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HomeMy WebLinkAboutVALLI VUE ESTATES #1 BLK 1 LT 1• ' I DUL Municipality of Anchorage Page 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: GiVa�2o2 PID Number. Name: Wastewater System: ❑ New Upgrade G N IkQ I �S'I� t25N P STD I/ �S Address: I C Coto ( 5 ABSORPTION FIELD Phone: No. of B Brooms: )A Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: I ZGPD/Sq. Total Depth from original gr de% Ft Lot: Black: Sub`di/vision: Depth to pipe bottom from original grade: Gravel depth beneath pipe `I Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: I �� FL Ft. WELL: 1-1 New ❑Upgrade Gravel width: �� Number of lines: Distance between lines: • Ft. Ft. tj 4L Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipematerial: to Ft. Ft. Driller: Date Drilled: Static Water Level: Ins`\t.alllIer:///�_ rG® lJp :Z Date instAAT-,7 ^� _I FL V V•` Yield: Pump Set at: Casing Height Above Ground: TANK GPM FL SEPARATION DISTANCES AepticJ d ❑S.T.E.P. To Septic Absorplion Lin Holding PubliGPrivate Manufacturer: Capacity in gallons:t OD From Tank Field Station Tank Sewer Lines Well 1 1 1 Material: Number of Compartments* Surface i6at+ LIFT STA Water /.(J Lot // �1. t Size in gallons: Manufacturer: Line /✓/�' 'I' I t "Pump on" level at: .'Pump off' level at: High water alarm at: Foundation (� t Curtain _ Pump Make odel Electrical Inspections performed by: Drain Remarks: 61; V-1 of BENCH MARK Loc tion and Descri tion: 2or ,_ Assumed Elevation: ^�6 AV. Lj oa°��yy�� � a 9114 S & S ENGINEERING 2(i4 Inspections performed by: 17034 Eagle River loop Road, Nba eS: 1 St 995 ®'cv°ee v "onv"cvcu va .c®•v ° ® aeB8°° Eagle River, Alaska (�� 2nd ®M ; ROGER J. AFER a Department of Health a uman Ser ices approval ® °�P ® ''°••.••�••'° ti`s it Date: � Reviewed and approved by: � 72-013 (Rev. 9/91) MOA 25 / 77 Permit No. �� �� Page�of !� Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description�� t I PID No.: I Z "!�O 1 o t n n *Ai r I� I_'OZ t-tGJi: 'LYG`L- ew GPti. S.'r SG?ct_E � ••�— ziO/ 72-013 A (Rev. 9/91) MOA 25 Iii J. Ht No. 8A15 PAGE 1 OF MUNICIPALITY OF ANCHORAGE l qL�D DEPARTMENT OF HEALTH AND HUMAN SERVICES laowl P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 _23-012 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920285 DESIGN ENGINEERS & S ENGINEERING OWNER NAME:STOKES CHARLES P & MARSHA H OWNER ADDRESS:10620 EAST TREE DR ANCHORAGE, ALASKA 99516 PARCEL ID:01531102 LEGAL DESCRIPTION: VALLI VUE ESTATES #1 BLK T 1 LOT SIZE: 20807 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 1 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1 L DATE ISSUED: 9/15/92 EXPIRATION DATE: 9/15/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. VERIFY INTEGRITY OF EXISTING SEPTIC TANKS. RECEIVED BY: DATE:�?/Z� ISSUED BY: `� L� DATE: q-/5'%� 1 hP\ A. September 1, 1992 HEALTH AUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 SEWER & WATER MAIN EXTENSIONS SEWER& WATER INSPECTION REFERENCE: Valli Vue Estates, Block 1, Lot 1 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 6941211 Request you issue a permit to upgrade the septic system serving the referenced property. ENGINEERING STUDIES An adequacy testwas performed on the existing system and the AND REPORTS absorption capacity of the system was found to be adequate for a three bedroom house. A test hole was excavated and a percolation test was WELL INSPECTION performed in the area of the proposed upgrade. Attached is &FLOW TEST the proposed upgrade design. This property is served by a Community water system. There are no protective well radii which encroach upon the property. SITE PLANS We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. If you have any questions or require additional information ROADDESIGN for your review, please contact us. Sincerely, f SOILTEST JRTOGER J. SHAFER, P.E. PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN RJS/LSU/lsu 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 §®@® e ��e dRR » RqR� (n \ K4q% §(% % ) \ § |2/ m } $»§ & _IN / § / @ % % e IEAST TRF �mgUPGRADE' 4 »} \ \ n ��k>FUD ' \(\§§�k � |2/ no�mmnm 0/m;.�*� m . o: /*z zi 4/m%±� Of p \q$ �A _ !�* Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: M I+�LJ\__�ttf DA LEGAL DESCRIP``u- I—li ¢71 VSA -1 rerl ownship, Range, Section: REPTH I F�EfJ 0 � 2 I 3 �y 4p •p 4 s `n 5 6 . T 6 , 7- 8- 9 8 9 �fv �i 10- 11 0 11 � J 12 ` G 13 14 15 16 17 18 19 SLOPE WAS GROUND WATER ENCOUNTERED? D S IF YES, AT WHAT L O DEPTH? P E Depth to Water Aller Menitaring7----- _ Dale: PLAN 20 cul PERCOLATION RATE_ TEST RUN BETWEEN COMMENTS (o ~ (minutes/inch) PERC HOLE DIAMETER FT AND 7 FT PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River � LI,,�o�o,7p� CR�poad 0_ 12> 1 —9 '--- ACCORDANCE WVAkLhT�LVt Thj%gRa JYAL AlGUf l INES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) tOM�(ir`"�lL�,-�- 20 cul PERCOLATION RATE_ TEST RUN BETWEEN COMMENTS (o ~ (minutes/inch) PERC HOLE DIAMETER FT AND 7 FT PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River � LI,,�o�o,7p� CR�poad 0_ 12> 1 —9 '--- ACCORDANCE WVAkLhT�LVt Thj%gRa JYAL AlGUf l INES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) August 12, 1922 ROBERT SHAFER. P.E. ROGER SHAFER. P.E. CIVIL ENGINEERS (907)694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS Mike Ke2By VISTA BETTER HOMES 9 GARDENS REAL ESTATE 3000 C Street #101 Anchorage, Alabha 99503 SEWER d WATER MAIN EXTENSIONS REFERENCE: Lot 1; Block 1; Vatti Vue Estates 01 Dean. Mr, Ketty, INSPECTION WATER At youh Ke�luest an adequacy test was pen(onmed on ,the septic system INSPECTION t1 J 'L 4 y 1- U I' y serving the re6ereneed property on August 11, 1992.. WateA was added to the system white water levet measurements were taken ENGINEERING STUDIES Srom the monito)ting tube located within the Qeach6ieCd seepage pit., I AND REPORTS regut to .in6orm you that 6Aom the data collected we have deteAm.ined the absorption .is onty adequate 6o4 a 3 bedroom capacity., To obtain a Health ce4-ti.6.icate 6o4 a 4 bedroom house .the leachS.ield w tt need to be upgraded., The upgrade process begins with the excavation o6 a test WELL INSPECTION hale and per6oAmance o6 a percolation test with groundwater monito)Ling.. 8 FLOW TEST A design can ,then be developed and a peAmlt 6or the upgrade obtained Srom .the Department o6 HeaCth 9 Human SeAv.iees., 16 /you have any questions or .i6 we may be o6 6urther se4v.ice, please SITE PLANS contact us.. S.ineeuty, ROAD DESIGN ' ROGER J., SHAFER, P.,E.I RJS/gm SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 c n ro 0 Z: 0 ' d N M W � a hNhNNNn+ y� C N a Q1 IG - CO C!:D Q NCI W I Q H -LS I r1 Ei }, S i NO W %i r, MUNICIPALITY OF ANCHORAGE DEV .TMENT OF HEALTH AND HUMAN SER% -IS Environmental Health Division D J 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address ?0' $ox HZ4/v 99511 WELL , y� 91- 7-07)/ "j" Phone(s) Permit No. No. of Bedrooms LOT LINE LEGAL DESCRIPTION Lot % Block Subdivision t/t4LL ✓NEST FOUNDATION%o jj Township. Range. Section rZy(( ill AS-BUILT DIAGRAM (Show location of well, septic system. property lines, foundation, driveway. water bodies, etc.) TANKS SEPTIC ❑ HOLDING Manul�actu/�rer IYNG/l Capacity in gallons Material S�E�L No. of Compartments TYPE OF SYSTEM []TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade FT Total depth from original grade FT Fill added above original grade 0 FT Gravel depth beneath pipe FT i8 09 f G Z Gravel length y� V FT Gravel width FT Total absorption area SQ FT Distance between lines FT Number of hoes Soil rating SQ FT Pipe material Installer S �l� Date Installed � �3•-�7 WELLS Ali V SB 7c oa IbA i K ❑ PRIVATE OTHER (Identitv) Classification (A,B,C) Lts�Hi , Total Depth FT Cased to FT Installer Date Installed: REMARKS: ftl:Fre Tl1K 44,o t-W ordill * / ��ST,✓h �Ot� /� �iL T/MlK fi ctP�iPAI� _ /�'0 !, Scale: /�' Inspections Performed by: : aNE�I ENGINEER'S SEAL /fl %A✓K/Lft /�%Lg�. Date inspection was performed according to all �— certily [hat this Municipal and State guidelines in effect an this dale: � l Health Department Approval: '40 � "- �.. Date: 72-013 (3/85) ^ � MUNiC`toALITY OF 4NC1-10RAGE ^��epa,tment of Health & Human Services 5YS L Street , Anchorage, Alaslka 99n01 343-4720 ON - SITE SF tolFI[ PermH Number: 8J()249 Upgrade Data lssued: W/18/W, Owner Names G[UROF G. SCAN[IK� Owner Nddress: P.D. BOX 112614 ANCHORASE, AK 99511 r A N K PF:MIT Day F11one: 316-A71? Parcel 10 01��-311-02 Loi Legal:\5ubdivision: VALLI VUE ESTATES #1 Lot: 1 Block: 1 i Section: 14 Township: 12N Range: 3W / Lot Size .0 A (sq.1t" or acres) Max 8elrooms: f1his Permits 4 iota! C+paciLy: 1 SE�TIC TANK: Minimum toAal sepLic tank capacity: 1,25O gallons" Each septic Lank must have at least 2 compartments. Depth to top of septic tank(s) < 4..) fent requires insulation over tank(s). NGTIFY D.H.M,S. PRIOR TO INSPECTION 9Y ENGJ:NEEo I CERTIFY T�AT: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. [ will insiall the system in accordance with all MOA codes and regulations, a/"d in cnp�1101ce wii-1 the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements !or the set back distances Orom any existing well, wastewater disposal system or public sewprage system on this or any adjacent or nearbylrl. 4. I understand that this permit is valid |or a maximum of A bedrooms. l alsu understand that the capacity of the total system is 4 hedrooms and any enlargement will re i additional pwrmiL. DATE: _~_~~��__�~ _____-�._� .... ( Own er) GEI]R�;��S, 9CHN�!I)ER y y lssued Dy: D(olE: -z/�_--/�-���-`���'___-___--_ I `.2 GREEN H USEIII L C C I r 15 Cn - I I I a /Jo �m%Fz�eTie/h W[L_LS dJ17P•li a� - 900 � 0� . y ;lm®PSss� MOTE ��� Tnr`F^;_�.r:,.'•-7(.,r LOT HAS COMMUNITY WATER � � `�`•'"''+ !�'•�-•`nom^•ti't Y�ti e,' .Vr.'•,- SJri os•? Q �4 CANT 7J 2P o P Na\ DECK <� T P c 7 a Z vNN=O �✓ G F 1E v,^y 40" LEGEND e i::.; 5/S"EEAR •• •fq•an G. Ccopa No. L' .533 � >• 3 Va.i n a OD tib �,0 .•. D /� /'•p• '.c.•c m c .....:....•'.� 'G . GF. ;VEL,., D AREA . o.,. • RALLRGAD-CRJSS TIES j �. .o, e, ryho, r o� o • Q M c- lT] j $e ¢r Reserve Area As -Built Certification I_/1/JI I hereby Certify that I have surveyed the des- cribed property hereon and that no enchroach- ments exist except as indicated, EXCLUSION NOTE: Easements of record, other than those shown on the recorded plat, are not shown hereon. It is the responsibility of the owner to deter- mine the existence of easements, covenants, or restrictions not appearing on the recorded sub- division plat, Under no circumstances should any data hereon be used for construction, est- ablishing boundary lines or fence lines. v,pEOFAt 1•y 6 R . REID, JR. ' 2251 A, •..., Co i PPofessioaa\ e prepared by: BRYAN E, UUvrxtt Registered Professional Land Surveyor 4601 Northwood Anchorage, Alaska 99503 date:5/6/84 by: SEC scale: 1"=30, jobdl84-05-01 grid:2599 ck, legal description: LOT 1 BLOCK I VALLI VUE ESTATES UNIT No,l GRF"_~ER ANCHORAGE AREA BOP'_"VGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME <Ja rnM,0-5 /tr MlP ADDRESS ��`� (' �> C PHONE79V 3�7(E LOCATI ON Lir S/ fiyei ��MAILING ✓i Je 01 &2111' V LEGAL DESCRIPTION L -f I ��//I' Obt'P s_IC/ #/ SEPTIC TANK: jj JJ NUMBER OF DISTANCE WELL ( &G MANUFACTURER Uh ��G MATERIAL /�/l" �r �- COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER OR WIDTH /Z, LENGTH/� DEPTH /0' LINING MATERIALS ; RIB SIZE: DIAMETER_DEPTH_42� DISTANCE FROM: WELL r TOTAL EFFECTIVE ,( BUILDING FOUNDATIONS-�p�/, NEAREST LOT LINE / 5 ABSORPTION AREA (WALL AREA)q_0' L('e SQ. FT. ADDITIONAL ABSORPTION WELL TYPE C" '1O/ CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES NEAREST SEWER LINE , APPROVED DISAPPROVED RE DEPTH SEPTIC TANK_ YJ Sb /{� /n SOiI DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: A1k9 GI f() PIPE MATERIAL: q// Cr/ %6601 qj LOT SLOPE: REMARKS: N DATE 5-ZJ-- '_?L Form No. EQ -037 7 a� �VO Y € S 5 F i NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION I '1 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 C'? INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED MAI�G ADDRESS `� � PHorv�_377411 e / �— SEEPAGE PIT DRAIN FIELD OTHER 3X�/ FINANCED THROUGH TO BE INSTALLED BY �, ZSva so1L TEST RESULTS 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 ( 25O& TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK 5- FOUNDATION FOUNDATION TO SEEPAGE PIT �p DRAIN FIELD r ilx3/I., v/',4_ EEPAGE AREA SIZE TYPE- — �J/�gw'zI XZlwy'cv; b S, J DIAGRAM OF SYSTEM SEPTIC TANK TO SEEPAGE PIT WALL / f SEPTIC TANK , SEEPAGE PIT 2 U DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD d L SEEPAGE PIT 1"6 ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK. iw 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. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. Jl/ � G.A.A.B. OR LICENSED DESIGNER 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 s6 - a APPLICANT'S SIGNATURE Gr/` -'ii ER. ANCHORAGE AREA, BOROUGH Depar :en•t of Environmental Quality 3330 "C" Street Anchorage, Alaska 09503 } Pur f o (rI e 1 F Date performed i 'al � . criotion:— ,.- reports: Soils log e b••f)t F C,ot 1 a- s on Jj O ,Co 14 _ as ground o-aater encountered? If yes, at shat depth? Reeling I Date 1 Gross Time I Net Time I Depth to HCU I I 7 r.71-771 —4 14 _ as ground o-aater encountered? If yes, at shat depth? Reeling I Date 1 Gross Time I Net Time I Depth to HCU Municipality of Anchorage •� Development Services Department / ; Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street �Y 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 Parcell.D. _D�5- II -0 _ COSA# c)Q t)2(�� 1. GENERAL INFORMATION Expiration Date: 9 — 3 i — / 0 Complete legal description VALLI VUE N1: BLOCK 1, LOT 1 Location (site address) 10620 EAST TREE DRIVE •ANCHORAGE. AK 99507 Current Property owner(s) DAVID & BARBARA LANTZ Day phone 223-2945 Mailing address 10620 EAST TREE DRIVE •ANCHORAGE, AK 99507 Lending agency Day phone Mailing address Real Estate Agent DAR WALDEN W/ KELLER WILLIAMS Day phone 865-16406 Mailing address 101 W. BENSON BLVD. SUITE 503 *ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site a Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well 0 Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowner§. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my Guidelines for this application, investigation, based on procedures outlined in the Certificate of On -Site Systems Approval 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. 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Address Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, VD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily tdentitiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory othat t results do not guarantee future performance of the system, nor do they guarantee there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSO. The content of this report is for listedthe sole benefit of the owner other person or party is of authorized, nor orr I it reliance confer any legal night wha whatsoever. any S. DSD SIGNATURE Approved for � bedrooms. Disapproved. Phone 337-6179 Date $ Z DG ."..:.I.. Conditional approval for bedrooms, with the flowing stipulations: Attachments: L/ COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Other I F AIyC ON-SITE••'•.G+= WATER AND : R'= • WASTEWATER : • PROGRAM By: / C> Original Certificate Date: I -3 — (Rev 11105) ­... ..._.. __ Municipality of Anchorage Development Services Department \ Building Safety Division �- On -Site Water& Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: VALLI VUE#1; BLOCK 1 LOT 1 Parcel to: 019�_ .3II-02 A. WELL DATA Well type COMMUNITY If A. B, or C provide PWSID# 210605 Well Log (Y/N) Date completed Sanitary seal (YIN)— Wires properly protected (Y/N Total depth ft. ; Cased to ft. Casing height (abo round) in. FROM WELL LOG AT IN TION Date of test Static water level ry, ft Well production g.p.m. g.p.m. WATER SAMPLE RESU Coliform colonies/100 ml. Nitrate mg./L. Other bacteria colonies/100 ml. Ar ic: ug./L. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA SEPTIC/FIBERGLASS 5/22/74 Tank Type/Material SEPTIC/STEEL1 Date installed 9/23/87 1000 Tank size 500 gal, Number of Compartments 1 Cleanouts (Y/N) YES Foundation cleanout (YIN) Y Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping ell /of Pumper /Vlck4 Rl�lf P'4 12 A� C. ABSORPTION FIELD DATA eEt.ow EXISTING Gant 5/22/74 85 CONCRETE SEEPAGE PIT Date installed) 9 /23/92 Soil rating ED o2 !bd 1_2 System type TRENCH Length 13 ft, Width 3 ft. Gravel below pipe 5 ft. 10 1 24 Total depth •8.75 ft. j Eff. absorption area 130 ft' Monitoring tubo YES Depression over field NO Date of adequacy test :**8/6/09 Results (Pass/Fail) PASS For 4 bedrooms i Fluid depth in absorption field before test DRY in. Water added 735 gal. New depth 4 in. Elapsed Time: 5 min. Final fluid depth DRY In. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — •*1992 TRENCH TESTED D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Access (YIN "Pump off leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? COMMUNITY WATER SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line areas On adjacent lots On adjacent lots 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 tots 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 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS Date COSA Fee S ` f 9 a Waiver Fee $ Date of Payment S� 0 q Date of Payment Receipt Number (7 S `� Receipt Number (Rev. 11/05) I I I I LOT 3 I I I I I I I I I I I I b TRACT A _ .W _ — — — 580 00'00uTt BHT — 171-36 GREENHOUSE HOURS STORY FRAME WTH DAYLIGHT BASEMENT Ill szr GUY CREER 1': LOT 21r.� LS -8033 bar OJ�� 448.T rFrPb . ..... _ _..a a' VST` LEGEND C e FOUND ROAR ' O SET REBAR S/Bx]O' v/ YELLOW PLASTIC W WTIC CLEANOUT LIGHT LOT IS SERVED BY COMMUNITY WATER AS -BUILT OF LOT 1, BLOCK i, VAW VUE ESTATES UNIT N0. 1 M � . v LOT 1 EAST`TREE `a PA 30^ I: DECK GUY CREER 1': LOT 21r.� LS -8033 bar OJ�� 448.T rFrPb . ..... _ _..a a' VST` LEGEND C e FOUND ROAR ' O SET REBAR S/Bx]O' v/ YELLOW PLASTIC W WTIC CLEANOUT LIGHT LOT IS SERVED BY COMMUNITY WATER AS -BUILT OF LOT 1, BLOCK i, VAW VUE ESTATES UNIT N0. 1 M � . v EAST`TREE `a 30^ I: I hereby certify that I hove surveyed the property shown and described hereon and Del Norte Surveying, Inc, that no encroachments exist except as indicated. It is the' responsibility of the owner to determine the existence of any easements, covenants, or restrictions which ra d "asst Adw"kno" �I do not appear on the recorded subdivision plot. Under no circumstances should any (Kn 71544 h --(9M tadOalrAX data hereon be used for construction or for establishing boundary or fence lines. I Drown G. Greer I Grid 2539 1 Scale V-30' 1 Dote Aug. 23, 2009) File No. LANK—AB.DWG I MUNICIPALITY& H ANCHORAGE • '� DEPARTMENT OFFHEALTH &HUMAN SERVICES Division of Environmental Services 19 On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# 1. GENERAL INFORMATION HAA# h IQNgn(`r(n_12� Complete legal description Lot 1; Btock 1; Vatti. Vue E3.tate6 01 Location (site address or directions) Property owner Cha)tteb S.toke3 10620 East Ticee Drive Day phone Mailing address 2310 Haxding Avenue Musset Shotea Alabama 35661 Lending agency Mailing add Day phone Agent Mike Kettcy VISTA REAL ESTATE Day phone 562-6464 3000 C St+cee.t #101 hm: 346-3067 Address e eho4age,llaahn 99505 - Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 XX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site — Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC 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 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 CERMO Phone Address 1; 1,34 Engle River Loop Road No. 204 'eagle River, Alaska 99577 Engineer's as aEngineer's signature Date 6. DHHS SIGNATURE XL_ Approved for u ^ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 0 UJITIC Date �f iZ- 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. IM25(Rev. 1/91) Back MOA 921 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST *AL)" VUR Legal Description: -5b � t L­� Parcel I.D. 072 A. WELL DATA Well typeOO' "11'ltlJ q_ f A, B, or C, attach ADEC letter Log present(Y/N) Total depth Sanitary seal(Y/N) Date of test Static water level Well flow Pump level Date completed Cased FROM WELL LOG ADEC water system number-?i,"-1'7th X10(006 Driller Ing hei Wires properly protected (Y/N) AT INSPECTIONMUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION SEP 2 g 1992 g.p.m. YCE I V E D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 7,00 + ; On adjacent lots Absorption field on lot 200' + ; On adjacent lots Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/HOLDING TANK . DATA �� �1 2 Date installed t� - 22 -all- Tank size 1000 Compartments / Cleanout (Y N) //-Foundation cleanou (Y N) Depression (Y/N High water alarm (Y& Alarm tested (Y/N) OIL Date of pumping -7 Pumper��e, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 1 (of 5pzj 4XL:) Well(s)onlot I�T� Onadjacentlots—Foundation To prop(Absorption field Water main/serviceline Surface water/drainage 72-026 (Rev. 7/91) From CONTINUED ON BACK PAGE C. LIFT STATION Date instaed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical codes level at Man SEPARATION DISTPMCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer "Pump off" level at Cycles tested Surface wa D. ABSORPTION FIELD DATA Date installed, 'Z- Soil rating 2 r'i System type_"29ZD %2�44, Length (?�' Width �'? �__GraveUthickness i r Total depth ' v✓ Total absorption area I?22�_ + �� �� Cleanouts presen Y/ ) Ll IqZ.. Depression over field (Ye Date of adequacy test: Results (pass/fail) IS fi for Peroxide treatment (past 12 months) (Y SEPARATION DISTANCE FROM ABSORPTION FIELD TO: .n. .0•9u If yes, give date Well onlot __�• Onadjacentlots %l�f71 i Propertyline_ / To building foundation IBJ To existing or abandoned system on lot On adjacent lots ?-:2n f -F Cutbank t.10 iJ:Z Water main/service line ( O 14'-' Surface water 4— Driveway, parking/vehicle storage area Curtain drain Q D t..t r V_=r-A D,W. -X, f iA t STI _ 66 SY A -p E. ENGINEER'S CERTIFICATION2 I certify that i have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ENGINFFRING Signature 17 13" ";a 1, Rivr' Loop Road No, 204 z.ad iveP. Aa ca 99.577 Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-026(Ray. 3/91)Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number �'� ooQOoo U14 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 FOR: S & S Engineering April 22, 1992 PWSID # 210605 WALTER J. NICKEL, GOVERNOR (907) 349-7755 My review of the records on file in this office reveals that the Valli Vue Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, U, J'i 1,0W Byron Roys Project Engineer BR/cf MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES II—t /'� (� CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date �C- ����' /)- 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or direction/s) �p��L��sT S�� e: Telephone: Home �Y,?%729 Business (b) ..Property Owner _ _ � E-��� � p Mailing Address (c) Lending Institution �!� telephone i Mailing AddressG- (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: or: Check here ❑, if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well ❑ Communityg 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, 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. Page 1 of 2 72-025 (Rev 8/861 Front 5. 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 �7 C S 'T `� Telephone rc y c Address P Date 6. DHHS APPROVAL Approved for 40" bedrooms by/� a` / v' Date Approved Disapproved Conditional Terms of Conditional Approval dhh5 CAUTION �11gm,va�"' /v-6-$7 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 courtesyto 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. Page 2 of 2 72-025 rae� 8/861 sack B. SEPTIC/HOLDING TANK DATA r"z-,/iy /oe 0 / Date Installed As Size fz>a No. of Compartments / StandpipesYf ) Air -tight Caps#J'iV) Foundation Cleanout/N) Depression over Tanls(YO Date Last Pumped :Z/A Pumping/Maintenance Contract on File (Y/N) rU1_1A for �/A Holding Tank High -Water Alarm (Y/N) Ate— Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well .>'Zo t� To Building Foundation To Property Lirte 12= 9� To Disposal Field To -Water Main/Service tine i z©/ To Stream, Pond, Lake, or Major Drainage Course f�t /Ver Comments , ' Page 1 of 2 72-026 (Rev. 8/861 Front MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) OF.A' CHECKLISTFEBRUARY 1984 pAUNICIPALITI' ` CPJI IG. I 264-4744 ✓ �` ��yu� Legal Description: !� A. WELL DATA � Well Classification If A, B, C, D.E.C. Approved/N) Well Log ent (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Groun Sanitary Seal on Casin ) Electrical Wiring in Conduit (Y/N) Depression Aro 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 Sewer Line To Neares ublic Sewer Cleanout/Manhole To Nearest Sewer vice Line on Lot Water Sample Collects ; Date Water Sample T Results Comme B. SEPTIC/HOLDING TANK DATA r"z-,/iy /oe 0 / Date Installed As Size fz>a No. of Compartments / StandpipesYf ) Air -tight Caps#J'iV) Foundation Cleanout/N) Depression over Tanls(YO Date Last Pumped :Z/A Pumping/Maintenance Contract on File (Y/N) rU1_1A for �/A Holding Tank High -Water Alarm (Y/N) Ate— Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well .>'Zo t� To Building Foundation To Property Lirte 12= 9� To Disposal Field To -Water Main/Service tine i z©/ To Stream, Pond, Lake, or Major Drainage Course f�t /Ver Comments , ' Page 1 of 2 72-026 (Rev. 8/861 Front C. ABSORPTION FIELD DATA i Soils Rating in Absorption Strata Type of System Design Cr, Z Date Installed S 2z,/i97% Length of Field /S Width of Field z- Depth of Field Gravel Bed Thickness l Square Feet of Absorption Area -- 3 y Standpipes PresentViN) Depression over Field (Y/(,�) Date of Last Adequacy Test Results of Last Adequacy Test /l,✓ S Separation Distance from Absorption Field: To Water -Supply Well / To Building Foundation Lot /l To Water Main/Service Line "z o To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Property Line �S To Existing or Abandoned System on On Adjoining Lots '> > �� To Cutbank (if present) 6V14 i Dimensions — Manhole/Access (Y Level at — Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have b cked verified, conformed to all MOA and HAA guidelines in effect on the date of this inspection. i Signed Date Company S .� _ MOA No. V OF /q4 ®0� P •° °, Receipt No. /U O 6 U 0p���' • 9TN •°.�0/'�6 7 Date of Payment % 0'�'t•' °• ••• •°,��„� Amount: $ /10 Cl) IER C. REID, JR. ®Q° °• CE • 2251 Page 2 of 2 ��� Q.p °.�°*°�\ •t\� �a �._ro7essiot� �• �' 72-0261Re, E861 Reck If � ,itf � WALTER J. NICKEL, GOVERNOR 1�, ��Al� i �, , C r LI L'AA li Lf"13 rq DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE (907) 349-7755 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 September 17, 1992 Mr. Roger Shafer S & S Engineering SUBJECT: Valli Vue Subdivision Class "A" Public Water System, PWSID 210605 Dear Mr. Shafer: I have completed a review of this office's files concerning the monitoring status of the above -referenced Class "A" Public Water System and found the following: 1. The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on August 10, 1992. This does meet the provisions of 18 AAC 80.200(a) of the State Drinking Water Regulations. 2. The last inorganic Chemical Contaminants Sample results were submitted to this Department on August 13, 1992. This does meet the provisions of 18 AAC 80.200(a). 3. The last Radioactive Contaminants Sample results were submitted to the Department on October 12, 1988. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were submitted to this Department on November 12, 1991. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above -referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Enviornmental Eng. Asst. II r ;,.A on i eeyoao P•'Ver by C. i:. n n n n STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 "C" STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 DATE: __-9--30--87 -------- PWSID #: 210605 To Whom It May Concern: According to the records on file in this office, the _ VALLI VUE Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Ronald S. Klein Environmental Field Officer r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL l OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) ���-1 "LS/,;_�c"i. I-),- /Z l/ve -*- / T/av 23�0 S- 2. 4 btll eTvl"i � �v •'t�tl.. rty Owner C. (c) `Lkging,lnstitutLQn b." (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: List contact_Rerson and day phone au TYPE OF RESIDENCE Single -Family Number of Bedrooms _ 3 Telephone: Home 75141-17"F Business & gr—/70 3 Telephone Check here Fd, if hold for pick up. �r bel?w./ 3. WATER SUPPLY Individual Well ❑ Community, 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 J4 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. Page 1 of 2 72-025 iRev 81861 Front r MUNICIPALITY OF ANCHORAGE (Mol MUNICIPALITY OF&�IORITY APPROVAL (HAA) ENVIRONMENTAL SERVICECHECKLIST - FEBRUARY 1984 264-4720 AUG 1 2 1987 Legal Description: � / � � �zAe RECEIVED -7 „-J t?=3” s,14 A. WELL DATA Well Classification PO4/ye— If A, B, C, D.E.C. Approved (9N) Well Log Present (Y/N) Date Completed 1 Total Depth Cased to Depth of Grouting Static Water Level Pump Set Casing Height Above Ground — Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on To Nearest Public Sewer Line Cleanout/Manhole Water Sample Water Sample B. SEPTIC/HOLDING TANK DATA ;al on Casing (Y/N) — Around Wellhead (Y/N) On Adjoining Lots On Adjoining Lots — To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Date Installed 5'12a -7`i Size /"Do C) No. of Compartments Standpipeso/N) Air -tight Caps U"IN) Foundation Cleanout/N) tV/ "126 ER C/w0Y RT Depression over Tank (YO Date Last Pumped f} 6 7-� 1 fAlCS R,26 , Pumping/Maintenance Contract on File (Y/N) %J/4 ; for Holding Tank Nigh -Water Alarm (Y/N) ) 1A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation 6 To Property Line To Disposal Field /% To Water Main/Service Line 2 To Stream, Pond, Lake, or Major Drainage Course None Comments �r Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata l5S �7 14w- Type of System Design Date Installed S ,i c. z�� X Length of Field I r i Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area — -1 G Y/©ReDepression over Field (Y/(9-- Results sults of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 'J/� To Building Foundation 131 Lot N/// To Water Main/Service Line 72011 i Standpipes Present // Date of Last Adequacy Test S,L�r To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Property Line /S To Existing or Abandoned System on On Adjoining Lots 7 20 l To Cutbank (if present) No,w A-ez,^ 30 t I — Dimensions — Manhole/Access (Y/N) Pump Off' Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have ed, verifie , )r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA N���7—��� Receipt No. o U /—«U 0_3 op �� ° ''• � �� Date of Payment 00.0 �° ��°�• °•�•� a 6 r...B Amount: $ .1106 A menu _- REI ! dr Page 2 of 2 72-026 (11/84) STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 DATE: ___—Ausmst_13:_1987_-- PWSID: 210605_______________ To Whom It Nay Concern: According to records on file in this office, the--VALLI_VUE Water System is in compliance with the State Drinking Water Regulations for monthly bacteriological sampling only. Sincerely, Ronald S. Klein Environmental Field Officer