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VALLI VUE ESTATES #2 BLK 2 LT 4
Valli Vue Estates #2 Block 2 Lot 4 #015-322-54 GRED ~R ANCHORAGE AREA BOF �6H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /-+1 MAILING ADDRESS�fPHONE r LOCATION LEGAL DESCRIPTION SEPTIC TANK: DISTANCE NUMBER OF ` FROM WELL(&-�1--&,Z4s. MANUFACTURER '�-A-i MATERIAL ���-�O COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITYf'%'1C'Y' GALLONS. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELLS 1u//md FOUNDATION �� NEAREST LOT LINE.;/W `�Y OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES /) TRENCH WIDTH' N. N. TOTAL EFFECTIVE ABSORPTION AREA '71%o SQ. FT. LENGTH OF EACH LINE {1 1 DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE Z 02. ABOVE TILE IN. WELL: C% TYPE BUILDING FOUNDATION CESSPOOL — APPROVED — DISTANCES: f CONSTRUCTION NEAREST LOT LINE DISAPPROVED INSTALLED BY: SEWER LINE DEPTH: ''. ' PIPE MATERIAL: �'✓'%M1'a'zlb-i.-� LOT SLOPE: REMARKS: Form EQ -032 i DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE , TANK , SYSTEM_ REMARKS DIAGRAM OF SYSTEM DATE 27_?�0`7-� APPROVED GRE;/ -'2 ANCHORAGE AREA 13OFY�GH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 a., ... SEWAGE DISPOSAL SYSTEM —APPLICATION AND NAME -OF APPLICANT W/ r INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED MAI SEEPAGE PIT DRAIN 9-q .00 9'3u MIT /� PHONE OTHER FINANCED THROUGH - TO BE INSTALLED BY SOIL TEST RESULTS2QQ G M �/ 717%-��`" T�oTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. O� SEPTIC TANK SIZE' v V(5 / TYPE MINIMUM DISTANCES. REQUIREMENTS c FOUNDATION TO SEPTIC TANK rla FOUNDATION TO SEEPAGE PIT , DRAIN FTRD ` $ ' SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK • . SEEPAGE P • DRAIN�F�Ft9-9 NEAREST LOTLIFE WELL TO SEPTIC TANK � SEEPAGE PIT .� DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK , SEEPAGE PIT DRAIN FIELD // SEPTIC TANKJ�, SEEPAGE PIT ">`�'". DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. r( GRAVEL BACKFILL/ CONFORM TO BOROUG RE ULATIONS REGARDING]/r INSYALLATION. G.A.A.B. OR LICENSED DESIGNER I CERTIFY THAT I M FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE...._.. DESCRIB SYSTEM IS IN ACCORDANCE WITH SAID CODE. APPLICANT'S SIGNATURE (2� O/R NO. E'-016 LSA SIZE _`-1i/ ,q TYPE. F � s r Performed for (! Legal Descrip _ /.!n: This form reports: GREATER ANCHORAGE ARLA D'OROUG„ Department of Environmental Quality 3330 "C" Street Anchorage, Alaska 99V)3 SOILS I.OG - PEROI.ATION PEST Depth Feet 1 Date -._- 2- 3 4 _ �1Gz2r�'Gz s 6- 7- 8 - 9- 10 - 11 - 12 - 13 - h v Was ground water encountered? «'c� S7Ope If yes, at what depth? Performed Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate minute. Proposed installation: Seepage Pit Drain Field Depth of Inlet Depth to bottom of pit or trend COMMENTS: Performed f3y:� EQ -040 (6/74) t 7897\ • '-e Municipality of Anchora o 3 2016 On -Site Water and Wastewater Program�C.AUG (907)343-7904 , Certificate of On -Site Systems Approval Parcel I.D. 015-322-54 Expiration Date: 1. GENERAL INFORMATION Complete legal description Valli Vue Estates #2. Block 2 Lot 4. Location (site address) 10640 Lone Tree Drive Current Property owner(s) Mailing address Real Estate Agent Thomas & Kelly Jantunen 10640 Lone Tree Drive. Ancho 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone , AK. 99516. Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual F Individual Water Storage ❑ Holding Tank ❑ Community Class A Well it Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Received by: Date: �l COSA to be release the, unless otherwise requested by the engineer. COSA Fee $ FJ a!o Waiver Fee $ Date of Payment 8�5�l� Date of Payment Receipt Number 0 Receipt Number COSA# Waiver# 5. STATEMENT OF IN PECTION QY ENGINEER,, As certified by my ss�.°g 'axed here and as of this vakdatiop 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 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 Slate 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 descdbe 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 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 warrangc 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) 272-8218 Address P.O. Box1017, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 7/26/2016 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By:l=� Original Certificate Date: 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 COSAblue Sheet £ - 1, c If more than 1 septic system is on the lot: COSA Checklist # + of 1 Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Valli'Vue Estates #2. Block 2 Lo# Parcel ID: 4. 015-32254 A. WELL DATA Well type A 1f A, B, or C provide PWSID # 210605 Well Log (Y/N) Date completed Sanitary.seal (YIN).— Wires properly protected (YIN) Total depth ft. Cased to5���AT s' g above ground) in. FROM WELL LOG INSPECTION Date of test Static water level ft. ft. Well production g.p.m. 9— p.m-WATER SAMP ESULTS: Colifor colonies/100 mL Nitrate mg/L nic ug/L Date of sample: Collected by: B.. SEPTICIHOLDINGTANK DATA Tank Type/Material Septic/Steel Date installed 9/30/1975 a Tank size 1000 gal. Number of Compartments 1� Cleanouts (YIN) Foundation cleanout (YIN) Y Depression over tank � (YIN))N High water alarm (Y/N) N Date of pumping �� "%� PumperA± 'r lam . �ryL� S C. ABSORPTION FIELD DATA Date installed 9/39/1975 Soil satin 200 SF/bdrm Deep Trench g (g.p.d./fe or fe/bdrm) System type Length 50 ft. " Width 3 ft. Gravel below pipe 7 ft. Total depth 12,9 ft. Eft. absorption area 700 fe Monitoring tube Y Depression over field N Date of adequacy test"7/261201.6 Results (Pass/Fail) Pass For 3 bedrooms ^ _ A' n n Elapsed Time: 65 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date ■ 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 61STANCES WELL ON LOT TO Septic tank/lift station on lot On nt loace is Absorption field on lot On adjacent lots Public sewer main Public sewer manhofelcleanout Sewer /septic service ' Holding tank Animal con>Wfilent areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 1`00+ Wells on adjacent lots 200+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ - Water Service line 1.0+ Surface water 100+ Driveway, parking/vehicle stoFage 0 Curtain drain 50* Wells on adjacent lots 200+ F. COMMENTS SuNeY on file. . 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 $feyen Pannone Date 7/26/2016 ,COSA canary sheet_2E-15.doc ■ 1 �-- Municipality of Anchorage • Development Services Department Building Safety Division q 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. 015-322-54 1. GENERAL INFORMATION Complete legal description Lot 4, Block 2, Valli Vue Estates No. 2 Location (site address) COSA # 0_DC W't'1 % r Expiration Date: f � ` 1e7— — /—Z 10640 Lone Tree Drive Anchorage, AK 99507 Current Property owner(s) Chadwick and Sandra Gailey Mailing address Lending agency Mailing address Real Estate Agent 10640 Lone Tree Drive Anchorage, AK 99507 Mailing Address Uriless,otherin/iequested, COSA will be held by DSD for pickup. ,r AII-IMRR-faF�2F-1`tiR-(1f1MC Three (3) 3.; TYPEOF WATERSUPPLY: Individual Well Individual Water=Storage Community Class A Well Public Water System Day phone Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ✓❑ ❑ Individual Holding Tank ❑ ✓❑ Community On-site ❑ ❑ Public Sewer. ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DS, D S/IC3NATURE Approved for 3 bedrooms. Disapproved. Phone 522-7773 Date 12/9/2011 4W �V� Ali AW A V0 �••0• • ' �y'�J N MIS L ANXAM Conditional approval for bedrooms, with the following stipulations: `� • �Xtte7�iCYYHiCK FRIJIURAM Jam✓ '' .... • • O ``.� Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Certificate Date: (Rev. 11105) Municipality of Anchorage • Development Services Department Building Safety Division a 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: Lot 4, Block 2, Valli Vue Estates No. 2 Parcel ID: 015-322-54 A. WELL DATA Well type Class A Date completed Total depth ft. Date of test If A, B, or C provide PWSID # 210605 Sanitary seal (Y/N) Cased to ft. FROM WELL LOG Static water level Well production WATER SAMPLE RESULTS: ft. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION Coliform colonies/100 mL Nitrate mg/L Arsenic: mg/I Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments one Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 4/15/2011 Pumper A Plus Home Services C. ABSORPTION FIELD DATA ft. Other bacteria Collected by: colonies/100 mL Cleanouts(Y/N) Y High water alarm (Y/N) N Date installed 9/30/1975 Soil rating (g.p.d./ft2 or ft2/bdrm) 200 SF/BDRM System type Deep Trench Length 50 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth 11 ft. Eff. absorption area 700 ft2 Monitoring tube Y Depression over field N Date of adequacy test 12/9/2011 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 458 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Size in gallons "Pump off' level at in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 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? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank 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 N/A Water service line >10' Surface water >100' Wells on adjacent lots >200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >200' F. COMMENTS: OF N G. ENGINEER'S CERTIFICATION .i C7 • • °�'" MI •� 1 certify that / have determined through field inspections and i•*• 49 , ••• ••• review of Municipal records that the above systems are in �.•�eggs 0 ............... conformance with MOA COSA guidelines in effect on this date. �, •fi.AN100=4 A, Engineer's Printed Name Michael E. Anderson, P.E. •�cJ',� •s.� ; tN AW # g , e�,p�,s�t -fit -�r �'�' •► Date 12/9/2011 ,i D pROfESS1Q�p COSA Fee $ ya D _ Waiver Fee $ Date of Payment oti I I I (, Date of Payment Receipt Number (`��0 Gil Receipt Number (Rev. 11/05) in. Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA # o�oas3 Expiration Date: — :t ;. — ( 7 1. GENERAL INFORMATION Complete legal description Lot 4 Bk 2 Valli Vue Est #2 Location (site address) 10640 Lone Tree Drive Anchorage AK 99516 Current Property owner(s) Tinnie 8 David Polke Day phone 346.4452 Mailing address 10640 Lone Tree Drive Anchorage AK 99516 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: 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 Onsite 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 Onsite 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. Box 102954. Anchorage. AK 99510 Engineer's Printed Name Steven R. Pannone. P.E. Date 61161c & Engineers Comments: in conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines .@ Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. Theo operational life of all wells and •••��� pera septic systems depend on the local soil condition, ground water �.�• QF aaaaa levels that may fluctuate during the year, and the water usage of the family being served by the system. �•�p��� -�^�� aa� 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 arc no hidden defects or encroachments. PES can therefore not provide any warranty for future a"_ ..._00 performance nor give any estimate of how long the system will continue to meet the operational , $ requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed �� n Steven nno c�` above. Any reliance upon or use of this report by any other person or party is not authorized nor will it �i c No. Ct e t 9 confer any legal right whatsoever.�3y1 5. DSD SIGNATURE 44,4.�;irf'.•' Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: •.... ,.,..,.,w• n ^1DCI1U Piuvibury Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By ��{,L&� Original Certificate Date: IR" twos, Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragew 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: _lot 4 Bk 2 Valli Vus Estates 92 Parcel ID: 0 /,S 3 .2-Z r z�- A. WELL DATA Well type 9 Date completed _ Total depth ft Date of test If A. B, or C provide PWSID # 210605 Well Log (YIN) Sanitary seal (YIN) _ Cased to ft FROM WELL LOG Static water level \ ft Well production \ 9.p -m. WATER SAMPLE RESULTS: Coliform oolonies/100 ml Nitrate Arsenic: Date of B. SEPTIC/HOLDING TAN DATA Wires properly protected (YIN) Casing height (above ground) in. AT iucocr rine ft mg/L Other bacteria oolonies/100 mL Collected by: Tank TypelMaterial Greer Steel Data installed 9=975 Tank size 1000 gal. Number of Compartments 1 Cleanouts (YIN) Y Foundation cleanout (YM) Y Depression over tank (YIN) fy High water alarm (YIN) WA Date of pumping 5131f2006 Pumper A+ Home Services C. ABSORPTION FIELD DATA Data installed 9Gf4Li975 Soil rating (g.p.d./ft2 or fe/bdrm) 200 System type Deep Trench Length _50 ft. Width 3 ft Gravel below pipe 7 ft. Total depth 11 ft. Eff. absorption area Z&fe Monitoring tube Y Depression over field." p Date of adequacy test _61112006 �tesulb (Pass/Fail) For I bedrooms O le Fluid depth in absorption field before test�� 10 � e S�i 'A ' �nL(1'p Water added gal. Now dep 7— Elapsed Time: Q min. Final fluicfde Up Absorption rate > 4W+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date STATION [s 'Pump on' level at Datum Size in gallons 'Pump ofr level at in. s tested E SEPARATION DISTANCES Manhole/Access High water awn level at b circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT Septic tankA)ft station on lot On a cent lots Absorption field on lot On adjacent Public sewer m ' Public sewer manhol nout Sewer / c service line Holding tank I containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation S Property line JQ+ Absorption field V Water main 50+ Water service line 25+ Surface water 100► Wells on adjacent lots 200+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main _ 40+ Water Service line 25+ Surface water 100► Driveway, parking/vehide storage 25+ Curtain drain _ 1S Foundatlon Draln Wells on adjacent lots _200+ F. COMMENTS ,4v,4 Qfpwvec.l bo** G. I car* that 1 have determined through field inspecMms and I -/� -. 9' review of Municipal records that the above systems are 91 conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone. P.E 00•-4t ie 1 r, •'.:? Date COSA Fee $ Date of Payment Receipt Number /i (Rev. 11 M5) Waiver Fee $ _ Date of Payment Receipt Number in. L ��. ,c5zC S a•. Sen/E: {N•40' EAVACUTS Of RCCCRD, OTHER THAN ItIOiE SIKWN ON THE RECORUED 1y11 ARE 141771 SIIrYWN HERCON. N89� 59'95'iV /93.7/' 0." 4414SAr.4 04 'r, Z4 Y Z4 I 'J 3 0 Recd{!{,•ed 7•/0 •Bc �/f� AS-OU/L T Th;•r valr 117LLEi RL).. I ha:rrhr rvrlil,, that 1 have xanvcved the following described rtapvrlF:.. - cor- 4,. azecK z,..- ---..._. VPC_ E S TAT/z S UN/T No. Z �;tt.'• ; "' `••,�• i r Anrhor:irr firrr+rdlnl: Prerinel. Alaska, and that the e. «r,' •v `, ••''a impr•.ct•rortds nttufdrd Ihelt+m are within the prnperlp rr-1 • _+ Ines :rml du wa ove rlap nr enrnc+th on Ihr pro n, �• r+ • I••' ... 'r •� ,+ lvillf; adjarrnl Ihorelu. Mat no improvements an prep_ fl- - "' :r rrlF lyialt :alpernt Ihcrel•+ rncruar�r nn the premises in iC/,Jj�fyl (�%(�/a�JC.4M=i`+•r.. s( Qursli.m :md that Iliac are no, rw,d••aays. Iransmiccion �• �v `•+"' • • i lines or ulher vi.:ihic caxrtnr•uL: nn said prnlr•rly rxtr11 � .i 1a :+ Irod �•lnl �:.y 1 n< indirabvl Ir•nvn c; •�t `"�.'., �'s�' •'� UMM it Anrhnrare, Alaska � ,j'r-,.;Ic•.u�•:.�;:,• /Sf •rt..,• r.r N _ .. 10:•75. FTCF,I7 WAI.ATKA & ASS66ATF4 Eev:iorrr.l mal Curcr�•nr.: 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. # L t) �:�.� S� HAA # 1�tS CSS �I 1. GENERAL INFORMATION Complete legal description I -e JL1 11 B K I L A LL I Vy aE � Location (site address or directions) 10 % 4 0 l-�' o e- Ire- e - Property owner Mailing address C Day phone 2.Lg1 - �EIf `/ Lending agency Day phone �b 3 -773 Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 32; V 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(R v. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 'tip L�w�� 4 Phone Address ,2c > t__l Engineer's signature 6. DHHS SIGNATURE X Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments 0 411Th Date I I I .�; , h/ -.-;- bedrooms, } bedrooms, with the following stipulations: Date / - 3 ^ �� The Municipality of An-horage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7M25 (RaV 1/91) Back MOA k21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: L,2+ t [�1/ Un-1JiVL) -e-R2 Parcel I.D.: A. WELL DATA t 1` — Well type If A, B, or C, attach ADEC letter. ADEC water system number '9' 10& U' u Log present (Y/N) Date completed Total depth Sanitary seal (Y/N) Cased to FROM WELL LOG Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: Casing height (above ground) Wires properly protected (Y/N) Collected by: AT INSPECTION Other bacteria g.p.m. B. SEPTIC/HOLDING TANK DATA F - e -o ll -1 Date installed &4t5- Tank size / D40 Number of Compartments �Cleanouts (Y/N)--/ Foundation cleanout (Y/N) - _ Depression (Y/N)j�_ High water alarm (YIN) / } Date of Pumping %4s( 9. Pumper ,YO r 9 Ga04 f !4ti!4f 'l C. ABSORPTION FIELD DATA F e -o {'Lf 11-4 U N I �� O J Date installed g130 % tom Soil rating (g.p.d./ft' or 0bdrm) � System type �IU44 e -t Length ,`j D I Width :3 Gravel thickness below pipe 7 Total depth Effective absorption area 7690 Monitoring Tube present(Y/N)4L Depression over field (YIN) N1 IIZ Date of adequacy test 1-781'76- Results (Pass/Fail) � For 75 bedrooms 1_ I Fluid depth in absorption field before test (in.); { 5 Immediately after "/OUgal. water added (in.): G `�' Fluid depth (ins.) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump mi" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot N Absorption field on lot Public sewer main Sewer /septic service line "Pump off' level at* adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: F a O IA VAu N t IZ CtJ2� Building foundation _—�15 Property line � 10 Absorption field U Water main/scrvice line % / U Surface water/drainage, 42 Wells on adjacent IotS SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation _,, CpZo { Water main/service line > /0 Surface water Irl o V7 Driveway, parking/vehicle storage area Curtain drain � b2 D Wells on adjacent lots N/p Property line 1700A�// F. ENGINEER'S CERTIFI/CATIO,' // 11 / ., 0 h fGLC CL cu d� t Vl ;) .�, c�-�<%•ryt Y' ib .�b-G 11�� f. r u (-co-t� �'E�? twi'Ic7 '1 e ��.•r�-� 2 -Lt 0-` I cei'tifV that bkats�n " - J GC na if run aec with MOA ILIA guidelines in effect on this (late. Signature Engineer's Name Ca �n e vl �� t)�(� t �E� Il n fit. 1 pur kind V: J Date X9 HAA Fee $ oey) < <� Date of Payment Receipt Number CZ/ Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number Jim Cross November 30, 1995 Municipality of Anchorage Department of Health and Human Services On -Site Service Section 820 L Street Anchorage, Alaska 99501 Subject: HAA Lot 2, Block 4 Valli Vue Estate #2 Gentlemen; During a HAA inspection of this property it was observed that the configuration of standpipes did not agree with the inspection report on file with the health department. An HAA for this property was issued in 1992. The applicant of that HAA inform me that there was some discussion about additional stand pipes at that time, but the Heath Departments file does not indicate any such discussion. Can it be possible that the record file is erroneous, and that the depicted system belongs someplace else? The submitted line drawing shows the configuration of the stand piped found. This system was tested by adding 300 gallons each to the trench clean outs and sump. The trench accepted 900 gallons of water without backing up into the tank or water showing in the monitor, which was accessible to 2 feet below the invert of the lateral pipe. The water level in the trench is clearly more than 2 feet below the top of the rock. Since the system has been in continuous use, that fact in itself shows that the system is working. The additional fact that 900 gallons added in a time frame of 2 hours did not cause water to be observed in the monitor, gives additional proof that the system is operating satisfactory. Yours Tobben Sp rkland P.E. oz T. SPURKLAND P.E. m c,; 203 WEST 15TH. AVENUE SUITE 203 � z y O ANCHORAGE, ALASKA 99501 (907)279-3916 rM -< 1 Fax(907)-276-6013 - O m z Jim Cross November 30, 1995 Municipality of Anchorage Department of Health and Human Services On -Site Service Section 820 L Street Anchorage, Alaska 99501 Subject: HAA Lot 2, Block 4 Valli Vue Estate #2 Gentlemen; During a HAA inspection of this property it was observed that the configuration of standpipes did not agree with the inspection report on file with the health department. An HAA for this property was issued in 1992. The applicant of that HAA inform me that there was some discussion about additional stand pipes at that time, but the Heath Departments file does not indicate any such discussion. Can it be possible that the record file is erroneous, and that the depicted system belongs someplace else? The submitted line drawing shows the configuration of the stand piped found. This system was tested by adding 300 gallons each to the trench clean outs and sump. The trench accepted 900 gallons of water without backing up into the tank or water showing in the monitor, which was accessible to 2 feet below the invert of the lateral pipe. The water level in the trench is clearly more than 2 feet below the top of the rock. Since the system has been in continuous use, that fact in itself shows that the system is working. The additional fact that 900 gallons added in a time frame of 2 hours did not cause water to be observed in the monitor, gives additional proof that the system is operating satisfactory. Yours Tobben Sp rkland P.E. NO SCALE CLEAN OUT \ 8 FEET DEEP 8 TRENCH FOUND BY PROBING DEPTH 5,5 FEET RESIDENCE -� \DECK Q MONITOR/SUMP s oao aG�5 LATERAL SEEN 1,5 BEL DW GROUND BOTTOM PLU66FD AT 4 FEET BELOW GROUND c��sn ce-zz<� �rn 4� TOBBEN SPURKLAND P.E. I I LOT 4 BLOCK 2 VALLI VUE ESTATES $4 I I SEPTIC SYSTEM LAYOUT 203 W 15TH. AVENUE DATE: NOV. 30, 1995 ANCH. AK. 99501 J1M WORTHINGTON 1064400 LONON£TRf£ SHEET: 1/1 GRID: 2533 Parcel I.D. # MUNICIPALITYHEALTH & HUMAN • '� 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 O 15- 3 z Z -- 54 HAA# (JA I1031r7 1. GENERAL INFORMATION Complete legal description Location (site address or directions) No 4-0 LaNEr-ttK Property owner 15I<Ilp �R.��nAN Day phone Mailing address co Lo,� ntEs T1r_kje / M,+etao t 91?5f (0 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well ics Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site — Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC . attesting to the legality and status of system. 72-025 tRev. 1/91) Front MOA #21 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 Ktj t �`,`L"7, 6,j (�' o ea`-R�tjU Phone 33 -?—(, SL o Address 451 tA Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments 0 bedrooms. 411TIC Date bedrooms, with the following stipulations: Date _ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 3 V Roy -art - b:nPefel'i%' r'oa Imola. 41 bedrooms, with the following stipulations: Date _ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services • HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: VAI"w UNG jtz 1..4 BZ Parcel I.D. 01r 3 Z2 —S4— A. WELL DATA / c� Well type A If A, B, or C, attach ADEC letter. ADEC water system number Z / o K0 0 J Log present(Y/N) Date completed Total depth Cased to Sanitary seal (Y/N) FROM WELL LOG Driller height Wires properly protected (Y/N) Date of test Static water level Well flow 9— p.m-Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RE TS: Coliform Nitrate Da sample: AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA o q�3U��s Date installed \/`'/,` " Tank size X000 Compartments — Cleanouts (r/ N) Foundation cleanout (Y/N) e g Depression (Y/N) High wateraiarm (Y/N) N �A Alarm tested (Y/N) IJ 1,4 Date of pumping Pumper S R L S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots N A Foundation nI To property line �Absorptionfield 6 /W/atermain/service lin --G Surface water/drainage 0!� —,� J 04-'11, 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION A' Date installed ,v Ma cturer Size in gallons Vent(Y/N) High water alarm level "Pump on" Meets MOA electrical c 6s (Y/N) SEPARATIO (STANCE FROM LIFT STATION TO: Well D. A13SORPTION FIELD DATA Date installed Length 5n Total absorption area On adjacent lots Width �r _ 70b e/Access(Y/N) "Pump off" level at Cycles tested Soil rating Z/O Surface water System type Gravel thickness __ / Total depth Cleanouts present(Y/N) Yc S Depression over field (Y/N) /V© Date of adequacy test Results (pass/fail) L�GI i for _{ bedrooms Peroxide treatment (past 12 months) (Y/N) 0 M C L7 ,6 V a If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot f r On adjacent lots /V//) Property line / To building foundation _ � �'-' To existing or abandoned system on lot /' "I On adjacent lots Cutbank ":�S Water main/service line Surface watere �rt Cji( ;j 1 r7 Driveway, parking/vehicle storage area — Curtain drain Z �� i,-"� e 1,h / E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect e p a I ` (�•° 4( Signature pf3�. yFl ;I +4 vagina amu Engineer's Name 0 64 d Date' [ l� �r • Robert E. Kra Ili p�Ro'' -7 a� HAA Fee $ ( `U ' Waiver Fee: $ Date of Payment '9-2-0-71 Date of Payment Receipt Number 2Z'7' 7/ -W& Receipt Number 72-026 (Bev. 3/91) Back MOA 21 date of this inspection. av • _ MUNICIPALITY OF ANCHORAGE � DEPARTMENT OF HEALTH & HUMAN SERVICES y Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# 1. GENERAL INFORMATION HAA # 090 1 011LOD Complete legal descriptionyrt I I I 1/� {- E spa L� s t y 6/dl;,L z Location (site address or directions) 106,10 GOAIe Iree diI,V2 Property owner _5k/l' 7" r-ee A"'C7 `c �I Day phone Mailing address �D(oyo 60*e �rec e% gtiCk Lending agency Mailing address Agent 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 ,2 5 Day phone Day phone 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 yes Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from -State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 �hl-el �HAi H{ertLtal Phone Address Engineer's signature 6. DHHS SIGNATURE: M Approved for Disapproved. bedrooms. Date 337- Iio S/on ill. yva l.q�Q Robert E. Kniet No. 4149-E Conditional approval for 22�_ bedrooms, with the following sti ' pulations: i _e / ui.. 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 order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Ray.1/91) Back MOA021 /c-�Lf}i.tyw. e,i Co Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST / '0� Legal Description:y41)i VKG " lv�14_ Z Parcel I.D. d� $Z — 5V A. WELL DATA - Well type Log present (Y Total depth — Sanitary seal(Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ADEC water system number SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service WATER AMPL Col' rm ate of sample: RESULTS: Date completed FROM WELL LOG B. SEPTIC/HOLDING TANK DATA Date installed Driller Casing Wires pr7AT otected (Y/N)W.y ° a INSPECTION g.p.m. TO: On adjacent I On adjacent to/j Public sewer manhole/c/je Petroleum tank ! Nitrate Tank size 1 000 Cleanouts (Y/N) Y -C 5 Foundation cleanout (Y/N) [, W o o: UD W ^� g W 'u �G bacteria I by: ev i Z q Compartments High water alarm (Y/N) Nf� Alarm testi Date of pumping R I f " Pumper —Depression n((Y/N) /Vd (Y/N) A1/' / \� SraACS SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)`on lot On adjacent lots WA_ For To property line e sir Absorpttionfielldd a Watermai Surface water/drainage /VS r l Z e liney / 72-026 (Rev. 7191) Front - . CONTINUED ON BACK PAGE C. LIFT STATION �r Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical "Pump on" level SEPARATION DI NCE FROM LIFT STATION TO: Well on On adjacent lots D. ABSORPTION FIELD DATA Date installed Soil rating t t Length $ Width Gravel Total absorption area —✓' Depression over field (Y/N) A d Results (pass/fail) Peroxide treatment (past 12 inonths) (Y/N) s 4 < u�rer /Access(Y/N) — "Pump off" Cycles tested Surface water System type 4 ne In C t / Total depth 7 fnouts present (Y/N) Date of adequacy test for SEPARATION DISTANCE FROM ABSORPTION FIEL TO: Well on lot N�T (� O)n djacent lots A' To building foundation — 1 f r To existing 1 1 On adjacent lots 130 Ir utbank 35 Surface water 36/ dtp. 6dll" Drivew y, parki' OCurtain drain � � — i�YR Int 1' �>lR- E. ENGINEER'S CERTIFICATION i I certify that 1 have checked, verified, or conformed to all MOA lac Signature ` Engineer's Name �O loC t i Yl ie r �e Date HAA Fee $ 1 i C').U) Date of Payment 1�- lao c� ) Receipt Number raQLY�–] I ��111D 72-026 (Rev. 3/01( Back MOA 21 If yes, give date /Property line_ nned system on lot main/service line. storage area -- HAA guidelines in Waiver Fee: $ Date of Payment Receipt Number bedrooms t if&� on the date of this inspection. r A .e o • iso e° osan . Robede E. Kniefol t 4ni �1 ® c a4149 F ae99 00 �F4pROFE$$\��\P � tlDha�� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date /3e, 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L4 S z Jo- )Iyue 1 S 14- Location 4 Location (address or directions) (b) Applicant Name 5]1,oFt"exmIft Telephone: Home �4:62303 Business 744 364 Applicant Address ( D G 4- o o to e Ti-? e 9 (c) Applicant is (check one): Lending Institution ❑ ; Owner/buildero ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution WN .rx l-R:sk PK C'3C- Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family 0 Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well$ NOCommunityP( Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite,K Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 %i F. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ,A,q r^� l L � o T - Pte- — tna! . Telephone 34 4 4:7711 Address 7/.2-7 //o s lfu y Date b /_30/ -WATER ALL NOTE: This Health thority proval V's' merely cer fies at the ubject ater we produ d 150 loos pe droom er day nd tha certifie labor ory tes showed no presen a of /in m bac ria in a mple o that wat No wa ntee or rtificas pressed o fmpli concerni g the 1 g term a quacy orof the water pply. ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval inspection merely certifies that the subject on-site sewage disposal - system accepted at least 150 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Department of Health and Human Services. No warantee or certification is expressed or implied concerning the long term adequacy of theon-site sewage disposal system. Construction data reported on buried system components is from MOA files and was not verified during this inspection. 6. DHEP APPROVAL Approved for bedrooms byL i Date Approved Disapproved Conditions Terms of Conditional Approval deep CAUTION N^cIL H T CORMM I CE - 4369 •• f ,,' iV' �p�•cfL�iessle�`: ,�, The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 79-828 1111841 ' MUNICIPALITY OF ANCHOR DEPT. OF EAGE EWRONMENTALPRO'ECTIp ` / ) MUNICIPALITY OF ANCHORAGE (MOA). N HEALTH AUTHORITY APPROVAL (HAA)uN '01986 O 1�QC CHECKLIST - FEBRUARY 1984 9U 264-4720 Leggal Description: Free nn n1Q U I VE D L4 F z I/al)i Vu9-1 511, 11zA,93W A. WELL DATA Well Classification caws . I6 B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground — Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot moo® 'f" On Adjoining Lots To Nearest Edge of Absorption Field on Lot -7OQ + ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed -9/3 0 7. Size 10100 — No. of Compartments If Standpipes (Y/N) y Air -)tight Caps (Y/N) Foundation Cleanout (Y/N) -� Depression over Tank (Y/N) /" Date Last Pumped & 12 -f- Pumping/Maintenance Contract on File (Y/N) n /f"1 ; for Holding Tank High -Water Alarm (Y/N) Al 1A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well BOG * To Property Line P To Water Main/Service Line Course Comments Page 1 of 2 72-026(l v84) i To Building Foundation To Disposal Field S To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 12 00 Type of System Design TYe✓i Date Installed -7 S Length of Field Width of Field �C Depth of Field 9 z Gravel Bed Thickness % Square Feet of Absorption Area 700 Standpipes Present(Y/N) Depression over Field (Y/N) —. N Date of Last Adequacy Test Results of Last Adequacy Test M_-- .3R +d Separation Distance from Absorption Field: To Water -Supply Well O f To Property Line y -> t - To Building Foundation 1 S r To Existing or Abandoned System on Lot NO 2N, rz I�ac a -r d ; On Adjoining Lots .l e) + To Water Main/Service Line 10 t- To Cutbank (if present) ✓�� To Stream/Pond/Lake/or Major Drainage Course AJ To Driveway, Parking Area, or Vehicle Storage Area (S reL I ( it g-eg, 0V e✓ -t re-ot c5sl6le Comments D. LIFT STATION n)M Date Installed Size in Gallons — "Pump On" Level at High Water Alarm Level at . Tested for Electrical Codes (Y/N) _— Comments Dimensions Manhole/Access (Y/N) "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection Signed Mali +L_171e2 Date 6130,166 Company u7 I hAY MOA No. � �,, Receipt No. _Zo -r 4 q Date of Payment _l _3_tl� Amount: $ S o>o Page 2 of 2 72-026 (11/84) BILL SHEFFIELD. GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: rson Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 vv� a _v"' DATE: June 10, 1986 PWS I.O.k 210605 To Whom it May Concern: According to records on file in this office the VALLEY VUE SUBDIVISION Water Regulations Water System is in compliance with the State Drinking Sincerely, Steven W. En'a, PE Distric-k,�ngineer 11 Id ram(lex 9 5. LEGAL 'DESCRIPTION , T " MUNICIPALITY OF ANCH RA 0 r -7Q 6 D ��N STREET LLOCF/y�(}I (/•/1 DEPARTMENT OF HEALTH & ENVIRONMEWfiAL PROTECT �^•'.N-- 825 L Street - Anchorage, Alaska 99501 NUMBER OF BEDROOMS SINGLE FAMILY ENVIRONMENTAL ENGINEERING DIVISION„/ Telephone 264-4720 j, y,' j',' [n " ❑ Two ❑ Five ❑ MULTIPLE FAMILY REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES 7. WATER SUPPLY DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. ❑ INDIVIDUAL* 1. PROPS TYOWNER�- -Al COMMUNITY PHONE since June 1975. For wells drilled prior to that date, give well L depth (attach log if. available.) B. SEWAGE DISPOSAL SYSTEM MAILING ADDRESS INDIVIDUAL/ON-SITE** ..If individual/on-site, give installation date i / V If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY PROPERTY R S ENT (If dif rent fro above) 3Rd�•t /„� by this Department. PHONE f C�- 2. BUYER PHONE n MAILINGADDR S 3. LENDING INST TUTION / PHONE On S MAILING ADDRESS 4. REALTOR/AGENT PHONE bLICIT— MAILING ADDRESS 4,107 5. LEGAL 'DESCRIPTION , T ` LP� 0 r -7Q 6 D ��N STREET LLOCF/y�(}I (/•/1 ! 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June 1975. For wells drilled prior to that date, give well 0 PUBLIC UTILITY depth (attach log if. available.) B. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** ..If individual/on-site, give installation date 1- 1" If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 3 /.9 �. 500 74 THIS SIDE FOR OFFICIAL USE ONL - INSPECTION APPOINTMENTS DATE RECEIVED TIME - TIME TIME DATE DATE DATE INSPECTOR - INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE Z3,1�'THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE: ❑PUBLIC UTILITY Connection Verified __ PERMIT NUMBER DATE INSTALLED �1 r INSTALLER ❑Septic Tank or ❑ Holding Tank Size: 1666 If Tank is homemade give dimensions: SOILS RATING - TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL_1 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS - PROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) - - LEGAL DESCRIPTION 72-010 (Rev. 3/78) GREATER ANCHORAGE AREA.BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Februray 2, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1. Approval requested by: First National Bank of Anchorage Mailing Address: Post Office Box 720, Anchorage Phone: 279-4481 2. Property Owner: John Armstrong Phone: 344-1646 Mailing Address: Post OfficeBox 4-2057 3. Legal_ Description: Lot 4' Block 2 Valli Vue Estates #2 4. Location: 10640 Lone Tree Drive, see map 5. Type of facility to be inspected Single Family No. of bedrooms 3 6 Well Data: Community System A. Type B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: On—site system. A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 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) `s Page 1 of two pages Page 2 of two;pages Re est for Approval `of Individual ier & Water Facilities {w 4~ Legal Description Lot 4 Block 2 Valli Vue Estates 4 2 Comments Approved Disapproved Date—C/—% Appr Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 1 -ur'Llly LII<1L LIIC IIIIVI'IIIQLIVII uV116QI11Cu 111 L111a 1C4Uazb Ivl ulvlvvuj accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) $pi GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality g,oAly,,.• 3330 C St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV xx 2. Property Owner: John Armstrong Mailing Address: P. 0. Box 4-2057 Day Phone 344 1646 3. Name of Buyer: Carl J. Freeman, Jr. and wife, Linda a. Mailing Address: SRA Box 30C Day Phone 277-1401 work nc orage, Alaska zW) 4. Name of Lending Institution: The First National Bank of Anchorage Mailing Address: P. o. Box 720, Anchorage Phone 279-4481 Alaska 5. Name of Realtor or Agent: Bowden Realty (Larry Ludke) Mailing Address: 301 E. Fireweed Phone 277 1482 6. Legal Description: Lot 4, Block 2, Valli Vue Estates # 2 Location: 10640 Lone Tree Drive, Anchorage 7. Type of Facility to be inspected: Residence No. Bdrms. 8. Water Supply Type of Supply: Public Utility x Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type.of System: Public Utility Individual (on-site) If Individual, date of installation EQ -037 (1/74) 3 x