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Home My WebLink AboutVALLI VUE ESTATES #1 BLK 1 LT 10 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ,~'A//J? ~'O/4,~D ~0 SEPTIC ABSORPTION Address TANK FIELD WELL P.one(s) Permit No. NO. of Bedrooms WELL LEGAL ~ESCRIP~ION /W, _ ~ ~,i V~g F0UNnAT~0N /~' 2~ ~O'+ Township, Range, Section AS-BUILT DIAGRAM {Show location of well septic system, prope~y nes, oundation, TANKS SEPTIC ~ HOLDING Manulacturer Capacity in gallons Material No. of Compadments ~T~ 2- ~ ~,, TYPE OF SYSTEM ~ ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ Depth to pipe bottom from T°tal depth fr°m °rigin~l grade % ~0 FT ~ FT Total abso,ption a,ea Distance betwee, lines WELLS g PRIVATE g OTHER Ildenlilvl BEMABKB: I~ ~unicipal and Stale guidelJn~ in ellecl on this dale: 72-013 (3/85) Id t..I Iq .i: C :I: F' A I... ]: T Y 0 F A Ix! C I'"1 0 R Aii:) E Department c:~f Health & l'-IL/liial] Sepvic:~s [~[:]5 L. ~3/:.l"eet~ AFIc:l"~opag~ Alaska 99501 34[S-4720 hi "' S Z '1" E S E W F2 R & S E F' T I C Issued: 0812.9189 Engineer' Desiglqed T A N I-::: P E IR I"! :[ T ER~ner I,,lame~ BENNY L..EONARD Owl']~r Addr'ess~ :l. 41:L H STREET ~/BICH, AK 9950 ])ay F:'h c)n e ~, 277-4 F'arr.:e:[ Id: C)15--3:i.t.--:[1 Lc)'k Legal: Subd:Lvisic)n: VALJ...I VUE EG"F. :P~$:l. [u.C~t.: Sect:Lon: :t4 Townsh:i.i]: :[:?.N Range: 3W Lo't Size 29()03 (sq,, fi:.~ ~::)r acPes) t'.'h'~x BedF. oom~s: This l:::'~:H'mJ.'[:: 14 To't. aI Capacity: 4 :[0 Blmck: 1 GEPT]:C TANK: Min:[mum tota:l !~:;ep't. ic tank capac:i.t¥: 1,250 gallc~rH.-:h, t~nl.:: must have a'L l~ast 2 cc, mpar'tmemts,, :Oepth to top of s~pt:Lc feerk i'eClu:i.r'es insLti,~d'.:LmF~ C)W~r t. ank (s) ~ Eac:h sep{ :i. c tarlk (ss) < 4.0 TIq]:S SYST!EM MUS]' BE INSTALI..IZD :i:lq ACCOI::/DAh![:E WITH THE ENGINEER' S DIES :I:GI,I. DI..IHS MUST BE NOT I F:']iED F:'R ]:OR 'f'O AI_..L. I NSF'EC, T' ! ONS, "i'li]:S F:'I:~:RHZT :iS FOR A 4 BEDROOM SINGL. E FAMILY F~ESIDIE:Iq[;E ONL. Y~ AND WILL Ii[XI::~IRE E)N 12./3~./[~19. ZNST~L..LA]'ION CIF A LZF:]- S"I'A]'ICHq N]:L..L RECi~U]:RE IHE APF'ROPR:[ATE ELECTIR:[CAI.. ]:NSF'EET'FION. CERT I I:::'Y THAT: :!: am ~amil~,ar wi'M"~ the requ:i.~ements for on-si'Lc se~,~ers and we:l,].s as set - ..... . ~.,4.~..c~= c~t' Alaska.~ mr,...h by the Murtic:i. pa].iCy of Artclnoracje (MOA) and t'h,~ ''~'~ .... and in ccm~!:)].ianc~ (4i'kh the design I t~:[].], adhere to ali MOA and Sta'[e c)f Alaska reciu:[Pemen'Ls fop t. he~) set back ii LU'iCIE~:.i"fB'LAfqd that this per'mit is valid .For' a maximum oF 4 bc~dr, omm~ ]: any e~r~lar, gem~ni requJ, re ~.cJd:['[.J.c)l'~.:[ pe~r.m:tt~ S i gFied: DATE lssued By: DATE PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street, Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAl. DESCRIPTION: 1 2 4 5 6 7 8- 9 10 J 11- 12 13 14 15 16 DI!PT. Township. Range. Section: .5 / ,/ ,7--/ZX/ ,,~ :~ ~ SLOPE SITE PLAN WASGROUNO WATER ENCOUNTERED? S IF YES. AT WHAT 0 DEPTH? P E I PERCOLATION RATE (mrnute~a~nc~) PEFIC HOLE DIAMETER TEST RUN BETWEEN FT ANO F~ /"~'~ ' Muni~paii~ of Ancho.ge ' '""~ '[~/ DEPARTMENT OF H~LTH & HUMAN.SERVICES SOILS LOG -- PERCO~TION ~ST 6- 7- 8 9 10 11 12 13- 14- 15- 16- 17 18 19 20 WAS CROUNO WATER ENCOUNTERED;; IF YES. AT WHAT DEPTH? P E PERCOLATION RATE __ (mmule~mc~! PERC HOL~ DIAMETER COMMENTS TEST RUN BETWEEN FT AND __ F~' ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATF- DATF' ~/'~' ~/~ 72-~08 (Re~. 4'8,5) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL OESCR,PTION: ¢1...~ I ~ b"[" [O BtJl~.~-~'~___.. Township, Range, Section: SLOPE 5 6 7 8 9 10- 11 13- 14- 15- 16o 17 18 19 20 SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 13epth to Water After Mon(ledno7 ~0 ~.~, Dale: ~ross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minute~,/mch) PERC HOLE DIAMETER __ TEST RUN ~ETWEEN FT AND FT COM~.E,T$ ~~ ~ C.~_.0~_J C.~ {~.,~-! ~ ~- I~ PERFORMED BY: WL~ ~j~ I M~C ~5~ CERT[FYTHATZHISTESTWASPERFORMEDIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ ~ ~ NooOo4*00'E 160.( 3O Michael E. Anclprson 4381 - E '1 I' MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot !0; Block 1; Vaili Vue Estates ~,~1 Location (site address or directions) 6717 Double Tree Court Anchora9e, AK Property owner Mailing address Lending agency Mailing address Travis &Linda Chapman t7~ v _7 Double Tree Court Day phone 346-3210 Anchorage, AK 99516 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site :;~:?~ Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fronl 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 s & S ENGINEERING 17u;~i ';agie ~iv.r L,~-.,~, ~,,,,J ~,~. 204 Phone __~ ~/' - ~ ~/'7 ¢/ Eagle River, Alaska 99577 Engineer's signature - Date ~'//? /'~ ~ DHHS SIGNATURE ~( Approved for ~' Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 Pending 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 enginebr's work. 72~'25 (Rev 1/91) Back MOA ~'21 Municipality of Anchorage C 71V, E DEPARTMENT OF HEALTH & HUMAN SERVIC~,~¥ Environmental Services Division ' 825 L Street, Room 502 · Anchorage, Alaska 99501..o~(907) 343-4744 Health Authority Approval Checklist LegalDescription: LoT Io Fj~oc,,¢ / v,t~,~./ 'v,,,,~ .# / ParcelI.D.: 015" - 31/- )1 A. WELL DATA Well type ~ L ,~ r J Log present (Y/N) Total depth Sanitary seal (Y/N) Date of'test Static water level . Well production o~of sample: If A, B, or C, attach ADEc letterl ADEc Watei sysiem number ~ ! Date completed ~'~ Cased to C~(above ground) ~.i~s properly protected (Y/N) FROM WELL LOG .,,,,,,,/,,,,,'~ AT INSPECTION B.)_SEPT--~HOLDING TANK DATA ~ g.p.m, g.p.m. Nitrate Collected by: Other bacteria Dateinstalied ~/~ //~'~ Tanksize I~"0 Number of Compartments Foundation cleanout (~N) ¥ ~ 5 Depression (Y/~) DateofPumping $' /1~ / ~t ,C Pumper C. ABSORPTION FIELD DATA Date installed ct,/~. ~ / S~ Length ~;o / Width Effective absorption area ~;00 Date of adequacy test ~/1~ Soilrating (g.p.d./fFo~): I..~O Systemtype Gravel thickness below pipe Total depth Monitoring Tube present ~/N) ¥ ~' ~ Depression over field (Y~ Results (Pass/Fail) ~; $ For Fluid depth in absorption field before test (in.); Fluid depth O (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) /vo,,~ Immediately after ~'<~ gal water added (in.): Absorption rate = ~ O o -~- g.p.d. ~c,~o,~V If yes, give date -- bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump o~ff at* High water alarm level at* *~:)atum E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Public sewer manhole/cleanout Absorption field on lot Public sewer main ~ Sewer/_~se~e line Lift station SEPARATION DISTANCES FROM ~I'I~HOLDING TANK ON LOT TO: Foundation &- -~- Propertyline 5- --~ Absorption field Water main/service line Io '-/- ~ Surface water/drainage /oo + Wells on adjacent lots Property line Surface water Curtain drain ,~,,, ~. ~,vo ~,0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ o / ~- Water main/service line / I o o -J- Driveway. parking/vehicle storage area S- Wells on adjacent lots I certi~ that I have determined thru field inspections and review of Municipal rec~,~,~'a~d~ms are in conformance wit~MOA NAA gui~lines in effect on this date. ....bngineersName ~. ut2~/~_ , c ~ HAA Fee $ ~ O~ /E-'r~ Date of Payrnent Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (-M~-,%i~-i\ 1. GENERAL INFORMATION Complete legal description Lot 10; Block 1; Valli Vue~Subdivision #1 Location (site address or directions) 6717 Double Tree Court, Anchorage, Alaska Property owner Mailing address Dop~]d ~hnd~no9 Day phone P.O. Box 102063, Anchorage, Aalska 99510 263-7864 wk 346-2517 hm Lending agency Mailing address Day phone Agent Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well ~ Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25 (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 Address Engineer's signature 5 & $ ~NGINE. EP, IN~ 17934 Eagle River Loop Road No. 204 Eagle R|ver~ Alaska g~577 Phone DHHS SIGNATURE ~/'X/__ Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Cer[ificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /.~'~7- /(--)[ /~ ~, /,/~/.("Y /-//~.,¢ Parcel I.D. ~--~//<~-- A. WELL DATA Well type C/'~/.-~(~/v'/'~'~y If A, B, or C, attach ADEC letter. Log present (Y/N) //.//~ Date completed Total depth /t///~ Cased to //'//~ Casing height Sanitary seal (Y/N) /L///~ Wires properly protected (Y/N) Date of test Static water level Well flow Pump level g.p.m. ADEC water system number Driller /V,~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot ~/'//~ AT INSPECTION ; On adjacent lots ; On adjacent lots g.p.m.~ ~O Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Public sewer manhole/cleanout Petroleum tank ~ ' Nitrat~///o/- ¢ Othe;teria ~ Collected by: Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~'~ - ,'~--[ - '~'~:~ Cleanouts ~'/N) ~- High water alarm (Y/~,.~ Date of pumping Tanksize /~c.c~ ~ Compartments Foundation cleanout t~N) ~'~ "~ Bepression (Y/(~ Alarm tested (Y/N) A'//,'~ c~'~'~-~'2- '- Pumper //~['/- /J~,,~- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /LY.~ On adjacent lots ~ r./. Foundation To property line ~0 ~f- Absorption field '~ ~ '~ .water'main/service line Surface water/drainage f~00 /~ 72-026 (Rev. 7/91)Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed .~//~ Manufacturer Size in gallons ~ Manhole/Access (Y/N) ~;i (wYilNe)r ala r m ,eveI ~~_ Cycles te'~e;mP °ff" 'eve~l a~t Meets MOA electrical codes (Y/N) __~ SEPARATION DISTANCE FROM LIFT STATION ~0: Well on lot ____ On adjacent lots ~~Surface~ D. ABSORPTION FIELD DATA Date installed ~1 - ~,- [--c~2- Soil ~~ ~/~/~ System type ~/ Length 6°, _~L~Wid t h .~,r /.../ , ~ Gravel thickness Totaldepth Total absorption area Depression over field (Y/~2 nO Results (~s/fsil) Peroxide treatment (past 12 months) (Y/~_~ ~.(~ C..¢:: ~ Cleanouts present {~N) Y¢~-'-~ ~ Date of adequacy test ~-,"~.? - ~ ~f ~/:P~ ~- for /-~ -- bedrooms ~-~ O '(' ~/~0co m' If yes, give date /~2/,/'+ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot A///~F On adjacent lots ,¢~,00 "/- Property line /0 / To building foundation ~0 /f' To existing or abandoned system on lot On adjacent lots ¢'~"~ ~ ¢' Cutbank 01,,~1~+ E~,uFP Water main/service line Surface water {04.,) ~ f" Driv y, parking/vehicle storage area E. ENGINEER'S CERTIFICATION ¢J I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date S & S ENGINEERING 17034 Eagle River Loop Road No, 20~ Date of Payment /P.~ / / ~,//~ Receipt Number ,~. ~¢'/. O..,,q- Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 600 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA '99515 WALTER J. HICKEL, GOVERNOR (907) 349-7755 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: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on August 10, 1992. This does meel~ the provisions of 18 AAC 80.200(a) of the State Drinking Water ~-egulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on August 13, 1992. This doe~s meet~the provisions of 18 AAC 80.200(a). The last Radioactive Contaminants Sample results were submitted to the Department on October 12, 1988. This does me¢ the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 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 cbmpliance 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 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING HAA # //-¢ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (c) Lending Institution Telephone: (home) ~ Business I17, -/ .,% ,/ Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone ¢-,- (e) Mail the HAA to the following address: (or check here ~ 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 [] Community El""' Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ 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. Z2~)25 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As cerii'fied 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 end 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 Address Date Telephone Engineer's Seal 6. DHHS APPROVAL Approved for /Z// ..bedrooms by Approved ,~/~ Disapproved Terms of Conditional Approval . ~'~~ ~/~/ Date Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 Mu n ici pality of Anchorage is not responsible for errors or omissions in the professional engineer's work. MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) MU N i C[ ~ [E~c~ LAI,,~¢.) F,~g~R U A R Y 1984 Legal Desodpfion: A. WELL DATA Well Classification Well Log Present iY/N) Total Depth Cased to Static Water Level 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 Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments $~. /~Tm,4~/-/E.~ LE RECEIVED Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~ ¢¢ '/' ~¢¢' ~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~'-Z¢-,~'P Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: /Z 5"~ No. of Compartments Air-tight Caps (Y/N) ,V Foundation Cleanout (Y/N) /~J Date Last Pumped ~'z.d ~r/~u~r/~ ,4/'~?~J; for ~,,¢~-,~/,,,' Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water-Supply Well Z.<~¢ To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88)Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ¢- ~/- ~ Width of Field ~ / Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well Z.,~¢,' To Building Foundation Z To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ¢ ,~ ' Depth of Field ,~ ' Gravel Bed Thickness ¢// Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line /¢ / To Existing or Abandoned System on ; On Adjoining Lots ?~/¢ To Cutback (if present) Z'~' ('~,.¢z-u,~..¢~) Dimensions High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Size in Gallons ~ Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at ~ Vent (Y/N) '~-_.~ Pumping Cycles during Adequacy Test. Date MOA No. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspecti°r~/A/¢~ ~ Signed f/-1~¢4~*(~,~ Company /Z~¢~ } ;'¢~ Engineer's Seal Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88} B~ck Receipt No. __ Waiver Fee: $ Date of Payment Page 2 of 2 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 December 1, 1989 STEVE COWPER, GOVERNOR 563-6775 FOR: WAYNE MC FADEN PWSID: ~ 210605 According to the records on file in this office, the Valli Vue Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Environmental Fie~d Officer VEC:bas