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VALLI VUE ESTATES #2 BLK 5 LT 4
Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water 8 Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:/ANww.muni.org/onsite a (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP161046 PID Number: 015-123-53 ❑ New ®Upgrade Name: SAM HALEY ABSORPTION FIELD EAST TRENCH WEST TRENCH Address: ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 10035 MAIN TREE *ANCHORAGE, AK ❑Other Phone: No. of Bedrooms: soil Rating: Total Depth from ongmal grade: (707)688-2899 4 0.8 12 GPD/Sq. Ft. 10.5 FL LEGAL DESCRIPTION Depth to Pipe invert from original gmde: Gravel depth beneath pipe: SEE DWG. Ft. s:�i Ft. Subdivision: Block: Lot: Fill added above original grade: Gravel length: 25 VALLI VUE ESTATES #2 5 4 SEE DWG. Ft. 25 F owns lP: — anger — ec Ion: Grovel avian: t. Bede Number of line Distance between linea: 2.5 SEPARATION DISTANCES 2.5 Ft�ftmmhee,: — Ft. Total absorption area: Diet. between benches: Septic Absorption Lift Holding Public/Private Tank Field Station Tank Sewer Lines 800+ SaFt16.2+ Ft Well — — — — 25'+ TANK ❑ Septic ® S.T.E.P. ❑Holdin ❑Other Monufacturon Capacity: Surface Water 100'+ 100'+ 100'+ — ANCHORAGE TANK 1500 Gal. Lot Line 5'+ **1'+ 5'+ _ N/A Mate" Number of wmpmtmente: STEEL 2 Foundation 5'+ 10'+ 5'+ — LIFT STATION *SECOND COMPARTMENT OF STEP TANK Curtain Drain NONE KNOWN Manufacturer: ca".4r.. ANCHORAGE TANK *500 G.I. Remarks: PER CONTRACTOR OLD TANK DECOMMISSIONED "Pump on' level at: 'Pump off' level at: High water alarm at: 44 40 46 PER UPC. BOTTOM OF EAST TRENCH Pump Make & Model: Electrical Inspections Performed! by: INSPECTED BY MOA EMPLOYEE TIM ECKLUND PF200511 MOA ON 4/13/2016. **OSV161018 PIPE MATERIAL House to tank D3034 Tank to D2665 Installer drainfield ARM SERVICES LLC. Drainfield D3034 CO/MT D3034 Inspector GEG, Ltd. BENCHMARK (Assumed elevation) Inspection 98.89 F t. Dates: 1st 4/13/2016 2nd 4/13/2016 ....n and Description: 3rd 4/14/2016 4th 4/15/2016 TOP OF MANHOLE Community Development Department Approval ENGINEEWSWAL Conditional approval: Date: <gS,��ph ......4.. ..... ............ :. G... ess. o9i CE -79153 I Approved: v t64 Date: I Qd �t 4e �d prof Inspection Report —1-1 12.doc ��Oe PERMIT N,VMBER: PARCEL ID NUMBER: .GSP161046 RECORD DRAWING 015-123-53 rr_»w"irf� uuI — JI.7 I!!.`J CO2 - 47.9 42.9 CO3 - 43.6 16.9 C04 - 58.6 37.7 MT1 - 31.1 19.9 MT2 -61 41.5 MT3 - 44.2 19.3 MT4 Fn _ Al i tan e,2 VALLI VUE ESTATES #2; / / / VALLI VUE ESTATES #2; BLOCK 5, LOT 3 BLOCK S. LOT 5 X\ WATER LINE LOCAT N P,ER NQRT ERN X UTILITIES LOCATE EXISTING 4 BEDROOM HOUSE , 1.25" PVC CONVERTED TO 4" D3034 10 FEET BEFORE THE DNERTER VALVE / NEW GRAINFIELD NEW 1500 GALLON STEP TANK \\ C - W /\O Y / f MT CO 3 j APPROXIMATE LOCATION / MT T.H.#�1 OF ABANDONED SEEPAGE) CO T4 / CR0 C / °ke �w TREe 0R W �W W f APPROXIMATE LOCATION �OF WATER MAIN /W \ WW 'W _W— --W / N GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 1741 E. i000R 940. 308E tot • uCM96cE. M 98507 • PM M71 667-6119 • FM !9071 S5 2" PREPARED FOR: PHONE NBER: PAGE NUMBER: SAM HALEY (7 07 6UM88-2899 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: VALLI VUE ESTATES #2; BLOCK 5, LOT 4 D.J.G. TYPE OF WORK: DATE: RECORD DRAWING 4/22/2016 2 4 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161046 Tax Code Number: 01512353000 Work Type: Septic Upgrade Permit Effective Dates: March 22, 2016 to March 22, 2017 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: VALLI VUE ESTATES #2 Site Legal Address: VALLI VUE ESTATES #2 BLK 5 LT 4 G:2538 Owner/Address: HALEY SAMUEL R JR & SHERIDAN K 154 SAYBROOK AVE VACAVILLE CA 956874129 Site Mailing Address: 10035 MAIN TREE DR, Anchorage Lot Size in Sq Ft: Total Bedrooms: lent �0 5(r Mrrmen r 20037 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Receiv( Issued Municipality of Anchorage Development Services Division On -Site Water and Wastewater Program n,enr Department **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV161018 COSA#: Permit#:OSP161046 PID#: 015-123-53 Legal Description: Valli Vue Estates #2. Block 5. Lot 4 Engineer: Garness Engineering Group Applicant: Sam Halev Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: /X Waiver is not Granted: Date: 3 / Approved 6 Name of Reviewer MUNICIPALITY OF ANCHORA Community Development Department Development Services On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I. D. 015-123-53 110] "'J** MAR 14-2nt Phone: 343-7904 Fax: 90 7997_ Property owner(s) SAM HALEY _ Day phone 707-688-2899 Mailing address 10035 MAIN TREE *ANCHORAGE, AK Site address 10035 MAIN TREE *ANCHORAGE, AK Legal description (Sub'd, Block & Lot) VALLI VUE ESTATES #2; BLOCK 5, LOT 4 Legal description (Township, Section & Range) Lot APPLICATION IS FOR: ( Rall that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage Sq.Ft. Number of Bedrooms 4 THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST POR: TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) DRAINFIELD TO LOT LINE Distance: 1 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 60 Waiver Fees: 1215 Date of Payment: .3�1nnl0111, Date of Payment: 311&// Receipt Number: Receipt Number: ®� Permit No. 65PIto16 We Waiver No. jj5y/je 161 (Rev. 01/11) APPLICATION IS AN: Initial ❑ ® ® Upgrade Renewal ❑ ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST POR: TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) DRAINFIELD TO LOT LINE Distance: 1 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 60 Waiver Fees: 1215 Date of Payment: .3�1nnl0111, Date of Payment: 311&// Receipt Number: Receipt Number: ®� Permit No. 65PIto16 We Waiver No. jj5y/je 161 (Rev. 01/11) GARNESS ENGINEERING GROUP, Ltd 's" 7`is ° t �' w,s _ CIVIL & ENVIRONMENTAL ENGINEERS,--- March 15, 2016 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System Upgrade for Valli Vue Estates #2; Block 5, Lot 4 To whom it may concern: The existing 4 bedroom house is served by a public water and private septic system. The drainfield is in a state of failure and needs to be upgraded. We are proposing that a new 1500 gallon S.T.E.P. tank and deep trench type drainfield be installed. Two test holes were excavated on the property and the drainfield is designed within the 30 foot radius of test hole #2. Comments regarding the design are summarized as follows: 1. SOILS: See the attached 2016 logs which show the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns. 4. TOPOGRAPHY: As can be seen on the attached topography drawing, the average topography around the proposed drainfield is 5-10%. 5. WAIVER: We are requesting that your department issue a lot line waiver for the proposed drainfield from the required separation of 10 feet to 1 foot. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have anA questions, please contact us at 337-6179. Thank you for your assistance. E., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com VALLI VUE VALU VUEf ESTATES #2; EST TES #2; / LOT 23, BLOCK 3; / BLOCK 3, LOT 20 BLOCK 3, LOT 21� VALLI-VUE EST #2 / 1 , � I� l VALLI VUEESTATES BLOCK 3,#LOT / 19 I VALLI VUE ESTATES VALL ESTA #2; BLOCK 3, LOT 22 BLOC / LOT _---- VALLI VUE ESTATES #2; \ BLOCK 3, LOT 18 / VALLI VUE '. ..... ': L \ \ / ESTATES #2; BLOCK 3, LOT 17 / �EPTIC \ y AREq VALLI VUE ESTATES #2; / BLOCK 3, LOT / /-15 EPTIC ARS SYSTEM VALLI VUE ESTATES #2; / BLOCK 3, LOT 16 / SERVED BY A COMMUNITY WATER EM AND PRIVATE SEPTIC SYSTEM. / / I VUE TES #2; K 5, 3 / VALLI VUE / ESTATES #2; BLOCK 5, LOT 6 VALLI VUE E STAl E ,2 / / BOCK 5�2 / LOT 5 VALLI VUE EXISTING 4 ESTATES #2; BEDROOM HOME /7\ BLOCK 1, LOT 47 iO 5 / / EXISTING SEPTI VALLI VUE ESTATES #2; / / VALLI VUE BLOCK 1, LOT 46 / / ESTATES #2• �� VALLI VUE ESTATES VALLI VUE /� #2; BLOCK 1, LOT 44 ESTATES #2; i \ = LOLOC 51, TRE /7 sFpT/� q ��411 / /VALLI VUE ESTATES #2; BLOCK 3, LOT 10 / VALLI VUE ESTATES #2; BLOCK 1, LOT 43 VALLI VUE ESTATES #2; BLOCK 1, LOT 42 1 1 / /VAW VUE V / BLOCK ESTATESI LOT 1 / 51 BLOCK 1, / LOT 49 VALLI VUE ESTATES #2; BLOCK 1, LOT 50 GARNESS ENGINEERING GROUP, Ltd ' CIVIL & ENVIRONMENTAL ENGINEERS- 3901 E. MM Rd SURE 101 INCIpRgCE. OH 99EW - PHONE 190A 3n-RI1 PREPARED FOR: PHONE NUMBER: IPAGE NUMBER: SAM HALEY (707)688-2899 1 1 OF 2 LEGAL DESCRIPTION: DRAWN BY: VALLI VUE ESTATES #2; BLOCK 5, LOT 4 D.J.G. L TYPE OF WORK: DATE: �- SITE PLAN FOR SEPTIC UPGRADE z /1 s /') E2 NUMBER OF BEDROOMS:4 GALLONS PER DAY (GPD): 500 PERCOLATION RATES: 7.5 MIN/INCH PROPOSED APPLICATION RATE: 0.8 MINIMUM DRAINFIELD SO.FT.: 750 FT' MAXIMUM DEPTH OF EXCAVATION: 12 FEET WIDTH: 2.5 LENGTH: 2 0 25 FEET EACH - 50 FEET TOTAL EFFECTIVE: 8 FEET ACTUAL MFT.: 800 FT' GEG, Ltd. HAS A 8 PAGE SPECIFICATION EXISTTNG DRAINFIELD ✓,, i LETTER THAT PERTAINS TO THIS DESIGN. TO APPXIMATE LOGATI N NOTE: THE CONTRACTOR OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS SHALL HAVE THE SOUTH LOT INSTALLATION, THE ENGINEER, WELL DRILLER, LINE FLAGGED BY CONTRACTORAND PROPERTY OWNER AGREE REGISTERED LAND SURVEYOR THAT THEY HAVE READ THEE SPECIFICATIONS AND AGREE TO ACCEPy THE PRIOR TO CONSTRUCTION. TERMS AND CONDITIONS OUTLINED. VALLI VUE ESTATES #2; / / / VALLI VUE ESTATES #2; BLOCK 5, LOT BLOCK5,LOT5 WATER SLOCALOCATION �VNOR HERN UTILITIES LOCATE / 'A `• •: ;" EXISTING 1260 GALLON SEPTIC TANK 4 r .'. •. �.: .., TO BE DECOMMISSIONED PER UPC -4 PROPOSED 150 GALLON S.T.E.P. TANK; INSTALL DOUBLE CLEANOUTS BEFORE / / EXISTTNG DRAINFIELD ✓,, i TANK,TANK TO BE PLUMBED SO THAT FLOW MAYBE DIVERTED BETWEEN EXISTING APPXIMATE LOGATI N OF 1�ATER MAIN RAINRELD AND PROPOSED GRAINFIELD i EXISTING 4BEDROOM HOUSE T..BL / APPROXIMATE LOC ATI OF VALLI VUE ESTATES #2; / / / VALLI VUE ESTATES #2; BLOCK 5, LOT BLOCK5,LOT5 WATER SLOCALOCATION �VNOR HERN UTILITIES LOCATE / 'A `• •: ;" EXISTING 1260 GALLON SEPTIC TANK 4 r .'. •. �.: .., TO BE DECOMMISSIONED PER UPC -4 PROPOSED 150 GALLON S.T.E.P. TANK; INSTALL DOUBLE CLEANOUTS BEFORE / / EXISTTNG DRAINFIELD ✓,, ^;. TANK,TANK TO BE PLUMBED SO THAT FLOW MAYBE DIVERTED BETWEEN EXISTING / i RAINRELD AND PROPOSED GRAINFIELD / EXISTING 4BEDROOM HOUSE PROPOSED DRAINFIELD (2 @ 25 FEET EACH); CONVERT TO 4' PVC A MINIMUM OF 10 FEET - BEFORE FLOW SPLITTER i M 8 0 Vod Tw#1 CO Go FE / � D ' \ APPROXIMATE LOCATION OF ABANDONED SEEPAGE PIT APPROXIMATE LOCATIONN i� / / OF WATER MAIN / i \ SCALE: GARNESS ENGINEERING GROUP, Ltd ...............................'1.., CIVIL &ENVIRONMENTAL ENGINEERS - ' 0 erot E lUYORRWq&IIIE 1M•ANGIOgp(�,N(Bf®i•PNUNEWOiI>0id1iY•GAIt f�/bB9N!• WE98fIEwrxyu,swprkp,mn / PREPARED FOR: PHONE NUMBER:PAGE NUMBER: ,• ' ••••, �O SAM HALEY (707)688-2899 2 OF 2 ♦1 A ° 4 EGAL DESCRIPTION: �♦ S CE -79 •' VALLI VUE ESTATES #2; BLOCK 5, LOT 4 DRAWN BY: ♦ / YPE OF WORK: D.J.G./L.K.B. ♦ ♦♦ Fp pI•i�iF''P�,F% DESIGN FOR SEPTIC SYSTEM UPGRADE DA 3/15/2016 ♦♦♦� �5��+��• CARNES_ S ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS — 3701E.TUDOR ROAD. SUITE 101 -ANCHORAGE. AN OWN-PHONGWR 33 Ib -EP%(00])33B 46'WEWITE: wani.gm¢¢mrppeemg.mm SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: VALLI VUE ESTATES #2; BLOCK 5, LOT 4 PERFORMED FOR: SAM HALEY DATE: 2/29/2016 UE (fe 16 11 12 13 14 15 16 17 16 19 ORG TEST HOLE #1 GM ML ✓ISUALLY 'ERMEABLE SOIL CLASSIFICATIONS DEPTH TO GROUNDWATER DATE DRY 2/29/16 •. 3/7/2016 3:46- IIIIIilll 2 MR 30 2" 4 3 4:16 - 6" N/NN • 2" IIIIIIIII 5 O - 61. WWI 6 2° 4 M5:1630 DEPTH TO GROUNDWATER DATE DRY 2/29/16 DRY 3/7/2016 3:46- DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 3/1/2016 1 3:46- 2 4:16 30 2" 4 3 4:16 - 6" - 4 2" 4 5 61. 6 2° 4 M5:1630 PERCOLATION RATE 7.5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6 FT. AND 7 FT. 20 1 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ❑ NO SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY: ERIK WIDGER COMMENTS: PERCOLATION READINGS ARE WITHIN 1116 OF INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERF RMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: ,S_ /C GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3101 ETUEIt ROAq SUITE 101'ANC80RAGEAKBg507'PXGNE(DO) 337b17E'FAXX37)3333-MBSITE'. vnrv/.pe ngn—qcm SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: VALLI VUE ESTATES #2; BLOCK 5, LOT 4 PERFORMED FOR: SAM HALEY DATE: 2/29/2016 DE " (fee 10 11 12 13 14 15 16 17 18 19 20 111: GM ML VISUALLY PERMEABLE TEST HOLE #2 SOIL CLASSIFICATIONS DEPTH TO GROUNDWATER DATE 111111111 2/29/16 DRY 3/7/2016 3:44 - 6.. %% 2 NNN IIIIIIIII • 4-7/8" k 3 VZZMA0 11311 - • ly.�.� 30 4-7/8" 1-1/8 5 DEPTH TO GROUNDWATER DATE DRY 2/29/16 DRY 3/7/2016 3:44 - 6.. - 1" = 100' DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 3/1/2016 1 3:44 - 6.. - 2 4:14 30 4-7/8" 1-1/8 3 4:14 6" - 4 4:46 30 4-7/8" 1-1/8 5 4:46 - 6" - 6 5:16 30 4-7/8" 1-1/8 PERCOLATION RATE 26.6 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6 FT. AND 7 FT. A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY: ERIK WIDGER COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PER OR ED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 3 K116 b Municipality of Anchorage Page k of - DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Sv'i40/JJ PID Number: 016- /9-3-53 Name: F4 ^ h L Y � f � P_ ,'t Wastewater System: ❑ New ❑ Upgrade Address: NILILAT ABSORPTION FIELD i Lf 96?$ OLD Lu S72EE Phone: No. of Bedrooms: ❑ Deep Trench ❑Shallow Trench ❑ 8ed ❑ Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: -- GPD/S. Ft. Lot: Look: ock: Subdivisi 7 VAIL-I.. ( V u r4 Z. n�eJl Depth to pipe bottom from original grade: Ft. Gravel depth beneath pipe Ft. Township: Range: Section: Fill added above original grade: Gravel length: FL FI. WELL: ❑New ❑Upgrade Gravel width: Number of lines: Distance between lines: Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. SD. Ft. Driller: Date Drilled: Static Water Level: — Installer. Date installed: a 37 Ft. Pump Set at: Casing Height Above Ground: TANK mYield: j�2 / 14 (1ct G.vL� GPM Ft. Ft. SEPARATION DISTANCES Septic ❑Holding ❑S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: TAN K Capacity in gallons: ��( v From Tank Field Station Tank Sewer Lines QAC w Well Material: Number of Compartments: Surface LIFT STATION Water A&O Lot Size in gallons: Manufacturer: Line , !fJ "Pump on" level at: vel at "Pump off' le : Highwater alarm at : Foundation �1. Curtain Drain r4� _ Pump Make B Model Electrical inspections performed by: BENCH MARK Remarks: 6z�e Location and Description: �H//stampp wt Gr k g�u_vQ or2,f � // o /t�ril l n .PJC/ a✓I /J'� � n Assumed Elevation: p..e -:. , /" 'ENGINEER'S SEAL. its 4 1 t Inspections performed by: Dates: 1st 2nd t CL,,...., Department of Health and Human Services approval ' F4W > `740 -27 Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 LOT 16 \ / LOT 3 Lar s LOT 10 BLOCK 3 / 0 .. ti 1980 TRENC4 —� /s A SWING TIES. E r C .SllY/ AB 7 ET AC 19 1 50 GALBC 12 AD 38 v BD 35 BENCH MARK AE 33 �j BE 28 � � CONCRETE CRIB I / ti I LLTIKED TRE—EiD\VE I OT 44 I LOT 45 I BL 17CK 1 UNIT #1I BENCH MARK: BNTTOM SIDING ASSUMED EL£V. 10000 ITOBBEN SPURKLAND P.E. VALLI VU #2LOT 4 BLOCK 5 I I SEPTIC SYSTEM AS BUILT 203 W 157H. AVENUE 10035 MAIN TREE DATE.- JUNE 30, 1997 /NCH. A- 9,,, SAM & SH£R HALEY SHEET, 2/3 GRID: 2538 PERMIT # SW970 /b n- PID # 015-123-53 VVE0504201V6 961 INV ELE 92.0 INV £LE. 92.46 1 .•�P�................ i � 49th �e i IP50 SEPTIC TANK /.... TDBB SPURKLAND II c', 1, ti == No. CE -2225 1� . BENCH MARK. BOTrOY SIDING ASSUMED ELEV. 100.00 TNBBEN SPURKLAND P.E. VALLI VU #2, LQT 4, BLOCK 5 SEPTIC SYSTEM AS BUILTS 203 w15th Ave 10035 MAIN TREE DATE' JUNE 36 1997 Anchorage Ak 99501 SAM & SHER HALEY SHEET: 3/3 GRID: 2538 PERMIT I SW970155 PID 1 015-123-53 VVE05043.DWG PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970155 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:HALEY SAMUEL R JR & SHERIDAN K OWNER ADDRESS:10035 MAIN TREE DR ANCHORAGE, ALASKA 99516 PARCEL ID:01512353 LEGAL DESCRIPTION: VALLI VUE ESTATES #2 BLK 5 LT 4 LOT SIZE: 20037 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/26/97 EXPIRATION DATE: 6/26/98 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.-65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED B ISSUED BY: DATE: 6 ` 4-Q-7 DATE: ( - 2 L- T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 Subject: Collapsed Septic Tank Lot 4, Block 5, Valli Vue #2 10035 main Tree Gentlemen; June 26, 1997 We are requesting an emergency permit to replace the collapsed septic tank at this property. The owners live in Hawaii, and did not become aware of the problem until two days ago. The residence has been rented out for the last ten years. I have enclosed an As Built of the property with the work required outlined. Yours MWeisl_"AMMI '" E� RON/clPI117Y ✓(/�&A[ Ric s ON R 2 61997 �C��VFD JU.n-25-97 10,:00A dr daves auto repair s - vacs,-, OC et 1 W r•r /\ t "r'o• O 808 833 6334 p.01 'A VA ff � V r n; a A B 4 = ,4 �, y ZoF_ ,------------- Cf�r l sz_r 7r= - I hereby certify that 1 hovq surveyod the following daser;6ad property, Lot_ ALdilion llI I Y.Iri X...��'fFL.. _ -- 'f''"'trocar:{ing procincy Alarea, and t.':.:r the `���'...°+••.e+�4(1t`i� impravomoots situated thereon aro within the property lines and do not o•arlap or ancrooch F Jvy'`1P, QA the property lying adlocant ilrarato, that no improvrmenis on property iyinj c.;ac,ni Co!eto 1 s a enuaoch on_1 o premisos_.ln-question oral that those arc no raad.voys, or ( fey,, =-�-F other V;5:61*e eowmanh on said properly oncopt os indicated harvon, 6J_ •._n""', •+�e+,..;.,+ �/•i, _I�,..,«-_ ri Tib r. 5 Andnorayv. ��4 ,4• +•fi'o�tt t5i•elonen' �,+, �:� . 4 fft ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION rENVIRONMENTAL ENGINEERING DIVISION - �•— 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMPnHONE 2 Q C /� �d ❑NEW NUPGRADE MAILING ADDRESS If !!'' '' ci W. CT 0 LEGAL DESCRIPTION — LOCATION NO. OF BEDROOMS Uy DISTANCE TO: Well Absorption area Dwelling PERMIT NO. EZ wF Manufacturer Material No. of compartments rn Liq. capacity In gallons Liq. capacity in gallon a IF HOMEMADE: Inside length Width Liquid depth 6 YFDISTANCE J t7Z TO: Well Dwelling PERMIT NO. OEF facturer Material Liquid capacity in gallons 4 m= DISTANCE TO:/©� Well Foundation Nearest lot linePERMIT O. ©FXJa LL z Z w F - No. of lines p2 gth of a ch line Total len th f lines Trenc w' th inches Distance bettypef� ines /V y � f Top of rile to finish grade Material beneath file ry inches Total effe ive ab orption area LJ C7 Length Width Depth PERMIT NO. Q F- wd Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIP AT��EEpRIAL ��✓✓ 1 j S ILTESTRATNG INSTALL 9 REMA KS O% K2, 9c, 1\1413M f�7H IcyAPPROVED L -TE LEGAL 4d7-` 72 -OM -Mev. 3/78) t-) GRIF`7ER ANCHORAGE AREA 60J��"UGH Department of Environmental Quality 3330 C Street ' Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME J°N'I% ���ST,�OnJ� MAILING ADDRESS 99K '�'^2D�% PHONI LOCATION- LEGAL DESCRIPTION �T '�j LO C/ , vz?"l U,c SEPTIC TANK: S DISTANCE 0,9" 1. lr sq yL NUMBER OF h FROM WELL MANUFACTURER MATERIAL .STtE"L COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /0-" GALLONS. SEEPAGE PIT:y f /'� i NUMBER OF PITS / DIAMETER OR WIDTH_. LENGTH_. DEPTH �• LINING MATERIAL liYfiS� �eCRIB SIZE: DIAMETER_DEPTH DISTANCE FROM: WELL �f- /f TOTAL EFFECTIVE BUILDING FOUNDATION NEAREST LOT LINE Zo ABSORPTION AREA (WALL AREA) ��� SQ. FT. ADDITIONAL ABSORPTION WELL: Chi. lM. UJAi �c� TYPE )-BUILDING -FOUNDATION _CONSTRUCTION NEAREST LOT LINE NEAREST SEWER LINE DEPTH SEPTIC TANK_ CESSPOOL ./ OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM f DISTANCE FROM: SEEPAGE SYSTEM ' INSTALLED BY:Z'O'�'''� PIPE MATERIAL: �(.<,. mry � 8o,e.y LOT SLOPE: _ I IIx REMARKS: (;�/LUOKEO T,es6 DATE S- 9" 7(/ APPROVED Form No. EQ -031 M1 1r-4 I I=- I! '1=1 L_ I -r *-0 ID F= F=iC �r H 'tF�`� iiuE �oi DEPARTMENT Ur HEALTH AND ENI+IRONMENTAL t-ROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 II:CY� -AO a3ta— I T_E ,sE:wE=F2 uFn, c3FC'HC}E F 1=FZm I T PERMIT NO. C 800024 /� � ! LP1L�WtSY1 alvbu v LOP. 17. - APPLICANT BARBARA LYONSIPAVELKO 2804 W NLB 59503 276-2804 LOCATION MAIN TREE LEGAL LOT 4 BLOCK 5 VALLI VUE EST. LOT SIZE 20000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING <50 FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C1 F TF 1= = L_EtaGTH= -2'i C�F? "%PPE1_ LIEF 7r rS THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE I5 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. t_ :� I FaF EC -T I ��t 1 FiF E F2E!t_o I FEC1 BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING, UPON THE TYPE OF PUBLIC: WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION, F}EF<'M I T l=XF=* I Fa'E=• CxEC~EME3EFi' �s � r I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INC_.LUDE MORE THAN 3 BEDROOMS. SIGNED APPLICANT BARBARA LYONS/PAVELKO ISSUED BY ------------------------------DATE- 2 �,=- <1 _c L_1 a--- V4. 0 I� or, r l"p rl rtut� I a �r�L I T aF ear � u FaraR �E_ o F�� DEPARTMENT Oj^NEALTH AND ENVIRONMENTAL nPOTECTION — 825 'L STREET, ANCHORAGE, AK. SS, y r 264-T f 20 Lw-- tit iCa �t�t- I TE: n->s=L I =F F=rE=F?M I T (,1 P L* RAO PERMT.7 Nd.- < 1 APPLICANTLIIotU LOCATION ir�xaihr��� LEGAL L 14 i3KS V)ALC1 VUR 7' TYPE OF SOIL ABSORBTION SYSTEM IS: PC 3V�-- �� � LOT SIZE Dmf vc r- - SQUARE FEET MAXIMUM NUMBER OF BEDROOMS = ^ � SOIL RATING (SQ FT,'BR?= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E}EF=;rTH= L- L_E:M13-rH < S� GF��',�EI- C]EF='TH= c THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET?. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET?. F2EL4U I FR! E[7 EF}T I C TFitdKS;I 2!E:- 0F�L_L_01 S; 111111,_ 111. All PERMIT APPLICANT HAS THE RESPONSIBILITY T,3 - INFORM THTC DEPARTMENT DURING THE -- INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWA r ;Sa > I N:E;F}EC=T I (D N- a F-1FZE FREL,-*U I F e: C% --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. p'EFRM I T F=XF=r I FaZE� G+EGEM1BEFZ :31-s I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPLICANT 197:SA AND WELLS AS SET ENLARGEMENT IF THE ISSUED BY_A::�`--- --------- DATE_ �� _(_-) _ V3. 2 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO 3330"C"STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT , `�m 5 t "Aj MAILING ADDRESS b O ✓�k J -?,C)5PHONE r/'</ INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK I' SEEPAGE PIT �,DRAIN FIELD OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS wt„�Li2�' NOTE: 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. SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE TYPE 17- MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK 15 / d 0 / B FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL / SEPTIC TANK - , SEEPAGE PIT ?O DRAIN FIELD /D / TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT — DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK /O / SEEPAGE PIT /O / DRAIN FIELD SEPTIC TANK. SEEPAGE PIT DRAIN FIELD /vy 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. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE `T `� APPLICANT'S SIGNATURE 4ER ANCHORAGE AREA BOROUGH j Depar�ment of Environmental Quality 3330 "C" Street ` Anchorage, Alaska 99503 Performed for� �e �r Date performed " 2— 7 _ Legal Descrip on:This form reports: Soils log Percolation Depth �— Feet 1 n c. - 3 -• — 4 _. 5 .. �G) - /as— 11 7�H-- E91 6- 9a s �o 10 - bP 11 - 12 - 13 - 14 - Was ground water encountered? If yes, at what depth? `Reading Date Gross Time Net Time Depth to H2O Net Drop Proposed installation: ,r�eoage pi Drain Field D-Pt.h of Inlei;DejJtli to, bottom of pit or Co - .ENTS: — --- __ .. Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 5 T Y Certificate of On -Site Systems Approval Parcel I.D. 015-123-53 Expiration Date: !A?qk 1. GENERAL INFORMATION: Complete legal description VALLI VUE ESTATES #2' BLOCK 5 LOT 4 Location (site address) 10035 Main Tree Drive *Anchorage Current Property owner(s) Sam & Sheradon Haley Day phone 707-688-2898 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well Community ❑ Public Water System Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -5,150 Date of Payment Receipt Number COSA# 0SGZ112-1 Waiver Fee $ Date of Payment Receipt Number Waiver # ah 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. Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101 -Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE X_ System #1 Approved for _4_ bedrooms #AECC884 System #2 Approved for bedrooms `0\? OF i Disapproved ` ��Q 'Spp�i� Conditional approval for bedrooms, with the followtipul`R44TE `9m WATER AND By: LZ L zl Original Certificate Date: yAVZ I The Municipality of Anch ge Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representatio 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 ✓ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other MI Legal Description: VALLI VUE ESTATES #2; BLOCK 5, LOT 4 Parcel ID: 015-123-53 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for Well production at time of test gpm Water storage tank volumeons Well disinfected for m test? ❑ Yes F No ❑ Colif acteria is Negative itrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample ;Static evel at beginning of test ft. mments COMMUNITY WATER SYSTEM B. TANK DATA Age of tank(s) 5 years Tank type/material STEGISTEEL Measured operating fluid level in septic tank I ❑ Standpipes/foundation cleanout per record drawing Date of pumping 12/1/20 D. ABSORPTION FIELD DATA DUAL TRENCH - WEST/EAST C. LIFT STATION R Required maintenance completed Age of lift station 5 years Lift station material STEEL Comments: Which system tested (date installed) 4/15/16 Adequacy test date 4/9/21 FOR ALL standpipes present per record drawing Results QPass For 4 bedrooms Total measured depth from grade 12.0 ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 3.66 ft (min) Water added 624 gal ❑ N/A — pressurized field New depth 44 in Al Monitor tubes go to bottom of effective. If not, state Elapsed time 120 min depth into effective' FillCode-requiredsoil cover over field Final fluid depth 13 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies: 1989 TRENCH PIPES NOT FOUND (IN SNOW)- CONDITION OF THE 1989 TRENCH IS UNKNOWN 'MT3 EXTENDS 7.66' BELOW INVERT & MT1 EXTENDS 7.91 BELOW INVERT COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes Community Sewer Manhole/Cleanout >10 ' Yes if No ft s if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Se lc Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > Private Wells > 100' Animal Containment > 50' ❑ Yes if No ft Yes if No ft ft Community Wells > 200' Yes if No ft Water Service Line > 10' Manure/Animal Excreta Storage > 100' if No C ity Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5J+ ft Surface Water > 100' Q Yes if No ft Property Line > 5' 17771 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Absorption Field > 5' P/1 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 111 Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below TESTED WEST TRENCH ONLY - EAST TRENCH WAS DRY UPON ARRIVAL AND STAYED DRY THROUGHOUT THE TEST G. ENGINEER'S CERTIFICATION o l certify that l 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. 4 ............. ....... _ ff A. Garn s: COSA Checklist yellow sheet #AECC884 �Y;N � aPa\ \af ro f e s slon°o Ga From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No **1 ft Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' Yes if No ft S` Water Service Line > 10' Q✓ Yes if No ft Community Wells > 200' r7l Yes if No ft V Surface Water > 100' 0 Yes if No ft 0 rst F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL **OSV#161018 TESTED WEST TRENCH ONLY - EAST TRENCH WAS DRY UPON ARRIVAL AND STAYED DRY THROUGHOUT THE TEST G. ENGINEER'S CERTIFICATION o l certify that l 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. 4 ............. ....... _ ff A. Garn s: COSA Checklist yellow sheet #AECC884 �Y;N � aPa\ \af ro f e s slon°o Ga MUNICIPALITY OF ANCHORAGE Development Services Department Phone- 907-343-7904 On -Site Water & Wastewater Section Fax- 907-343-7997 Lift Station/Pump Vault 7- - , OwnerL("_�,.,41 Street Address Septic Tank: -Sludge level , Z� inches -Pumping: requiredyes 66 -Pumping completed yes no Lift station: -Pump basket cleaned �es,, no -Effluent filter cleaned -Control floats cleanedyCs) no -Proper float settings confirmed ygsL no -Operation satisfactory 10 n Alarm System: -Dedicated electrical alarm circuityes -Audible and visual alarm inside dwelling X4 no -Alarm system operation satisfactory not satisfactory S Manhole Riser. -Ground water intrusion at riser to tank connectionyes ,no -Ground water intrusion around pipe penetrationsyes snO -Weep hole functional e no -Manhole lid: Functionaly"es, no InsulatedN�&no Properly Secured )ft no Other -All manufacturer required inspections and maintenance completed tLs no iaf Qualified Maintenance Provider: Technician Date of maintenance Company X IL-1 4 It Signature 4- Date Fronri: ARM Septic Services LLC ARMServi.cesAK@�,)utlook.com SUbject: Re: 10035 Main Tree Date: Apr 27, 2021 at 10:42:37 AM Ton: Sonja BlewettSonja@garnl-,Isse,,-igit-ieer',BF-ig.co�-n It was a typo on our part and Yes for satisfactory and yes for dedicated alarm circuit. Sorry about that. Mariah Sent from my Whone On Apr 27, 2021, at 1101:1311' 'AIM., Sonja Blewett <SonjL@garnessengineering.com> wrote: Good morning! Just following up if your guys were able to confirm the highlighted statements on the report were fixed. Thanks! ----- Original Message ----- From: Scan <Scanftarnessengineering.com> Sent: Tuesday, April 27, 2021 11101:27 -A -M, TO, Soni,2 Blewett <SoaiaQaa[ness in a MAYO 9 2016 •� Municipality of Anchora On -Site Water and Wastewater Program t (907)343-7904 << q Certificate of On -Site Systems Approval Parcel I.D. 015-123-53 1. GENERAL INFORMATION Expiration Date: i _ f S'_ j ` Complete legal description VALLI VUE ESTATES #2; BLOCK 5, LOT 4 Location (site address) 10035 MAIN TREE *ANCHORAGE, AK Current Property owner(s) SAM HALEY Day phone (707)688-2899 Mailing address 10035 MAIN TREE *ANCHORAGE, AK Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System WaiverNariance request Received COSA to be releaaed to the TYPE OF WASTEWATER DISPOSAL: Individual Q Holding Tank ❑ Community ❑ Public Sewer ❑ unless otherwise requested by the engineer. COSA Fee $ ato8)) Date of Payment 51 /b//�, Receipt Number 02-q.5161 COSA# CSU(o U �,O Date: Waiver Fee $ C215 - Date of Payment /o alp Receipt Number b35F7k Waiver #— OSV 1 W bRl 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. Name of Firm Garness Engineering Group, Ltd. Phone (907) 337-6179 Address 3701 E. Tudor Rd., Suite 101, Anchorage AK, 99507-3246 Engineer's Printed Name Jeffrey A. Garness Date qf2Z L, In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordancewith the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the dates of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, grcundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit ofthe person/party who retained GEG. Reliance upon the information provided in this report by any otherperson or party, including but not limited to subsequent property purchasers, Is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the \V(OF((A&� �ve� y�'Qyrri =J= ON-SITE WATER AND _ Original Certificate Date: tarn 1a.• • • • • "- - V PROGRAM if 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet &1-12.d.c If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: VALLI VUE ESTATES #2; BLOCK 5, LOT 4 Parcel ID: 015_123-53 A. WELL DATA Well type A Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE If A, B, or C provide PWSID# #2210605 Well Log (Y/N)_ Sanitary seal (Y/N)_ Wires properly protected Cased to ft. FROM WELL LOG ft. p.m. Coliform oolonies/10O ml. Nitrate mg./L. A ic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Casing height (abo AT INTION Collected by: in. Tank Type/Nlaterial SEPTIC/STEEL Date installed 4/13-15/2016 Tank size 1500 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping NEW Pumper C. ABSORPTION FIELD DATA eeLow Fwn� cRaDE Date..installed 4'13-15/2016 Soil rating .p.d./ rfilbdrm) 0_8 26 2.5 Length 25 ft. Width 2.5 ft. *12.3 High water alarm (YIN) YES EAST WEST DEEP TRENCH System type DEEP TRENCH 8.03 Gravel below pipe 8.11 ft. Total depth *11.6 k Eff. absorption area 800+ ft2 Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test = in. Water added =gal. New depth =in. Elapsed Time: = min. Final fluid depth = in. Absorption rate >= 600+ g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — INTERIOR ALARM PER CONTRACTOR D. LIFT STATION *SECOND COMPARTMENT OF STEP TANK **PER MOA ELECTRICAL INSPECTION REPORT Date Installed 4/13/2016 Size in gallons *500 Manhole/Access (Y/N) YES "Pump on" level at 44 in. "Pump of level at 40 in. High water alarm level at 46 in. Datum BOTTOM : OF TANK Cycles tested NEW Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WELL Septic tanknift station on lot Absorption field on lot— Public sewer main Sewer /septic service line areas On adjacent On adjacent lots ver 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 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1*1 1 Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ _ F. COMMENTS G. ENGINEER'S I oe/fify 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 i1Llrt IR•v. 11/05) |§E*§ E!Jlgm ! ®§§ ; §|@ ■�; \§) r; MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) esf%eS Location (address or directions) / \J 7 (b) Applicants Name3i � a, Applicants Address_ /o0,3��"_ �ar.fi-re _�"`�'�-�"-s�, 1/.5•^�, (c) Applicant is (check one) Lending Institution Owner/builder Buyer C:71 ; Other f -::l (explain); (d) Lending Institution — Telephone Address (e) Real Estate Co. & Agent Address Telephone �® 2. T of Residence Single -Family Number of Bedrooms 3. water Supply Multi -Family Other (describe) Individual well F—_1 Community (=-F Public Note: If co mainity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrocans specified in this HAA (Y/N) �l%%;,� 4. Sewac-te DisDosal Onsite FE1 Public Community Holding Tank Is the wastewater disposal system adequate for the r -m er of bedrooms (Y/N) [Page 1 of 21 2-15-84 5. Engineering Firm Providinq Inspections, Tests, Data and Information I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this ir4spectiono signed Date Name of Firm �� o ��� ��s i:iv- BS Tele -one hone Address r Signed by Date ............... NO s 9 S6 -I_ j (ENGINEER SEAL.) DHEP royal _ Approved for f ? bedrooms Approved a�� Disapproved Terms of Conditional Approval <_.. Date Conditional � �' Tae Municipality of Anchorage Department of Pealth and Environreental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedroom and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: J KB2/d5/s (Page 2 of 21 2-15-8n DATE C° 7 PWS I.D. To Whom It May Concern: According to records on file in this office the Water System is in compliance with the State Drinking Water Regulations. Sincerely, �% BILL SHEFFIELD, GOVERNOR i DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 274-2533 ANCHORAGE, ALASKA 99501 DATE C° 7 PWS I.D. To Whom It May Concern: According to records on file in this office the Water System is in compliance with the State Drinking Water Regulations. Sincerely, �% RaM CONSULTANTS, INC. 5024 CORDOVA • BOX 6087 • ANCHORAGE, ALASKA 99502 • PN. 90]-2]9-0483 • TLX. 090 25360 GEOLOGISTS u RANNEgS B veroas MUNICIPALITY OF ANCHORAGE February 27, 1980 R&M yjNo nldll 6"'T & VIRO MEM;' -,L r.-..'IECTION VWR Scientific 1301 E. 1st Avenue FEB 2 % 1930 Anchorage, Alaska Attention: Barbara Lion of Commonwealth Marston RECEIVE Re: Adequacy Test on Existing Sanitary, Sewer System; Lot 4, Block 5, Valli Vue Subdivision, Anchorage, Alaska Dear Ms. Lion: Per your request of February 22, 1980, we conducted a test of the sanitary sewer system on the above described property. One -thousand gallons were pumped from the septic tank prior to the performance of the test on the seepage pit. During the test the liquid level in the seepage pit was monitored as 600 gallons were removed and 1,100 gallons were pumped back into the seepage pit to the inlet level. All liquid levels were measured below the top of the standpipe and are shown in the following table: Initial Liquid Second Water Third 24 -Hour Total Reading Removed Reading Added Reading Reading Drop (gallons) (gallons) 10.15' 600 15.65' 1,100 6.75' 10.0' 3.25' The average specific capacity is 9.7 gallons per inch based on two sets of readings showing 9.1 and 10.3 gallons per inch. After twenty four hours the liquid level was measured again at 10.0 feet. It had dropped 3.25 feet or 39 inches. This indicates an average effluent acceptance rate o 378 gallons per day for the surrounding soils. If the 4 bedroom resi ence on the property is to house 8 people, the average load on the system can be expected to be 600 gallons per day. We can therefore conclude that the system is not disposing of effluent at an adequate rate for a 4 bedroom residence. We appreciate this opportunity to be of service to you. Please contact us if you have any questions regarding this letter or if we can be of additional service to you. Very truly yours, R&M CONSULTANTS, INC. Jai iJ e Cecere Proj ct Manager JC/dj/AT&SI-C ANCHORAGE FAIRBANKS JUNEAU VALOEZ WASILI_A GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C Street, Anchorage, Alaska 99503 274-4561 Date Received ,- / 7- ;15 - Time S Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: /14---l- % ' , Mailing Address: 16o -)L I,/- —Z, Phone: 7 -5-2- 2. 5- 2. Property Owner: (���x x� Phone: �44-46 Mailing Address: ' _ `��'.7-0— �l _ C ��S- 3. Legal Description: 4. Location: 5. Type of facility to be inspected �, No. of bedrooms 6. Well Data: A. Type �— B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: A. Installed t5- 8- 7c/ B. Installer - - C. Septic Tank: 1 Size 2. Manufacturer ,tk,a,t - , ¢l D. Seepage Pit: 1. Absorption Area VJIVQ'7 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) Pagel of two pages Page 2 of two pages - Rec, t for Approdal,-of Individual S,,-,r>�& Water Facilities LVga1 Description Comments Approved Z-14� jxDisapproved Date Approval;Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM no i certiTy tnat zne inrormazion conzaineu in anis r"eyueat, ivr appiuva& w vo accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date ,ntf i certiTy tnat zne inrormazion conzaineu in anis r"eyueat, ivr appiuva& w vo accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date "`.A i, GREATER ANCHORAGE ARL-; BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 4/9/75 1. Type of Inspection: CM120 VA PHA CONV X . 2. Property Owner: John.Armstrong i Mailing Address: Box 4-2057 - Anchorage, Ak. Da.y Phone 344-1646 J. 99509 3. Name of Buyer: Thomas M. & Barbara R. Pavelko Mailing Address: 1678 Eucalyptus St. Day Phone 272-9507 9%LllAr' Brea, Calif. 92620 4. Name of Lending Institution: The First National Bank of Anchorage Mailing Address: BOX_4-2090 Anchorage Ak. 99509 one 274-1521 5. Name of Realtor or Agent: Durenda Mantsch Mailing Address: .3222 snenard Rd - Skyway Reale',lone 274-8561 Anchorage, Alaska 99503 6. Legal Description: ror Bik S_ Valli-Vue r_states L o ca ti on Anchorage, Alaska 7. Type of Facility to be inspected: SFD No. Bdrms.4 8. Water Supply Type of Supply: Public Utility x Individual If Individual, number of dwellings presently served If Individual, depth of we'll 9. Sewage Disposal Syst::111 Type -o7 System: Public utility Individual (on-site) X If Individual, date of installation ALASKA VALUATION SERVICE, INC. BOX 3-655 ANCHORAGE, ALASKA 99501 PHONE 344.8231 April 16, 1975 1st National Bank So, Center Branch Anchorage, Alaska Attn: Jack Litton RE Appraisal #3024 L 4, B 5, Valli Vue Armstrong/Plovik Dear Mt, Litton: At the time the above appraisal was made the home was under construction, It was our understanding there were to be 4 bedrooms, 3 up 1 down, Upon reinspection we have found there are 2 bedrooms up plus 1 bedroom and a den on the lower level, Very u,//ly��yours, l� L.G. Carmer LGC/mb. MUNICIPALITY OF ANCHORAGE ` DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MAY 4 1984 CHECKLIST - FEBRUARY 1984 RECEIVED Legal Description: A. WELL LISTA Carr�mctni� /.r/t/� //cUu2V Sa,v o! Well Classification /9 If A, B, or C, D.E.C. Approved(Y/N) 5 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 On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sever Line Cleanout/Manhole To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected By ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK ARTA Date Installed sl'1711 Si y No. of Compartments _ Standpipes (YIN)X.->- .- S Air -tight Caps (Y/N) Lf Foundation Cleanout (Y/N)Z s Depression over Tank (Y/N) /✓� Date Last Pum/ped Pumping/Mainteranoe Contract on File (Y/N) �v ,y ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: / To water -Supply Well X-1�14 To Building Foundation / v To Property Line -'s / e) To Disposal Field To Water Main/Service Line ° To Stream, Pond, Lake, or Major Drainage Course: n/1� Comments¢ 4%-. 2-15-84 [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA D. Soils Rating in Absorption Strata 'ate Type of System Design Date Installed ,�v�e� 3Length of Field 'Y s� Width of Field Depth of Field —*�< 6 " Gravel Bed''ThickneSs'Y- Square Feet of Absorption Area �6 Standpipes Present (YIN) )Ie --1 Depression over Field (YM) 4/�o Date .of Last Adequacy 'lest Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Wall To Property Line /f To Building Foundation %/ To Existing or Abandoned System on J Lotman r y ; On Adjoining Lots > zoo To Water Main/Service Line 9 p)V To Cutbank(if present) ILI To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Stcrage,Area Co//m�nentS X 2>,Il P {�S '%jam C nec7-4{ /"^,�-,- 1,74. 07' flose- '?rd LIFTSTATION 7�wisi Si %t Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) J ;-e ,e I4 /„s v o"F hoase. Dinens ions Manhole/Access (YM) "Pump.Off" Level,at Vent (YM) 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 HAA Guidelines in effect on the date of this inspection. Signed ^' Date Conpany /'� u �h % �SS®G/A7es MOA No..5 may aJ- KB1/d5/s (Page 2 of 21 ENGINEERS /SEAL 2-15-84 i - DATE RECEIVED - - INSPECTION APPOINTMENTS TIME - TIME TIME NUMBER OF,BEDROOMS SINGLE FAMILY CI Cil_ Ar(\ -Q DATE DATE DATE Pk Three ❑ Six 7. WATER SUPPLY {C)'lr�. INSPECTOR INSPECTOR - INSPECTO? MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH C 825 LStreet- Anchorage, Alaska 99501 ENVIRONMENTAL P.;CTECTION ENVIRONMENTAL SANITATION DIVISION OCT 2 ® 1081 Telephone 264-4720 pp�//'' EUllll�� REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERF�Cfl4I ME D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWN PHONE MAILING ADDRESS /003 72?sFinJ l �r=� `7XG l�n�el-(oKA�� PROPERTY RESIDENT (If different from above) - PHONE 4Jkwa, 2. BUYER nn 6ti1C � -Dex-) r S E HK'V' I�DSe> 1J PHON1E/ 4 - oC 74 _ MAIL G ADDRESS 4L[ fUCiWeSS ���V L(/D. ���� timet (c 3. LEyDING INSTITUTION PHONE �7�- 7W l arnAS i -A -Z ���T�� MAILING ADDRESS y 44 �JS ES AZV- __&, V 4. REALTOR/AGENT - r&,r K _:5ZAtO c�u{ru�(�Y PHONE 27L —/ MAIDDRvE`,SS OT2, +CV �c / AN / K� - �'f JO 5. LEGAL D`f- '�� S y'Sf DESCRIPTION lot -e{4L(-I STREET LOCATION loo3S Vito( e09AJee_ of rtir<krUT� Nb �Koo�Ea' 6. TYPE TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY El one El Four EJ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Pk Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled f4- COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM A INDIVIDUAL/ON-SITE** MSD YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY - 1. TYPE OF RESIDENCE ❑ SINGLE-FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS - ❑ ONE ❑ 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 INSTALLER ❑Septic Tank or ❑ Holding Tank Size: A200 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS &V_�APPROVEDFOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 72-010 1 Rev. 6/79) " l t ti DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE ❑ One ❑ Four ❑ - Other DATE DATE INSPECTOR INSPECTOR INSPECTOR 7. WATER SUPPLY MUNICIPALITY OF ANCHORAGE FFLI�1��//�� DEPT. OF I''ALTH & HEALTH & ENVIRONMENTAL PROTEAN ; F,O ECTION ❑ INDIVIDUAL* DEPARTMENT OF 825 L Street - Anchorage, Alaska 99501 • I A N 1 '. 1980 ❑ PUBLIC UTILITY ENVIRONMENTAL SANITATION DIVISION B. SEWAGE DISPOSAL SYSTEM Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER YEAR ON-SITE SYSTEM PHONE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MAILING A DRESS 6 C) _ PROPERTY RESIDENT (If different from above) PHONE SIS 'n f� - - _'e 2. BU PHONE //- MAILI GADDR ESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE / MAILING ADDRESS // �03^ -"!tet �S3-0 q �/ / e J-` h 5. LEGAL DESCRIPTION l t ti STREET OCATIO A510 3 5-- l 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ - Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY 2� Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled - 'I COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM 7. WAS INSTALLED. ,� INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ 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 DATEINSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS r 12 APPROVED FOR -3 BEDROOMS [1—CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE -fY-� BY _ - �yl 72-010 (Rev. 6/79)