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HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 5 LT 11' ~MUNICIPALITY OF ANCHORAGE HeaF ,~ and Environmental Prote~on Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 ................. [~-~.CTION REPORT ON-SITE SEWAGE DISPOS.~,, SYSTEM SEPTIC TANK: DISJ Ar',;CE /~ NUMBER OF FROM WELL_?_'~)/4_~_~i_ MANUFAClURER .~-'~__~2~--~'_ HAl', RIAL ~( ...... COMPARTMENTS INSIDE LENGTH__'-- . .... INSIDE WIDTH "~_ IQUiD DEPTH ........ ~ LIQUID CAPACITY.~GALLONS. ~) f. ~ TOTAL LENGTH f ABSORPTION AREA_~ SQ. FT. LENGTIt OF EACH LINE 8 DEPTIt OF FILTER DEPTlt; TOP OF llLE TO FINISII GRADE ~ ..... MATERIAL BENEA~ft TILE ~ ~ .... IN. ABOVE TILE_ ~ IN. SEEPAGE PIT: Log C~ib Rings BUILDING FOUNDATION____, DIAMETER__ , OR WIDTH LENGTEI___, DEPTH Crib Size,: DIAMEIER ..... DE, TH_____ DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE ..... ABSORPTION AREA (WALL AREA) SQ. FT. Well Class:~zz~, Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials:C~,~-- ~---~3 # of Bedrooms::~=?- Installer: ~~--~1 Remarks: ~_'~,~ ~ 'TI-JiF: l.!~h!Gi'H E:,:i:!,iE:Nr{-i):Cd'-,! i[:::; ii-liE i.!:[hlr%i'bi 'i'J)!~; i':,I!!;F'TH ~:q? F! 'i",;i%i.,ir:::N O~.;: E:']J[T ][:i:i; Ti. liE [:, ]: '-'~;'FFrit',!CE: E',E:"i'P!iiiZE:N THE: ::::::::::::::::::::::::::: OF 'll.liE E~J:;?.OU?..IJ:) F:thJ!::, "i'l-liii: Fi~¢TT'FCd"i OF: THE E:',:4(;l:f,,,'!:::fT:[i3!'.4 (::i'I'.,I F:'iEET;:,. 'i'!..i,=~:RF[ :1: ':~; i',ii::) ::i[;iE"i' p.t. :!: [;:,'I'H !::Oi:~: i'i;;:E:t'.,iCiili;:iii;. 'i"H!E Gi:;:l::f,?E:J [:)!:i?'i!-I )::i~; 'l"JiJE ?,i :i; ?-,! :i: i,J( !!,'i D, EP-i'H Fd'.4E:, 'Fiil~: F!iC!T"i'©?I i:Z!F:' 't'i..ih: i:i:',;.;',C:j::?,,,~iv?i' ])ep .~tment of Health and Environmenw~Protection ~ ~ - i~' '>L.'-:' "~' · ~ ~o ,~, R~o~.,,-"L. %7- :-. ' ~"' Anchorage, Alaska 99507 S()II~S I,O(; PE.R()I,ATION TEST ~ · l'his form reporl:s: "--S*Gi~'s-lb~----S--~ ................. -PG~-oq~-t-~gif'~-~- ...................... Dei~ th Feet 2 3- 4- 5- 8- 9- ll - Was ground water ellCOUntered? /1/0 If yes, at wna£ de.~UP . tO Wote'r- Readin,~ Oate Gross Time Net Time _ _e?_t}~_ Net -Proposed ~nstallatlon: oeepage Pit Urain Fieh] IJupth of InleL . .~e~t'lG't}~"bG't~G~l' ~it or trench '-~'~ ......................... EQ 0.i0 (6/74) I /~x(~.~¢,..~) DEPARTMENT OF HEALTH & HUMAN SERVICES · ;: ~- Division 0f= EnVirOn mentalserViCes ..... : :~:: : , ::: ~:: ,~: ~. B°~ i:96650'~ . On-SiteAnch0rage, AiaskaSe~ices Section 99519-6650:'" ' 343~7~ ' CERTIFICATE OF HEALTH AUTHORI~ APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ~ 015-123-46 ~ HAA ~ '~'~ GENERAL INFORMATION Complete legal description Lot 11; Block 5; Valli Vue Estates %2 Location (site address or directions) ,:"" AnchoraQe, /~.p..r.0p;e~y. own~r ?::' ~,ichard & Jackie SloeL~m "' ~ 6701 Crooked Tree Drive :;''Mailir~gladd'ress '~'!' .,Lending agency Mailing ~ddress '?' 6701 Crooked Tree Drive Day phone 346-1615 Anchorage, AK 99516 Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~*i3 '~ 3. TYPE OFWATER SUPPLY: Individual well Community well xxx Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE ~F WA~TEWATER 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 ~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 Author ty Approva~ application snows that the on-site water supply and/or wastewater disposal system is safe, functic r~al and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. s & s ENGINEERING Phone Name of Firm ,- ~,,,-- ~-,,~ ~.;ver Loop Road NO, 204 Eagle River, Alaska 9~577 Address Engineer's signature '~/~/X~' - ~¢~v¢,~-~ Date DHHS SIGNATURE Approved for .3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments · : /.. ~' 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 engineeCs work. RECEIVED Municipality of Anchorage IvlAY 1 1 1998 DEPARTMENT OF HEALTH & HUMAN SERVI~m^u~r o~ ANCHO~ Environmental Services Division ENVIRONIdENTALSERVJCESDJ¥I~_~ 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Health Authority Approval Checklist LegalDescription: L~e'i- It ~.oc,~ 5' V4~-'-I V¢~ -.~¢~ ParcelI.D.: OI.,~--/A. 3 -~ A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level If A, B, or C, attach ADEC letter. ADEC water: system number Date completed ~ Cased to _ __ /,,,g~s~g height (above ground) /,/,'Wires properly protected (Y/N) FROM WELL LOG / AT INSPECTION Well production · g.p.m. WATER SAMPLE R~ Coliform Nitrate Date of sa.~J~: B. SEPTIC/HOLDING TANK DATA Date installed 5~/~~'/7 7 Tanksize Foundation,,CJ'ean0ut ~N) ¥ g -¢ Depression (Y~ Date of P.ur~ping ~/~':~/q 7 C, ABSORi~TiON FIELD DATA Date in~tal!ed ~' 5- 7 ? Length : ~ 0 Width Pumper Collected by: Other bacteria g.p.m. Number of Compartments 03. Cleanouts(~N) /./o High water alarm (Y/~. .~, o System type T ~[,v c/-/ Total depth I'~ Soil rating (g.p.d./fF or~. $ 3 / Gravel thickness below pipe Effective absorpbon are~ Momtonng T~be prese ~N) Depression ov~r field (Y~ ~ Date of adequacy test ~/n / ~ ~ Results (Pass/Fail) ~ ~J For 3 bedrooms Fluid depth in absorption field before test (in.); ~ / Immediately afler~9~ gal. wate~ added (in.): ~ I ? '/ Fluid depth ~ G/' (ins) Minutes later: I ~ Absorption rate = ~ ~ ~ .g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ ~w~ ~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons -------- ...... Manhole/Access (Y/N) "Pump on" leve '~tt~-~'~P~mp Off'' level at* High water alarm level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot k/ /4 Absorption field on lot N (",¢ Public sewer main I'~ //) Sewer/septic service line /V' /4 On adjacent lets On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation &" '/- Property line ~ -/- Absorption field Water main/service line /0 -/- Surface water/drainage /¢~ ¢ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~0 ¢'P Building foundation Water main/service line Surface water / o ~ ~ Driveway, parking/vehicle storage area ~ o Cudain drain )v 0 ~ ~ ~ ~o ~ ~ Wells on adjacent lots ~ ~ 5 F. ENGINEER'S CERTIFICATION ~¢~r; I ce~ify that l have determined thru field inspections and review of Municipal ~r~ that th~ ~s are in conformance with MGA ~ guidelines in effect on this date. ~J "~ ~.~ HAA Fee $ ,=:~, /~ Date of Payment Receipt Number' 5 ~--~ ~-~./~-~ ) 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number