /1j1-JWZ (signature)
PdOeCoA, �( (print name)
(rev. 05/18/2018)
Date:
Title:
Page 3 of 3
Municipality of Anchorage Page I of –3--
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 u Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: -5-W . (0 3.6' e _ _ _ PID Number:
Name. E
R nl C-S 7" S (G. v�
Wastewater System: ❑ New VA Upgrade
Address:
!1201 our (?G(, An ch ffk 995/%
ABSORPTION FIELD
Phone:p No. of Bedrooms:
3 y6 — 2 ctS3 3
❑ Deep Trench ❑ Shallow Trench G/ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION '
Soil Rating:
Total Depth from original grade
018 GP>
U/S Ft
Lot. Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
_ I I G RECNL r9N
a•9 Ft.
v.6 Ft.
Township:
IZN
Range:
3w
Section:
22
Fill added above original grade
Gravel length:
I'H FI.
2Yr Fl.
WELL: e--xis r, ❑New ❑Upgrade
Gravel width: 20
Number of lines:
Distance between lines:
Ft.
q
5:O Ft.
Classification (Private, A,B,C):
Total Doplh:
Cased To.
"Fetal absorption area: a
Pipe material:
Ft.
Fl.
5_(90 SQ. Ft.
I it(" DIA SCH EO teo PvC
Driller:
Date Drilled:
Sialic Water Level:
Installer:
I Date installed:
Ft.
64Rt-s GACA vgT•INO--
fie/ it /91
Yield:Pump
Set at:
-
Casing Height Above Ground:
TANK
GPM
Ft.
FL
_ SEPARATION DISTANCES
_
❑ Septic ❑ Holding W S.T.E.P.
To
Septic
Absorption
Lin
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
Atnehora e Tank
1?6_0
Well
10 2
101'
102,
—
73 t
Material:
Sf-ee(
Number of Compartments:
Surface
Water
7 «
> loo'
> I00'
LIFT STATION
Lot
Line
HO'
2'
HO'
—
H0'
Size in gallons:
25-0 a
Manufacturer:
Anc,o e Tun k f/ 0rep co
Foundation
32
r
32
,
32
O
"Pump on" level at:
yztr
"Pump oft" level al:
38n
High water alarm at:
H6n
CurtainP
rr�p ak��& Mn eIG Ictrical Inspections performed by:
rl fV !J
Drain
7 yx� M O•A.
Remarks: sySFem rnsfal(e�i er
BENCH MARK
Location and Description:
�Fa✓ran d- lb/ lime, waiver, prop S hc, /unk
-T'hresholrf c�f bctremenf �c9or
alld Ce cb u rr.! �rNe� abandonec/ r'n
Assumed Elevation:
pace. Perc rine of unolerl rn NG-
loo, 00 Ft
r
1s < (2o Yntn /ri+ch, l%itrli (e anr�P ceuclrile hryh leve/ a(e(rn,
ENGINEER'S SEAL
;y` ;•°°.a easr. nI7
410un1�00C fn S/1 arra a1em-en/ of 6ui(rlrn 6eC4
exCaverhu.q Coverea anriC hevAeae 777nv ccynS ueiTrn
Inspections performed by: F(aH*,!? Teeh Dates: 1st 12/3/9(
" �,•' f,r ;,_; ; 'e v 4
2nd 12/H/9/.........°.°...•°•..�:...
Department of Health ani-d H man Serres approval
S'3. •.°.°'`I" `'" `_ A100
.E.f
CE -n'j
r
v��d'`'�=
Reviewed and approved by: _—Z _Date: '' �`
'
°••••°°•^;'t:;=ci
n_
Permit No. .5 W 9 /O 362
Page a of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: 1= 1, 13 1, 6: neem land S /.D PI D No.: 0/,5_/_7212
112 th A VE,
New IeS06.
STC -P T/+Nf;
Lu. 0 M EIYCO
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20
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NC -w ?o' 7( 29_�
So IH AG.C. GeD
T6M
.,A,
a„t=xlsrinG
3 BORr1
HauSC-
W07"
Flattop Technical Service
14530 Echo Street
Anchorage, Alaska 9951
72-013 A (Rov. 9/91) MOA 25
Il `
SLAIN G 7-IG„S
LAI—._ I __— 1,n 11 1 ___ Y9„l
ENGINEER'S SEAL
t OF /
a J�
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�yG .ereeo •i�si •Ya'ooaa er••(
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Jvt,Lb-6b6 :auoudalaj • 0999-61966 e�SL'ly'ab-eA0gouy • 09996E X09 'O'd
NOISIAIO S301AHS 1tl1N3WN0HlAN3
S301Aa3S NVwnH 4Ntl o Iltl3H u01N3WIUVd3a
a6saououy j.I W
10 afied Q 'oN 41Lua9d
Sol
INSPECTION FtPOA't ,
MUNICIPALITY OF ANC4HORAGE9BUILDING SAFETY DIVISION
3500 EAST TUDOR ROAD ;
INSPECTIONS (907) 563-3464
INFCSFiMAT
� Igp7) 788-0211
NAMEow
PERMIT PERMIT
STREET ADDRESS. /_PHONE�7
E
LOT-/ BLOCK/ r _ SUBDIV.g/_4t?C
FOOTING ❑ ELEC. TEMP, ❑` pLBG, UNDGR;
FOUNDATION ❑ ELEC. SERVICE pLRG,:AOUGH
BOND BEAM ❑ ELEC.ROUG
FRAMING ❑ ELEC. FINAL _ GAS�'.TEMP ,
INSULATION ❑ OTHER - ❑ GAS _ ❑.
SHEETROCK ❑ -- ❑ MECHANICAL ❑
STRUCT, FINAL MECO "FINAL ❑'
❑ FIRE FINAL ❑ PLbGSFINAL ❑
OTHER ❑ ZONING _ _ ❑, OTHER ❑
O NONCOMPLIANCE OBSERVED CORRECTIONS ESSENTIAL AS
EXPLAINED BELOW
❑ WILL REEXAMINE AT NEXT INSPECTION ❑ DO NOT 0 fdO AL UNTIL REINSPECTED,-'
,1
COMMENTS
84-002 (Rev. 11/87)
0.
OSWD03OU ON-SITE SEWER/WATER SYSTEM PAGE : 0001
COMMENT DISPLAY
COMMENT SOURCE: PARCEL
TYPE: INTERNAL ID
NUMBED'.:
01517219
FINAI, GRADING COMPLETED, OWNER TOOK
PICTURES TO BANK UPON
920615
HEDNB 001
WHICH THE BANK RELEASED THE ESCROWED
FUNDS. NO REQUEST FOR
920615
HEDNB 002
A NEW HAA WAS MADE, AS -BUILT SIGNED
OFF 6/15/92.
920615
HEDNB 003
: COMMODT : PFI:HELP PF3:RETURN PF5:ADD COMMENTS PF7:BACKWARD PF8:FORWARD
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910362
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:SILVA ERNEST K & GLORIA
OWNER ADDRESS:11201 OUR RD
ANCHORAGE, ALASKA 99516
PARCEL ID:01517219
LEGAL DESCRIPTION: GREENLAND BLK 1 LT 1
LOT SIZE: 27153 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED:11/13/91
EXPIRATION DATE:11/13/92
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
1. ENGINEER MUST CERTIFY THAT UNDERLYING ML LAYER WILL
PERCOLATE AT LESS THAN 120 MINUTES PER INCH. IF IT
IS GREATER THAN 12.0, A NEW DESIGN MUST BE SUBMITTED
WHICH PROVIDES A SEPARATION OF 6 FEET TO THE ML LAYER.
RECEIVED BY:� DATE: /1 10191
ISSUED BY:
DATE: //-/'V---w
Municipality of Anchorage
Department of Health and Human Services dhh5
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
November 14, 1991
Ted Moore, P. E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Waiver Request for Lot 1 Block 1 Greenland Subdivision
Waiver Request #WR910052, PTD #015-172-19, #SW910362
Dear Mr. Moore:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 1 foot.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Susan Oswalt
On-site Services
Concur:
1.A;,Ihn Smit.
ram Manager
On-site Services
' r.AUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR910052 PID# 015-172-19 HA# Permit #
Date Received: November 7, 1991
Legal Description: Lot 1 Block 1 Greenland Subdivision
Engineer: Ted Moore, P.E., Flattop Technical Services
14530 Echo Street, Anchorage, Alaska 99516
Applicant: Ernest & Carol Silva
Waiver Requested: Lot line waiver - 1 foot of east property line
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted:_ Waiver is NOT Granted:
List Conditions or Reasons for above:
Date: By:
Name of Reviewer
Rec #: 23212/9060 Amount: $ 70.00 Date Paid: Nov 7, 1991
CIVIL & ENVIRONMEN'I'Al, I;NGINEE1tIN(; • ENERGY CONSERVA'IION
THEODORE F. MOORE, P.E.
PH: (907) 345-1355
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
November 7, 1991
ANCHORAGE
WICES DIVISION
I • E
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
The purpose of this letter is to provide the required design narrative in support of our application for a "
permit to upgrade the wastewater disposal facilities on Lot 1, Block 1, Greenland S/D, located at 11201
Our Road. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for
your review. We are also requesting a lot line waiver to allow the proposed soil absorption bed to be
within 1 foot of the east property line.
The soil test results indicate that the best area for the proposed system is near the east property
boundary just north of the 100 foot radius from the well. In order to fully utilize these optimum soils
without conflicting with previously disturbed areas, we need a lot line waiver to allow construction within
1 foot of the east property line. Since this property line abuts a road right-of-way, construction up to the
property line will have no adverse impact on the ability to construct on-site systems on adjoining lots.
The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil
log, the native material between 1.5' and 3.5' is a slightly silty sandy gravel with a measured perc rate of
2 minutes per inch. Using the soil application rate of 0.8 gpd/sq. ft. specified for bed type systems in the
wastewater ordinance, this 3 bedroom residence requires a total absorption area of Q x 150)/0.8 = 562.5
square feet. The proposed 20' by 29' bed design has a total absorption area of 580 square feet. The septic
tank effluent will be pumped into a pressure distribution system. The pump output is nominally 30 gpm.
Since each 1/8" dia. hole will pass 0.4 gpm with 5' of residual head, a total of 30/0.4 = 75 holes are
needed. Thus, with 108' of laterals, the optimal hole spacing is 18". Since the proposed bed will
encompass test hole #1, after water monitoring was completed the owner has been saturating the test hole
with water to speed the compaction process and thereby avoid future settlement problems.
The proposed project will have the beneficial impact of eliminating a septic tank which is less than 100
feet from a private well and abandoning a presently sub -standard soil absorption system. The project will
have no impact on present or future water supply and wastewater disposal systems serving adjacent
properties, nor will it have any impact on reserved space/surface and subsurface, or on drainage,
Please give me a call at 345-1355 if you have any questions on this submittal.
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
NOV 0 7 1991
RECEIVED
Sincerely,
Ted Moore, P.E.
'.4,/ n
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2 PARK DIST PIPe
5'C --W rt c -RAVE!, 0 I a. 7r
S. L1r/CC,IN(r SANO
NAIUC- SANDY G-RAVG4
SCCT ION "A_ �j'
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kiattop Technical Services
14530 Echo Street
Anchorage, Alaska 99519
L11 13 1 6 R5EN I -AN D ;ID
SCPTIC SYS T', (APGRADE
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kiattop Technical Services
14530 Echo Street
Anchorage, Alaska 99519
L11 13 1 6 R5EN I -AN D ;ID
SCPTIC SYS T', (APGRADE
_
PG -AN er X ^ SGCT (0(1(
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Flattop Technica(Services
14530 Echo Street, Anchorage, AK99516
Phone (907) 345-1355
Lot 1, Block 1, Greenland S/D
11201 Our Road
Wastewater disposal system upgrade
Specifications
1.0 General:
1.1 The scope of the project consists of abandonment of an existing septic tank and seepage pit and
installation of a new 1250 gallon septic tank with integral lift station and a 2.0' x 29' shallow soil
absorption bed with pressurized distribution.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform with Municipal and .State
requirements.
1.3 All separation distances shall be in conformance with Municipal requirements, unless specifically
waived. A lot line waiver is needed to allow construction within 1 foot of the east property line.
1.4 The contractor shall be responsible to obtain any necessary utility locates, and to work around any
buried utilities.
2.0 Septic Tank:
2.1 The existing 1250 gallon septic tank is to be properly abandoned by pumping, removing the top
and crushing and burying the tank in place.
2.2 The new septic tank shall be a 1250 gallon Municipally approved STEP tank with a minimum of
two compartments, and shall be. set level on undisturbed soil. Each compartment shall be equipped with a
watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with
2 inches of approved burial type, rigid insulation.
2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot. A cleanout
shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5
feet downstream of the septic tank.
3.0 Lift station:
3.1 The lift station shall be installed either in the second compartment of the septic tank which has an
additional 250 gallon capacity, or in a separate 500 gallon tank. The lift station shall be an "Orenco"
system as supplied by Anchorage Tank, or another Municipally approved package system.
3.2 The contractor shall be responsible to obtain the necessary Municipal electric permit and
inspection, and to provide a copy of the electrical inspector's report to the engineer overseeing the
construction of the wastewater disposal system.
3.3 The on, off, and alarm floats shall be set at the elevations specified by the lift station supplier, and
their proper operations shall be verified by the contractor.
4.0 Soil absorption system:
4.1 The soil absorption system shall be constructed by carefully stripping the surface peat and reddish
sandy loam to a depth of approximately 1.5 feet over the proposed soil absorption bed site to expose the
top of of a slightly silty sandy gravel stratum.
4.2 The bottom of the excavation will follow the natural contours of the gravel stratum. Compacted
medium sand complying with Municipal specifications shall be placed on top of the exposed gravel as
necessary to create a level base for the bed at the elevation of the highest point in the native gravel.
4.3 A total of 0.75 feet of approved sewer gravel shall be placed on top of the sand with the perforated
pressure distribution pipes laid level such that the pipe inverts are no less than 6 inches above the bottom
of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the
#200 sieve.
4.4 The discharge pipe from the lift station, the manifolds and the distribution laterals shall all be
1.25" diameter schedule 40 PVC, assembled with glued joints. All distribution laterals shall have 1/8"
diameter holes drilled in the bottoms on 18" centers and shall be configured as shown on the plan drawing.
4.5 Monitor tubes shall be of 4" diameter and installed in the locations shown on the design drawings.
The portion of the monitor tube extending through the sewer gravel shall be perforated.
4.6 Two inches of rigid, burial type, insulation is to be placed over the top of the sewer gravel and
then covered with approved filter fabric before backfilling with a minimum of 2 feet of unclassified soil.
Fill slopes shall be no steeper than 3:1.
4.7 Topsoil and seeding over the disturbed areas shall be the responsibility of the owner.
4.8. The old seepage pit shall be properly abandoned by pumping, removing the top and backfilling
with clean soil.
5.0 Inspections:
5.1 A total of 5 engineering inspections will be required during the course of the project: (1) initial
stakeout with the contractor to establish the location of the system and to discuss the plans, specifications
and construction procedures, (2) after the native material has been excavated to expose the infiltrative
surface to ensure that it conforms with the soil test information, (3) after the sand leveling material has
been placed, (4) after the sewer gravel is in place and the distribution pipes have been laid and connected
up to the septic tank, but prior to placement of insulation and filter fabric, and (5) after final backfill and
grading is complete. The septic tank requires one inspection after it is set level and the piping connected,
but prior to backfill. This inspection may be incorporated with any of the above inspections.
5.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer. For winter construction the contractor shall protect the
bed area from freezing at night by tenting over it and providing heat as necessary.
Flattopd °5..•....C•,Q`�b
Technical Services
14530 Echo Street A'�;"1 Z;LN Ff,nEA
Anchorage, Alaska 99518 •'••ti'••••••••••••....; •';.�
• +.� Municipality of Anchorage �I
DEPARTMENT OF HEALTH & HUMAN SERVICES F. MOOREgo rcAF
F
825 "L" Street, Anchorage, Alaska 99502-0650 "r •• :lI L CE •e3589 oR.' ��`�it
go,
SOILS LOG —PERCOto
LATION TEST 4`�Ooo
`fdplOfl]SS�', ����' .
�aAr•c ww►.�'
PERFORMED FOR:_ g ca es�- ( /ivc�
DATE PERFORMED:_ /0` / �S" /9/
LEGAL DESCRIPTION:
(EFtr DEPTH Pf
1 SM
11
1'
1:
1:
14
15
16
17
18
19
20
COMMENTS
6F'
M1.
r icc (
S/d Township, Range Section: <
ReaVtjh scenery (aam
S(IyhP/ s6r
SCCA 11-1y 6.rave/
Crra+ Cmvetft -,elf
CoAesic�r
Ht<,raC�ryy(^y
Crr c%Y S0170(y S'(l F L
Sa.�,Ler WAS GROUND WATER
()(ppjA// ENCOUNTERED?
SamC J IF YES, AT WHAT
(Ln,�/ilsrf
(r -n(2 le
DEPTH?
0411110 Water Aller M , T. Ory
Monitoring? Date: 1) Z N
C 2
/Z
PERCOLATION RATE a (minules/inch) PERC HOLE DIAMETER 7 ((
TESTRUN BETWEEN -3. O FT AND 3.S _ FT
"" Stiaf/ow beet, rYc, san,-.0 �'�(/.�'r rleeo(a�
tv S.
PERFORMED BY;
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATEflTIFYI I-- T 7— HIS TEST WAS PERFORMED IN
72-008 (Rev, 4/85)
Flattop Technical Services
14530 Echo Street m'�,�:.�sEAr
Anchorage, Alaska 99518 0"""""""""'••'�•�'•
• ar Municlpalily of Anchorage �� • • • • • �,
DEPARTMENT OF HEALTH &HUMAN SERVICES TRe000rE r-. ?.100RE;
825 "L" Street, Anchorage, Alaska 99502-0650 CE - 3589ILI
ti •
SOILS LOG — PERCOLATION TEST 0��,2 '••••••••' p'� 0
T, (�. # I A 4 )A; Prolossl.Ja1±♦ar
PERFORMED FOR:—9 r es Cc�t.ro If SI, lvcc DATE PERFORMED:__(O / 25' I9/
LEGAL DESCRIPTION: (3 ,�,_ 4!5:r+Gen (ano( S/d Township, Range Section: SeC Z2, T -r Z A(,
DEPTH Pt SLOPE 1 SITE: PLAN t
1
SM Alo�tsh Suno(y Loon,
2
3 6� $Iryhll� sftA
Sune(y Travel
4 V
5 M4 Gray gMvefly Srlf
13, K
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
ENCOUNTERED? N
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? —
Dale:
S
L
O
P
E
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
.�
�IVL•;�I.��I
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE __ (minutes/mch) PERC HOLE DIAMETER
TEST RUN BETWEEN _ FT AND __ FT
COMMENTS TCScu (,e C:;tu GZSSeSC hore zonlrA( .eKI-Cel of SoeIS e/IC0C_j rtw
in tern Aa(e 4-_
PERFORMED BY:( I TCCh. SvC �=%74�,,� CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /I uV 9I
72-008 (Rev. 4185)
.a 416 ". `iL'04 Or
Flattop Technical Services
14530 Echo StreetAl
Ci) p�srAt�,.gY♦O
Anchorage, Alaska 9951S 0 '°' "'•••"•'•••••���
• Municipality of Anchorage 0Y
DEPARTMENT OF HEALTH &HUMAN SERVICES ° °�* 0 i •..°R.
h%THFODO.iE F. A.100RE % 0.
825 "L" Street, Anchorage, Alaska 99502-0650 G° CE - 3589 . jjr
SOILS LOG — PERCOLATION TEST �Or�Jr'`''•••...•••'•� `�w
r _ Ff. 9 i 6
PERFORMED FOR: 95ro.eg Cc�#r^o ( 4"14'C_< -DATE PERFORMED: to / ZS" /9/
LEGAL DESCRIPTION:__ Green fano( SIC) Township Range Section: S'•Gt 22� 1 2 n()
3 u! s, rt.
DEPTH A f SLOPE
FFFTI
1 S M I3Coi�u /i sanot/ (oath ��
2
3 MG �rro� gravt(fY SiIF
4
5
6
7
8
9
10 WAS GROUND WATER
ENCOUNTERED? _ N
11
IF YES, AT WHAT
12 DEPTH?
13 Depth to Water Aller
Monitoring? Dale:
14
15
16
17
18
19
20
Reading Date Gross Net Depth to Net
Time Time Water
-Drop
L___J PERCOLATION RA1 E (minutes/inch) PERC HOLE DIAMETER
T t4. # 13 TEST RUN BETWEEN FT AND _ FT
h
COMMENTS rdg� G ol2 oQtccr 4r,PSiauf �'!o°^1-znn/r../ ._, Le.,.d ...G'
,SOLL(7GPCt.(( o f s u f Arx,�7 r'� IM 7h1rJ (0 C.Ct fr cin
PERFORMEDBY: �(� reck 5t -c i !�. //-'�
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9/
72-008 (Rev. 4/85)
A77;%iy \,. • "4 •1.
Flattop Technical Services • q�'�e
A• • •
•.
14530 Echo Street sEA
Anchorage, Alaska 9951E ""'"'••••••••••••••�•••
• Municipality of Anchorage Y
DEPARTMENT OF HEALTH & HUMAN SERVICES���••�+� •••�'�••••'•'•'
y i�OriE F. A,Ac0RI: j !
825 "L" Street, Anchorage, Alaska 99502-0650 �1 n., '>•THCODCE - 3589 ti
SOILS 7. LOGS' PERC CATION TEST ��4`asprof s,J�x���+
PERFORMED FOR: i_= rt? .e7 �ceYO / Slyvice _ DATE PERFORMED: IO / 2S /9/
LEGAL DESCRIPTION:-., 1, G 1, green (cana S/p Township Range SeCtion: S',eC 22 All
DEPTH p,f., SLOPE ) SITE PLAN
CFC 1
1
SM
2
3 6-P
4
Red,�kxh s-ctno(�,
S(I hfly srl�
saxc(y Franey
(rrUy 1ravelf y srtf
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water Alter
Moniloring7 — Dale:
PERCOLATION RAT E (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND _ FT
2fCGCt �1GrrZanlet ( -exFanf (--PJC
coc< /7 t -e recc , n7 1 V
PERFORMED BY:IF— /a��rn— TtCti. SSC I �Q%%?avyL
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON T"HIS DATE. DATE: 9/
72.008 (Rev. 4/85)
M G.
5
13. H.
6
7
8
9
10
11
12
13
14--
4-151617-
15-
16-
17 -
18-
18-
19-
19-
20
20
-rF
ff'1C
COMMENTS
% l F {1i
Red,�kxh s-ctno(�,
S(I hfly srl�
saxc(y Franey
(rrUy 1ravelf y srtf
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water Alter
Moniloring7 — Dale:
PERCOLATION RAT E (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND _ FT
2fCGCt �1GrrZanlet ( -exFanf (--PJC
coc< /7 t -e recc , n7 1 V
PERFORMED BY:IF— /a��rn— TtCti. SSC I �Q%%?avyL
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON T"HIS DATE. DATE: 9/
72.008 (Rev. 4/85)
Flattop Technical Services '•'�'
14530 Echo Street �:�: ')FrA� 'StEp
...
Anchorage, Alaska 995117 "' `"'•"•'•••••••••�%�•
• �.r Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
i
e �•�•���'::'
,t , Tf{'OD02E CORE
825 "L" Street, Anchorage, Alaska 99502-0650 ��� '.• CE - 3589 �'�~�a,
SOILS LOG PERCOLATION TEST4f10r` *04,44 4W
T. 1� -I=#' 4'Z profess;ma'+Ff��
PERFORMED FOR: g I"ilesl^ t, Ccr^o I Silyct DATE PERFORMED: IO
LEGAL DESCRIPTION: �S reQn fano( S/� Township Range, Section: Sec 22 7-1 Z A( (? 3 ko X M.
DEPTH Pf SLOPE 1 SITE PLAN
1
2 Pt
3 5M liede.(tcA SQnofy (ou/n
4h e mm rnf gray uu . ere(o fh
6 M►. (raY growelly S,(¢
7 Oense, hard r4 y' ihl
8-
10-
1O �h? M 11 WAS GROUND WATER
ENCOUNTERED?
11 CJ -MX SGlno(x Sr(f
Soi�-er 0(1�/J 11 DEPTH7AT WHAT
12
N
S
L
O
P
F
13 Deplh le Water Aller M. T: dna
6 Moniloring? Date: III If 19
14-
15
16
17
18
19
20
1 14 q1tt?
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
cc
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
COMMENTSTEST RUN BETWEEN _ FT AND _ FT
�_A�•Errcc( gPnPrG[ll�, na,¢ �.(P.r'rrccb(C �n Conlfy-uCitvn of an on-Sl��
Sol( c�bsarnhoe) x 1 Aem,
PERFORMED BY: FIQ(FD» TCCA SNC ! le -f
d CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I J �6 I9I
72.008 (Rev. 4/85)
CIVIL& ENVIRONMI,"N'PAL b;NCINI?I?ItING • ENERGY CONSI:ItVA'I70N & ANALYM6S
THEODORE F, MOORE, Y.E.
PH: (907) 345.1355
M.O.A. DHHS
Attn: Susan Oswalt
P.O. Box 19-6650
Anchorage, AK 99519
November 15, 1991
RE: 1/1 Greenland S/D - Upgrade Permit # $W 910362
Dear Sus:
14530 ECHO ST,
ANCHORAGE, ALASKA 99516
As requested on the subject permit I hereby certify that in my professional opinion the ML soils
underlying the proposed soil absorption bed will percolate at a rate of less than 120 minutes per inch and
therefore 6 feet of separation to impermeable soils is not warrented in this design.
Sincerely,
Ted Moore, P.E.
.....�� .. � • .fii�lll �iCTV1CC?S
GAAE.HD.I OR TER ANCHORAGE AREA BORAI '>I
DEPARTMENT OF ENVIRONMENTAL O.UALII Y
,- _-3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPE=CTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
NAME- - ADDRESS_--- PHONE - -
i
LOCATION_�r X1'1%-!/�_l%l�%'! /I = I�GAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
SEEPAGE SYSTEM:
_(- _GALLONS.
SEEPAGE PIT:
TERIAL_ ZZ NUMBER OF 1- COMPARTMENTS -'� -
7i "[-�
LIQUID
INSIDE LEN GTH==_INSIDE WIDTH - DEPTH_
NUMBER OF PITS _L______- OUTSIDE DIAMETER__ 4 -OR WIDTH;%! LENGTH-_-�--Z`, DEPTH__,
LINING MATERIAL / f�-_ "-'{</�� ._-__-. DISTANCE FROM WELL lJ� __.. BUILDING FOUNDATION
NEAREST LOT LINE_ /��`���TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA).
TILE DRAIN FIELD:
-
_SQ. FT.
TOTAL LENGTH
DISTANCE FROM WELL _,_F.OUNDATION___ -,-NEQftEST LOT LINE _, OF LINES -
NUMBER OF LINE_..__-_ DISTANCE BETWEEN LINES __TREI CFI WIDTH_ --_IN. TOTAL EFFECTIVE
ABSORP'Ti N AREA_--__ _SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE_. DEPTH OF FILTER MATERIAL BITIEATH TILE IN. ABOVE TILE
WELL: TYPE •"//!_- - '.•�, DISTANCE FROM , ,-_ , WATER /l.,
DEPTH � ,BUILDING F-OUNDATION. �-' '=- ---SAMPLE- �� NEAREST
/ii /E%19
/ NEAREST / SEPTIC / SEEPAGE __. i OTHER
LOT LINE -1/` SEWER LINE,TANK SYSTEM_____-? CESSPOOL.X//��� SOURCES
DISTANCES:
DIAGRAM OF: SYSTEM
X�
f
\4
p
1. \•
DATE/��/APPROVED_,.
GREATER ANCHORAGE AREA BORuUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
3500 TUDOR ROAD POUCH 6.650
ANCHORAGE, ALASKA 99502
TELEPHONE 2798686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
NAME OF APPLICANT _11, T;OZL
MAILIN ADDRESS L'� J / k'pH ONE _
INSTALLATION LOCATION
L✓k w. -(2d oq, c9luo.
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK - X SEEPAGE PIT_ �I /1 DRAIN FIELD , OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED 1/YL t� �SLC6"I K�'i"L/L.C1 � �j'•4f y .�,,
FINANCED THROUGH se oT TO BE INSTALLED BY �4c-ic (,/',�}r,�"KCL J/,�
v
SOIL TEST RESULTS mµ4 NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TES7
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. ��� , a
SEPTIC TANK SIZE 1�W TYPE ���'-v'e'�_n dr SEEPAGE AREA SIZE �"wV �ti( l'L TYPE �&
I
0 III
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
D /
:
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
/
SEPTIC TANK TO SEEPAGE PIT WALL 15=
_
SEPTIC TANK
r
SEEPAGE PIT
DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
SEEPAGE PITy0
DRAIN FIELD
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, �_, SEEPAGE PIT
TO RIVER, LAKE, STREAM.
SEEPAGE PIT
/©a ( , DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO _CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANA AND,,,SE_EPA_GE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH A\\\UTHORITY
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCR ED YST ISL IN A�;��NCE
WITH SAID CODE.DATE C✓
APPLICANT'S SIGNATURE
r) 7C;4" �N'YjaSD'I t (I i
a r: * u . — � 1 1. tic(
lih'crai Reports, f,,
j, on T,T.
Depth
SWI
///,
6Cv G (
cj
i9 t' lin
Cp(rf
Was Ground vlater Fnoourli.ered .?
if ;rsa
At
Frc: r. d I
')emc". Drca +i
Do h To to z
romm
c.
Tei;t Performed By
iv`eY Drop;,
• Municipality of Anchorage $'
On -Site Water and Wastewater Program
(907) 343-7904 , Y
Certificate of On -Site Systems Approval
Parcel I.D. 015-172-19 Expiration Date: J!
1. GENERAL INFORMATION
Complete legal description Greenland, Block 1, Lot 1
Location (Site address) 4970 East 112th Avenue Anchorage, AK 99516
Current Property owner(s) Daniel Neary Day phone
Mailing address 9800 McCready Circle Anchorage, AK 99507
Real Estate Agent
2. TYPE OF DWELLING:
7 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Three
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for
unless otherwise requested by the engineer.
COSA Fee $ qqo — Waiver Fee $
Date of Payment /P -/Y 3 Date of Payment
Receipt Number ({orirn Receipt Number
COSA# �C�3 l gas 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 andfor wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed'Name Michael E. Anderson, P.E. Date. 1 112 0/2 01 3
6. DSD SIGNATURE
/ System #1 Approved for
System #2 Approved for
Disapproved
Conditional approval for
7
bedrooms IA10WA& & Atsoe-xsoN : ��"
bedrooms
®���F9f0� oho �Ca �S,•°E'�«
�,g�pR_����
bedrooms, with the following stipulations:
By: / Original Certificate Date:
The ni all nchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 9 b 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 engineers work.
7. ATTACHMENTS
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA blue sheel_E ..c 0
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # _of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Greenland, Block 1, Lot 1
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 8/17/71 Sanitary seal (Y/N) Y
Total depth >150ft. Cased to >40 ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production 9 -
p.m -WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate '624 mg/L
Arsenic N/D ug/L Date of sample: 11/11/13
Parcel ID: 015-172-19
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground) >12 in.
AT INSPECTION
11/19/13
60.9 ft.
6.5
g.p.m.
Collected by: Anderson Engrg.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/Steel Date installed 12/3/91
Tank size 1,250 gal. Number of Compartments 3 Cleanouts (YIN)
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N)
Date of pumping 08/13 Pumper A Plus Home Services
C. ABSORPTION FIELD DATA
Y
N
Date installed 12/4/91 Soil rating (g.p.d./ft2 or ftZ/bdrm) 'S GPD/SF System type Bed
Length 29 ft. Width 20 ft. Gravel below pipe '6 ft.
Total depth 3.5 ft. Eff. absorption area 580 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 11 /19/13 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption Feld before test 0 in. Water added 450 gal. New depth 5 in.
Elapsed Time: 1,440 min. Final fluid depth 0 in. Absorption rate >= 450 g p d
Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed 1214191 Size in gallons 250 Manhole/Access (YIN) Y
"Pump on" level at 43 in. "Pump off' level at 41 in. High water alarm level at 45 in.
Datum Bottom of Vault Cycles tested 3 Meets alarm & circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOTTO:
Septictank/lift station on lot >100' On adjacent lots >100'
J
Absorption field on lot
>100' On adjacent lots >100'
Public sewer main
N/A Public sewer manhole/cleanout N/A
Sewer /septic service line >25' Holding tank N/A
Animal containment areas
>50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
>5.
Building foundation >5 Property line >51Absorption field
>1 00'
Water main > 10' Water service line > 10 Surface water
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line 2'*** Building foundation >10 Water main NIA
Water Service Zine > 10 > 100' Surface water Driveway, parkinglvehiclestorage > 10
None Noted >100'
Curtain drain Wells on adjacent lots
F. COMMENTS
***See Lot Line Waiver
G. ENGINEER'S CERTIFICATION
I certify that t 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 Michael E. Anderson, P.E.
Date 11/20/2013
COSA brown sheet_10-10-12.doc
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UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCAUNG. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT suRV£v SURVEY TYPE
SYMBOLS
0
FOMDATION AS-BUILT
SET REBAR DRAINAGE ASPHALT
❑ nlA 51NumRE AS-BUki
O FOUND REBAR e 0 e WOOD FENCE "'I� CONCRETE
❑ PLOT PLAN ... AS-Buu_T ... LOT SURVEY. TOPOWlAPHY
004 ASSUMED ELEV. X X X METAL FENCE ® WOOD DECK
A - L D CORN SET FlCATON AS-SV T .. N0 C001BNS 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 CLEANOUT5. 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
MAY 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
��qy1,
of ��
Prepared by
Robert E. Johns, Jr. & Assoc.
PLOT PLAN
...,,Nnwwl ,..A Xd,.
�^• we eeY^ °e•+� ^"m• v° "'°L'
.•E
�� .. 9 /
r `P�,.••........
••• j
I.♦
Professional Land Surveyors
•^a
"0" fwi° °"'�hAi° s m wa °"'-'
m eM ybn ytl b tlw eNt N mY
C.�•, • 'y
••
170D Brink Drive.
ANCHORAGE. ALASKA 99504
Mwoe
••I.ep• oM .Wtl•. all FnwNum Mw Mw
m.evae w w emn.
•' • *VIP
Scale:
Rec. Lot S.F.
Rea Plat File No.
FOUNDATION AS-BUILT
4 th ,.•
Afff1"50'
....: .... .....:....:♦
�7•^All nA
%
—
'-
Date Surveyed:
11/21/13
Drawn by.
REJ
Checked b .
�MK
�Rewa a ave I r l
��,„-^a�. ,
/
sy:.
,ROSE ..�
,,°
�. :w exm•wa a wee r.a.
w. ad ,„ we•rrwwa .rl Wwe
•
ROSE :t.KfN"'S, J
♦ t i
♦♦�ey''•
Date Drawn:
11 /21 /13
Orifi: 263
W.O.
13-601
FINAL STRUCTURE AS-BUILT
t Rae.H c +ver +.. s•+r eNM1 e+l l
4� 2 S �A�
�♦ He '''•., yot �1
Legal Description:
�
.................'•
Lot 1 Block 1
: � :
.www wW_
a� P"feaso�dI e6:'�
p�u..•.•�
GREENLAND
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section 44
MUNICIPALITY OF ANCHORAGE
P.O. Box 196650 Anchorage, Alaska 99519-6650 ENVIRONMENTAL SERVICES DIVISION
343-4744
CERTIFICATE OF HEALTH AUTHORITY AUG 41 1997
APPROVAL FOR A SINGLE FAMILY DWELLINGS 2
Parcel I.D. # O 15- 17 2 19 HAA #
GENERAL INFORMATION
Complete legal description I=c, 1 S/oc k Z_C-rceo /ctncl S' /b
Location (site address or directions) 1 1201 Our Rd
Property owner
_F_rne_r� S, lvec
Day phone
3K -2V,;,3
Mailing address
/! 20 i Our- Rof•
A�ctio�cz 4tc �9S/�
Lending agency
_C/ 6;z
V
Day phone
2 63 -o 7 ao
Mailing address
12i w. F mew eek
dune A-ncAo��.
/4i< 99so-3
Agent Soon 7P
Zla)t c R rz Day phone
27 3 - 7 ZSl
Address `J2V1
"0
e. /41-r 99s -D3
Unless otherwise requested, HAA will be held for pickup
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well ✓
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL: ;.
Individual on-site V
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA N21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm 7_,fcA/7 1.c ca f SC�Y (i 1 t �1
Phone 3 `/.r- 13575"
Address / iy lO ECho S^i� ,�}�cGrascz�t
A6< 995
Engineer's signature !72�6,ee
Date
;- a ,.
%.
i -`S•zf •ate„
a , r
3'•fiAJC600 tesepap�fejLnA'n
�`'�,
/n��/.��/'�.
w
e - y
y ff 9!•p r
t
6. DHHS SIGNATURE
bedrooms.
Approved for
Disapproved.
Conditional approval for bedrooms,
with the following stipulations:
Additional Comments
M�^.
By: - �,—./
Date
atIT
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) Back MOA W21
MUMCmH4.l'I"i' 01-ANCPIut2riUE
Municipality of Anchorage IiNVIRONMEWAL SERYIGIiS DIYIS
DEPARTMENT OF HEALTH & HUMAN SERVICE%G 0,1 1997
00*
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907}0.744
kw*t VLU
Health Authority Approval Checklist
Legal Description: l.al/ 1 Q(oC Lc Green 40o( S/OParcel I.D.: Or S / -7 2/
A. WELL DATA
Well type PVA _ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) _ V Date completed P►'r or fo (9/t7/7/
Total depth 150 1 jq�e r^ M-0-4. Cased to ^= 15'0' Casing height (above ground) 12 " 4-
Geacum en
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Wires properly protected (Y/N) Y
AT INSPECTION
7i2y 197
6Y'
g.p.m. 6.O 9 -p.m
Coliform O cal /l cVon.e Nitrate O, 2SS° m Other bacteria 3 Co/
Date of sample: 7/ ZZ `i/ 9 7 _ Collected by: F!a f/u�, %rc ti Suc
B. SEPTIC/HOLDING TANK DATA
Date installed 1'213191 Tank size /ZSU al Number of Compartments < Cleanouts (Y/N) `r
STI- P
Foundation cleanout(Y/N) Y
Date of Pumping 8/1197 _
C. ABSORPTION FIELD DATA
Date installed 2 / N / 9 /_
Length 2 9' _Width
Depression (Y/N) N High water alarm (Y/N)
Pumper :Cc zccef
Soil rating (g.p.d./ftz or ft2/bdrm)C7.8 System type
aet.1
Ir
QeaC
?0' Gravel thickness below pipe C.d' _ Total depth 3,S'
Effective absorption area S-60 0' Monitoring Tube present (Y/N) Y Depression over field (Y/N) A/ _
Date of adequacy test 7 /2'i / 97 Results (Pass/Fail) P64i For _ bedrooms
5W M.T. *
Fluid depth in absorption field before test (in.); S.S Immediately after ?9'J- gal. water added (in.): 7•S _
Fluid depth 7 i 2S _ (ins) Minutes later: 13 9 Absorption rale`= _ 'IS -0 g.p.d.
Peroxide treatment (past 12 months) (Y/N) N If yes, give date N. A.
K As avcu-rj%ea CA,,1f+ Delo R0/A on 7/2.5'197 -i-A11 S<of v eYS/r
72-026 (Rev. 3/96)` M S Joy L j W / o ver ly. ac( / Deur cwA e,) fj rll ea A, ¢he lent l oo4
/t+t ha,Ffam o�C /i�;�riu� /u/ o%//rryufzon r,�.0 n<fcuck,
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
rA
Size in gallons l ZS -O Kcil STEP _
"Pump on" level at* w 3 " _ "Pump off' level at* y/ II
High water alarm level at* `iS *Datum cof/v^, oX I • i• L/&u/f
Cycles tested "— 6
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /04'
Absorption field on lot
Public sewer main
10 1,
On adjacent lots _ > (00 '
On adjacent lots _>1GG '
A. Public sewer manhole/cleanout IV - N•.
Sewer /septic service line > 2S Lift station /OF- ' _
SE=PARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation 3 Z Property line NO ' Absorption field IS
Water main/service line > U" Surface water/drainage > laa' Wells on adjacent lots > ro•o 1
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line 2Wcrlvrr Building foundation _ 32, Water main/service line
I.(ru ax. f
Surface water
Driveway, parking/vehicle storage area es -
Curtain drain NP�n a s -e en Wells on adjacent lots _ > 10
F. ENGINEER'S CERTIFICATION
f certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HAA guidelines in effect on this date.
Signature
�M
Engineer's Name _ �'h ev aLcy� !_• /`room 0
�7.
Date A-fe/urf .2• 1997
HAA Fee $
Date of Payment`
Receipt Number d 3 QC;? /
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
let;(li'bave systems are
MIL ME Environmental Services Inc.
Arm
CT&E Ref.#.
Client Nance
Project Namel#
Client Sample ID
Matrix
Ordered By
PWSID
974036001
Flattop Technical Srv.
N/A
1.1,S1,0reenland S/D
Drinking Water
L
'3075615301 P.02i05
Client POM
Printed Date/Time 07/28/97 16:32
Collected Date/Time 07/24/97 I3:00
Received Date/Time 07/24/97 15,20
Technical Director: Stephen C. Ede
Released By
Allowable Prep analysis
Par_ ame _ter Results POL Units Method Limits Date Date lnit
Nitrate -M 0.254 0.100 mg/L SM18 4500•NO3P 10 max 07/25/97 JRJ
Total Coliform 3 00 w/0 COLI SM18 92226 07/24/97 TMN
F t_ 1 QC c=11 HIVl MUKHUt 9075615301 p.04i05
/1 ME Environmental Services Inc.
. fieIL Laboratory Division•�i�s►irir��tiisioii'i®iioiivrrasiois'ri®irniiiri.►o.
Drinking Water Analysis Report for Total Colifor
READ hNSTRVCTIO.NSO:V REY£RSESIDE BEFORE COLLFCT/.N'GSA.HPL,
MUST BE COMPLETE❑ BY WATER SUPPLIER
C PUBLIC WATER SYSTEM I.D. e
Q PRIVATE WATER SYM4NI
Q Stnd Results Send Invoice
❑ Sand /nvoiC(t
Fla/ -4,# IecA ntrce1 .SwU
7"rvLvow_
3 rr
3 yS—e 7"
91G036 �� "/0 car; r'
Sent to A. DX C. Anth FbRa Jun G
/fAGAC110'y4e .�h
91�1�
Date: � Time:
❑ SrnJ Rqu(tl
❑ Sand /nvoiC(t
Lab Ref. No.
Result-
Analyst
SAMPLE DATE: 22 IT ZZ
Month Dsy Year
SAMPLE TYPE:
p Routine 0 Treated Water
0 Repeat Sample (for routine sample p Untreated Water
with lab ref. no. )
0 Special Purpose
Time Collected
SAMPLE LOCATION Collected By -
L G•re In trot A S•/D / : 0Cj1"
rzf. Pont
rn Bacteria 200 w atter Drive
Anchorage. AK 99618.1605
Tel: 19071 562.2343
Fax:.(907) 561.5301
e�
TO BE COMPLETED BY LABORATORY
An sis shows this water SAXiFLE to be:
,d Satisfactory
0 Unsatisfactory
0 Sample over A hours old, results may
be unreliable
Q Sample too long in transit; sample should
riot be over =S hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received 12 _
Time Received 2-0
,\
s.nalysis Be;nn /6V _
Annlytieal .'*Iethot(: Z"Membrane Filter
C TIO-bIUG
• dumber ofcolaniei 100 ml"
-
Lab Ref. No.
Result-
Analyst
91G036 �� "/0 car; r'
Sent to A. DX C. Anth FbRa Jun G
Filed
Date: � Time:
Client notified of unsatisfactory results:
C] CJ
Phoned � Spoke with Fixed
Date: _ Tinc:
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUC Result: Total Colirorm E Cali
MembraneFilter-,Dire" Count cat Celoniestloo ml
VerMestion: LTI3 BGB�-„COLIFIIUNI� LNrC•r r.ctl.r.
Fecal Colitarm Confirmation �+�•� __
ON -(N.w Al"fe'd
Final Membrane Filter Resalts vs-s� �ColiforMADO ml
Reported lir `et , YP _i fly! $,� Tim• (� firs
Comments: oL'
IN Sim Member of the SGS Croup ISociite Glnhale de 5urrtillnncol
” ` _ - _ "_ _...�. -•.•• ., --.... .. ..nin a+nw ..rr. .nnurr!Aq ..leer 1101 NCW ICOCCV n4nn WMT VIRGINIA
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services -
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcell.D.# 015717Z19 HAA#
1. GENERAL INFORMATION
Complete legal description 1-0 r -Z; 6160c fc 9. green %cna S /1b
Location (site address or directions) f 12Gr OCA r- fi?oe.
Property owner E r/7 eSf Si lv C -C Day phone 3 y 6 - z 1,5_3
Mailing address 11 20l Our (fid (-k 995/6
Lending agency Naf11 Sank o.F' A(mk� Day phone 257 -3ysi
Mailing address erxel) ��Ghoe«cue, i9 k 99SO�
Agent None Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: -3
3. TYPE OF WATER SUPPLY:
Individual well Ll�
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA H21
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 furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm _ FlmkJO e Tech4'Ic0c! Seevr r yr Phone 176S—
Address 1 530 /1=660 H'nc1i01-cxc/e A�-, 995'/6'
Engineer's signature °%�'`*�%�� �' C Date 2 9191
y+ 7!3. l
/ -- 1
6. DHHS SIGNATURE ~` �razd4a
Approved for bedrooms.
Disapproved. / �� )
Conditional approval for Alz���� bedrooms, with the following stipulations:
Additional Comments
M
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA 421
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST 44
Legal Description: L. I, B/k 4, 6-reenlqnof Parcel 1. D. —Q1Sl7P- 19
A. WELL DATA
Well type Pr1va%e If A, B, or C, attach ADEC letter. ADEC water system number N- A.
Log present (Y/N) _ N pate completed Prior 1to 8/7/ Driller (.(n k
Total depth 1.4'O ' Cased to 02 ' Casing height 3 y /0
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
U
Wires properly protected (Y/N)
AT INSPECTION
9 / / Z / 9 / MUNICIPALITY OF ANCHORAGE
j� Z ' ENVIRONMENTAL SERVICES DIVISION
g.p.m. _--' 6, 2. 0 i9,91
KECEI V ECJ
; On adjacent lots _ > ioo '
; On adjacent lots _ > 1 cAO '
Public sewer main _ 3 ( Gv' Public sewer manhole/cleanout > (��G
Sewer service line 75-' Petroleum tank _ N ane r3as�rver�
WATER SAMPLE RESULTS:
Coliform O
cvf /!yo rn .C.
Nitrate _ 4 0, 1 my /-e Other bacteria
O cm/ /(vO m4
Date of sample:
9 91
Collected by:—Feak!5?' 7 -,?ch
B. SEPTIC/HOLDING TANK DATA
Date installed 12 /K /9 1 Tank size 1 'ZsD2 gee t Compartments
Cleanouts (Y/N) Y
High water alarm (Y/N)
Foundation cleanout (Y/N)
Y
Alarm tested (Y/N)
Depression (Y/N) N
Date of pumping N. A, (new ins f• ) Pumper N,
y
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot 10a --On adjacent lots_> (GU' Foundation_
To property line y0 Absorption field 15' Water main/service line_ 5 S'
Surface water/drainage _> IC10'
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed i2 / y 19/ Manufacturer AMC60L-xVe_Te�g /c Z Or"enco
Size in gallons 2 �'O d ro C .7' Manhole/Access (Y/N) _
Vent (Y/N) 'r _ "Pump on" level at M 21( "Pump off' level at 301
High water alarm level H6 II
Meets MOA electrical codes (Y/N) Y
Cycles tested N, A. Cnew iAS/.
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot IO 2 On adjacent lots > 100' Surface water
D. ABSORPTION FIELD DATA
Date installed I Z / `1 1? r Soil rating 0, 5 Pa /Ff , System type tae
Length
Width 20' Gravel thickness
Total depth 1.6-
Total
.5
Total absorption area 5-64 A( Cleanouts present (Y/N) c M, 7: '.c
Depression over field (Y/N)
Results (pass/fail) N.
Peroxide treatment (past 12 months) (Y/N)
Date of adequacy test Ll -N- (New i�s>`•�
for
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot t o J —On adjacent lots > IVO '
If yes, give date
Property line
To building foundation 3 4- To existing or abandoned system on lot —LO
On adjacent lots _> 30 _Cutbank N(A• .Water main/service line 15-15-�
Surface water il� «4 / Driveway, parking/vehicle storage area 2b'
Curtain drain Nyne aLiC9rwev(
E. ENGINEER'S CERTIFICATION
bedrooms
I certify that I have checked, verified, or conformed to all MDA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name 7�GI ec'c-tca�
Date 12/9/9/.
HAA Fee $ Z20 Waiver Fee: $
Date of Payment /l]- °f / Date of Payment
Receipt Number �r y`{G Receipt Number
79-OPR (R.v 3/91) Rank MnA 21
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
u 6�
aaoearaA. TELEPHONE (907) 562-23435633 B Street
-� Anchorage, Alaska 99518
I`
Drinking Water Analysis Report for Total Coliform,13acteria
TO BE COMPLE=TED BY WATER SUPPLIER
❑ PUBLIC WATER SYSTEM I.D. # -
PRIVATE WATER SYSTEM
FL 6TTOF TEC N• SVCS 3 �dS- 13 5S
Name - Phone No.
1`-f5So�cdJ�T
Mailing Addrm
ACL4, (
e11y Slate Zip Code
SAMPLE DATE:
Mo. Day Year
SAMPLE TYPE:
Routine
Check Sample (for routine sample
with lab ref. no. _� ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLE Time Collected
No. LOCATION Collected By
1 I t 6RC NL/Nb S/D ;ooCh'�els
2 LP KE- 959 E
4
5
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
>j Satisfactory
❑ Unsatisfactory
❑ Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.. iv
Date Received / �/Z(
554AnTime Received 1554-
Analytical
alytical Method: Membrane Filter
No. of colonies/100 ml
Lab Ref. No. Result' Analyst
FT -1
FT -1
L - I Im-1�
W
A.1) -E -C.
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS Membrane Filter: Direct Count ( ) Coliform/100 ml
BEFORE
COLLECTING SAMPLE
Verification: LSB
Fecal Coliform Confirmation
BGB
Final Membrane Filter Results (( y Coliform/100 ml
Reported By~ - Date
TNTC = Too Numerous To Count
OSI = Other Bacteria
PAIN ONE OF TWO p.m.
REh1AINDER TO FOLLOW
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
ANALYSIS REPORT BY SAMPLE for WORKorder# 38205
Date Report Printed: SEP 14 91 @ 12:17
Client Sample ID:1/1 GREENLAND PRESSURE TANK
PWSID :UA
Collected SEP 12 91 @ 13:00 hrs.
Received SEP 12 91 @ 15:54 hrs.
Preserved with :AS REQUIRED
Client Name :FLATTOP TECHNICAL SRV
Client Acct :FLATTOT
BPO # PO # NONE RECEIVED
Req #
Ordered By :TED MOORE
Analysis Completed :SEP 13 91 Send Reports to:
Laboratory Supe vi o STEPHEN C. EDE 1)FLATTOP TECHNICAL SRV
Released By 6 VL-� 2)
Chemlab Rof #: 914783 Lab Smpl ID: 1 Matrix: WATER
Allowable
Parameter Tested Result Units Method Limits
---------------------------------------------------------------------------------------------------------------
NITRATE-N ND(0.10) mg/l EPA 353.2 10
Sample ROUTINE SAMPLE COLLECTED BY: CHRIS.
Remarks:
=veOv 1
Tests Performed
See
Special Instructions Above UA -Unavailable
ND-
None Detected
°' See
Sample Remarks Above
NA-
Not Analyzed
LT -Less
Than, GT -Greater Than
f,toN sc3s Member of the SGS Group (Soci6t6 Gcn@rale de Surveillance)