HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 4 LT 18Val 11'0 Vue
Estates #2
Block 4
Lot 18
#015-341-61
N`Cl °ALI o'
MUNICIPALITY OF ANCHORAGE
F On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
s http://www.muni.org/onsite
l
On -Site Wastewater Disposal System Permit
Permit Number: OSP201379
Work Type: Septic Upgrade
Tax Code Number: 01534161000
Site Legal Address: VALLI VUE ESTATES #2 BLK 4 LT 18 G:2538
Site Mailing Address: 10400 LONE TREE DR, Anchorage
Owner: CUSHMAN FAMILY TRUST
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
11/23/2020
11/23/2021
21638
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Date:
Issued By: Date: I 22 v
3
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICM/ELL PERMIT APPLICATION
Parcel I.D. 015-341-61
Property owner(s) CUSHMAN FAMILY TRUST
Mailing address 10400 LONE TREE DR, ANCH AK
Site address SAME
Day phone
Legal description (Sub'd., Block & Lot) VALLI VUE ESTATES #2 BLK 4 LT 18
Legal description (Township, Range & Section)
Lot Size 21,638 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Receipt Number: 0o 7, i N
Receipt Number:
Permit No. 0519Z0137c(
Absorption Field
0
Initial ❑
Single Family (SF) 0
(w/wo ADU)
Septic Tank
0
Upgrade ElDuplex
(D) ❑
Holding Tank
❑
Renewal ❑
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: `� X16, 2s r/Jpi
PWaiver Fees:
Date of Payment: / 111,2 0 2 d
Date of Payment:
Receipt Number: 0o 7, i N
Receipt Number:
Permit No. 0519Z0137c(
Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Sept. 20, 2020
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: New septic permit
Legal: VALLI VUE ESTATES #2 BLK 4 LT 18
To Whom it may concern:
This is a request for a septic permit on the above referenced lot. The field has failed and the replacement
space is limited therefore we are proposing to install a new field in the same location but add a STEP tank to
allow for a much bigger field, see the site plan. With the new lift station the old field will be much bigger
which will be good for the longevity of the system. The residence is serviced by community water so we
don't have any wells to be concerned about, but we do have a small creek in the back yard which limits the
area for a new system. This new replacement system will not impact any of the neighbors or encroach on
any wells, septic or open water issues.
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201379, Deb Wockenfuss, 11/23/20
SEPTIC FIELD SECTION
DESIGN CRITERIA:
9' EFFECTIVE
3 BDRM X 150 = 450 GPD
SOILS = 450/0.45 = 1000 SQ FT REQ'D
1000/2(9) = 56', USE 70'
2.0' WIDE
70' LONG
(1) TRENCH
13' DEEP
-19'
(TH#1)
-2'
ML/SM
OR 1.5'2.0'
-13'
-4.0
MOUND OVER
FILTER FABRIC
SEWER ROCK
3,3(
GRADE
1"=200'
PROPERTY LINE
EXISTING SEPTIC
EXISTING HOUSE
NOTE:
ADJACENT PROPERTIES SERVED
BY COMMUNITY WATER.9'TRIBUTARY OF
SOUTH LITTLE
CAMPBELL CREEK
SCALE:
DJRDRAWN:
DATE:
VALLI VUE ESTATES #2, BLOCK 4, LOT 18
Anchorage, Alaska
CHARLES CUSHMAN & CAROLYN KIRCHNER
9/7/2020
-WEST TREE DR-
-L
O
N
E
T
R
E
E
D
R
--MAIN TREE DR--BROW
N
T
R
E
E
C
I
R
-
-13'SM/SP
+2/(6 #
& INSULATION
PROBED TO 20'
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201379, Deb Wockenfuss, 11/23/20
1"=50'
PROPERTY LINE
EXISTING
HOUSE
EXISTING ABSORPTION FIELD TO BE
REMOVED AND REBUILT PER THE PLAN,
DECOMMISSION REMAINDER
NOTE:
ADJACENT PROPERTIES SERVED
BY COMMUNITY WATER.
NEW 1,250 GALLON
STEP TANK WITH (2)
20" RISERS
DRIV
E
W
A
Y
SCALE:
DJRDRAWN:
DATE:
VALLI VUE ESTATES #2, BLOCK 4, LOT 18
Anchorage, Alaska
CHARLES CUSHMAN & CAROLYN KIRCHNER
9/7/2020
100.0'
CRE
E
K
S
E
T
B
A
C
K
TRIBUTARY OF
SOUTH LITTLE
CAMPBELL CREEK
VALLI VUE ESTATES #2
BLOCK 4, LOT 19
VALLI VUE ESTATES #2
BLOCK 4, LOT 17
VALLI VUE ESTATES #2
BLOCK 3, LOT 41
VALLI VUE ESTATES #2
BLOCK 4, LOT 30
VALLI VUE ESTATES #2
BLOCK 4, LOT 31 -LONE TREE DR--BROW
N
T
R
E
E
C
I
R
-
SEPTIC
COMM. WATER
SERVICE LINE
5:1 SLOPE TYP.
CO
FCO
8:1 SLOPE TYP.
GRADE BETWEEN CLEAN OUT PIPES IS 2'
TYP.
EXISTING WATER, MAINTAIN MIN. 10'
SEPARATION.
TEST HOLE FROM
ORIGINAL PERMIT
3' EXTENT OF THE
FILL COVERING
FIELD,
SHED
1
S3.0
NO SLOPES OR CUT
BANKS GREATER
THAN 25% WITHIN 50'
OF THE SITE.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201379, Deb Wockenfuss, 11/23/20
1"=50'SCALE:
DJRDRAWN:
DATE:
VALLI VUE ESTATES #2, BLOCK 4, LOT 18
Anchorage, Alaska
CHARLES CUSHMAN & CAROLYN KIRCHNER
9/7/2020
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201379, Deb Wockenfuss, 11/23/20
Municipality of Anchorage Page I 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: sW9500DO PID Number: 0152,41(ol
N8meWastewater
System: ❑ New Upgrade
Roz &-P--rItcl
Address:,O yOO �oNE T4ic DRr�E
ABSORPTION FIELD
Phone:
No. of Bedrooms: 3)Deep
Trench O Shallow Trench ❑ Bed ❑ Mound O Other
LEGAL DESCRIPTION
Soil Rating: D.y5
Total Depth fr lmltoriginal grade:
GPD, Ft
Lot: Block: Subdivision:
Depth to pipe bottom from orpg "1 grade:
Gravel depth beneath pipe
u
1•I15
18 LL VMC
! 1 Ft.
IF
Ff
Township:
Range: Section:
Fill added above original grade:
Gravel length:
-70' O'
Ft
1& 1 1 Ft
WELL' ❑New ❑ Upgrad
Gravel width; r
Number of lines:
V-
Distance between liner
I 12'fi
.Z.5 Ft.
Ft.
Classification (Private. A.B.Cy
T spin:Cased
To:
Total absorption area:
Pipe material: ASTnn
Ft.
Ft.
I l SO. Ft
F Sl O
Driller.
Date Dnlled:
Stahl water Level:
Installer.
TW.Cv X
Date Installed:
5•I'S•45
Ft.
yield:
Pump Sal at:
Cuing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
aseptic 0Holding ❑S.T.E.P.
To
Septic
Abaorptim
Un
Hptding
blb/PrlvaM
Manufacturer.♦
Capacity In gallons : 1000
From
Tank
Field
Ststidn
Tank
Sew*, Linn
11Qc44ORAbC
_
r
Material:
Number of Compartments: a
Wel(
e7•�t
x700 t
--'
e'Z� t
STa:s L
Water
—
_
LIFT STATION
IDD'+
Lotf
1
�.
In gallons:
Manufacturer.Line
3."Pump
1
on"level at:
"Pump el at:
High water alarm at:
Foundation
513l
Curtain
ISize
Pump Make
Electrical Inspections performed by:
Drain
No
EK►a
u0NRemarks:
BENCH MARK
GRtiv(L- Li�Grw VLCRi.A3E-O A
Location and Description:
EF FEcTivt DEPrH ONCA(AJGD IJ[
-ToPoc "o 9cc
TO Sfr{ �oNe,n9r1'•
Assumed Elevation:
100.0
EN` EAL
OF
; `:^ • ;^t Ilr
S 6 S ENGINEERING
1 34 Eagle River Loop Rud, No-
Dates:lst S'1�•9s
�,,
"j�
Inspectionsperformej
E�
2 4S
�L IOEERT COWAN
C.
CE -8801
Department of Health nd Hum ervIces appr v I
�t';;;;•,.,- �;>N�
Date:
i�-=`:--=--
Reviewed and approved by:
T2-013 (Rev. 9191) MOA RS
Permit No. SW950027 Page 2 of 2
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
VALLI VUE ESTATES #2, BLK 4, LOT 18 01534161
Legal Description: PID No.:
}
cot CO2
FINAL GRADE I
98.2' i
97.5'
f CO4 MT � COB B4'r
.........._..................................................................._....................................:- ...................._.........
{ ...............................
NEW ': INSULATION
88.8' 1000 CAL ., 88.4'
SEPTIC
TANK
' ...................................._B .............
88.0'
. S � R
.......... . .....................................................................:........................................... } .........................
1
I I
83.0' 83.0'
77.5' NO WATER FOUND
i
I } A 13 C
FCO 13.0' =— --
! STI 8.0' -- 31.0'
ST2 9.0' =— 37.0'
C01 9.0 29.0' --
.._._. _._._.0O2..._}0:0'- 28:0'...,__..._
__` CO3 19.0' 36.0'
4 C04 73.0'
�+ € MTI 71.0 640'
} I I EW TRENCHES C05 14.0' 17. 0'
--
11 j MT2 15.0' 19..0' --
i1
........................................_..................
+ .............006....42.0' 34.0'..— -----
............................. ......... ..... _ ............. ..._..... _....... ' 1.......+�_.................;;.........
1 LOT 18 F
1 II f
1 I� jj
_.____.__.._._....._......_.._._._._._.......to ..�. _Wi____._...._. B._......__ ._.._._....._ . _.�.....__._.__........ __._._..
t
col
_w
NE 1000 GAL A I ........... .,
SE IC TANK s!' EXISTING r c�;•'.. 49
3 BDR
r HOUSE
EXISTING ROBERT G COWAN
SCALE t' - 40• SYSTEM Y
AOMOONED D PLMY j �G�.``; y. Cr SBOI
72-013 A (IM) -
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE AQ, 00
DEPARTMENT OF HEALTH AND HUMAN SERVICES �j-('�•-L7
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650 SPm
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT S-Ial�S
PERMIT NUMBER:SW950027
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:RICCI ROBERT A & CATHERINE A
OWNER ADDRESS:6320 BROWN TREE CIR
ANCHORAGE, AK 995516
PARCEL ID:01534161
LEGAL DESCRIPTION:
VALLI VUE ESTATES #2 BLK 4 IT 18
LOT SIZE: 21638 (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:
DATE ISSUED: 3/08/95
EXPIRATION DATE: 3/08/96
I. 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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
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 PROVISIONS:
RECEIVED
ISSUED BY:
q10
BY: ��C�C��S /�[eu�CPt�u-s �a DATE:
-�%Y�1✓�L ( / `'�' '/ �_—\ DATE :�1���j r
S&
Febnuacy 28, 1995
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX(907)694-1211
HEALTHAUTHORTY
APPROVALS
MUNICIPALITY OF ANCHORAGE
Department o6 Heatth and Human Seavi.cea
P.O. Box 196650
SEWER&WATER Anchoaage, AK 99519
MAINE%TENSIONS
REFERENCE: Lot 18; Btock 4; VaPei. Vue Eatatea 02
Requeat you .i,aaue a peami.t to aeptace .the septic ayatem aehv.ing the
SEWER&WATER
INSPECTION ape bedroom house on the ae6eaenced pwpuay.
A teat ho.te was excavated and a peLcoeati.on .teat pea6o,med. The
appaoximate .location o6 the .teat hole .ia .located on .the attached a.tte
ENGINEERINGSTUDIES plan. The monitoring tube within the teat hole has been checked and
ANDREPORTS bound to be dhy.
Attached .ca the paoposed upgnade design.
WELLINSPECTION This phopeaty .is sehved by a Community Wates System.
6 FLOW TEST
We do not anticipate any adveaae e66ect6 on neighboaing p%opeatiea by
the .instaUation o6 the phopoaed aeptic ayatem. These ace no
protective well aadii which encA.oach upon the pnopenty.
SITEPLANS
Should you aequ.ine addi Lionat i.n6o4mation, pteaae contact ua.
Sinceaely,
ROAD DESIGN
SOILTEST ROBERT C. COWAN, P.E
RCC/gk
ENCLOSURES
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
MPECTIONS
ONSITE
WASTEWATER
DISPCSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577
1" r- 50' 1 UPGRADE
SCALE
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PERFORMED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
DATE PE
LEGAL DESCRIPTION:/' /X� [�7 U1F Township, Range, Section:
SLOPE SITE PLAN
DEPj.(i
'(FEET) ORGANICS HJT}
COMMENTS
SIL? r^I SrcTyt
tep.%6 5
WASGROUNDWATER
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
Depth m Water Aker z
Menitaingt Batt
S{: ireTy '-A.
+6 F1Nc S
� FEw Pwsrxc
a ==mm
0 our=0wrol 0mFul mE�
�REPAa �RlvFau l v
DOWN -6 PERCOLATION RATE'46 (mmutewinch) PERC HOLE DIAMETER
9
TF<T RI IN RFTWFFN 1,S FT Alun 16f-25_ FT
PERFORMED 8Y: �)e— I CERTIFY THAT THIS EST EST WAS PERFORMED IN
ACCORDANCE VVALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 3 /2 / oI 5-
72-008 (Rev. Alias)
�REPAa �RlvFau l v
DOWN -6 PERCOLATION RATE'46 (mmutewinch) PERC HOLE DIAMETER
9
TF<T RI IN RFTWFFN 1,S FT Alun 16f-25_ FT
PERFORMED 8Y: �)e— I CERTIFY THAT THIS EST EST WAS PERFORMED IN
ACCORDANCE VVALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 3 /2 / oI 5-
72-008 (Rev. Alias)
ROBERTC. COWAN. P.E.
ROBERTA. SHAFER, P.E.
ON-SITE WASTEWATER DISPOSAL SVSTEII CMLENGINEERS
CONSTRUCTION PRACTICES (907)694-2979
and FAX(907)694-1211
MATERIAL SPECIFICATIONS
MEALTMAUTMORITY
APPAMALS
REFERENCE: Lot 18; Mock 4; Vatti Vue Estates M2
GENERAL:
SEWER & WATER
AWN EXTENSIONS
1. The scope o6 this paoject includes .the .c.na#alX.ati.on o6 .two
teach6ield ttenchea .to weave .the .th4ee bedroom aeaidence
Located on .the ae6e4enced paoputy. The existing tAench is to
be abandoned in ptace. The existing 1000 gatton septic tank .is
SEWER&WATER
INSPECTION
.to be excavated, pumped, cAuahed, and abandoned in ptace.
2. ConstAuctlon ahatt be in accoadance with .the appaoved site pian
and design daawinga, Municipal pewit with any speciat
ENGINEERING STUDIES
paovizions 0a conditions, and att appticabte Sate and
ANDREPORTS
Muri.ci.pat Wasteulatet Di6po6at Regutationa.
3. The conAactoa ahalt be aesponaibte boa obtaining any necessan.y
undeagaound utiUty Locates.
WELL INSPECTION
aFLOWTEST
4. Unlez6 apeci.6icatty agaeed o.theawi.ae, the paoputy owner ahaU
be aesponsibte boa 6inat gaadi.ng aaeaa subaequentty depaeaaed
6aom Aoit Aettting.
SITE PIANS
5. Coninactoas inatatti.ng "natewa-tea diapoaal systems must be
ceati.6ied by .the Municipat Heatth Depaatment boa system
in6tattation6. Owneas ins.tatting .thein. own systems must atao
aeceive paioa appaovat 6aom the Municipat Heatth. Depaa.Lnent.
ROAD DESIGN
SEPTIC TANK INSTALLATION:
SOILTEST
1. A septic .tank is .to be conataucted by a ceati.6ied septic tank
manu6actunea. Constn.ucti.on shaft include tvo 4" cLeanou.ta boa
pumping access.
PERCOLATION
2. The septic tank shaft be 46ub6ici.entty bedded to paevent
TEST
4ettting oa 4hi6ti.ng o6 .the tank.
3. Att a.tandpipea on ,the septic tank ahatt extend a minimum o6 12
inches above Gina.£ gaade•
STRUCTURAL&
KCMANICAL
NSPECTIONS
ON SITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577
Page Two
Lot 18; Block 4; Vatti Vue Estates M2
Febtuany 28, 1995
4. Septic .tanks .i.nataUed with teaa than 4' o6 coven ahatt be .in6utated.
5. A 6oundation ateanout shaft be .instatted one to Jour, beet 6hom the
buitding 6oundation. In the .Line between the tank and the teach6ietd
there shah be two adjacent cteanouta (unteaa an e6btuent pumping system
exists within the septic tank). These ateanouts ahatt be .located on
undiatuAbed Boit not more than 10' Jnom the tank. The 6iA6t cleanout,
.in .Line, shalt be to clean towaAd the teaeh6ietd. The second ateanout
ahatt be to clean towztd the septic tank.
6. F.rnat goading oven the septic tank ahatt be such that a positive 6tope
exists away 6tom the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the propoaed trenches to the dimensions shown on the design.
The bottom o6 the excavation ahatt be within 2 inches o6 .tevet. 16 the
4idewaU_6 o6 the excavation become smeared, they must be naked or
senatched (toughed -up) begone gravel (aewe,% nock) placement.
2. Once the grave.t is .inatatled, the di4tnibution pipe is to be .cnatatted
.levet with the pen6otation6 6aced dowmwAd. Gravel is then to be placed
over the di.atti.bution pipe to ptovlde a minimum o6 2 inches o6 coven
oven the pipe.
3. A a.eLt battier must be instatted between the J nat gtavet layer and the
native soil back6itt. Ensurte the a.itt bannieo covets the entice gtavet
sut6ace begone placing baek6,i.tt.
4. Mon.itot tubes shad be o6 6oun (4) .inch diameter and inatatted
apptox,imately .in the toeationa shown on the design. The portion o6 the
mon.itoning tube extending through the gnavet ahatt be pen6o4ated 6tom
the bottom o6 the trench to the .invent o6 the distribution pipe. This
.is equ.ivatent to the e66eetive depth o6 the gravel as noted on the
design.
5. Baek6.itt over the Ji.nat gnavet layer must not be lean than twenty -Jour
(24) -inches. Insulation must be .cnstatted when the back6.itt depth is
leas than thi ty-a.ix (36) inchea. The 6.i.n.ish grade over the trench must
be mounded to prevent the 6onmation o6 a depreaaion a6tet aettting.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank ptopoaed 6or .cnstattation must be eonatAueted by a
Municipatty approved septic tank manu6actunet.
Page Th)tee
Lot 18; Block 4; Valli Vue Estates #2
FebAuaty 28, 1995
2. The boltowing pipe matetia a ane approved boa use in septic system
instaUationa .in .the Munici.patity o6 Anchoaage:
Type og Pipe
PeAgoAated
Sotid
Cast
Icon
Yea
Yea
ASTM
D3034
(PVC)
Yes
Yea
ASTM
F810
(HDPE)
Yea
No
ASTM
D2662
(ABS)
Yea
Yea
Use o6 a type ob pipe otheA than tiated above must be approved by the
inspecting enginee)t.
3. Insutati,on ahatt be at teaat 2" thick extAuded diaect buAial potyatyAene
(Dow Chemical Company Sty)to6oam HI oA equal).
4. Septic tank .in.teta and owners shaft be jitted with wateAtEght couplings
(CautdeL, Fe)tnco, o)t equal).
5. A peAmeable nontoxic satt bavUeA (Typan 3401, Mina6i 140/N, oA equal)
must be instatted between the 6inat leach6ietd gtaveL LayeA and the
native ao.i.E back6itt.
6. ALL Leach6ieLd gAaveL (aeweA )tock) shaft be 0.5"-2.5" acheened gtaveL
with less than 3% passing the #200 sieve.
7. When sand .is being used as a jitteA matek al, .its g)tadation
apeci6ieation6 must eon6o4m to euAAent M.O.A. oA D.E.C. aequinementa.
INSPECTIONS:
Typieatty these wi.LL be a minimum o6 th)tee (3) inspections )tequined during the
.inatattation o6 the wustewateA diaposal system. These inspections w.itt occuA as
60ttows:
1. The b.inat .inspection must be conducted a6teA the excavation o6 ditches,
pits, tAenchea, oA beds and be6o)te the .installation o6 any gaavet. A
septic tank may be set in peace, but may not be back6.itted be6oae this
.inspection.
2. The second .inspection must be conducted a6te% the placement o6 the ai.Lt
baAAiea, gaavet, diatnibution .Linea, standpipes, eleanouta, and
.inaatati.on, but be6oae the ptaeement o6 any otheA back6,itt.
Page FouA
Lox 18; Block 4; Vatti Vue Estates 02
February 28, 1995
3. The jinat .inspection is to occuA upon j nat grading o6 the property.
06ten theAe witt be more .than these 3 inspections tequited, espeecaGty with the
.inatattati.on o6 mutti.pfe trenches, sand 6.ittea6, pressurized dlattibut.i.on
systems, etc. Thus, the inspecting engineeA .is to be contacted at teast 24
houA6 prior to the atatt o6 conatwetion. 16 neceaaary, a pre -construction
meeting wi tt take ptace on-a.c te. The .inspecting engineer w.i tt not coordinate,
diAect on contAot .in any uny the conttactor's activities.
The owner. ahatt contract wi.th the contractor to per6o4m the work outlined .in
these speci6i.cation4 and plana and .in accordance with the attached M.O.A.
pvhm.i t. There wit be no contAactua2 emangement existing between the
contAaetor and S I S Engineeting. S 9 S Engineering shatf be the owner'a
representative and wilt .inspect the work as stated above to document the
contAactor'a activities. Final acceptance o6 the contAactor's work testa with
the owner and the M.O.A.
S I S Engineering ahatt have no tiabitity to the owner or to others bot acts or
omissions o6 the contractor or any other petaona peA6orming work on this project
or the 6aUjjAe o6 the con#Aactot to carry out the work .in accordance with these
construction documents. S I S Enginm ng'a inspecting engineer Witt not be
teapons.ibte 6or the conattucti.on means, methods, techniques, sequence,
ptocedurea or the satiety precautions .incident to this project.
C NTRACT R INSTALLER
n r
�.� GREA ER ANCHORAGE AREA BM..JGH
1>`1 Department of Environmental Quality
• i�"`3330 C Street
w -
Anchorage, Alaska 99503
INSPECTIOtj REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS
LOCATION ffllLsr'/�. LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE
FROM WE t'
MANUFACTURER �Lc.PX�%"
MATERIAL �'P
NUMBER OF
COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
q2
LIQUID CAPACITY��(SAf15�N5.
TILE DRAIN FIELD:
TOTAL LENGT
DISTANCE FROM WELL FOUNDATION�NEAREST LOT LINE�Q � OF LINES ;� r
NUMBER OF LINES !! DISTANCE BETWEEN LINES TRENCH WIDTH_�IN. TOTAL EFFECTIVE
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE 3Y FT
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE _& MATERIAL BENEATH TILE_�IN. ABOVE TILE A IN.
i
WELL:��,v�
TYPE
CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING
NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION
. LOT LINE , SEWER LINE , TANK . SYSTEM
CESSPOOL
, OTHER SOURCES /
APPROVED
DISAPPROVED REMARKS �"l t
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH: —
PIPE MATERIAL:�L
tLOTSLOPE: _-�!�
REMARKS:
Form EQ -032
DIAGRAM OF SYSTEM
MUN I Z; I F='RLL I T4• OF Fir•aCHLiFt:L�GE
DEPARTMENT OF HEALTH HND ENVIRONMENTAL PROTECTION
2510 E. TUDOR RD. , ANCHORAGE, AK. 99507
276-2221
Zo aA-i-��
Ot-J—� I TE �EWEF� F�EFt:t•'1 I T �~�
PERMIT NO. C 76389 )
HPPLICANT HRRVEI_LF/HRRRISON 3201 "C" ST - SUITE 217 277-1550
LUCHTION LUNETREE DRIVE
LEGHL L18 64 VALLI VUE LOT SIZE 20000 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MH'XlMUM NUMBER, OF BEDROOMS = 3 SOIL RATING (50 FT/BR)= 125
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[�•EP "i H= 14 LEr�LGTH= 3� GF<Nk�EL L7 I- -r ►-
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
Fs:E 17,!U I Fc:EL7 S}EF=•T I C TF=rAtF SS I - = 1Q i GFiLI_�r JS
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT 14ILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-51TE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE !-JELL OR 200 FEET FOR R PUBLIC WELL.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
F1EF2M I T krFiL I L7 F=Cry: 4r4E YEFIFZ FFROM I S�L�E
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUD,� MORE THAN 3 BEDROOMS.
APPLICANT HARVELLE/HARRISON
ISSUED
donitzuction E7cit -fall
• -one tett is Worth • thousand opinions"
2204 Cleveland Anchorage, Alaska 99503
Performed For Harvelle/Harrison Date Performed 6/15/76
Lenal nescrintion: Lot 18 Block 4 Subdivision Valli–Vue Estates
This Form Renorts Soils Lon Yes Percolation Test_ yes
tenth
Feet
2-
4 —
it Characteristics
Sandy Silt (ML)
6 — with occasional gravel layers
8-
10 —
12-
14
Fine Sand (SP – SW)
16-
18
20—
Was
0—
Was r7round Water Encountered? No
IF Yes, At what Oenth?
�iuiiOMNI
Depth to H2O Net Oron'
inches inches
6 15 76 0
24 hrs
0
3
O
FTJ-
180 min
190 min
I�1�1
5 6
Readinq Date Gross Time Net Time
Depth to H2O Net Oron'
inches inches
6 15 76 0
24 hrs
0
3
O
FTJ-
180 min
190 min
220 mi
6 76 250 min
5 6
f— •
Percolation Katem nuGc
Proposed Insta ation: Seenaae Pit Drain Field
Death of Inlet Oeot o ottom Of Pit Or rent
CnmMENTS: 125 Square feet drainage area required Per bedroom.
No around water or bedrock encountered.
Test Performed By
Data Certified By.CONSTRUCTION TEST B
Date: 6/16/76
,/ .ifj. i
\ Municipality of Anchorage
1C1
• ; j/-- Development Services Department fi
Building Safety Division
On -Site Water and Wastewater Program , r,
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. oi5-34i-6i COSA # oa D3 N
Expiration Date: / a — ;2 0 — / O
1. GENERAL INFORMATION
Complete legal description Valli Vue Estates #z Block G Lot aEl
Location (site address) ioyoo Lone Tree Drive. Anchorage, AK ggso7
Current Property owner(s) Shanon
Hanson & Angie Hooker Day phone 3346964
Mailing address zo400 Lone Tree Drive, Anchorage. AK ggro7
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
2-
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑ Individual On-site
Individual Water Storage
❑ Individual Holding Tank
❑
Community Class A Well
® Community On-site
❑
Public Water System
❑ Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (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 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.
Name of Firm Pannone Engineering Services LLC Phone 272-8218
Address P.O.Boxlo2asa Anchorage AKggS10
Engineer's Printed Name Steven R. Pannone P.E. Date 19?110 L
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
The results describe the performance of the system under the conditions
accordance with MOA DSD Guidelines & Regulations. reported
encountered at the time of the test, and separation distances measured to readily identifiable features.
life all wells and septic systems depend on the local soil condition, ground water
�SSSaa
aa4•
Tile operational of
levels that may fluctuate during the year, and the water usage of the family being served by the system.
��•,
�P,.+•'"'"""••.,
These conditions are outside the control of the evaluator of this system. All systems eventually fail and
O
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
T.
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
00--
perfom=ce nor give any estimate of how long the system will continue to meet the operational�_„....
requirements of the MOA DSD. Ile content of this report is for the sole benefit of the owner lined
..... i
♦ f1i15teven R. PonnonelF
00 No CE 8149::
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
# x
#e
confer any legal right whatsoever.
�aaaaaa�;a.'��
5. DSD SIGNATURE
_� Approved for 3_ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
ON-SITE
WASTEWATER
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: �" d
(R". 11105)
Municipality of Anchorage
o..
• Development Services Department`:
j Building Safety Division `
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.munf.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Valli Vue Estates #2 Block y Lot 18 Parcel ID: oi5�41.6i
A. WELL DATA
Well type A
Total depth_ _--
Date of test
Static water level
Well production
WATER SAMPLE
If A, B. or C provide PWSID #i2 o6os
FROM
Sanitary seal (Y/N)—
Cased to ft.
Well Log (YIN)
Wires properly protecte
Casing height,(aUi5ve ground) in.
AT
N —
ft. —
g.p.m. —
ft.
9—
p.m-
Coliform colonies/100 mL Nitrate mglL
Other bacteria co . /100 mL
Arse ' : _ ug4 Date of sample: _
Collected by:
B. SEPTICIHOLDING TANK DATA
Tank Type/Matedal Anchorage Tank Steel Date installed
9/32hgg5
Tank size %000 gal. Number of Compartments 2
Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) 11
High water alarm (YIN) NIA
Date of pumping %oha/2oog Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 01-diggg Soil rating (g.p.d.Ife or 0bdrm) o.LS
System type Deep Trench
Length 7gl3o ft. Width 2.5 ft.
Gravel below pipe S.o ft.
Total depth SL.S ft. Eff. absorption area a000 ftZ Monitoring
tube Y Depression over field N1
Date of adequacy test aohahoog Results (Pass/Fail) Pass
For 3 bedrooms
Fluid depth in absorption field before test 51s.glaxo in. Water addedy5o gal. New depthSS.S/15 In.
Elapsed Time: 2o min. Final fluid depth o.00 In.
Absorption rate >= i ro+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
D. STATION
Date insta
'Pump on.
level at —
Datum
E. SEPARATION DISTANCES
Size in gallons
`Pump off' level at —In.
tested I V
SEPARATION DISTANCES FROM WELL ON
Septic tank/lift station on to
Absorption field on lot
Public sewer main
Sewer /seDWIervice line
containment areas
Manhole/Access
High waterglanf'ilevel at
alarm & circuit requirements?
I� Orbe 'scent lots
On adjace is
Public sewer ma
Holding tank _
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation c+ Property line so+ Absorption field 20+
Water main 2s+ Water service line + Surface water 200+
Wells on adjacent lots 200+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 20+ Building foundation 20+ Water main 2c+
In.
Water Service line so+ Surface water zoo+ Driveway. parking/vehicle storage 2S+
Curtain drain None Known Wells on adjacent lots Zoo+ (o �_I _ I bit Off_ 5f,00
F. COMMENTS (,l)0'Cr lrq- OPS roPer+T�C�
Serulce� f�(rs/0Vfrbm 5treef fo �no�t5e.
615431f- on 4,(.C- , Io, se��} t crn v eguire�vtrzt tf eac�eerlrzc�
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.
Engineer's Printed Name Steven R. Pannone, P.E.
Date C'(?(0L "2
COSA Fee $ % O Waiver Fee $ _
Date of Payment O - /S % Date of Payment
Receipt Number C O 9 �/ Receipt Number
(Rev. 11105) .
U..t
No.CE 8149
Municipality of Anchorage
• i Development Services Department
Building Safety Division .. •.
On -Site Water 8 Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-341-61 HAA# /�. 0359
1. GENERAL INFORMATION
Expiration Date:
Complete legal description VALLI VUE ESTATES SUBDIVISION #2• BLOCK 4, LOT 18
Location (site address or directions) 10400 LONE TREE DRIVE • ANCHORAGE, AK 99507
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
DANA do JERRY PASOL Day phone 770-5737
10400 LONE TREE DRIVE • ANCHORAGE, AK 99507
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well ❑
Individual Water Storage ❑
Community Class"A" Well
Public Water System ❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
N
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 4 by an independent professional civil
engineer registered in the State of Alaska. 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 private or Class C well and may
be reissued with new water samples. (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 engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation dale shown below, 1 verify that my
investigation, based on procedures outlined 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 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.
Name of Firm CARNESS ENGINEERING CROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 + ANCHORAGE, AK 99507
Phone 337-6179
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines B Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate ofhow long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit oflhe owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
By:
Approved for bedrooms.
Disapproved.
-7 6 Z/05 -
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
(R.. 1201)
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 3 Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.ei.ancharage.ek.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: VALLI VUE ESTATES SUBDIVISION #2: BLOCK 4, LOT 18, Pard ID: 015-341-61
A. WELL DATA
Well type NI
Date completed
Date of test
Static water level
Well production
COMMUNITY WATER
If A. B. or C provide PWSID# "A"
Sanitary seal
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform colonies/100 ml.
Arsenic:
B. SEPTICIHOLDING TANK DATA
ft.
g.p.m.
Nitrate
l Log
protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
of sample: Collected by:
ft.
—
9—p.m—Wel
oolonies/100 ml.
Tank Type/Material STEEL Date installed 5/12-13/1995
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alar (Y/N) N/A
Date of pumping 5/10/2005 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA FAnQW EXISTING Q WEST/EAST
Date installed 3/13/1995 Soil rating .p.d. ftlbdr) 0.45 System type DUAL TRENCH
Length 70/30 ft, Width 2.5 ft. Gravel below pipe 5 ft.
Total depth -14.5/14.6 ft. Eff. absorption area 1000 fe Monitoring tube YES Depression over field NO
Date of adequacy test 6/28/2005 Results (Pass/Fall) PASS
For 3 bedrooms
Fluid depth in absorption field before test 49.5/20.5 in. Water added 301/320 gal. New depth 58/37.7 in.
Elapsed Time: 156 min. Final fluid depth 56.25/36.75 In, Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM 8 type) NONE KNOWN If yes, give date
D. UFT STATION
Date installed
"Pump on" level at _in.
Size in gallons
High water alarm level at
Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot
Absorption field on lot
Public sewer main
service line
COMMUNITY WATER
On adjacent
On
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 10'+ Absorption field 10'+
Water main 10'+ Water service line 25'+ Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 100+ Building foundation 10'+ Water main 10'+
Water service line 'UNKNOWN Surface water 100'+ Driveway, parking/vehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
*SEE S&S INSPECTION REPORT (5/13/1995) AND DESIGN DRAWING (4/24/95)
G. ENGINEER'S CERTIFICATION
I certify that I have determined through Held inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name JEFFREY A. GARNESS
Date - :r4(27- /0S
HAA Fee $ q30
Date of Payment -7'2; -0
Receipt Number o I jS(P(G
(Rev. 12101)
Waiver Fee $
Date of Payment
Receipt Number
I S ��ze�d�
Municipality of Anchorage ,
Development Services Department
Building Safety Division =`�,i"k,
CWAPI
On-Site Water and Wasiewater Program : _ ,,
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-66EO
www.ci.anchorge.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel l.D. 01�- 341-171 H.AA MJ 1417D201-177
Expiration Date: 5 - ;2_0 - 03
1. GENERAL INFORMATION
Complete legal description I -O t 10, V i (I; e _Vo-e_�s��1G5
Location (site address or directions) I DH ov 1-ONt= i 2c E 99514 -.�7
Current Property owner(s) In 14Z1JY0VA Day phcna
Mailing address
Lending agency
Mailing address
Real Estate Agent
Day phone
�S O Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:'
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class A_ Well
Community On-site
❑
- Public Water System
❑
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 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except behveen 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 private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificatesare 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 outlined in the Health Authority Approval Guidelines for this application, shcws 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 cbtained 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 nodes, ordinances,
and regulations in effect at the time of installation.
Name of Firm o bb eki-fs'> r 1G lc, d17 7 E Phone o'_ 7% -A9L
L&7 l _
Address �b ?� U ,,54_, I Za
Engineer's Printed Name lC)Uec, SPUU41tr fzk"42 Date 911 IOZ
4„r
5. DSD SIGN i;'� l Tw!
Approved for 3 bedrooms. `�'°^'" "•"' `''
Disapproved.:...
Conditional approval for __ bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory; ' Supplemental Engineer's Report
Well Flow Advisory Other
By:(Lt�� / 2f -Z Original Certificate Date: °i " •2 O - O Z
61,
(Rev. 0107)
Municipality of Anchorage
• Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
47W South Bragaw St
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchorage.akus
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Vali; tae. ESWte Y3 PikA It 18 Parcel ID: 01S3141 (01
A. WELL DATA
Wen type _L
Date completed _
Total depth R
Date of test
Stade water level
Well production
It A, B, or C provide PWSID ff10b0S Well Log (Y/N)
Sanitary seal (YIN) _
Cased 10 fL
FROM WELL LOG
Wires property protected (YIN)
Casing height (above ground) in.
AT INSPECTION
R ft
g.p.m. 9—
p.m-
WATER SAMPLE RESULTS:
Coliform colonies/100 ml.. Nitrate mg.A.
Arsenic: _ mgA. Data of eample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material A na`+oL-%Ae Ta,n) S}«L
Tank size Jam_ gal. Number of Compartments
Foundation cleanout (YIN) —y- Depression over tank (Y/N)
Date of pumping Weiv o I
Pumper ) SA�At( 5
Other bacteria colonies/100 ml.
Data installed gl 3 19S
Cleanouts (YIN) Y
High water alarm (YIN)NT
C. ABSORPTION FIELD DATA
Data installed 4131 3 Soil rating (g.p.d.Ae or ferodnn)0_ System type Qu al Irtmk
Length 70'130 ft Width 'a.5 R Gravel below pipe S ft
Total depth 14 ft Eff. absorption area j000-fl2 Monitoring tube Y Depression over field No
Date of adequacy test 9-(0-6a Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test%in. Water added � gal. New depth5Stin.
Elapsed Time: 7 r n*s. Final fluid depth _46-z. in. Absorption rate >= #60 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) Nano known If yes, give date ✓
D. LIFT STATION
Data installed
'Pump on' level at _ in.
Datum
E. SEPARATION DISTANCES
Sae in gallo
'Pump at _ in.
C tested
SEPARATION DISTANCES FROM WELL ON
Septic tanlrAft station on lot
Absorption field on lot
Public sewer main
Sewer /septic service one
Manhole/Access (VM)
High water alarm level at in.
Meets alarm d draritt mquiremems?
TO:
On adjacent bb
On adjacent loft
Public aewe�dta
Holding7n _
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation ta. c. Property one _tel Q Absorption Reid S. 5
Water main ld'r Water service one WOW 1 Of Surface water Non c, kwwj n
Weds on adjacent lots NIA,
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property one ?a'0 Building foundation be Water main
to +
Water Service line 8i9 Surface water Davis. Driveway, parkk* tilde storageOff _
Curtain drain Nam Wefts on adjacent lots NIA
F. COMMENT'S
G. ENGINEER'S CERTIFICATION ,. S" 0 A
I ce that I have determined through field ins
rtHy rough pec[tons and r...:,y..,,....>....... ,
review of Municipal records that the above systems ars in �. s
conformance With MOA HAA guidelines in effect on this date. *' •s';' • d
Engineers Printed Name i &We N V r V-14 K W di s•••.• c✓
Date _ 9119115 -)v7 -%n `1 c n pr:{s .y C�:�
HAA Fee $ a 76� Waiver Fee $ _
Date of Payment Q r 7/0 Z Date of Payment
Receipt Number 51 R0 Receipt Number,
(Rev. 11101)
=-;t-02 G8:32sn
~ ~ 1
F•dr-K7;-AKTC-3:OLb�' CAL+PrlYT,CAL MAI
i rrG yr
•Ny
gFell's
•COT23t2ddt T -M- P 0:M F- 1!.
�i -- o,fd
re
w
!
qqG ` 1
`wn-s god Donlon
O(`.:CKe M any er,e0.$ cWye"c"Olp 4t K37ir)A: BUILT - �4 0,4 ,�.�.1..°����:
v,it.:o nx .sr er, Ns ss✓urlad s1W!sblW uca% A ESS10N1•%+,�
Ucorr no eircumssurcea should a.) dell hereon be] \
sw rcr eons:awon or rut auo;uhlrg bou'lavy ar
Aea Sne/. T`s surveyor uku teraarslbilisy for sra EASEMENTS OF RECC.'tD,CTHER THA�
in•lEW ft. 14d10n only. THC".- SHOWN ON THE RECCRDLD PLAT.
ARE NOT SHOWN HCRYON.
107• •':� BLOCK fit. BRASS CAP14CNS:MLNT
I/L!LC�ti•,�c+T��:, (PLATNO.:__). .o :RUNPIPE
?ANCHCRAGFRE„OR'):NGD!S-MICT • REBARCOPYERFOLR+D
_ I .
HIM AND TACK
LATE: IFTY ISCALE: WORK ORDER: FIELD BOOK; GRID NO.:
tP:EEI'ARSD BY: - /
DMNG it' ASSOCIATES'
P.O. BOX 110029
A��H9RAGE i.K 94ilidlOZS REVIMNS pATE BY
05
MUNIi.'1 )UN OF ANCHORAGE
DEPARTMENT OF HEALTH t£ HUMAN SERVICES
Division of Envkonmenial Services
_ On -Site SeMrss Section
P.O. Box 198550 Anchorage, Alesks 9851"M
(907) 343.4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY/D�WELLING
Parcel I.D. # 015-341-61 HAA # a�Q3 95
1. GENERAL INFORMATION tSi{QS
Complete legal description ""r r r `" rFASU20 SIO #'' 1 OT 18 BLOCK 4
Property owner VARnl & MARY TOtICHTON Day phone (907) 346-1975
Mailing address 10400 1 QNF TRFF DRIVE. ANCHORAGE AK 99516 MEN
Lending agency
Mailing address
Day phone
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
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 xx
Holding Tank
Community on-site
Public sewer
NOTE: if community wastewater system, provide written confirmation from State ADEC
Ing to the legality and status of system.
72-025 (Rev.1191) Frors MOA 021 CampAw Verelan
Note: Alaska Water and Wastewater Coi sur�nts, Inc. shall be pald $700.00 at,
or prior to, t�asirtg for the engineering services protrided.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation data 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 flies and from my Investigation and Inspection, the on-site water supply andfor wastewater
disposal system Is In compliance with all MunidI and State codes, ordinances, and regulations in effect
on the date of this inspection. / /Ila
Name of Firm
Phone —(907) 337.6179
Engineers Signature I Date 9 iv
In c&Xk1cding this ev WWon, AWWG, ! provide a thorough, conscientious engtrre ng k of the
systan In aoao mlanoe with ADEC and HS Guidelines 6 Regulatbns. The reported resu is described the
perib►rn v= d the system under the enoourKerad at Me dime of the fast, and aepamtlon distances
mos sed to medflyldanflfmbb features. The Weratlorra/ file of all wells and septic systema depend
on the bral sow =ndrtbn, ground water kwft got may fluctuate during the year, and the water
00004pOO
IJ58ge Of flAB fainly being served by the SyS(am. These unndidorus are outside the corr6cl OI o0
Me evaluator of tee system. Sfldsladory test results do not guarantee future performance .....!. Cf 4
of the system, nor do OW guarantee that Breve are no h/dden defects or encroachments. s ��
AW WC, Inc. can therefore not provide any warranty fur future ssbmata of how bng the C j: I y*
sy Stem wf/l continue to meet the operational requirements of theADEC or MOA DHHS.....:.. ..... ..........
The content of this report is for Me sole bene& of the owner listed above. Any (0
reliance upon or use of this report by any other person or party is not authorized, ........ .....
norwill Itconfer any legal right *ft tsoever.�Q p J i -795 frn A. am ss.-
�� y
B. DHHS SIGNATURE � iiP Fv
_1�Approved for _bedrooms�4p°rip, .....^a`�oo�
oleaslo 0
Disapproved �4op000�
Conditional approval for bedrooms, with the following stipulations:
Additlonal Comments
By: d44, Date S - 2 r/ - o h
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 to 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 cmissicns in the professional engineers wort.
7Z= (Rev. 1191) aeric MCA 121 Comp Vers7on
Municipality of Anchorage SKE C E I V
DEPARTMENT OF HEALTH & HUMAN SERVICE
AEM
an " street Rm 602�
1., Archorage Aleelm M01(n y�T44AUG 23
MUNICIPALITY OF ANCHUMGE
-i WINMENTAL SERVICES DIVI<'
Health Auftrfty Approval CheMlst
Legal Desalpd= VALU VUE SID 02• LOT 18, BLOCK 4 Parcel ID.: 015-341-61
A. WELL DATA
Wal Typa C Acc n' RA, s. or C, atmch ADM letter. ADM water system M07dw 210605
Logi (Y)N) Date completed
Total depth Cased to Casing h&W (above Oramd)
senit»try Wlros properly protected (Y)N)
FROM WEll 1.00 AT INSPECTION
Date of ted
Stattc water level
Wel production
WATER SAMPLE RESULTS:
CdUorm Nit<a�
Date or sample: Collected by:
B. SEPTiCMOLDTNO TANK DATA
Dft katIaged 5/13/95 Tw* stae 1000 N1mlber of Compwbw is 2 Clea mfr (Y/M YES—
Faadatlan deanout (Y/IM YES Deprosebn (YIM NO High water alarm (Y/M N/A
Date CCpramping 6/23/2000 Pumper A+ HOME SERVICES
C. ABSORP710N FIELD DATA
Ode koWned 5/13/2000 Shc rating (g p dll2 or 1l2WM) 0.45 SY tam type DUAL TRENCH
Lang,h70'/30' 1Nldth 2.5' Gravel thldaloss below ptpo
5' Trial depth 14'
ER *A SW"W area 1000 SO F7 Malt"N Tube present (Y/M YES Depreselon overtleld (y" NO
Date or i bal 8/17/2000 Reardts (Pass1F4Q PASS For 3 Bedrooms
FNtld depth k1 ab60rpoorI tleld before test (kLX 35' 37" ImmedM* WW595/ 1984. water added (kLr5-4 5' 53"
Fkdd depth 51.50150w (Ins) Minutes later 150/120 Abaorp&M rates ` 450+ GPD
PeroDdde b'eebm t (past l2 mortthe) (Y/M NONE KNOWN It yse, 00 date
TKOs Qdw %WCWVAw%%f"
0. UFT STATION
ManholefAmm
Mph watwalarm
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOTTO:
1 rl
Public waw
at' 'Pump dR' level af'
Ine LIR atatlon
SEPARATION DISTANCES FROM SEPTIMOLDING TANK ON LOT TO.
Foundation 5' Property Ina 5'+ Ammon flab 5'+
Water mahoserAm Irle 10'+ SurfM vl8WddmkWp 100'+ Wells en IDfa 200'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
PropertyIne 10'+ &WngfourdWon 10'+ WdwmetyaerAeggM*UNKNOWN
Blaf=water 100'+ DrNerra .parldrup/-Mcleof9fagnam 10'+
CIRC h droll NONE KNOWN yyells en IOts 200'+
'SEE S&S INSPECTION REP0111' (5/13/95) AND DESIGN DRAWING (4/24/95). ft j
Englneeft
MAA Fee $ 3 vry ' tri
Dam or Paymwd e lz -? I fty
Ra apt Number ie -Z �✓
r�o2e pay. a�sel ca�s.r vuwon
VV~ Fee $
Date of Payment
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services go
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 015-341-61 HAA # A A C� :1-00R1
1. GENERAL INFORMATION
Complete legal description Lot 18; Bloch 4; VaP.fi. Vue. Eatatea M2
Location (site address or directions)
10400
Lone.
Ta.e.e. Dtive
Anchokage.
APaa a
Property owner Rahont Ricci Dayphone (sn�-')^27*?-Am-
Mailing address 0563 17 l,ekh;tt Rgad £a!'t Eake 6ky, Wtah 84117
Lending agency
Day phone
Mailing address
Agent Lwow C2aah/ REMAX PROPERTIES Day phone 257-0130
Address 2600 Cordova Street Suite 100 Anchoaane A4aska 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
XXX
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 x xx
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.
72-0tS �Ntn.1/yt) front MOA121
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 5 b 5 ENGINEERING Phone 6C) Al — 17 - y
rm ag s River Loop o NO.
Address
Engineers signature
6. DHHS SIGNATURE _
Approved for bedrooms.
0
Disapproved.
Conditional approval for
Additional Comments
Date '�_ la 5 / `t S'
� OF
-e RMERT C. COWAN
CE rar.
bedrooms, with the following stipulations:
CAUTION
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.
T2C75(M'..1N1) 9r MOA41
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ( O -r ICA r$LO_K 4. VALL1 VU9 G�5r 4 1krcel l.D. 015-'541-40 l
A. Well Data
Well type -'cA self(DB, or C, attach ADEC letter. ADEC water system number 110605
Log present (YIN) Date completed Driller
Total depth Cased to Casing height
Sanitary seal (YM) Wires properly protected (YM)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump levell
SEPARATION DISTANCES FROM
Septic tholding tank on lot
Absorption field on lot
Public sewer main
TO:
RM
AT
On adjacent lots
On adjacent lots
sewer manhole/cleanout
Sewer service)Ke Petroleum tank
RESULTS:
of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed
S' I a - 9 S Tank size 1000
RECEIVED
g.p.m.
MAY 3 01995
Municipality of Anchorage
Dept. Health & Human Services
Other bacteria
Compartments z
Cleanouts(!9N) "(ss Foundation cleanout QN) 4cs Depression (YO No
High water alarm (Y® fJ o- tJ IA - Alarm tested (Y/® t/n — N/A --
Date of pumping Nev-� 'rAN K- — N fA - Pumper —NAA -
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 7Z0o '+ On adjacent lots a 00 + Foundation 5
To property line 3fo t Absorption field I Water main/service line 101,r
Surface water/drainage k00 14
72 -M MY Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size In gallons Manhole/Access (Y/N) _
Vent (YIN) *Pump on" level at "Pump off"
High water alarm level Cycles
Meets MOA electrical codes (Y/N)
SEPARATION
D. ABSORPTION FIELD DATA
STATION TO:
adjacent lots Surface water
Date installed 5 .13- 95 Soil rating (GPD/Ftz) 0.45 System type-bm"Ti2s-NcN
Length Ivor Widlh Z•`oGravel thickness 5' Total depth 1`i'
Total absorption area" l 000 F' Cleanout present ISN) VES Depression over field (Y& No
Date of adequacy test64/—A Nrw WSTC*•l Resufts (pass/fali) for Bedrooms
Water level in absorption field before test After test
Peroxide treatment (past 12 months) (Y/N) If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ;pUb'+ On adjacent lots Z00'-," Property line 14 r
To building foundation 13' To existing or abandoned system on lot 32 r
On adjacent lots rO �r Cutbank So '+ Water maintservice line /o'•r
Surface water /00 t Driveway, parking/vehicle storage area 36 r
Curtain drain NonIE KNOWN
E. ENGINEERS CERTIFICATION
I cei* ffrat I have checked, verfbed, or conformed to all MOA and HAA guidelines in eller �tl�Rl off this inspection.
t�_ O i(f w
i
Signature C� L,1 �••""""�r+....' C,,..
r
Engineers Name �0%E,¢ T C. C�„ w g.✓ �� � '��p
n ROBERT C. COW
Date S A9 /C? S—CE-SIIot f
HAA Fee $
Date of Payment
Receipt Number
72-0z8 (318)• Bade
Waiver Fee $
Date of Payment
Receipt Number
S&
May 26, 1995
ROBERTC. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX(907)694-1211
HEALTHAUTHOR&TY
APPRWALS
MUNICIPALITY OF ANCHORAGE
Depattment o6 He.aP.th and Human SeAvice.a
P.O. Box 196650
Anchoaage., AK 99519
SEWER& WATEfl
MAIN E MNSIONS
REFERENCE: Lot 18; Btock 4; Valli. Vuee, E6tate6 02
A ConditEonat. Hea-Y.th Authoaity Appaovat (HAA) wa6 .Caaued on 3/8/95
SEWER&WATER
INSPECTION
bon the. aeSeaenced paopenty. AU woak uquivd boa the Conditi.onat
HAA W been compteted.
P.teaae i6eue a buU Heatth Authotity Appaovat at th.i.6 .time.
ENGINEERINGSTUDIES
ANDREPORTS
16 you a.equiAe additional .i.n6oamatEon, ptea6e contact u6.
S.inceaety,
WELL INSPECTION
8 FT.LXV TEST
��✓
""
A , P.E.
RCC/gk
SITE PLANS
ROADDESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577
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
Parcel l.D.n OSS-- HAA# �1A�i5�87
1. GENERALINFORMATION ;w.C;I,. ,.3;..c.
Complete legal description Loi 18• M"ik '4:'V&W"Uui•_Eata.ted 02
10400 Lo a Thee Daive
nose (R«. inv FI MOA"l
Location (site address or directions) n
Anchohage AK
Property owner:' Rohvht Ripe Day phone
(801)272-4809
2563 E. Lockhart Road Satt Lake City, Utah
84117
Mailing address
Lending agency Day phone
:
Mailing address
Lahhy CYank/.REMAX PROPERTIES Day phone
251-0130 +'
Agent. - -
-
2600 Cordova S#nee# Su �t¢ 100 Anehoha4e AK
99503
Address„
Unless otherwise requested, HAA will beheld for pickup.
4
2
NUMBER OF BEDROOMS 3
�.
3.
TYPE OF WATER SUPPLY
rn
fl
m o
Individual well
:�
-
Community well XXX
...
� f t0
,_ 1
Public water
rT �"' ^' g
NOTE: If community well system, provide written confirmation from
State ADEC 'st-
Ing to the legality and status of system.
-
-4.
TYPE OF WASTEWATER DISPOSAL '
Individual on-site XXX
_ =Holding tank
Community on-site
Public sewer
of written confirmation from State ADEC_
NOTE: community wastewater system, provide
attesting to the legality and status of system.
- -
nose (R«. inv FI MOA"l
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 5 i C E NGUNG&RI G Phone .6 `�- �q -7
17034 Esyb RI Loop aad 204 .
Address
Engineeessignature Date 3 v"
REQUEST YOU ISSUE A CONDITIONAL HEALTH AUTHORITY APPROVAL. SEPTIC SYSTEM TO
BE UPGRADED PER S d S ENGINEERING DESIGN DATED 2/24/95. SYSTE INSTALLED
'NO LATER THAN 15, JUNE 1995. �fi
�% ROEE]T C.
6. DHHS SIGNATURE 0jj �r,�, CE 8801
It fqE • ��
Approved for bedrooms tty�pRCFcss�o�iair-.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
:t. Additional Comments
By; 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.
rnmMW uv+) B, uwm
® Municipality of Anchorage Ak
AHM
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:, Zcocy-�Lj VALLI VUE EsT.!I`2 Parcel I.D. (0 1 S — 3
A. Well Data
Well type rg3m av,u iry If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth
Sanitary seal (Y/N)
Date of test
Static water levet
Well flow
Pump levell
FROM WELL LOG
Casingheig
_Wires properly protected o z
AT INSPECTION
SEPARATION DISTANCES FROM WELL TO:
M
t•T't
•� C
� T
M
oC
� c
o"
Z
SepticXelding tank on lot Zoo ' f ; On adjacent lots Z.co
Absorption field on lot Zoo' _;On adjacent lots 2, 045
Public sewer main 7S , r Public sewer manhole/cleanout /roa 'F
Sewer service line 2 C I '--Petroleum tank 64
WATER SAMPLE RESULTS:
Coliform
Date of s
B. SEPTIC/HOLD4NG TANK DATA
/Jo LATtiLTNAN
Date Installed G I rs/ea' Tank size /aoo Compartments Z
Cleanouts (DN) VEs Foundation cleanout (Z?J) VES Depression (y( A)o
High water alarm (Y RU A10 NM- Alarm tested (Y® Ala
Dateofpumping NEL rAut. NIA- Pumper N.14 -
SEPARATION DISTANCES FROM SEPTIC/HGLDING TANK TO:
Well on lot 200' F On adjacent lots 200 Foundation 70'
To property line /q Absorption field 9 Water main/service line
Surface water/drainage /00 't—
CONTINUED ON BACK PAGE
72-026 (3193)' Front
C. LIFT STATION
Date installed Manufacturer
Size in gallons
Vent (Y/N)
High water alarm level
'Pump on' level
Meets MOA electrical codes (Y/N)
SEPARATION
Well on
D. ABSORPTION FIELD DATA
LIFT STATION TO:
)ss (YM" )
'Pump off' Level at
tested
On adjacent lots Surface water
NO LA+TCI► THAM
Date Installed Soil rating(GPD/Ftz) /1.4S System type P6,-P72.eA:-4
Length /2S' ' Width 2•SGravel thickness 4f' Total depth /4'
Total absorption area /000 Cleanout present(l�l) Y&T Depression over field (YIP AJO
Date of adequacy test .),/A- NEw syrTE►^Results (pass/fail) or Bedrooms
Water level in absorption field before test After test
Peroxide treatment (past 12 months) (Y/N) If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO
Well on lot 200' t On adjacent lots 200 '!- Property line !o'
To building foundation 2r.' To existing or abandoned system on lot _ 161.,-
On
o'+On adjacent lots to 1y Cutbank M' r Water main/service line /01.
Surface water /op ' r Driveway, parking/vehicle storage area $b +
Curtain drain NOAIB KNoWA)
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect
Signature 2 t�
/
Engineers Name 6A d f% r, u.v
Date -312 Z `I Sl
HAA Fee $ • r�J
Date of Payment 3/AiV�
Receipt Number �C-2PZ
72-026 (393)' Beck
Waiver Fee $
n thP_ Q of this inspection.
OF:
. Sad
!' 1 ROURT C. COV1AN
Date of Payment
Receipt Number
Date of Payment
Receipt Number
s-
DATE RECEIVED -
INSPECTION APPOINTMENTS
TIME
TIME
TIME
NUMBER OF,BEDROOMS
❑
Cj lit , ( r%_j
DATE
DATE
DATE
INSPECTOR
INSPECTOR -
INSPECTOR
Q COMMUNITY
since June 1975. For wells drilled prior to that date, give well
M(1NICIPALITY OF ANiii0RAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION
-\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
1 825 L Street • Anchorage, Alaska 89501 SEP 15 19M
ENVIRONMENTAL SANITATION DIVISION RECEIVED
Telephone 2644720
❑ PUBLIC UTILITY
RE UST FOR APP OVAL OF NDIVIDUAL WATER AND SEWER FAQCILITIES
DIRECTIONS: Complete all pans on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1, PROPERTYQW/ER
��ddii
PHONE ,
3 240
MAILING ADDRESS
54,4 601 ,ZQ-G AM: 10A,46&— 411P T?,D
PROPERTY RESIDENT lit different from above)
PHONE
15-4" 5
2, BUYER
7jioti,� S � CA7fi�� �/GG /
PHUNL
MAILING ADDRESS
3. ENDINGINSTITUTION
��cN 's Al./1SK� Scf/c1xF�a��oy S FED 6Ret Ow
PHONE
27z fl/
MAILING ADDRESS
35"00 I5-lDg'
4 ALTOR/AGENT
/Q "�Ce trrd� �i ></CR/T� e 3
PHONE
3 Y9 -(Aa 6
MAILING ADDRESS
D O)e" /0—/
5. LEGAL DESCRIPTION ' `
STREET O
LOCATION Lome- -Ft?aLr-
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
❑
❑ One ❑ Four Other
a SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
0 Three ❑ Six
7. WATER SUPPLY
❑ INDIVIDUAL'
"ATTACH WELL LOG. A well tog is required for all wells drilled
Q COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
Lam? INDIVIDUAL/ON-SITE"
(jr YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72010 (Rw. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY 'I
1. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ SINGLEFAMILY
❑ MULTIPLE FAMILY
❑ TWO ❑ FOUR ❑ SIX
2. WATERSUPPLY
PERMITNUMBER
❑ - INDIVIDUAL
DEPTH OF WELL
❑ COMMUNITY
DATE DRILLED
❑ PUBLIC UTILITY
Connection Verified
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
DATE INSTALLED
(o
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size:- 10 nQ ' If Tank is homemade
SOILS RATING
give dimensions:
J
TYPE OF TANK
MANUFACTURER �.
TOTAL ABSORPTION AREA
MATERIAL
k
4. DISTANCES
TanSeptic/Holding
Absorption Area
Sewer Line
Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line -
5. MMENTS
i
r
i
da -"APPROVED FOR 3 BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
gy
_Z�) r_ a
72 010 (Rev. 6/79)
n
n PLEAza Rus H
MUNICIPALITY OF ANCHORAGE
� MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
-� _ 11 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIONENyIRONMENTAL PROTECTION
!1 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221
�\
NOV 0 91976
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES RECEIVED C C c I\/ E D
1. Type of Inspection: CMRO VA FHA IC`OLNV 300{_
2. Property Owner: BATES,aIA710VS . & PFLEI(ER
7. Type of Facility to be Inspected: SINCIF F AII Y DI4EITJNG No. Bdrms. 3
8. Water Supply
Type of Supply: Public Utility ktdividv Q2n4Zan
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site) XXXi
If Individual, date of installation
72003(3/76)
Mailing Address: 3201 C SI= JACK WHITE OD.
Day Phone: 277-1553
3.
Name of Buyer: LEE El. & DOROMIY A. CARLSON
Mailing Address: 848 WFSf 56th AVENUE
Day Phone: 276-6811
4.
Name of Lending Institution: PBDPLFS BA'19 & Mur
Mailing Address: E20 7007
Phone: 7511
5.
Name of Realtor or Agent: DORT CLW
Mailing Address: 3300 C S1=
Phone: 278-2525
6.
Legal Description: LOT 18 BIDM 4 VALLI VUE
Location: 6430 BRCMN TREE CIRCLE ANCIIROA(;F ALASKA 99507
7. Type of Facility to be Inspected: SINCIF F AII Y DI4EITJNG No. Bdrms. 3
8. Water Supply
Type of Supply: Public Utility ktdividv Q2n4Zan
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site) XXXi
If Individual, date of installation
72003(3/76)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received November 9, 1976
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
1. Approval requested by: Peoples Bank & Trust
Mailing Address: Pouch 7007 Phone: 279-7511
2. Property Owner: Bates, Mathews, Pfleiger Phone: 277-1553
Mailing Address: 3201 C Street, Jack White Co.
3. Legal Description: Lot 18 Block 4 Valli Vue
4. Location: 6430 Brown Tree Circle
5. Type of facility to be inspected Single Family No. of bedrooms 3
6. Well Data:
A. Type Community B. Depth
C. Construction D. Bacterial Analysis
7. Sewage Disposal System: On—site system P4ma 11
A. Installed IgILa B. Installer
C. Septic Tank: 1. Size 1, cc0. 2. Manufacturer
D. Seepage Pit: 1. Absorption Area , ' 2. Material
E. Disposal Field: Total length of lines 4q,
8. Distances:
A. Well to: Septic tank , Absorption area Sewer Lines
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74) Page 1 of two pages
. -. .... - - _M...,.. _.r. ......... - ,. .. , ....... . __ , ........
Page 2 of -two pages - Rem )st for Approval of Individual e— er & Water Facilities
Le Ul Description Lot 18 Block 4 Valli Vue
Comments
Approved Disapproved Date
Approval.Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
1 cerTlTy LnaL Lne IMUTIlla LJull bV11La IIIc' ." ....,, ...y..... — -".- -
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74)
Date
