HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 6 LT 26VcxUi Vue
Estates #2
Block 6
Lot 26
#015-123-26
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Waslewaler Disposal System and/or Well Inspection Report
re,,nit Number: ,~ ['~ ~ ~ ~ PID Number: O 1 5 -- I ~ ~ --
~ ~0 E~ooE~ T~e ~ 6;r~le ~. ~51~ ABSORPTION FIELD
LEGAL DESCRIPTION so,,....~ ~.~.o/s~
'"'._.,,,.~6 t"'7''4"-" ~0"~i~' ~'~'~ '"'"'°'" ~"'"'"~'""'~'" ~""'~""'"'""'"'"'"-
..~,,o.: ~,,.......~0. o.,.,..,.,.l:.g..'
w~: ~ .~w = "..'~ ~"'"""'"' 3 ,,. ""W'""'" I
~~.~1"'''"s''''' .,.1~""'"~"-~'~ TA.~
SEPARATION DISTANCES . s...~ o no~.~., a s.~.~,P.
w.,, I~ Ioo? --~ 2~~''*'''': ~+~1 "~
Remarks: ~P~A4 ~ ~ ~T~ ~ ~O BENCH MARK
_ . ~;n~l 11OI7~ '~,~(~, c~.~o~
Deparlmenl of Heallh and Human uerwces approvm · ~,
Reviewed and approved ~. ~ Date:/~'~C'o¢
PERMIT NO. SW000454 PAGE 2 OF 3
Municip. alit oF .A.n_c h.o.r' a g.e.
DEPARTHENT OF HEA~TH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.D. Box 196650 eAmchorage, Ataska 99519-6650eTetephome: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 26, BLOCK 6, VALLI VUE ESTATES #2 P.I.D. NO. 015--12.3--26
LOT 33
YBOX
t LOT 25
LOT 27
/
/
/
/
/
/
/
/
/
/
/
/
(DIVERTER VALVE)
_ ~10' 'DEPTH X
OF WATER LINE\
~ DBL2~EXISTING 1250
SEPTIC: TANK
(INTEGRITY VERIFIED)
/ /
/
' LOT
/~ /
/ ',, /
/ /
/ /
/
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CE-8801
PERMIT NO. SW000454 PAGE 3 OF ~
MunicipoHl: oF'
DEPARTMENT OF HEA~TH ANI.) HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 SAnchor~ge, Al~skc 99519-6650 m Telephone, 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 26, BLOCK 6, VALLI VUE ESTATES #2 P.I.D. NO. 015--125--26
ST
FINAL GRADE/
EXISTING 1250
GALLON
SEPTIC TANK
ST2/GRADE
FINAL GRAD£j
MT1--86.9'j
C01=99.1'
·
NO WATER FOUND
80.9' B.O.H.
A B C
FCO 20.5' - 14.0'
ST1 20.5' - 14.0'
ST2 16.0' - 20.0'
DBL1 14.5' - 21.5'
DBL2 14.0' - 22.5'
C01 46.0' 72.0' _
MT1 57.5' 52.0' -
C02 65.0' 51.0' -
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343.4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Oct 26, 2000
Expiration Date: Oct 26, 2001
Permit Number: SW000454
Legal Description: VALLI VUE ESTATES #2 BLK 6 LT 26
Design Engineer: 0003 S & S Engineering
Owner Name: Marilyn Courthey
Owner Address: 6830 Crooked Tree Cir.
Anchorage, AK 99516-
Parcel ID: 015-123-26
Site Address: 006830 CROOKED TREE CIR
Lot Size: 20035 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
i~ Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail 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
(907) 343-4744 ( 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.
Received By: 9~"~fZ ~
Date: 10 --~. ~:- ~'0
Date:
George P. Wuerch.
Mayor
Municipaliq of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage. Alaska 99519-6650
hit p:Ewww.ci.anchorage.a k.us
October 27, 2000
Robert Cowan
S & S Engineering
17034 Eagle River Loop Road #204
Eagle River, AK 99577
Subject:
Waiver Request for Valli Vue Estates #2, Lot 26, Block 6
Waiver Request #WR000090
Parcel ID #015-123-26
$W000454
Dear Mr. Cowan:
Your request for a waiver of the required I0 feet horizontal separation from the
on-site wastewater disposal system to properly line has been approved. The approved
separation distance is 0.0 feet.
This waiver approval applies to the existing on-sitewastewater disposal system to
properly line separation only. Any future upgrade to the on-site wastewater disposal
system will require all separation distances be met or another approval from this
department.
If there are any further concerns or questions regarding this waiver, please call our office
at 3434744.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On-Site Services
Waiver Review Worksheet
WR#: WR000090 PID#: 015-123.26 HA#;
Date Received: October 18f 2000
Legal Description: Valll Vue Estates #2f Lot 26r Block 6
Permit~: SW000. ~.~
Engineer:. S & S Engineering
17034 Eagle River Loop Road~ #204~ Eagle Riverr AK 99577
Applicant: Marllyn Courtney
Waiver Requested: 0 foot walver from proposed drathfleld to the northwest property llne.
Criteria: 1. Geology Points:
A, Water Table
B. Soil SorptJon
C. Permeability
D. Water Table Gradient
E, Hodzontal Separation
2. Special Conditions:
3. Other:
Total:
Waiver is Granted: x~/ Waiver is not Granted:
List Conditions or Reasons for above: J,f.//}IVE. i~ ,~£~t F~
Date: I/') --2/., --O&7
Ret#: 06396 Amount: $1t5.00
Name of Reviewer
Date Paid: 10118/00
ROBERT C, COWAN, P.E.
October 12, 2000
CML ENGINEERS
(907) 694-2979
FAX (907) 694-121
TEST
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 26, Block 6, Vallivue Estates #2 Subdivision
It is requested that you issue a permit to upgrade a septic system to serve the existing
three bedroom dwelling on the referenced property. A zero foot waiver from the
proposed drainficld to the northwest property line is also requested.
One test hole was excavated and a percolation test was performed on 9/20/91. The
approximate location of the test hole is located on the attached site plan. Ground water
was monitored and after seven days the hole was dry 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,
Robert C. Cowan, P.E.
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUffE 204 · EAGLE RIVER, ALASKA 99577
DEPARTMENT OF H~LTH & HUMAN SERVICES
025 'L" Street, Anchorage, Alaska ~2~
SOILS LOG PERCOLATION TEST
OtSCm.T,ON:~A~I ~ ~Z Township, Range. Section:
1
6-
7-
8-
9-
17
COMMENTS
WAS GHOUNO WATER td0
E.COU...EO? ·
S
L
IF YES, AT WHAT O
DEPTH? p
E
Reading Date Gross Nel D*.lh to Net
Time Time ¥,'dler Drop
"~-'~.v'_ '-~]c_.j~ 0 ~,
~ 2.'40 I0~,'~ ~.~1~,' i1:/~',/~,,
.ERCO~.t,O.~..E lC) ,.,n.,.~,n¢.,PERC.OLED,AM.E. ~"
$ & S ENGINEERING
17034 Eagle Rtve~ Loop Road
PERFORMED
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECt ~N~HIS DATE. DATE:
72~08 (Rev 4/85J
- Municipality of AnchoragePage
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
"'~.5~. L... ~ ~ ~ Wastewater System: D New ~pgrade
~ ~~ ABSORPTION FIELD
P~on.: I.o.o,e~m,: ,~eepTrench O Shallow Trench OBed OMound mOther
Total ~pth from origina/grade:
GPU Ft. Fl.TANK
SEPARATION DISTANCES ~ep~ic~ Holding 0 S.T.E.P.
Wat~ ~ ~ LIFT STATION
Remarks: BENCH MARK
ENGI~'~SEAL
Depadment of Health and Human Se~ices approval .-~ .~ .~
Reviewed and approved by: Date: 7-2 / - ~ ~k[?OFESS~
72-013 (t/gt) MOA 25
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: ~/-~'-L,~.. I
\ \
No. 6215
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910314
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:HIGHLAND R L
OWNER ADDRESS:6830 CROOKED TREE CIR
ANCHORAGE, AK 99516
DATE ISSUED:10/03/91
EXPIRATION DATE:10/03/92
PARCEL ID:01512326
LEGAL DESCRIPTION: VALLI VUE ESTATES #2 B 6 L 26
SEC 14, T12N, R3W, SM
LOT SIZE: 20035 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
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 (ISAAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
VERIFY WATER LINE LOCATION AND DEPTH. SEWER SERVICE LINE
MUST BE A MINIMUM OF 18" ABOVE THE WATER LINE; WITH NO
JOINTS WITHIN 10' OF AREA WHERE PIPES CROSS.
ISSUED BY: _ _ · DATE:
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
SEWER & WATER
MAIN EXTENStONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELl. INSPECTION
& FLOW TEST
ROAD OESIGN
SOIL'[EST
PERCO[.ATSON
TEST
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
September 24, 1991
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, Alaska 99501
REFERENCE: Valli Vue Estates #2, Block 6, Lot 26
Request you issue a permit to upgrade the septic system
serving the referenced property.
An adequacy test was performed on the existing system and the
absorption capacity of the system was found to be less than
adequate.
A test hole was excavated and a percolation test performed in
the area of the proposed upgrade. Attached is the proposed
upgrade design.
Since the subdivision is served by a Class 'A' water system,
there are no protective well radii which encroach upon the
property. We do not anticipate any adverse effects on
neighboring properties by the installation of the proposed
septic upgrade.
If you have any questions or require additional information
for your review, please contact us.
Sincerely,
RJS/lsu
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERPORMEO ,OR~'n I ,~''P~~~ KJW F.~Z-I.'~---~E PER,OR
'EGA' DES~R,PT,O.:V'Abb!
1
2
3
4
5
6
7
8
9
10
13
14
17
2O
COMMENTS
Township. Range, Section:
SLOPE
WAS GROUND WATER HO
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
I~oniloring?
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
/~ ~:'~ ,~H~d. ~'1~" I"
) ~) (mmuteshnch) PERC HOLE DIAMETER ~ FTAND :::~'" FT
PERCOLATION RATE
TEST RUN BETWEEN
QGRE~-:R ANCHORAGE AREA BOP"IGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION ~,'~'~'
SEPTIC TANK:
DISTANCE ~
FROM WELL MANUFACTURER~'~"~,~ ~
MATERIAl ~ NUMBER OF
COMPARTMENTS ~'-
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
IIQUID CAPACITY /~' ~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER OR WIDTH__,
LINING MATERIAL~ 3E' CR~RI~B SIB SIZE: DIAMETER
BUILDING FOUNDATION ~ ~ NEAREST LOT LINE ~'~/,~
ADDITIONAL ABSORPTION
LENGTH DEPTH ~-' ·
DEPTH ~ /DISTANCE FROM: WELL
TOTAL EFFECTIVE Z~. J~~
ABSORPTION AREA {WALL AREA)
WELL: ~..~.~.
TYPE CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
APPROVED ~ DISAPPROVED
NEAREST
SEWER LINE
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK __ SYSTEM
REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED
PIPE MATERIAL:
LOT SLOPE:
REMARKS: ~-~'~
Form NO, EQ-031
DATE
G.A.A.B.
SEWAGE DISPOSAL SYSTEM "' " , ,
(
egam uescr~ ptr~6n: l~- ~,/-/
This fom reports: Soils ]o~~, '~-"~.
Depth
Feet
1
.'ER ANCHORAGE AREA B~RO~Hn ,,e
Depart,lent of Environmental Quality
3330 "C" Street
Anchorage, Alaska 99503
5
6-
Date performed
Percolation test
10-
11 -
12-
13-
.I
Was ground ~;,ater encountered?
If yes, at ¥~hat depth?
'~eading Date Gross Time Net Time Depth to H2O Net Drop
:.' minute.
r,'o?osed installation: Seepage Pit ' Drain Field
?,, ,t? cf Inlet De,~t,, to bottom of pit or trench
,orr .... D~,:.... ~c_ Certified {;/: Date:
EPL/ MS e4S,4
•;!�� Municipality of Anchorage 2°''
On-Site Water and Wastewater Program
(907)343-7904
Certificate of On-Site Systems Approval
Parcel I.D. 015-123-26 Expiration Date: &It Q aolci
1. GENERAL INFORMATION
Complete legal description Valli Vue Est. #2 B6 L26
Location(site address) 6830 Crooked Tree Cir. Anchorage, AK 99516
Current Property owner(s) Christina Calvo Day phone
Mailing address 6830 Crooked Tree Cir. Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family(w/wo ADU)
❑ Duplex
❑ Multiple Dwellings(Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class A Well El Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received b . irgr. 11 1Date: `/2l
112 i
COSA to be released to the engineer,unless otherwise requested b th engineer.
COSA Fee $ 59.4 Waiver Fee $
Date of Payment c1/g11' Date of Payment
Receipt Number C19336 Receipt Number
COSA# (35cI$f aQ / Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are)in compliance with all applicable Municipal and State codes,ordinances,and regulations in effect at
the time of installation.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the lest.
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R Pannone Date 9/19/2018
. ON-SITE �,. 0,.. �4 •.'f, h
_z WATER AND ,40:�. , i.,‘ •*,l
6. DSD SIGNATURE ;Q WASTEWATER •' \t='r' ' N..-
FO
/\ System #1 Approved for ( bedroo s PROGRAM i' .Steven . '•nnone•
6-1 �� ljl,•. CE-81499-/:
System#2 Approved for bedrool p� ��, ++ .r
Disapproved ��SERvtC !11 FNGIIS4Mt:.
Conditional approval for bedrooms, with the following stipulations:
Pt S (1 13edke' o 1 se6./ 2.. -3bpd ►
d�
c t`re- W t- a Flo r�Gta�~�.t�'. t+ i S yY cd
-1-o ►+tov 4-o r- 4c -L1 ilk Vie -t- S w i f 1-e 4e cQ 6 ' /
4— id,--7ZIerft" C �'�'l� .-r -, 'f' I`
I .-P, G S I IG,�Lv.c I S law,
n 1 #,Q - tc I VL Ill � 4` �
Vim? S-� s �P� �
og 'IA a OtAtciwk
wej
By: xeca Original Certificate Date: Sept �5J 2 C 1 g
The Municipality of Anchorage Development Services Division(DSD) issues Certificates of On-Site Systems Approval (COSA)based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other Iav�Z ._ O..d v i SO )c
COSA blue sheer` .
If more than 1 septic system is on the lot:
COSA Checklist# l of l
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Valli Vue Est. #2 B6 L26 Parcel ID:015-123-26
A. WELL DATA
Well type Class A If A, B.or C provide PWSID# 210605 Well Log(YIN)
Date completed Sanitary seal (Y/N)_ Wires properly protected(Y/N)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 6/10/1992
Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm(Y/N) N/A
Date of pumping
9/5/18 Pumper Isaac's Pumping Service
C. ABSORPTION
10FIE110L11D DATA
442
Date installed Ili. 11.2e150 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8/0.8 System type Trench/Trench
Length 44.5/50 ft. Width 3/3 ft. Gravel below pipe 6.5/6.5 ft.
Total depth 10/11.4 ft. Eff.absorption area 5�A/cpft• Monitoring tube Y Depression over field N
Date of adequacy test 9/14/2018 Results(Pass/Fail) O. For 4 bedrooms
Fluid depth in absorption field before test 0/54 in. Water added 600 gal. New depth 0/64 in.
Elapsed Time: 720 min. Final fluid depth 0/54 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment(past 12 mo.)(Y/N&type) Non Known If yes,give date
* °C13,\(\Q"e,\a-5 5`z dor 3 r-on. ; R ( e.6 4laarm ;m 2(c
* WEST Occa0 Q Q-1a. ‘r\ o2,.
D. LIFT STATION
Date installed Size in gallons Manhole/Access(Y/N)
"Pump on" level at in. "Pump off level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 1001+ On adjacent lots 1001+
Absorption field on lot 100 + On adjacent lots 1001+
Public sewer main 75 + Public sewer manhole/cleanout 100 +
Sewer/septic service line 25 + Holding tank 1001+
Animal containment areas 50'+ Manure/animal excrete storage areas 1001+
SEPTIC/HOLDING TANK ON LOT TO:
'+ '
Building foundation Property line 10'+ Absorption field 10 +
Water main
25'+ Water service line 10 + Surface water 100'+
Wells on adjacent lots 100 +
ABSORPTION FIELD ON LOT TO:
Property line 10 + Building foundation 10 + Water main 10 +
Water Service line 101+ Surface water 100'+ Driveway,parking/vehicle storage 101+
Curtain drain 50'+ Wells on adjacent lots 100 +
F. COMMENTS
Survey on file. *Per inspection report South c.o. of East trench - was not found-
approved inspection in 2008.
G. ENGINEER'S CERTIFICATION : ...4.P.'.4....21.
ry' N..\‘‘,
‘‘,
etlkk
1 certify that / have determined through field inspections and ,,r' .7!..' VI
review of Municipal records that the above systems are in j*: a., *S'
conformance with MOA COSA guidelines in effect on this date. fri••• � • •• ••
Engineer's Printed Name Steven Pannone ..:Sleveri W..Poririorie:••
Date 9/19/2018 6*:-. �C=8149
COSA canary sheet_2-6.15.doc
•
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT m '' 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory'
Certificate of On-Site Systems Approval # OSC181499
Subdivision: Valli Vue Estates #2 Block:6, Lot: 26
The septic tank for this property is 26 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
T Y 6 .
T t.: • "1 '�
r j , 4z: •Fa E rz
• v Iv.� �`.
{ /
.:„,,-'est •
`� :' yr,♦ Y• fi
�•! v w•
o• .
Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org
Municipality of Anchorage
Development Services Department
Bui!ding Safe,hi Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 ~//¢,/
Anchorage, AK99519-6650. . _, . ~--~.,~ j~¢.,
(907) 343-7904
CERTIFICATE OF 0N-SITE SYSTEHS APPROVAL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 015-123-26
1. GENERAL INFORMATION
COSA# ~--~¢'
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
; ,
Mailing~address
VALLI VUE S/D #2; BLOCK 6, LOT 26
6830 CROOKED TREE CIRCLE * ANCHORAGE, AK * 99507
PARKER MARTYN
6830 (:;ROOKED TREE CIRCLE
Day phone 644-3697
* ANCHORAGE~ AK * 99507
Day phone
Unless otherwi~, requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
Day phone
3. TYPE' OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well E-] Individual On-site ·
Individual Water Storage E-] 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 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 engineer's work.
4. STATE,r',{ENT OF INSPECT!ON BY ENG)NEER
As certified by my seai affixed hereto and as o1' the vafidation date shown below, ! verify that my
investigation, based on procedures outlined in the Certificate of Qn-Site Systems Approval Guidelines for this application,
shows t, i~~,,~**'~ on-o,~, water supply and/or wastewater dis~osa!. ~sy~f~m ...... ie ,far, a}.~.... S~f~, ............... f~,nction~! ~nd ~dequate
for the number of bedrooms and type of structure indicated herein. I furt,ffer verify t,hat based on the
lu~O~)~uo, ob~h~u .o,,~~,~'~ M~ni~.lp~,..~ o, ,-.,,cho, oge files and frcm,,,z~*" ,,,. ~.~,,~..,~, ,;'~"~°*;~'°*;'~" ~,,~°'~ .,,~-~'.,;'~"*i"" the
on-site water supply and/or wastewater disposal system is(are) in compliance with afl appficable Municipal
and State codes, ordinances, and regulations in effect at t,ffe time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 537-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
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 & 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 afl 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 of how 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 of the owner listed above. Any refiance upon or use of this:report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
~/ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Attachments: ~,O~ Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 11105)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other ,/d F./rl ¢ f(
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Legal Description: VALLI VUE S/D #2; BLOCK 6, LOT 26
A. WELL DATA
Well typeCOMMUNITY
Date completed
Total depth ft.
Date of test
Static water level
Well production
Coliform ~ colonies/100 mi. Nitrate~__mg./L.
ArSenic:
CHECKLIST
Parcel ID: 015-125-:
ICOMMUNITY WELL
If(~ B, or C provide PWSID# 210605 Well Log (Y/N)
Sanitary seal (Y/N). Wires properly protected
Cased to ft. , Casing height (ab~/e~und)
FROM WELL LOG ft~~
~g.p.m. g.p.m.
__ ug./L. Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
.Tank size 1250 gal, Number of Compartments
Foundation cleanout (Y/N) YES
Date of pumping 7/1/201 1
C. ABSORPTION FIELD DATA
6/.9-10/1.992
Date installed 11/20-21/2000
Length 44.5/50 ff.
2
Depression over tank (Y/N) NO
Pumper.
Date installed 6/9-10/1992
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
A+ HOME SERVICES
I'BELOW EXISTING GRADEI
Soil rating ~or ft2/bdrm) 0.8/0.8
Width 5/3 ff.
11992 TRENCH/2000 TRE
System type TRENCH/TREI,
Gravel below pipe 6.5/6..'
**578/ft2
Total depth*lO.O/Il.4 ft. Eft. absorption area *.65o Monitoring tube YES
Date of adequacy test **'7/15/201 1 'Results (Pass/Fail) PASS
Fluid depth in absorption field before test 40 in.
Elapsed Time: 120 min. Final fluid depth 45
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Depression over field
Fo~ ~ bedr(
Water added 600 gal, New depth 5;
in. Absorption rate >= 450+
NONE KNOWN If yes, give date
***WEST DRAINFIELD WAS IN USE AT TIME OF TEST. TESTED WEST DRAINFIELD ONLY. EAST DRAINFIELD W~
in.
r,,ICHI
ICH
ft.
NO
~oms
in.
~.p.d.
C.O.S.A.
DRY.
D. LIFT STATION
Date installed
"Pump on" level at__
Size in gallons Manhole/Access ~ J
in. "Pump off" leveJ_a.t/. High water alarm level at
in.
Cycles tested,
Meets alarm & circuit requirements~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
ICOMMUNITY WELLI
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots _.-.-~
.~er manhole/cleanout
Public sewer main ~
Sewer/septic ~ .-----~ Holding tank
~ment areas, Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5%
Water main 10'+ Water service li~e '~' 10'+ Surface water. 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *5'
Water service line'~'~ 10'+
Curtain drain NONE KNOWN
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots. 200'+
Water main 10'+
Driveway, parking/vehicle storage
F. COMMENTS *PER EXISTING WAIVER. NOTE: SEPTIC TANK IS UNDER DRIVEWAY. APPROVED PER 2008 C.O,S.A.
NOTE: SOUTH CLEANOUT OF EAST TRENCH COULD NOT BE LOCATED DURING INSPECTION. PER LAST COSA.
G. ENGINEER'S CERTIFICATION
! 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 JEFFREY A, GARNESS
Date
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
LOT 26
7113B
LOT 25
LOT 27
SCALE: 1 .'= 30'
EASEMENTS OF RECORD. OTHER THAN
THOSE SHOWN ON THE RECORDED ~.~
PLAT ARE NOT SHOVVN HEREON.
LOT 23
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
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. 015-123-26
1. GENERAL INFORMATION
Complete legal description
VALM rUE EST#2 BLK 6 LOT26
COSA#
Expiration Date: /~) *- .'~ ~) '* ~) ~,~
Location (site address) 6830 CROOKED TREE CIRCLE, ANCHORAGE, AK 99516
Current Property owner(s) ALLISON FAMILY TRUST Day phone
Mailing address 6830 CROOKED TREE CIRCLE, ANCHORAGE, AK 99516
Lending agency
Mailing address
Real Estate Agent
Mailing Address
KATHRYN McKORMACK REIMAX
110 W. 381h Ave., A.,',:horage, AK 99503
Day phone
Day phone
Unless othe~vise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class A Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank E]~
Community On-site
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. (Certif*~ates 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 vedfy 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 Watklns Engineering, Inc.
Address p.o. Box t 10443, Anchorage, AK 99511-O443
Engineer's Pdnted Name Cindy W. Ellis. P.E.
DSD SIGNATURE
~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for
Phone907-349-1851
Date °I - Z.4 - O ~
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By:
X
Arsenic Advisory
Maintenance Agreements
Supplemen~l Engineer's. Report
~'~)~'C'~OOOriginal Certificate Date: 7-
Municipality of Anchorage
Development ServiCes Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: VALU VUE EST//2 BLK 6 LOT 26
A. WELL DATA
Well type A
Date completed,
Total depth
Parcel ID: 015-123-26
If A, B, or C provide PWSID # 210605
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mL
Arsenic: rog/1
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N) NA
Wires properly protected (Y/N),
Casing height (above ground),
AT INSPECTION
in.
gp.m.
ft*
gp.m.
Nitrate mg/L
Date of sample:
Other bacteria
Collected by:I .
colonies/100 mL
Tank Type~Material STEEL SEPTIC TANK
Tank size 1250 gal. Number of Compartments 2
Foundation c!eanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping .7/21~2008 Pumper .A* Home Services
ABSORPTION FIELD DATA
Date installed 11/20/0o
Cleanouts (Y/N) YES
High water alarm (Y/N) NO
Date installed .11/2012000 Soil rating (g.P.d./ftt or f~Fodrm) 0.8 System type DEEP TRENCH
Length 50 fl. Width 3.0 It. Gravel below pipe 6.5 It.
Total depth 11.56 .fl. Eft. absorption area 650 Itt Monitoring tube YES Depression over field NO
Date of adequacy test ,,7/21/2008 Results (Pass/Fail) PASS For 4: : bedrooms
Fluid depth in absorption field before test 49.25 in. Water added 1007.7 gal. i New depth 64.0 in.
Elapsed Time: 60 min. Final fluid depth 53.75 in. Absorption rate >= 600 gp.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)NO If yes, give date
D. UFT STATION
Date installed.
'Pump on' level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons
*Pump off level at in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/~iff station on lot NA
Absorption field on lot
Public sewer main
Sewer/septic service line
Animal containment areas
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
Building foundation 5
Water main
Wells on adjacent lots 200+
On adjacent lots
On adjacent tots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Property line 20*
Water service line 10'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Buih:ling foundation 10 *
Surface water 100'+
Wells on adjacent lots 200*
Absorption field 5'*
Surface water 100'*
Water main 10'+'
Driveway, parking/vehicle store!;~e 5
Property line 5 (waiver)
Water Service line 10',
Curtain drain NA
in.
F, COMMENTS: Septic tank Is Instated In driveway, with pevernent risers, flush to the ground. Cleanout at the s~Jth end of the
eastern trench cannot be found. Trench is accessi~le through north ctsanout. Tested western trench. Fields have been alternated
annually, using diverter vane. *Water ma~n Is 10' east of west sEle o~ right of way. per K.'anich Ei~ r (water system operate).
G, ENGINEER'S CERTIFICATION
I ~ertify that I have determined through field inspections end
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Cindy W. Ellis, P.E.
Date '"7- "'/..~-/- O ~
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
Building Safety Division
MEMORANDUM
DATE: 30 July 08
TO: Buyer of Valli Vue Estates #2 B6 L26
FROM: Daniel J. Roth, Program Manager (~'
On-Site Water Wells and Wastewater Program
SUB J: Septic Tank
Tank manufactures do not design septic tanks to have vehicles driven over or parked on
them.
If in the future the system needs to be upgraded, this office will require the tank to be
moved outside the driveway or parking area.
LOT 26
LOT 25
7113B
LOT 27
/
/
/
/
/
/
/
LOT 23
SCALE: 1."= 30'
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. FB
FS'
BE
AS-BUILT NO CORNERS SET THiS DATE
I hamby ce~fy that I have perl'ormed a Mo~gagee's k~spec~on
of the following desedbed pmperb/: LOT 26 BLOCK'
VALL! VUE ESTATE~, I]N~T ~~
Anchorage Record ng Precinct, Alaska and tha! th-
Improvements $itua ed thereon are within the ~ rrnes
and do not overlap or encroach on the I:~/ylne
adjacent thereto, that no improvements on fi",e p~op~r[y lying
adjacent [hereto encroach on the promises in question and
that there are no roadways, transmission lines ~r other
· visible easements on seid property except es indicated
hereon.
Dated at A~lcho~age, AJaske
this__ 10th day of__JULY ,2008
FRED WALATY, A & ASSOCIATES
(907-248.1666) Engineers and Surveyo~
~ , , Mumc~ ~tyofAncho a~e
:,'. '~ :: Department of Healthand Human Services
\~.~..'~J// ', ",': ', ':: ' ' Division of Env ronmental Sen~ices - · ' ·
· ~;;::'"' "~': ::'"' ;" OnLSite Services Section ' 825 'L' Street· Ro~m502' · :""' ' · ': 4: ' ~ · , .. '-..., !,"-2-) P.O. Box 196650 Anchorage, AK 99519-6650
..... , ,~, :-J,: 'c ,,.: ,,.:? ;www. ci.anchorage.ak.us - .. .,
:,r , :~ I "''"' ' '"" :!''(907) 343-4744. ' .....
":,' .... · CERTIFICATE OF HEALTI:t AUTHOR TY APPROVAL . - .... .
· ,. - . ... FOR A SINGLE FAMI'~!DWEi_L. ING
P~cei I.D/';O)',-~-;,-./~..3 - ~ Fo .......
,~. ~.., ....... . ~.,
,,,,1 .~. :GENERAL INFORMATION
,' ...... Completelegaldescnpt~on BDt 26, Block 6. Vall~ Vue Estates #2
. '...', . .~ ~,.. ~., ~
~ ..... 3 .
. ..Location (s~te address or d~rect~ons) 6830 Crooked Iree C~rcle ..................
"~CurrentPrope~owner(s) ~lartlTn Courtney ,Dayphone '346-13~8..
Mailing~d~ress 6830 Crooked Iree Ctrcle~ Anchorage~ ~[ 99516
Lending agency
' -' · Mailing address
Real Estate Agent
Mailing Address
HAA# oo0
Expiration Date:
Dayphon~ ..' ,.: i '
Day phone
Unless othe~ise requested, HAA will be held by DHHS for plckup. HAA picked up by: x" ' ' ' ~: '
2. NUMBEROFBEDROOMS: 3
TYPE OF WASTEWATER DISPOSAL:
3. TYPE OF WATER SUPPLY:
.... Individual Well
Individual Water Storage
Community Class /~ Well
Public Water System
Individual On-site
Individual Holding Tank
Community On-site
Public Sewer
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
require.d .~'or the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system· DHHS also issues HAAs upon request to home owners.
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 less than 30 days old. 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.
72-025 (Rev. 0'1~00)'
5. STATEMENT OF INSPECTION BY ENGINEER
~,~ certified by my seal affixed herdt'0'~nd as'o, f the validatior~ date shown be!ow, I v?.rify that my investigation
based on procedures outlined in the' Health Authority A~pro~al Guideline~'fdr the",H~alth Authori~yAISp~'.o~al
~ ~.application show that the on-site water supply and -r~,. = ~.: ~. ~. ,. /or wastewate¥ disposal
~ ;syster~ is safe, functional a~d ad~luate for the number of bedrooms and type of structure indicat~,d her~ih.'l
- further ~erity that based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water s~Jpply and/or wastewater disposal system is in compliance with
all applicable Municipal and State ~odes, ordinahces; and regulations in effect at the tirn*e of installation.
NameofFirm : it,', , * .' . .~ ... · .. ~='-- , r '04'.:~ , .,-r. ~
f? 0'~4 Ea~le River Loop Roe~ No. 2 -- Phone ' * ' '7
. : , , ......
6.. DHHSSIGNATURE ................ '~'~.. c£-sS0t /~?~.
' ; Disal~proved. . , . : ., ...... ~ x~,?,,~.~,.~.~ .
............ Condition'al al~proval for ...... bedrooms, wah the following stipulations. - .
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date: ! ~Q. - ;;:L(',, - O I
Original Certificate Date:
Reissue Date:
72-025 (Rev. 01/00)'
Municipality of Anchorage ~
Department of Health and Human Servic~E C E I V E
Division of Environmental Services
On-Site Services Section 825 'L' Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650 DEC 1 ! Z000
www.ci.anchorage.ak.us
(907) 343-4744
MUNICIPALITY OF ANCHORA(~E
ENVIRONMENTAL SERVICES DIVISION
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
I~LecK C 'y,'t~-LI VV~. E.~',4~'O.~ ;e ~. Parcel I.D.:
A. WELL DATA
Well type /~ If A, B, or C provide PWSID # ~/o 4' O.J"" Well Log
Date completed Sanitary seal ' ~protected
Total dept,h ~ ft Cased to . ft ~,,Cas~ng~height (above ground)
FROM WELL LOG ~ AT INSPECTION
Date of test J
Static water level ~ ~y ~ ft
Well production j,~ g.p.m . g.p.m
WATER SAMPk~~S:
Coliform f colonies/100 mi Nitrate mg/l Other bacteria colonies/100 mi
Da~0~f sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material 5,/.,0 r'~ ¢ /
Date insta!led r.,//i/,~ Z' Tank size J*'3- 5-o gal Number of Compartments
Cleanouts ¥/z~ Foundation cleanout YaJ' Depression over tank '"' c High water alarm
Date of pumping q/l~/oo Pumper ~
C. ABSORPTION FIELD DATA
Date installed 11/3. o/eo Soil rating ~.p.d./ft~'~or ft2/bdrm) O, ~ Sys, tem type 3',~,~,,, ~.~
Length E' Oft Width ~ ft Gravel below pipe . ~. ~ ft
Total depth I ~. ft Effective absorption area ~'$'e fF Monitoring tube ¥~-~ Depression over field
Date of adequacy test ~/4 -~"~' Results (Pass/Fail) For · ..3' bedrooms
Fluid depth in absorption field before test in ~ New depth
Elapsed Time: rain ~. in Absorption rate >=
Any rejuvenati_on t~ mo.) (Y/N & type) If yes, give date
72-026 [Rev. 01/00)'
in.
__ g.p.d.
D. LIFT STATION
Date installed Size in gallons M~
"Pump on" level ~_ _igh wa.ter al_arm, lev. el at __in
Datum ~--~-----~C~ets alarm& circuit requirements
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot On adja~
Absorption field on lot .~djacent lots
Public sewer main ~ Public sewer manhole/cleanout
line tank
Holding
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~' Property line 3 q
,
Water main Io -t- Water service line
Drainage P' J/I Wells on adjacent lots. -~'/4
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 5" ' Building foundation ''~ ~ ~ Water main
Water Service line
Absorption field 3 o "/-
Sudace water / o o '-/-
I0 ~ Surface water I o o .-~
Wells on adjacent lots '~/,~
Io
Curtain drain
Driveway, parking/vehicle storage ,.3
F. COMMENTS
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 HAA guidelines in effect on this date.
Engineer's Printed Name
Date
HAAFee $ '~'
Date of Payment I
Receipt Number
/
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 01/00)*
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 I.D. # ~"~,~ -'~ - I ~ l, - ,-'~!,.~ ~.- HAA#
GENERAL INFORMATION
Complete legal description
Lot £6; B~oclz 6;
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
M~zr~_~ Bu~.n6 0 ~ ~,~,,~.,~ct ~ Day phone
15621 ./~Z6en CZ~.c~e Anehora,q~ A,~c,~l, za 99516
265-0740
Day phone
Agent
Address
Day phone
e
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
- Individual well
Community well Y,X
Public water
NOTE:
If community well*system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
· TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /~.O'T _,c"~-,! ~/--~C {j~LL.~- F~E Parcel I.D.,
~7~s ~
A. WELL DATA
Well type ~u~;7~/ If A, B, or C, attach ADEC letter.
Log present (Y/N) /'d/~
Total depth
Sanitary seal (Y/N)
Date completed
Cased to
Wires properly protected (Y/N)
A
DEC water system number ~
jL///~ Driller /~J/~
JU/~ Casing height A,//A
FROM WELL LOG
Date of test
Static water level /
Well flow / g.p.m.
Pump level
SEPARATION DISTANCES FROM WELL TO:-~
Septic/holding tank on lot ~C>O
Absorption field on lot ~ (~6 ~
Public sewer main
AT INSPECTION
; On adjacent lots
; On adjacent lots '~,'~
Public sewer manhole/cleanout
Sewer service line ~/~ Petroleum tank
B. SEPTIC/I'i~E{~ TANK DATA
Date installed ~_~--[(..~ - c( '7__ Tank size
Compartments "T'~O
Cleanouts ~'/N) "TWo
High water alarm (Y/~
Date of PumPing;
Foundation cleanout (~',1) Y~-,~ Depression (Y/r~
/'J/'/~ Alarm tested (Y~
. "/'/~-/dl~ Pumper . /~'/~
SEPARATION DISTANCES FROM SEPTIC/I-f~I;~I~TANK TO:
Well(s) on lot ~J/Jbt' On adjacent lots ~:q'~O~) ~-
TO propertyline Z~j-I ' ' _~'
Surface water/drainage
Absorption field
Foundation R ¢
Watermain/service line~ //0 ~
72-026 (Rev. 7/91) Fr(~t CONTINUED ON BACK PAGE
C. LIFT STATION
""Da* installed
Manufacturer ' ~
Manhole/Access (Y/N) ~
"~ level at
Vent (Y/N)
High water alarm level ~; tested
Meets MOA electrical codes (Y/N)
.~g~3Ao~ On adj ca ant lots Surface water
D. ABSORPTION FIELD DATA
Date installed' ~'/(~ ~'~'
Le, ngth ~"~, -~' Width
Total absorpti_o.n area
Soilrating _t~),~(~f'q/cJc Systemtype "~/~CH Total depth
Gravel thickness ~ ,c~ '
Cleanouts present (~7N)
Date of adequacy
If yes, give date
Depres~i'~n o~,er field (Y~__~
Results (pass/fail) /v~''~j/v~' ~'-~ for
ParoS(ida treatment (past 12 months~ (Y~_.~ '
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~///q- On adjacent lots
TO building foundation ~ ~'
On adjacent lots ~ ~' Cutbank
Surface water - [~(~
E. ENGINEER'S CERTIFICATION
Property line
To existing or abandoned system on lot
water main/service line
Driveway, parking/vehicle storage area
/o ?-
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date ~f this in~'pection.
Signature ': [ ~: _r~!,.',!_~_eR!.~!~
17034 Eagle River Loop Road No, 204
Engineer's Nar~g.~!.: r.;.~ , -';a;Lo ;;$77
Date ~.--" I q-q ~
Waiver Fee: $
Date of Payment
Receipt Number
HAA Fee $ /~'~/- '~---'"'~
Date of Payment ,~//~x-/~_~_
Receipt Number
72-026 (Rev. 3/91) BaCk MOA 21
DEPT. OF EN%IIRONMENTAL CONSER$~,TiON
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99503
WALTER J. HICKEL, GOVERNOR
(907) 349-7755
April 22, 1992
FOR: S & S Engineering
PWSID # 21O6O5
My review of the records on file in this office reveals that the Valli Vue Subdivision
Class "A" Public Water System, is in compliance with the routine coliform bacteria
sampling requirements listed in Table C, and with the inorganic sampling requirements
listed in Table B of 18 AAC 80.200.
Sincerely,
Project Engineer
BR/cf
#1:
/'"MUNICIPALITY OF ANCHORAG:''~
DEPARTME,.. OF HEALTH AND ENVIRONMEN', PROTECTION
825 L Street, Anchorao~. Alask~ 99501
264-4720
Date Received: March 30, 1978
Time ll~lf a.m. #2: Time I/~ ~3: Time ~
Date ~8~r~day Date ~-7~ ;")~3[' Date
Insp ..Pr~t~ Insp D/];~ / ~% .--- Insp
, , _,
REQUEST FOR APPROVAL OF INDIVIDUAL SEWE~_AN~_~2~]LE~ ~ILITIES .~/
1. Lending Institution Request: Alaska National Bank of the North
Mailing Address: 3301 C Street, Calais II Phone: 278-4581
2. Property Owner: John R. Armstrong
Mailing Address: Post Office Box 4-2057 99509
Phone: 344-1646
Legal Description:
Lot 26 Block 6 Valli Vue Estates Subdivision
6630 crooked ~'ree circle
Single Family Residence: (x)
Number of Bedrooms: Three
Multiple Family Residence: ( )
Number of Bedrooms:
Well System:
Permit #
Construction
Individual Well ( ) Community/Public System ( $
Depth of Well Well Log on File
Bacterial Analysis
( 1,
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System (x) Public Utility
Installed 19~See note on white sheet.
Installer
~O Manufacturer ..~
~'-~ Soils Rate /~'O Material
( )
e
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
Department o~ Heaith and Environmental Protection
Request ~or Approval o£ Individual Sewer and Wa~er Facilities
Legal Description: Lot 26 Block 6 Valli Vue Estates Subdivision
Comments:
Affadavit Attached: ~
Approved:
Disapproved:
Department Worksheet:
Letter Attached: ( )
Date:
Date:
1/O~{~!~/ 825 L Street, Anchorage, Alaska 99501
' ' ~'~R~quest for Approval of Individual Sewer and Water Facilities' ·
Mailing Address: ~-~' ~C~ /-~-~_O~7 Phone:
Name of Buyer:
Mailing Address:
Phone:
Lending Institution: ~~-~ ~~- ~,~ ~c-
Mailing Address: Phone.
Realtor/Agent: ~3'~-~'~
Mailing Address:
Phone: ~--~C ~'T
Be
Legal Desc.r. iption:
Street Location:
6. Single Family Residence: ~-~ Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply:_ *Individual Well ( )
If Individual Well, well depth
If Community System, name of system
Public/Community System
8. Sewage Disposal System: *~n-site System ~ Public System ( )
If On-site System, date of installation:
...... ~ .... ~o .... 0~-~ - '~.-~',-~_ ~¢~"~.~-,~
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77