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HomeMy WebLinkAboutGREENBROOK BLK 2 LT 1nbr'ook Block Lot #017-023-65 Municipality of Anchorage Development Services Department Eu~d'mg Safety Division On-Site Water and Wastevrater program, 4700 S. Bragaw St P.O. %x 1S6650 Anchorage. AK 99519~650 www.cLanc~orage.a~-us {~07} 343-7g04 0 N-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number:. Well: [] New D Upgrade SEPARATION DISTANCES ~ Septic Absorption Lift Holding Tank Field Station Tank ,.,~.~ I~' I0~ ' PID Numbe~ ' ~) I'7 --Oo~3 WastewaterSystem: [] New I~Upgrade q 4} ,_C/~/-.~ B S O R P TI O N FIELD TANK ~,Septic D Holding ri S.T.E.P. D Other.  LIFT ST~TIOR . ~, ~ ........ ~1 BENCH ~ARK S & S ENGINEERING .,,,~ ~, .17034E,gloRlverLoopR,d,"~.~l~. 1~ ~--I~-~)c~ ,nspecti0ns p=normeo DY.iEa~i. RI,er0 ll.~k. ~'~;~// U~,~. 2"d l~}--I Developme~.~s Department Approval rrr' '°1"1 PERMIT NO. SW020359 PAGE 2 or 3 Municip, Grit oF .A.n_c h.o. C g g.e.. DEPARTHENT OF HE~[THAND HUMAN SERVICES ENVlRONHENTAL SERVICES DIVISION . P.O. Box 196650 ~_Anchorage, A_laska 99519-665.0® TeJ.e,ohone:. 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 1, BLOCK 2, GREENBROOK $/D P.tO. NO. 017-025-65 i ! / / / / / // ~c~2,~ ; LOT 2 .v..~/ SEWAGE PUMP INSTALLED IN CRAWL SPACE-- EXISTING 1000 GALLON SEPTIC TANK AND SYSTEM DISCONNECTED AND LEFT' IN pLACE FOR FUTURE USE NEW ISO0 GALLON HOPE SEPTIC -NEW TRENCHES DeL2 FLOW SPUTTER) ORtV~.~AY EXISTING WATERLINE CLEANOUT Z PERMIT NO. SW020339 PACE ....... 1',1 u Q i_c i p. g_[ i ~ y_o. F ,~,nch.o. F o, gF.. DEPAI IMI:::NI gl- HI:::ALIH AINU HUMAN SERVICES ENVIRONHENTAL SERVICES DIVISION · P.D. Box 196650 ~._Anchoc~ge, A/~sk~ 99519-665,0 · Te.t.e, phoneL 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 1, BLOCK 2, GREENBROOK S/D P.I.D. NO. 017-025-65 ST1 ST_~- 1 02.4' FINAL G~NSULATION SEPTIO TANK CO1 C_02_ MTI~_JCO1 = 102.6' IC02 = 100.7' ~/ /FINAL GRADE--.~. C_04_ MT2d CO3 ~/./ IC04 ......................... ,,,,~ 2" INSULATION ~,,,,~_~ ......... ~ .......... "~L_]col = 98.5' ! ~-MT1 = 97.4' A B ST1 18.0' 24.0' ST2 20.5' 27.0' DBL1 22.5' 29.0' DBL2 25.5' 50.0' rs 27.5' $5.0' C01 46.5' 56.0' C02 11.0' 3,1.0' C03, 21.0' 47.0' C04 56.0' 71.5' MT1 46.5' 56.0' MT2 54.0' 70.0' = 100.7' = 101.8' J'~----],~C03 = 98.5' S> ~ lC04 98.6' ~'"- MT 2 97.4' · WATER FOUND ® 9;~.4' 89.4' B.O.H. MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT ~'/~' l,'q/P '~//~,/~ Z Upgrade /: ~ ~.~. ~.~. Date Issued:'Sep 12, 2002 Expiration Date: Sep 12, 2003 Permit Number: SW020339 Legal Description: GREENBROOK BLK 2 LT 1 Design Engineer: 0003 S & S Engineering Owner Name: Herb Herzog OwnerAddress: 13130VON SCHEBEN DRIVE ANCHORAGE, AK 99516-3208 Parcel ID: 017.023-65 Site Address: 013130 VON SCHEBEN DR Lot Size: 55227 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] DisposalField [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be In accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Parcel I.D. bevelopment Sol'vices bepartmetlt building Safety Dlvlslon On-Slle Water and WasleWater Program 4700 South Bragaw St. P.O. Box '196650 Anchorage, Al( 995'19-6650 www.cl.anchotage.ak.us (907) 343-7904 . O. ON-SiTE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 01'7 '- 0 ~. '~-GJ- PermitNumberSW020~'~ Property owner(s) Malling address ('1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Legal description (Sectlon, ToWnship & Range) THIs APPLIcATtOI, I Is FoR: Sewer Only [] Sewer and Well Sewer Upgrade ~ THIs PROPERTY COI, ITAINS: Hot Tub ~[~ Swlmmlng Pool Therapy Pool [] ~umber of Bedrooms Well Only Water Storage Jacuzzi Water Softening Unit [] I certify that Ihe above Information Is correct. I/udher cedit'y that this application Is being made for a Single Family Dwelling and Is In accordance with applicable Munlclpal Codes. (Signature of property owner or authorized agent) 17034 Eagle River Loop Road° No. 204 Eagle River, Alaska 99577 Permit Fees: .~ Dale of Peymenl: Recelpl Humber: (Rev. t2/00) Waiver Fees: Date of Paymenl: Recelpl Iqumber: ROBERT C. COWAN, CML ENGINEERS (~o7) FAX (907) 694-1211 August 30, 2002 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 1, Block 2, Greenbrook Subdivision It is requested that you issue a permit to upgrade a septic system to serve the existing four bedroom dwelling on the referenced property. One test hole was excavated and a percolation test was performed on 8/24/02. The approximate location ofthe test hole is located on the attached site plan. Ground water was encountered at 8 feet, and a~tcr monitoring the test hole for seven days water was found at 8 feet, as shown on the attached soils logs. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Rob'~ff C. Cowan, P.E. Rcc/j Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE R1VER. ALASKA 99577 AN AS-BUILT SURVgY DRA~ BY: F~ED WA~TKA DISTANCES. AND PROPE~Y UN~ PRIOR TO R FACTOR = 0.87 88' ~ TRENCHES ~ 44' EA.) CONTRA~OR IS REQUIRED TO / / PRIOR TO A~Y EXCAVATION WORK, Z I / / I I I I I I I INSTALL FLOW (TO BE DISCONNECTED & SYSTEM LEFT IN PLACE rOR FUTURE ~EJ__- /~ /DE ARMOUN ALL PORTIONS OF SYSTEM WiTH LESS THAN 5,S' OF COVER R[OUIR~ INSUL-~TION. ~Ft~4 SHOWN ON THIS SITE P~N ARE ~ SHOWN ON 4 SOI~ = 1,2 GPD/SQ~. FRED ~A~TKA 600/i.2 = 500 SQl. REQ'D. n Is THE R6SPONSIBILTY OF TH~ CONT~OR TRENCH CRITERIA: ~o VERIn EASEMENTS. REQUIRED SEPA~TION ~AX{ (907)694-1211 R FACTOR = 0.87 BS' LOnG (2 TRENCHES ~ 44' EA.) 2 INSTALL SEWAGE PUMP CO I0' IN CRAWL SURROUNDING PROPERTIES SERVED BY COMMUNITY WATER SYSTEM. r'~ ~.-' ~ ~ ~MT \\. .~ .-~ ' ALL POR,IONS OF SYSTEM WmTH LESS THAN 3.5' OF COVER REOumRE mNSULAT)ON. - CONTRACTOR IS REQUIRED TO OBTAIN LF1'IL{I'Y LOCATES PRIOR TO ANY EXCAVATION WORK. TRENCHES (INSULATE WITH 2" FOAM INSULATION) 1-2% INSTALL FLOW SPLITTER 10' MIN. ~v___v~V_--V~v~v~V - 10' MIN. -'~' EXISItNG ~~ INSTALL ~~ DOUBLE ~ EXISTING WATERLINE CLEANOUT / PROPOSED 1500 GALLON ./' HOPE. SEPTIC TANK EXISTING 1000 GALLON SEPTIC TANK (TO BE DISCONNECTED & SYSTEM LEFT IN PLACE FOR FUTURE USE}_ ~--- Legal Descfiptton: L 6 T' I Municipality of Anchorage Development Sen4ces Departmept · O~-$ite Water an~ Wa~tewater Pm~ram 47~SL P.O. Box 1~ ~.d ~.ak us ~ ~7~ ~oils Lo~ - Percolation Tgst ~L~ ~ ~~d~ship,~nge, Se~: : ..... · Dep~ 4- ,(20 7o - 11~ 12- 13- E~COU~R~D? ~//~ Date: "l~.l 14- Reading Date Gross.time Net Time Depth to Water Net Drop 17- " '/ ~8. ,, ,, ~'/~ ~o ~"&' ~'/~" 20- V ~ '/r" ~ '/~" COMMENTS PERFORMED IN ACCOJ~'~,;iI~~J"~I~D~JN~I~,,GUIDELINES IN EFFECT ON THIS DATE. DATE: Eagk~ River, Alid(I 99577 ROBERT C. COWAN, P.E. CIVIL ENGINEERS (gO'/) Sg4-2gYO FAX (~o7) 0~4-s2 t t ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 1, Block 2, Greenbrook S/D August 30, 2002 GENERAL: The scope of this project includes the installation of a 1300 HDPE gallon septic tank, a sewage pump in a tank in the crawl space and new trenches to serve the existing four bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Mumelpal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGLE RNER, ALASKA 99577 Page 2 Lot 1, Block 2, Greenbrook , $/D August 30, 2002 All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. /x ,,,uno,lion cleanout znau be in~t~n¢ Ir, four4eet4'romql,~building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCll/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom ofthe excavation shall be within 2 inches of level, lfthe sidewalls ofthe excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert ofthe distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. A subsurface disposal field may not be located on a slope greater than 25 percent unless there is an approved exception documented. Page 3 Lot 1, Block 2, Greenbrook 45/!) August 30, 2002 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tv~e of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the/1200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot % Block 2~ Greenbrook, August 30, 2002 The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance ofthe contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER NAME "' "--J' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, ALaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE [] NEW [~UPGRADE MAI LING ADDR~? EGAL DESCRIPTION LOCATION J Well Absorption area Dwelling ManufacturerDISTANCE TO:~ ~/~7'-'~ ~iF HOMEMADE: Ins,de length : iadt ,e~iaI DISTANCE TO: Well Dwelling NO. OF BE~/OOMS PERMIT NO. No. of compartments Liquid depth PERMIT NO. Manufacturer Liquid capacity in gallons Foundation DISTANCE TO: Material Nearest lot line~.~ t;c;w 2 ,nchas No. of lines Length of each line Top of tile to finish grade Total length of lines Material beneath tile Depth inches Length Width PERMIT NO, Distance betw~ lines Total effective absorption area PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Weld Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line DISTANCE TO: Sewer line Building foundation Septic tank PERMIT NO. Absorpt on area(s) OTHER PIPE MATERIALS SOIL TEST RATING NSTALLER REMARKS APPROVED DATE LEGAL DATE A F:'PL .'[ CANT ~: ADDF;:ESS: C,(.. N 1 Al, 1 PHONE: I_.EGAL. .'C)ESCI::;~ I I:::': DEF'ARTMIEIq'I" OFr 1'4EAL:TH AND ENVIRONMEIqTAL.' PROTECTION 825 I.... STREET, ANCHORAGE, AK 99501 ,¢.64"-'47,= ) I...OT S I ZE: MAX BEDI:¢OOIdS: 08 / }9/85 JEAN I I'ql:.']; L. UI...AY 41()5 'I"URNAGA I N ANCHORAGE; AK 248- 1 '717 SUBDIVISIDN: bREENbROUh. E SECTIOhI: " ~:. TOWNSH I F:': ,.55°'::7~. ~,.._. (SQ. FT. OR ACRES ) 4 L.OT: 1 BI,..OCK:,=° :t 2'.lq RANGE: 3W Listed I:)e].ot~ are 'l:.he op'Lions available to you in designing your septic system, Cl'u:,ose t. he option that best fils your site. · :E.~ 'EEC ~2} DIEPTH "FO PII::'E BOTTOH (FI",) 4,,0 GRAVEL DEF'TH (FT.) O. 5 TOTAL DEF:"TH (F'T',,) 4.5 GRAVEL.. WID't"H (F:T,,) 24.0 GRAVEL LENGTH (FI".) 45,0 GRAVEL. VOLUMIE (CU.YDS.) 40.() ]'ANK SIZE (GAL, S) 1,250.0 SOZL RATING (SQ.FT,,/BR) 177 4 ,, 0 1.0 5.0 5. O. 34.5 250.0 .~ 177 "" '~ ........ ' .7.. FT. EACFI) ~.,'-~. (:.¢RAVEL LENG¥1"{ > '75 FI',, IREQUIRES MUI._'TIF:'L.E RUNS (NOT EXCEEDING ~.~ TANK IdUST HAVE A"I" LtEAST TWO COMF'ARTMENTS I certify t. hat: IF A 'r'HEN WILL. ELEL~',TRIE'.AI_ WORK MUST BE DONE BY A I,,..ICEIqf:~ED EL. ECTRICIAN. IGNED ...................... DATE: AF'Pl I [tAN'f': ,'.l~I~]xtE I....UI.....AY 1. I am familiar w:i.'Lh 'Lhe recluirements {'or' on-site seweps and t,,~e:t, ls as set. for"Lh by 'l::he Mun:ic~ipa].ity of Anchorage (MOA) and. 'Lhe State of A].aska. 2. I will inst..all the system in accordanc:e ~,i'Lh ali'. HC]A codes and arid in compliar~ce k~i'f..h 'Lhe des:i, gn criteria of this pepmit. :3,, ]: wi].l adhere 't:.o all MOA and Stat. e of Alaska requir'ements f'c~r 't.,he set !:::,ac:l.:: disLaruzes f'pom any ex:i. stir~g well, wastewater disposal sys'Lem or' se~,~erage syst. em C)I'] this or any ad.jacertt cfr neapby. ].6t,, 4,, I Luqcler'stand that this permit is valid for a max:i, mt.tm of 4 I:H.:edi-oollts arid any enlar'gement t,¢i].], requipe an additional per'mi'L, L. IFT STATION ]:S INS. TALI...ED IN AN AREA COVERED BY MOA BUII..DING CODES, (1) AN EI...ECTRICAL F'ERMIT AND IIxlSI:::'ECTI[)N MUST BE OBTA]:NED; (2) AS,....BUIL..TS NOT BE AI::'F'F;:OVED WITHOIJT AN EI...ECTI:~IC~L. INSF'ECTION REF'ORT; AND C3) THIE F'ERMIT NO. · DEF:'F!R"FHEi'-~.T :if., ¢~EFIt...TH FIN[) EI'.¢v'TR-iqHFNTF:It~ P} .... -r' 1/ ":"; ..... t... :,TF..E[:. F., F:II'.,!C:HORFP2iE., RI':::. '9S~.~50::t. J 264 ..- 4 '2' 20 ,' ?*:'.:."005d. " RF'F'L. I l: FINT LOC:R T I ON LEGRL L.C,F.:KI4OOE:, HOHES I NC: ,. N ::, ..HEE,"N E:,F.: L:l. E:2 GREENE:F.:OOK ::,,. E: 46:I..:~ E.:US:i:NESS F'RRK I CT ,- '~'F' 44 4- ~ ;J~ '-': I':.~ _ F:IF:E FEE"t" T'-?F'E OF SC~IL. RESOR[3-f'ION S'¢STEH .... To,: DRFtlNFIELD Ml:l:,.::Ii'"ll. Jf'l NUMDEF.: OF EEE,F.':EHS = 4. SOIL. F.:RTINEi -'c'r._, ;. FT,.."E:R::,:~: :IX:5 THE REQUIRED SIZE OF THE SOIL.. RDSORF'TION S?%TEhl IS: THE LENGTH DIMENSION Z'.E; THE LENGTH (IN FEET) OF THE TRENCH OR DRF:!):NFZEL.D. THE DEPTH OF R TRENCH OR F'~T IS TIdE DZSTRNCE DET!,IEEN THE SLIRF:'RCE OF TFIE GROUND FIND THE BOT'I"OH OF THE EXCRVRTION (IN FEET). THE GRRMEL DEPTH ZS THE M]:NZHUM DEPTH OF GRRVEL. BETb.!EEN THE OUTFI:!L.L F'ZPE RND THE DOTTOH OF THE EXCRg'RTZON (IN FEET). .~ ~ t .' F'ERP'IIT FiF'F'LIr':RNT HRS THE F:ESF'CH'SIE:ILIT'¢ Tn INFORH TH:iS [:,EF'RRTME:I'.dT I:::,UF~:.~:NG -" ' ... FF. EFt ~ F!I'.4[/:, "rHF' INS;TRLLRTION INSPECTIONS r'lF RN"r' PlELI...S RDJ'RCEII,IT TO THIS'; "'"F-' """' ....... NIJr,IBEF.: OF RESIE:,ENCES THFfT THE P.IELL !-,.llL.l.~ :,.:.f-.. E. E:F:IC:KFILLING 3F Rl'.,l'-r' : r.:,lEI1 !.,.IITHOI...IT FII'dRL. INSF'ECTION. RNE:, RF'F'RECv'F!I_ F~,.' THT'E; DEF'FIRTfdENT 14tt._L BE SUE:.TEC:T T::) PF.'.U.:,E_.U. ICIN. MINtHUM r.:,ISTRNCE DETI.4EEN R 1.,.1EI_L RND FIN"r' ON-~SITE SEP.IRGE DISPOSF'~L. S'¢S'!'EH IS :1. OO F'EET FOR R F'RI'v'RTE I.,.tELL..~ OR · l__Sli~i TO ;:-"00 FEET FROH R F'UE,'LIC 14ELL_ DEPENDING UPON 'THE T"r'PE OF:' F'LII:i:LIE: fdEL.[ OTHER REQUIREr'lENTS f'IR'¢ RPPL"r'. SPECIFICRTIOI",tS RND CC~NSTRLIE:T!ON [:,IRC:~F~:F!P1S:; FIRE R',,,'RIL. RBLE TO INSURE PROPER INSTRLLRTION. i CERTIF'? TFIRT ±: I RH FRPIlLIRR b. IITH THE REQUIF.'tE:HENTS FOR ON-SITE SEI.,!EF.'.'S RN[:, tdEL.LS RS SET FORTH B"r' THE P'IUNICIF'RLtT"r' OF RNCHORFIGE. :2: I !4ILL... INSTRLL THE S'¢STEH IN RCCORr.:,RNCE 1.4ITH THE COE:,ES. S I FilqED: ...... ~~ .................................... Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN ,SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: L,..J~ I Rlor[C') ~¢~b~_,~ t~ Township, Range, Section: 1 2 3 4 5- 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS oL SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? t'/)~S S tF YES. AT WHAT / (~ DEPT"? / I P E neplh tn water Afler~ { OaIe: ~'-~'-c~t~'~''' MonitorinD? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE /o~ (minutes/inch) PERC HOLE DIAMETER _ TEST RUN BETWEEN ~, ~,~ FT AND ~'~'~ O ET ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/~ /'~'~- ~ Lth and Environmental Pr[ 'tion , Fourth Floor West .~.~ * 825 L Street , Anchorage, A].aska 99501 264-4720 i-tEE ,j[.w.,IN FIELD: TOTAL LENGTH !)l'.,t,.r:( ! i i.,ov, \: I I-~.I~Y~I:. _FOL;~i)/d'tO4 ....... NRAREST L©F LINE ........... OF LINE · ,E~ TRENCH WIDTt+-~__~- IN. -TOTAL EFFECTIVE i~ of Lines j ..... e~s~ .:,:~c: ~CT,,',~C:N ,F:,ili: i(.I (~ lli_! io i ~[;15) 1GRA[;E ..... MA-FIr. Itl/,!. [;ENEAIH llL([~] ....... ~. ABOVE -FILE ~ IN, ,3ilE~' '" PI [' -~ - r, DEPI'H DI:METE7 .... OR V/IDTH ..... L[z:.,G T.og Cllib Rings Crib Size: DI,'\MEI'ER ..... L, LPI-II .... ()ISTANCC FROM: ',',,'ELL .... ~ TOF>L E! FFC'IIVE hU'L.'.~'.!!': ~ 2'F _~,'~ IO'." .... i.:LAI/I_S1 LOT LINE .... £,VS©RPItON ARI]/\ (WAI.L AR,~A) $~. FT, ,';e ] i c Class: ~_~ ~___ l)cpt h: ?loll Distance To: Lot'Line 3!dg: Sewer Line: Pipe Materials: ~ of Bedrooms: [nshaller: Roma :ks: F'ENff"i ]: T I,¢..t. i],EF'FIi~TtTMEI'.,!T Cfi:-- NEF:tLTH FIND i!EN',,,"(i~:OI'.]i"iEI'.]TFIi.. PROTF(CT'TON ._ .:, r F. :.t:. t., FIN(]HOF.".IaGE", RK. '.:)'...-35E1::i.. ::' :: 4 - 47 ;::_' ~1 ( ';G::"E.E~:.7: .':, T'¢F'EE OF SO:Ii.. FIE:E.;OF.:E:TION '.::;'¢'.~TTEi,~ .TS: "FRENCFI MUM N/.iHE:ER qF E E[)F.'C 3ME;, = 7': THE Sqtt. IS: THE: I..'EF~G'I'~-t DII'"tEN'.:~;iOI'~ iS TH[.-.-. A_ENG' F:'EET') OF THE TRENC:H OF7 [')I-:;:fl:[NFZEiJ). THE i)EPTH OF' Ft TRENCH OF..'. PIT I'. D.I'Z, TFINCE F:ETI.,tEEN THF-~ SLJIE:FFICE i]F THE GROLliq[:, FIN[:, THE: E:O'TTOH OF THE (Ii'.,! FEET). THERE :i:'.'5 NO ZET I.,.tlD'TH EOF:'. "FHE~: GRFIViEL [:,EPTH t'~., THE MiNII DEPTI-i OF GF.:FIVEt. 6'ETWEF:'i"~ THE'.' OUTFRLi.. PI'F'E FIND THE: BOTTOM OF THE (IN FEET). PFIC'KRGE PLFINT MFI"r' BI FOi,.LCIW t NG CON[;,] EITHER FI CL. RLE, S FI CONT IN!]O/]~ FIGREEtl'IEI",tT FIEI':'~;I]IR:.F:'T ]' Ell'.,! .'.:~, :tLLED Fl'I" ]"HE F'EF.:M I TTEE '" S OPT :!: ON St..iS..)'ECT TO THE ]7 I N'.E;F FIF'Pi70',,,'ED PLFINT i"iF:I'¢ RE iNETFFILLEi}. !TEI'.,!F!NCE FIGE:EEME]~'~T JES F::E(.:.!U]:RE[]. .iF FI MR :[ NTENFtNCE: KEPT L~:ijf;':tF.:[:.]NT '¢ :' Lt I'"IFIY 8E F. iEQiJ ][ F--.".F~'[) 'YI.'} Et ~l_.ktk _~1:. T'HE E;E I i.. RND..-qZflE: '¢OU hiFi'¢ E;E SUBJECT TO PF.":'EE] _'TZOhi. E:RCKF']:LL..T. NG OF' FIN's' ::,~--IEIi WITHOUT F]:NML :[l'.~SF'EC:TION FiN. E:, FIF'PROVFIL i::'¢ 'TI-~]::~!; E:,EF'FitE:T'MEN'i" i4 Z LL BE ~iJBJE:CT 'T'O F'R 7 SE 'Z _ TI ON. M.T. NIMUM D]:L:;TFINE:E BETWEEN R i.4EL.L, lIND FiNer' ON-SZ"I'E :F.;EWFIGE D:[L~POSFI!,.. Z:'r'S]'IE['I ]:E; :LOO FEET FOR R PRIVFITE 14Eli... OF.': 200 FEET FOR R F'UE,'LZC i4ELL. O'T'HEF~: I:;.:EgLIIREf'IENTt'~; MR'-r' FIPPi...'-A SPECIFIC:RT]:OI'-~.S RND C:ON:STRUCTZON D'_r. FIC~RFIME; FIRE FiVFI.T.L. FIiiii:LE: Ti]) INE;L.IRE PROF:'ER:'. INS'TRLL. FITiON. i CERT J: F"¢ ]"HFr'F :i..: I FIM FRM.T. LiRR W~[]I'H ]"FIE REQUIREMENTS FOR ON-SZTE E;EI4ER% RND i,.iEL.LS RS E;ET FOR:TH E:'-¢ TblE Mi.IN I C I PFtl.. _T. T"r' OF FII",ICHOF,'RGE. 2: i t,.I]:L.i.. INSTRI_.t.. THE L=.,"r'?.';TEM IN RCCORDRNCE 14ITH THE COE:'EE;. 2:: ]' LINDERSTRNC' THFIT THE ON-E;]:TE :E;!:':}.IER :F.;"r':~'TEf"I f"tR"r' REQUIF..:E ENL.FIRGEI"!Ei",!T IF THE F.:E:E:;IE:'ENCE ~RF~"lO~[J..ED TO ]r/r.,ICL.,I,J't,}E MORE HI'HFIN 1.]-: OEE:,t:',~%]OI',I:E;. Performed For tonal Oescri~tton: This Korm Renorts Soils LDo 2204 Cleveland Anchorage, Alaska 99503 Les Pace Date Performed Lot 1 Block 2 Subdivision Greenbrook yes 8/25/76 Percolation Test nenth Feet 8 ~.: 14 16 18 - 20~ Soil Characteristics To~soi~l~ ~(MiL ) ..... Interlayered coarse Gravels and Sandy Silt (GP & ML) Ground water level Bottom of Test Hole Was Ground Water Encountered? yes Ie Yes, At what Demth? - 10 feet I I Readinq D'at'e Grnss Time Net Time Depth to H20 Net Dron t · Percolation Rate Hinute Prnnosed Installation: Seenaoe Pit -Drain Field De~th of Inlet Denth To Bottom Of Pit Or Trench CnU?ENTS: 125 square feet drainage area'required per bedroom. Test Performed By y/~,~.~-~. Y~. /q~,,~ Data certified .~m d~y cer~,i/y thnt I hnvo :;m'v¢~'ud the [oIlowin~ dcscrib~l opcrLy: ~ :V. ~o imp~(~vem,mis on )ro~C'J'ty ]yin; udjnce',~L lhcrcto o:~ch on the premises in quest on and thaC U'~ure ale no ro~a- nyx, transmis~isn lines o~ oLher vi~;ible cascmcnks on said o,'erLy excep~ as indicated kcrcon. / / ?ZOO 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description /~'~' 1~ Location (site address or directions) Property owner Mailing address Lending agency Day phone Day phone Mailing address Agent - Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: /"/' ~" TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOS/~L: 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 #21 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 //~J i~/=-'/'Z_$ O ~ /.~/,J.~//J~.-b~"77.,/~J~ Phone Address P-~. )~X Z~-qO 77~ /¢-¢V(~/¢0 ~/,¢ ~,~ Engineer's signature ~c~ ~:~ ~¢,~'~"~ . Date Approved for /~/!.,,'-~Z7¢_) Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: . _ . 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. 72~25 (Rev. 1/91) Back MOA#21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo'7- It ~¢or~c Z/ ~p,~E~ ~fL~Ol~arcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) FROM WELL LOG Date of test . Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Wires g.p.m. aroperly protected (Y/N) AT INSPECTION Septic/holding tank on lot ; On adjacent lots Absorption field on lot PUblic sewer main Sewer service line ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size /'~-~[~ ~/~- · Compartments Foundation cleanout (Y/N) Y Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Foundation water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C, LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/Z ~/~:~ / - Length t'~'5'"" / Width Total absorption area /~¢)~/~ Depression over field (Y/N) Results (pass/fail) ~ Peroxide treatment (past 12 months) Soil rating /77 r~r' '~/~/,),,l~;ystem type ~'~--~ Gravel thickness ~_~ ,o Total depth ¢ ~ Cleanouts present (Y/N) Date of adequacy test for d Y If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD 'FO: Well on lot 'K~Ch"'J ~ On adjacent lots /%]0 ~C Property line To building foundation ~-~' To existing or abandoned system on lot On adjacent lots Surface water Curtain drain E. ENGINEER'S CERTIFICATION ! Cutbank /~O~ Water main/service line "~/0 I Driveway, parking/vehicle storage area ~-'~) ~ ! I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name Date HAA Fee $ /7Z~-~ Date of Payment ~¢/~/,¢'--~'~ Receipt Number~-,/TZ~--7~¢¢' L-'/~v~ ~--~//~ 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 April 13, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Attention: Dan Roth Subject: Lot 1, Block 2, Green Brook Subdivision Health Authority Approval Certification Dew Mr. Ro~: Attached is the application for Health Authority Approval for Lot 1, Block 2, Green Brook Subdivision. During our initial inspection of the septic system on this property we. noted standing water in the absorption bed. We proceeded, however, with the adequacy test and noted the bed was functioning in conformance with Municipal regulations. We then attempted to determine why water continued to accumulate in the bed. A testhole was dug approximately 10' from the edge of the absorption bed. No groundwater was encountered until the excavation was 9' below the ground surface and more than 4' below the bottom of the absorption bed. The water in the system can not be attributed to groundwater, but is probably snowmelt runoff leaching into the system. Another excavation pit was dug into the system itself to determine if a biomat was preventing the water from percolating into the underlying soil strata. The drain rock was found to be very clean with no contamination of the underlying soil. Water appears to be percolating into the underlying soil, but continues to accumulate in the bed. We have not been able to determine the location of the water intrusion into the system. The bed is working as it was designed and is not in a condition of failure. Once breakup is complete, snowmelt runoff will cease to leach into the absorption bed and the water level will drop. The system will continue to function adequately in the disposal of septic effluent. Please let me know if you have any questions or comments concerning this system. Sincerely, Michael E. Anderson, P.E. DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 WALTER J. HICKEL, GOVERNOR (907) 349-7755 March 22, 1993 Municipality of Anchorage Dept. of Health & Human, Services SUBJECT: Greenbrook Subdivision Class "A" Public Water System, PWSID 210346 Dear Sir/Madam: I have completed a review of this office's files concerning the monitoring status of the above-referenced 'Class "A" Public Water SYstem and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on March 8, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on November 10, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on December 11, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on November 12, 1991. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking'Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II ADEOUACY TEST REPORT LOCATION: J'~T Ij ~J~,, '~J~.'~'~--"~J~K '~J'J~o DATE: ~N~P~CmO~,~ PROJECT ~ TYPE OF DWELLING: ~ NO. OF BEDROOHS: ~ SEPTIC TANK SIZE: FIo, Cumul, S..T. S.A,S. HTel S.A.S. MTe2 S.A.S. Time R~e Vol. Vol. ~ LiQu~ LiQu~8 Li~ui~ Li9~,¢ ~omme~t ~ (gp~) {gal {9ol} S.T. Level ~ Level ~ Level ~ Level IO. I I~1, o /Z~ ,~,' ~d'1 .... ' ,, ¢:~o .1~,, ~:.la .~' J a, ~b'~ ;0° .o~. 1~.5~ ~l'~ -' .~,, ~,~" TEST RESULTS; DATE: REVIEWED BY: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION la) Legal Description (include lot, block, subdivision, section, township, range) l.-ot d, ~locl~ 8~ ~ree~b,-ooN Location (address or directions) lb) Applicant Nam~ ~ll~n.~ M~nn~ ~rl~ Telephone: Home ~ ~6' ~(O~ Business ApplicantAddress I~ I~O ~ ~o~b~o~ ~c4o~ (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); (d) Lending Institution Address ~' 0 ! (e) Real Estate Company and Agent r~¢~ ( Address t~' t'/' O O /?t,~ r' J- z. ¢ Telephone _~ ~' ~ -- 0.5-0 [ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [] Multi-Fami,ty Number of Bedrooms Other WATER SUPPLY Individual Well [] Community [~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite I~ Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ' 72-025 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functior~al 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. NameofFirm F/~/'"'l'of~ ~-~C~,O~¢C~[ ~e~c~ Telephone ~-~1~ Address /~O ~cho %~j ~nc~~ ~ ~/~ Date ~ / I~ / ~ Engineer's Seal Approved for ~d~',/~_ bedrooms ~y~~~,~ Approved ~ Disapprov~~ -ConditiOnal Terms of Conditional Approval CAUTION The Muncipality of Anchorage Depadment of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Pacle 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: J-o"~ ENVIRONIv~NTAL PROTECTION APR ? RECEIVED WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results If A. B, C. D.E.C. Approved (Y/N) Date Completed Yield Cased to _ Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed _1/~O//?& Size Standpipes (Y/N) Y Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~I,/~ ~,~, To Property Line ~ To Water Main/Service Line ~, Course Comments Air-tight Caps (Y/N) No. of Compartments ~ Foundation Cleanout (Y/N) Date Last Pumped ~,/",~L¢ ; for N,/"J. Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(f ~/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area I 080 Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~, To Building Foundation ~,.¢' ~C~,,~ Lot ~ .~ ~ ~ To Water Main/Service Line ~ to Type of System Design Length of Field ¢¢,.,t ' Depth of Field ~/' * Gravel Bed Thickness ~" Standpipes Present (Y/N) Date of Last Adequacy Test 't /t¢ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ;~::~ Comments To Property Line ;~, t¢ To Existing or Abandoned System on ; On Adjoining Lots ~' ;~ ~ To Cutbank (if present) D. LIFT STATION hl,~. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ,~~ (~, ~ Date ~/ /lo" /"~" Company ~'[~/'~1~ r~4~c¢~( ~f MOA No. eCg"O$'~ Receipt No. ':z~'-I-'? ~'~' I .~..,~,~,~.~ Dateof Payment ~-~-~ ~ ~ ~ ~ .. Amount: $ (~ ~%~ ~ ~." ';~2~ Page 2 of 2 ~ * THEODORE F. ~OORE ,* ~' Engineer's Seal DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE: April 16, 1986 PWS I.D.# 210346 To Whom it May Concern: According to records on file in this office the GREENBROOK SUBDIVISION Water System is in compliance with the State Drinking Water Regulations Mncerely, Michael P. Lewis Environmental Engineer