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Home My WebLink AboutVALLI VUE ESTATES #1 BLK 1 LT 2Onsite File Valli Vue Estates #1 Block 1 Lot 2 #015-311-03 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://w .muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211326 Work Type: SepticTank Upgrade Tax Code Number: 01531103000 Site Legal Address: VALLI VUE ESTATES #1 BLK 1 LT 2 G:2539 Site Mailing Address: 10630 EAST TREE DR, Anchorage Owner: SELLE-REA NOEL D & MARIKO L Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: moot al)cparnicnot �u 8/5/2021 Lot Size in Sq Ft: Total Bedrooms: 8/5/2022 20419 ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Oil" Issued By: Date: s/Z� Date: 5 �� MUMCPAUTY OF ANCHORAGE Development Services Department7 17 On -Site Water & Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-311-03 Property owner(s) NOEL RAY Mailing address 10630 EAST TREE DR, ANCH, AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) VALLI VUE ESTATES #1 BLK 1 LT 2 Legal description (Township, Range & Section) Lot Size 20,419 Sq. Ft. Number of Bedrooms 5 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank 0 Upgrade El Duplex (D) El Holding Tank ❑ Renewal❑ Multiple Multiple Dwellings El Privy El and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: 5 0 2 1 Date of Payment: Receipt Number: 06 5 `I 5% Receipt Number: Permit No. d 5 P1 119 ,2(o Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Aug. 5, 2021 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic tank permit Legal: VALLI VUE ESTATES #1 BLK 1 LT 2 To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. The entire area is serviced by community water and the comm. well is over 200 feet away. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211326, Rebecca Carroll, 08/05/21 1"=50' PROPERTY LINE EXISTING HOUSE -EAST TREE DR-NEW 1500 GALLON PLASTIC TANK W/ 20" RISER, DEMO TANK PER UPC DRIVE W A Y SCALE: DJRDRAWN: DATE: VALLI VUE ESTATES #1, BLOCK 1, LOT 2 Anchorage, Alaska NOEL AND MARIKO SELLE-REA 8/4/2021 VALLI VUE ESTATES #1 BLOCK 1, LOT 3 VALLI VUE ESTATES #1 BLOCK 1, LOT 1 VALLI VUE ESTATES #1 BLOCK 1, LOT 19 HILLSIDE PARK PUD LOT 21 HILLSIDE PARK PUD LOT 26 -EAST TREE CT- -DOUBLE TREE CT- DCO DCO TCO COMM. WATER LINE, ALL OF THE LOTS SERVICED BY COMM. WATER NO WELL WITHIN 200' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211326, Rebecca Carroll, 08/05/21 GRE/f _�R ANCHORAGE AREA BOR; IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL $YSJEM-„ C. ,o�J / Nd_A4X0yQj4 ✓ C' � �getPos-^-_._ of W - NAME � v (//J G ADDRESS �� /,��/ / PHO/N LOCATION �CLa-d - .O� t��C_ fGAL DESCRIPTIONG�� / VV SEPTIC TANK: DISTANCE , NUMBER OF FROM WELL��I%Tt/ -'P'P�'dMANUFACTUR R) ��- ��'A'�AdTERIAL r' QX� COMPARTMENTS INSIDE LENGTH/L& ( INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. TILE DRAIN FIELD:'°°/X/��$p TOTAL LENGTH DISTANCE FROM WELLO-e_�"7'07 y' FOUNDATION NEAREST LOT LINE OF LINES NUMBER OF LINES / DISTANCE BETWEEN LINES TRENCH WIDTH J/ IN. TOTAL EFFECTIVE (%%0 nc0-ND+2+t� ABSORPTION AREA J SQ. FT. LENG OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE IN. ABOVE TILE IN. WELL: TYPE CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION , LOT LINE , SEWER LINE CESSPOOL , OTHER SOURCES DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK . SYSTEM_ APPROVED DISAPPROVED R MARKS DISTANCES: _ DIAGRAM OF SYSTEM INSTALLED BY SEWER LINE DEPTH: 3 SrO� GAJ A.L.rreii1 I PIPE MATERIAL: k 7,a'� LOT SLOPE:h�Y3il /6 REMARKS: DATE i�-PPROVED_ •� l--� G.A.A.B. Form EQ -032 -"� -''\ GRE _.� ANCHORAGE AREA BORT, 3- II��1I DEPARTMENT OF ENVIRONMENTAL QUALITY PERMyI/TNO. p ♦ a�� I II 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT 5 �/ //� MAILING ADDRESS/ dam/ c: AGS L�PHONE Z 7� NAME OF APPLICANT MAILIc`G INSTALLATION LOCATION LEGAL DESCRIPTION e�_Oi INSTALLATION OF: SEPTIC TANK L� SEEPAGE PIT /. DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED '� �Ufa7 ��/�~^��G �✓��n �L�'/�`X��I��G FINANCED THROUGH �, / TO BE INSTALLED BY so1L TEST RESULTS / "'G�� '�� NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED / T� iJ' 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 G�� r TYPE �`^ (%✓/li�J� SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PTT_,DRAIN FIELD SEPTIC TANK TO SEEPAGE Pig' WALL i Pj SEPTIC TANK �, SEEPAGE 'PI'frr DRAIN FIELD -� TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PM /� DRAIN FIELD SEPTIC TANK, /ejD. SEEPAGE /Do, 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. G.A.A.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26-G8 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE /G'�� APPLICANT'S SIGNATURE FORM NO. EQ-016�S/�� p'T� -- - f_�_/ -t - - --T-+- l pIA. i i I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26-G8 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE /G'�� APPLICANT'S SIGNATURE FORM NO. EQ-016�S/�� p'T� r, i I GREATER ANCHORAGE AREA BOROUGH a + DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 5 650 1 ANCHORAGE ALASKA 99502 TE+.EPHot,E 279.8606 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT / u�/L'�' -- --- MAILING /A�DURF.SS INSTALLATION LOCATION LEGAL DESCRIPTION 'Iel- r:. PERMIT NO. PHONE-; 5Yj � z 9 421 INSTALLATION OF: SEPTIC TANK V SEEPAGE PIT --L--. .DDRAIN �Y-FIELLDYL , OTHER TYPE AND SIZE OF FACILITY TO BE SERVED TO BE INSTALLEDBY SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED // �"' PERMIT VALID ONE YEAR - FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE ZTYPE +i'PPI DY COOfY Pt. P.SEEPAGE AREA SIZ yE ��./"`' //�j% TYPE � MINIMUM DISTANCES. REQUIREMENTS DIAGRAM OF SYSTE F 5 ft.�1!DATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT 20 ft. DRAIN FIELD 10 ft. " [AFT IRON SIPHON SEPIP[ MILD AIRTIGHT CRIB SEPTIC TANK TO SEEPAGE PIT WALL 15 ft - - TANK CAPS w SEPTIC TANK 5 ft. , SEEPAGE PIT 20 ft. . DRAIN FIELD 10 ft. _ - TO NEAREST LOT LINE. - CAST /".q WELL TO SEPTIC TANK DRAIN FIELD — SEEPAGE PIT ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK 10 ft . SEEPAGE PIT 10 ft. DRAIN FIELD 10 ft. SEPTIC TANK, 25 ft.. SEEPAGE PIT 100 ft. , DRAIN FIELD 50 ft. TO RIVER LAKE STREAM Lcvel CAST IRON INTO salt MINIMUM C 1 roquirO whenever line crosses under driveeay. L- �AAYEL RA`Rf ILt AROL':10 [p B. TIII NI NU!I ABOs'E WATER. ABLE)/' ' NI1.1 E!'if YELL + C'S CCHSIU!R ARr,A YELLS. - ' '•'N F.LL a CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF ?w SLEPAGE Pit EXCAVATION BASED ON SOIL TCST. 11:e1 :'!I1CAL EXCAVATION 5 FEET INTO UNDISTURBED SOIL. (I 7,K- '.,p' Ra PIT- 100' +:0 SEE@ LIIiE- 10 Grade: V -per !CO. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT or 1/4' p r foo: — B.'P_-PUBLIC A"Pt 10' prcreedin� FITTED WITH AIRTIGHT REMOVABLE CAPS. 10 TANK -80" HOUSE Lank 6 the. should I not exceed 2f. ' TO "IT- 120' NO SHIFT. 1.1:1;- AO 6' per 100 on flat GRAVEL BACKFILL 411 --no' ONLY CAS; IRON SCUER terrains. CAST 1POH, SEPTIC L IP.E PIPE s' \ TAnk I I"1(4 CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.-�-- I'104 IC II:TB l!:+= INCH DISTUR..P.[JI--j CAST IRON SIPHON PIPE `4 SOIL TO TA^.r,. 200' SEEPAGE PIT IO PIT - 1.00' I"Ca SEVER CRIB 16W-91ISOUPC1 OF .`JC� ' GRAVEL OACRFILL I HEALTH AUTHORITYOR 20 MINIMUM LICENSED DESIGNER APLST LOT LIME '1 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26.88 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE/� APPLICANT'S SIGNATURE`C.L.�C-�/� ANCHORAGE r - FAIRBANKS -- CONSULTANTS, INC. �` JUNEAU 249 EAST 51ST AVENUE • P -O. BOX 8087 ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 • TELEX 090.35419 September 24, 1975 R & M No. 562127 Mr. Jess Holiday - - Advance Realty 601 East Northern Lights Blvd; Anchorage, Alaska 99503 RE: Test Hole and Soil Log Report for Sanitary System Lot 2, Block 1, Valli -View Estates #1 Dear Mr. Holiday: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This inves- tigation was performed in accordance with your request of September 23, 1975, and those procedures outlined in a letter dated July 15, 1975,- g by. Mr. Rolf Strickland of the Greater Anchorage Area Borough Department $ of Environmental Quality. 'A single test hole was put down within the Lot 2 areaforthe purpose of - defining general subsurface soil conditions for the proposed sanitary p system. Excavation was accomplished with a tractor -mounted backhoe and the test hole was extended to a total depth of 14.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. - - - - - - Ground water was not encountered in the test hole.' �I We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. - - - - Very truly yours, R & M CONSULTANTS, INC. _ James W. Rooney Vice President - - JWR/WED/ja Encl. - t xc: GAAB -- - _ _ it 142273 TH-1 9-24-75 ' 0.0' SILT; TRACE SAND & ORGANICS SILTY SAND (SH) - 2.0' aO :Q °Dd .d SANDY GRAVEL TRACE SILT (GW) .a.o: - - :OP: - . q'c - - o:; 14.0' T.D. NO WATER TABLE i i ,I Log represents location of test hole Lot 2, Block 1 Valli -View Estates #1 r ADVANCE REALTY PROPERTY R Consultants I= Log of Test Hole ANCHORAGE FAIRBANKS _ ALASKA JUNEAU _ 'Anchorage, Alaska - oarE 9-24-75 ISCALE 1"=3' DwN ar WED CrWD er WED Paw. No562127 lowe No. A -01--i 142273 Parcel I.D. 015-311-03 Certificate of On -Site Systems Approval Expiration Date: S y7' 1 7 1. GENERAL INFORMATION Complete legal description Valli Vue Estates #1, Block 1, Lot 2 Location (site address) 10630 East Tree Drive Current Property owner(s) Gerald and Anne Morris Day phone _ Mailing address Real Estate Agent 10630 East Tree Dr Anchorage, AK 99507 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: Individual Well ❑ Municipality of Anchorage = Community Class Well tr_ On -Site Water and Wastewater Program ll (907)343-7904 saFEr: Certificate of On -Site Systems Approval Expiration Date: S y7' 1 7 1. GENERAL INFORMATION Complete legal description Valli Vue Estates #1, Block 1, Lot 2 Location (site address) 10630 East Tree Drive Current Property owner(s) Gerald and Anne Morris Day phone _ Mailing address Real Estate Agent 10630 East Tree Dr Anchorage, AK 99507 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ll WaiverNariance Day phone TYPE OF WASTEWATER DISPOSAL: Individual RX Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: v wV COSA to be released to }h gineer, unless otherwise requested by the engineer. Date:- L O 2 p l S COSA Fee $ 5 _ p Waiver Fee $ Date of Payment 9112,115 c Date of Payment Receipt Number 0346 ZG Receipt Number COSA#— 05C 1.J H 30 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that theta are no hidden defects or encroachments. Therefore we cannot provide anywarranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. - - - - Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIG _ System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone (907)272-8218 Date 6/5/2015 Conditional approval for bedrooms, with the following stipulations: By: / Original Certificate Date: The ici f orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet f _, If more than 1 septic system is on the lot: COSA Checklist # + of 1 Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description --Valli Vue Estates #1; Btock 1, tot 2 A. WELL DATA Well type Class 'A' If A, B, or C provide PWSID # 210605 Parcel ID: 015-.311-433 Well Log (YIN.) Date completed Sanitary seal (YIN) _ Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septata/Steel Date installed 09/24/1975 Tank size 12501500 gal. Number of Compartments 1 �1 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression ovet tank (Y/N) N High water alarm (YIN) Date of pumping 10/19/14 Pumper A+ C. ABSORPTION FIELD DATA Date installed 09/24/1975 Soil rating (g.p.d./ftz or ft2/bdrm) 85 Sf/br System type. Crib/Trench Length 11 /16 ft. Width 11/3 ft. Gravel below pipe 6/6 ft. 1251221 Total depth ft. Eff. absorption area 456 ft? Monitoring tube Y- Depression over field N Date of adequacy test 05/05/2015 Results (Pass/Fail) Pass - For 5_bedroom J 0/81 Water 785 New depth Fluid depth in absorption'field before test in. added gal. Elapsed Time: 170 min. Final fluid depth 0/81 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NO If yes, give date D. LIFT STATION Date installed "Pump on" level at Size in gallons in. "Pump off" level at Manhole/Access (YIN) _ in. High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Propertyline 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent Jots 100+ Absorption field 5+ Surface water 1-00+ in. Water main 10+ - Driveway, parking/vehicle storage1�* _ F. COMMENTS Uf\j, C2 t tJi�(r CCD(: Csr✓D I Ct /CWP CLOG Fk G. ENGINEER'S CERTIFICATION l certify that / 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. Engineees Printed Name Steven R. Pannone Date 05/08/2015 COSA canary sheet -2-6-1 5.doc Ai 0�m AL. ■ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) /d r Z 13.1E 1 I *66 y'uiT lstT- 4- Location (address or directions) %d t_J iib F -AST 79&C ni2lt"& b Applicant Name A kw Mo2Rl S T �bs.) -3�G - t b �`/ Business Applicant Address tUL" hr i (c) Applicant is (check one): Lending (d) Lending Institution Address (e) Real Estate Company and Agent Address L yQuyer ❑ ; Other ❑ (explain); Telephone Mail the HAA to the following address: n • 14161-f 0061 Telephone 3( res Ar«-rtc J" I / 993 HAJchora A Asll-A 'N, 03 2. TYPE OF RESIDENCE Single -Family W Multi -Family ❑ Other Number of Bedrooms - 13ei✓r_ooY)'V 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 Public ❑ Community ❑ Holding Tank ❑ Note: If cgmmunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 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 L• fi/�!fi Gllfo/iiGLI'/�G Telephone 7�' sj� 4 Address �n7 trc fur% ��3 Date �r�c f+lG < �ISQ3 ca J 6. DHEP APPROVAL'/ Approved for Approved bedrooms b 1Z Disapproved Conditional _ Terms of Conditional Approval dhep CAUTION Engineer's Seal Date y The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) it MUNICIPALITY OF ANCHORA(3'- DEPT. OF HEALTH R MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL P3tl TECTIgN HEALTH AUTHORITY APPROVAL (HAA) APR 16 M6 CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Ze)r r,2�� I '"e�// ED (114LLL VuE E57_472 --S" A. WELL DATA Well Classification CLASS ff OA B, C, D.E.C. Approved (Y/N) V Well Log Present (Y/N) N14 Date Completed u 114- Yield Total Depth 'V/A Cased to n/IFF Depth of Grouting Nl, Static Water Level Aldi Pump Set At MIA Casing Height Above Ground AIM Sanitary Seal on Casing (Y/N) 11/" Electrical Wiring in Conduit (Y/N) N1A Depression Around Wellhead (Y/N) IVA— Separation Distances from Well: To Septic/Holding Tank on Lot wAir aOvi ; On Adjoining Lots a� To Nearest Edge of Absorption Field on Lot "-266'tOn Adjoining Lots zx' 7+ To Nearest Public Sewer Line 1,1Z4 To Nearest Public Sewer Cleanout/Manhole VLA- To Nearest Sewer Service Line on Lot M/A, Water Sample Collected by N!R Date Water Sample Test Results Comments et AH S A �/ArC-e .5 S?C,T1 B. SEPTIC/HOLDING TANK DATA Date Installed �9 !-5 Size 0-505C° No. of Compartments �'� Standpipes (Y/N) Y Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contract on File (Y/N) N ; for t/ Holding Tank High -Water Alarm (Y/N) uIA Temporary Holding Tank Permit (Y/N) N1la Separation Distances from Septic/Holding Tank: To Water -Supply Well A;tb e- kle2l— �� l� To Building Foundation To Property Line /& / t5i _ '41/ To Disposal Field To To Stream, Pond, Lake, or Major Drainage -Course Comments' U[lJNCfZ lrlc�[1� TCD i/InlBl fit? <7> t /� lC�/w_ �� n Page 1 ofi;Z 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata $lS IVs7G11102 Type of System Design Date Installed %11,2 4 175 Length of Field �� r 71Zc1✓C-H �7cU5 121'1- ra-eo () Width of Field 3 Depth of Field 3r% cei Gravel Bed Thickness /,, �Cy—r /2c, Square Feet of Absorption Area 2%!t Standpipes Present (Y/N) ti Depression over Field (Y/N) !✓ Date of Last Adequacy Test / V1141 /3 J !� Results of Last Adequacy Test1k7 I�FNG'YO/{ 1 �cr %iec�Vee�yct. �7c 1/45 Q Separation Distance from Absorption Field: 1 To Water -Supply Well P"I'd 1541 411 119014'- To Property Line 14 To Building Foundation 3 S r To Existing or Abandoned System on Lot NSA On Adjoining Lots 4(2 1 = To Water MainServiceL e , To Cutbank.(if present),� To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Iqe 1 Comments i2&A1CP/ /n/OT GRA/N GE nu u9ATE2. D•T Rr"c-r�rr/J AeL 'Tyle /erP•rr�2tf L-)/-G�G/Z /t7 A 3 4' ae/(CY/ ooa rest GGvEG D. LIFT STATION Date Installed Aler 4(pheta-d,/e- Dimensions Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA *" Check Permitted Bedroom Rating Against HAA Request Icertify tha avec eckedyv ri%d, or. nformedtoallMOAanndHAA guidelines ineffect onthe date ofthis inspection. Signed Date /�� X -e Company "lEi� "� L� MOA No. Receipt No. `37 2 g(-) Date of Payment #- a,- 4' Amount: $ •� �- Page 2 of 2 72-026 (11/84) APPLIC!"'AT FALLS OUGT' UPPER HAL'`\ONLY Property Owner ( 4 ANnf� Ip t01�i-lJ 13;�'32V6 _�a `� i( 22D Matting Address �R �j JJB ( ��(JJ� Zip Code �q�U� Beyer TCN (;ad vh o kf Address Zip Code Lending Institutionp,NK d ) (Z Phone ,.� Address & ( S _ ( C, �1 ! Zip Code Realty Co. R Agent Phone Zip Code Address Date ) rr- Legal Description 1r 'r\ �� t}l� .�`t �}C'l `L) lSICIE\i two I! Nocx '-1— `I L Street Location Tye of Residence Single Family 5 ❑ Multiple Family No. of Bedrooms J ❑ Other Water Supply ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. K Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Inspector Sewer Disposal , (� ;K) Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector InspectofI� J \-,� __� `1 1+1v�`'U Field Notes: - DFcT C° _ ENVIe /— 'P. );V. -,_r,.a U :.TION - RECEIVED APPROVED BEDROOMS - 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' _ O DATE BY: 11.1 Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size 1' „) i , -' Well to Tank 72 023 (3182) C i Wit i Western States Associates, Inc. 1fSTE STAT F.S S pclS II� lit AS - — 1 l I Work Order Number S .,heel Number 633 East 81st Avenue ANCHORAGE, ALASKA 99502 I WORK SHEET Project I Cl'�crr Date - Conor.. tr.r _ Foreman/Superintendant - CESUiIPTIO'I OF ;ORK TO ilii l: GcJP(lL/eCk C' Oetail Of LA06r, � •:i;;"cot cr?fa to is 11 Hers O:' Qhul,ti ty lirly. Rate or Us) iI Cost Equipment Cost Material Cost Labor Cost Total hilount P, sits Sob to La Ittmize Payi 011 Tales and Inial a -t•, Fril .j lis its,, Ocerhrad 3 Profit etc, Below. Show each Rate.! Total ,tarllllls ... Ill"Il N-. .bo this is e. Contractor report of Li -:u 5 aaterlalz oxp=nir.i this date, but not an authorization for payment: __. Acknowledged by Contractor Wit i X3347 3 �2o�..t-• ^ ,y�vy�'g�o-e+ti°-� a,---n-r�,.�j o� is " � iia 6 ....w ✓�.«-too, �%i��,s; t/.'v62m , // � ,A 0