The URL can be used to link to this page

Home My WebLink AboutGREENBROOK BLK 2 LT 19,nbrook Block 2 Lot 19 #017-023-76 Municipality of Anchorage Page J of 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 Permit Number: ~-~'bdg3oZ'7~¢~ PID Number: ~J7- O7-i~-- 'TD Name: /~Y~ ~G~ Wastewater System: ~New ~ Upgrade Address: / ;~0~) ~3~ ~ ABSORPTION FIELD Phone: No. of ~rooms: ~ Deep Trench ~ShallowTrench D Bed ~ Mound D Other Total Depth from original grade: LEGAL DESCRIPTION SoilRating: e ~ GPD/Sq. Ft. ~/ Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Range: I Section: Fill added above original grade: Gravel length: I / ~ ~ Et, ~ ~ Ft. WELL: D New ~ Upgrade Gravel d~:e~OW~ Number of lines: l Distance between lines: ~ Ft. ~ ~ ~/~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe materiel: ~/~ O~ l~ ~.~ Ft. Ft, 75'~ SO. Ft. Driller: Date Drilled: StaticWaterLevel: Installer: Datejnstalled: ~ I / Yield: GPM Pump Set at: Ft. Casing .e~¢~*~o~ ~ou.u:~. TAN K SEPARATION DISTANCES ~s~tic : HoJding ~ S.T.E.P, To Septic Absorption Lift Holding Public/Private M~eufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~O ~ ~1~ ~~ ~ ~1 ~ ~ >~0t Material:~ NumberofCompadments: Surface Water ~/5~' >/~ ~/~ ~/~ ~/A LIFT STATION Lot Line Z bZI .~ /Z' ~/~ W~ /,~/~' size in gallons: Manufacturer: Foundation 2/~' ~ZZ' ~/~ ~ ~ "Pump on" level at: "Pump ofr' level at: l High water alarm at: Remarks: BENCH MARK Location and Description: ~ ~ - ~ ~B~ SEAL Inspections performed by'. Dates: 1st ., ,. ,,.,,"', ~~ Rev .... 72-013 (1/91)MOA 25 Permit No, page 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: /''~ /~' ~.~c/~_ ~.~ Permit No. Page -~ of we 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 · L~.~ I~/ ..~o CJL- Z., ~/'~-eo, J'~/DOolf.~. PID NO' Legal Description: ' , ; ~-', .......... ~ ........... ! .......... i'-'i'-'-i' : i~! ~.i i i-T!i ~'~:" i i ~1.......!'.'.'.'. '. '.".'.'.'.'.'.. · :-: : i': ...................... i'"'1 .............. ~ ............ i ....... i'":.i ~ ~, .~ ![..iii:',' .i i i' .~'~ ..... :..,,~..: =: ..... !...--i i...-:.. i ................... ~ ~l ~.. :. i:: -... ~.~..~ -:.:.....i ........ i..:..~ ' ~.~-~.--..i..~.! ................. .' ....','......': i.......,. ..... !.~....: ........ : '. =. ........... :':~ ...... i ..... t ....... ! ........ i":"" i'"'" ':'~- ! ...... '~ ...... i ........ i......', i ~ .'-! · .: - ~ 'i ..... ,~ ............................. - ", ..... ,! ........... i i i . . ~ !' ~ ' "~{'r,'~i '.~i i ~ i- · i i i 'i i' = ~ i ' ~ ........... i ...... : ........ ~ ............... i i. ................. -i........-.-i ........... ; ..................... ! ii- ........... ............... : .......... :-"~ .......... .:'""i"-: ........ i"~'~; '":'" :" '"'?:'": ................... ~fi~"i ........................ I ................. i'"" -~ i ! i ii ~ i. i :! ! ! ....... ......... ........ ......... .......... i.-'i..-......~l~,:~..~.....~ ~ ~ i ', ', i ~ ~ ...... ........ ........ ........ ......... ......... .......... ........ .... i:'."', i '.'.,.'.. '.. '.'.'. '".'.'i.'.. "..:: i.'.'. '. ". :!.' i' '. :i ~;i..: ;'.~i.'.-. '. i'..', i':...'. ".. '.i'. '.. !' ~ ..... i ...... i ...... [ ......... J ....... i .......... i ........ ~ ....... i i ........ i ....... i .......... i ...... ! ....... i. ........... i .......... i ......... f ......... i ! ~ ~ ~ : ....... i .... i ..... ~ ....... i i i :. i i i ! i i. : . . i .... i ...... ,~ ...... : ........ ~: ......... [ i : i ~, ...... ...... ~ i ........ i ...... i i i 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 PERMIT PERMIT NUMBER:SW930278 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:LEBARON KAYLEN OWNER ADDRESS:13036 ALGARIN CIR ANCHORAGE, AK 99516 DATE ISSUED: 8/10/93 EXPIRATION DATE: 8/10/94 PARCEL ID:01702376 LEGAL DESCRIPTION: GREENBROOK BLK 2 LT 19 LOT SIZE: 41564 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343~4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISI..~0~ON.q ' ~ t. ~ ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 July 31, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 19, Block 2, Greenbrook Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The topography on the subject lot slopes from a high point in the center in both an easterly and westerly direction. No ponding will occur over the area proposed for the onsite drainfield. Testholes excavated on the lot revealed no ground water with soils suitable for a drainfield. We are proposing to construct a shallow trench system with 3' of drainfield rock below the pipe. This type of system should provide adequate absorption of the septic effluent for the proposed three bedroom home. If the system is constructed in accordance with the attached design the following statements can be made: The system, if constructed as designed, will have no adverse impact on the wells currently in use or to be placed in the future on lots in the area. o The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. drainage patterns in the area. Sincerely, Michael E. Anderson, P.E. The system, if constructed as designed, will have no adverse impact on SHEETNO. OF CALCULATED BY DATE CHECKED BY DATE sc,~,.~ /% I~" CALCULATED BY CHECKED BY DATE DATE , $~r~o ~ X~ ......... & ,~381 j. E Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST SEAL) PERFORMED FOR: DATE PER Z~ 7 8 9 10 11 LEGAL DESCRIPTION: I.~;~F I~ J~' ~'I'~ Township, Range, SLOPE WAS GROUND WATER k~ ENCOUNTERED? I'~ 12 13- 14- 15- 16- 17- 18- 19- S IF YES, AT WHAT ~::: O DEPTH? ~,': ' P Gross Net Depth to Net Reading Date Time Time Water Drop ~ :,,. 1;~m i~ i~.a ~.~ PERCOLATION RATE ~:i!~ (minutes/inch, PERC HOLE DIAMETER TEST RUN BETWEEN FT AND ~ FT ACOORDANOE W,T. ALL STATE ^NO .,N,CIPAL G.,DEL,.ES,. E,FECT ON TH,S DATE. DATE: 72-008 (Rev. 4/85) Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street~.Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE PERFOI LEGAL DESCRIPTIoN:L~F I~~ ~' ~/~'~"J~:~T°wnship' Range, Section: I~1 II1~ I111 § 8 10 WAS GROUND WATER ENCOUNTERED? 11 IF YES, ATWHAT DEPTH? 12 1~2 ,.n.,.,, -- I 14 15 Net ~ Gross Time (~.) Depth to Net Reading Date Time Water~_i~,~ Drop ft'll~'~ , dlel~ ,,,~:~ I~ ,~,,,,, ~-~ 16 19- .~0~,,~ PERCOLATION RATE '~?'~ {minute~'inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~': FT AND 7 FT ACOORDA.C~ W,TH ^'~ STATE A.D.~.,~,~AL ~,DE',.ES,. E~ECT O. T.,S D^~E. DATE: ~/F//~-~ 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE PER LEGAl. OESCRIPTION: ~ [~, ~/' ,~-,~T°wnship' Range, Section: 10 11 12 13 14 15 16 17 18 19 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT ~ DEPTH? lilonitming? ~ Date: Gross Net Depth to Net Reading Date rime Time Water Drop i :14. TEST RUN BETWEEN PERFORMED BY: ~ ~ : ~ " ~-' ' '~/~'Z-~O°/- ~5~x~'--~I~TIFY THAT THIS/TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7~//~~ 72-008 (Rev. 4/85) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St, P,O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY: APPROVAL FOR A SINGLE' FAMIL'~ DWELLING HAA# H/~ Expiration Date: Current Property owner(s) Mailing address Lending agency Parcel I.D. O ./'7' O.,'~z- ~ ' 7 ~' 1. GENERAL INFORMATION Completelegaldescription':J.~'/- I ~ ~ c. o c,~ *:Z. Location (site address or directions) J "503 G A~-C.A~tt,,./ c, tAc,~-e_ ,~ ,~-~C,//, J¥~vtl) ~. ~4~;3'~,~,f... r°,~,~,f,~ Dayphone ~;f,~- $'~// Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: /"/ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Public Water System Well [] [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of AJaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 outJined in the Health Authority 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 flies 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. $ & S ENGINEEI[ING Name of Firm 17034 Eagle River Leep Read No. 204 £~3te River, Alaska ~577 Address Engineer's Printed Name 5. DSD SIGNATURE I~ Approved for ~ Disapproved. Conditional approval for Phone Date ~ ~, .............. ~, ...,'-; ,<.~",.., . ....'... ., ~;. ..~.J?._..,..,.. ~,: C~ -~o01 , '. C-.. ."."," -- bedrooms. ~,:.... :.: ..: bedrooms, with the followin§ stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: Municipality 'of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 47O0 Soum Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 w~w.ct.anct~orage.ak.us (S0?) 343-7~04 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescrtptlon: /.-o~' Iq ,8~.0c¢ ~ ~T.~e4[~'B,~o/c .S'/~ PamellD: A. WELLDATA C0~ ~'X ~,4~'t'~ Well type ~ ff A, B, o~ C provide PWSID # Well Log (Y/N) Date completed SanltanJ seal (Y/N) Wires prop~ Total depth ft. Cased to ft. Cas.,j~ight (above ground) FROM ~.~o0~T INSPECTION Date of t~t - Static water level ft- Well production J g.p.m, g.p.m. WATER ,~J~P~ Coliform ~'~ coloniesJlO0 mi. Nit~ate mg./I. Other bacteria __ Die'of sample: Collected by:. 4)/'7- in. colonies/lO0 mi. SEPTIC/HOLDING TANK DATA TankType/Material .~,,4T',c./ $T¢~.~ Tank size I r~ gal. Number of Compartments Foundation cteanout (~/N) ¥~, -~ Depression over tank (Y~) Data of pumping ~/17/OI Pumper Data installed ~/~./ Cl~ High water alarm (Y~..~ ~' 0 DA,~,~.~ C. ABSORPTION FIELD DATA D.tain.ta,,. Len~h ~ 0 ~. ~d~ ~ fl. To~I dep~ ~ fl. Eft. ~fion Date of adequa~ ,t '~/~/ Fluid dep~ in a~fi~ fl~d ~ ~t ~ ~. Wa~r add~ ~0 gal. Etaps~ ~me:] ~ / min. Fi~l fluid dep~ I ~. ~fion rate >= ~ymjuvenafion~nt(~t12~.)~lN&~) P~ ~0~ System type T '~ ,~,v ~-,~ Gravel below pipe ~' · -~- ft. __ Depression over field ~ 0 For ~/ bedrooms New depth } '~ ~ '* 9~,n. ~o~O g.p.d. If yes, give date - D. UFT STATION Date installed Size in gallons ManholeJ~:e~'-''-'-'''''/ 'Pump on" level at in. 'Pump ofl'~ter alarm level at in. Da~m ,..,...-~sted Meets alarm & cimuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/~lff station on lot On adjacent lots Absorption field on lot On adjacent Io__~..~''~'~'~'- Public sewer main ~"-'-'~~~1~ ~r manhole/cleanout :~C/HOLDING HTj;inc::n:T TO: Building foundation Water main '~t / Wells on adjacent lots I Property line 5"' 'f*- Water service line )0 "f- / Absorption field ,~ ~ Surface water /00 ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~ '/- Building foundation /O '~' Water Service line / 0 -~ Surface water Cu~indrain~o,.,~. ~',~*~ Wells on adlacent lots ~.~0 Water main ! 0 '/ Driveway, paddng/v~Nde storage F. COMMENTS O. ENGINEER'S CERTIFICATION I certify that I have determined through field i~pect/ons end review of Municipal records that the above systems are in conformance w~th MOA HAA~uldelines, in__ effecf on this date. Engineer's Printed Name Data HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description ~:~-r- Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Unless otherwise requested, HAA will be held for pickup. Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: e NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21