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HomeMy WebLinkAboutVALLI VUE ESTATES #1 BLK 1 LT 15Municipality of Anchorage I Development Services Department Building Safety Division On-Site Water and Wastewater Program. 4700 Elmore Road P.O. Box 196650 Anchorage. AK 99507 Page ( of Z— www.ci.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SCO vY 00 a PID Number: ( Nre • Wastewaters stem: ❑New Upgrade L* Aetrasa 01, C-C, ABSORPTION FIELD Prlarla NunDa r 6abornaAl qcy T� O Sn Tears O 8e 0 Manu O oew LEGAL DESCRIPTION1R°°''"" O Tar Oepm om onq.W ppe GPryFl 9. FI. agrx L« slna.srn I ( I' �SFi(�1G� Daps o pp. Doxam can mpMr pass 1.5-Fl. Gesaal am D.wn ppe (D• i NG Fl Tp p Paps Saagn Fa Pease tlo a angnw V•a Gre al LapM O FI. Y R. Well: /12— ❑New ❑Upgrade Gravy wgln. ?.D naan°ar r ura Puanu Delwean Ma Fl. — Fl Claarnuam (Pm e. A e. CI. Tar D• Pee m Tar aoaoplgn asa Mpa Mabnr FI. FI 7(v Ft', Deaw �. DnW SIrK We. L. MMMW11-r +s Dal! malrl l FI MAA ♦/T ♦ 7-7 Yrq Fu SSM Gaanv�.pmADpa.Gewq TANK GPM/04 Fl. FI SEPARATION DISTANCES C7.Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To SeptlG Absorption Ufl Holding ublCMMate " iehi•' - b Fran Tank Field Station I Tank Sewer Line Ape4 lb"k • ( Gr w« /ee + too'+ N N f zs � Mal.lr {-T Nuegee r crepanmars S , ( Z swecewaa too� top'* LIFT STATION LML. Gr Fanealgn /�• � �y (V � 'Pump w rv. al Puny w wry el nyl wela rrm r n n M Cunan pan • ; / /1'. Puny Man° e M Electrcy lnapa ws pManre DF BENCH MARK Loulen.q Dawplgn C • uunwa w.alnMl FI A ,/ II Inspections by: if"(11 -e- 4 a-100-7 Dates: 1" �� 0/ - L• S Engineers Stamp performed /1 rd 2-d (1177W V-P0 Development Services Department Approval • c��:''•�y�i ••••',}`. Conditional Approval Date: i *:•491" !%a` :ea • MdI�FiAZL N. ANDLMN :•"i Q Reviewed and approved by: / Date: �Z' -' O Pis. ce•sarM•� !f rf; !`s�s//p •���oi,� Permit No. SW040050 Page 2 of 2 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: LOT 15, BLK 1 VALLI VUE ESTATES #1 S/D PID No.: 015-311•_6_ M A B C ELEV. ELEV. DO U B L E TREE I LOC TED IN THE AWL PA T08 9 .3 CO2 32 18 0 99.1 32 17 0 99.8 TCO2 37 23 0 99.9 CO3 31 27 0 100 95.6 VALVE 40 30 0 100 95.6 C04 37 23 21 99.8 95.5 IAT 23 0 43 99.7 lCos 129 123 1 44 199 BENCH, CONCR SLAB WATER SERVICE LINE HOUSE CO CD2 O C01 B ' 002/ice CO / TEST HOLE RADIUS / OLD CRIB© SCALE: 1" 20' 411 v M! srtn / -.MICHAEL N. ANDERSO , N; ♦ G ♦ � No. 9 / 69 � SEPM 4 5510 ♦♦ ICTS nn su -vo 40� ��� Permit Number: SWO40050 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade c�)-51vy—v3orr t�1-7 oy— �6 a~ -t Date Issued: Apr 09, 2004 Expiration Date: Apr 09, 2005 Parcel ID: 015-311-16 Legal Description: AALif WE ESTATES#1 BLK-A LT .15-7 Design Engineer: 0088 Anderson Construction & Eng'g Site Address: 006766 DOUBLE TREE CT Owner Name: JOHN SMITHHISLER Lot Size: 20870 SO. FT. Owner Address: 6766 DOUBLE TREE CT Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516-6840 This permit is for the construction of: ❑✓ Disposal Field ❑Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Issued By. D.. bau-1Date: r Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. .O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Q I ( I — (co Permit Number SW 0¢00;0 Propertyowner(s) "%0(n r � [r v Day phone 940— 14L -(C:;- Mailing address (1) CP %(D & b& IJ) ( n. + r e- C" i✓ I Q Mailing address (2)_A0040Ri4GE, RL/3 SKR ' " Zip Code / 9507-6840 Legal description (Lot, Block & Sub'd.) Ly 7< I S (� ( f j n �� , � f a e /_= s jo,rS,qf Legal description (Section, Township & Range) Lot Size 20970 Acre THIS APPLICATION IS FOR: Number of Bedrooms Ll Sewer Only tf Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade X THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Waiver Fees: Date of Payment: 9 Date of Payment: Receipt Number: OS D 2 Receipt Number: (Rev. 12/00) Michael N. Anderson, P.E. Civil/Structural Engineering 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 June 3, 2004 Municipality of Anchorage Department of Health and Iluman Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 15 Block 1 Valli Vue Estates #1 Subd. To Whom it may concern: This is a request for a new septic permit for the above residence. The existing tank has been replaced under an emergency permit and now we need to upgrade the leach field. A test hole was excavated and found to have silty sand (SM) in the top 6 to 7 feet, then clean sand (SP) below 7 feet to the bottom of the hole at 17 feet. No water was observed in the monitoring tube. The perc rate was approximately 3 minutes per inch at elevation 6 feet. The new leach field design is a trench 64 feet long with 6 feet of effective depth. The subdivision is on community water therefore no wells were shown on the plan. Drainage is to the north west at abut 2 to 5 percent. No slopes greater than 25 percent exist near this property. This new system will not impact the neighboring properties due to the large community well and layout of the existing systems. If you have any question please call me at 345-3377 Sincerely Michael N. Anderson, P.E. DOUBLE TREE CT NOTE: SURROUNDING SERVICED BY NEW 125Q' GALLON WATER. —O'MALLEY ROAD— Septic Design Prepared For JOHN SAfIT11IIISLER VALLI VUE ESTATES #1 LOT 15 BLK 1 Prepared By MICHAEL N. ANDERSON, P.E. 4640 SIIOSIIONI DRIVE (907) 345-3377 / FAX (907) 345-1391 SCALE: 1"=200' JUNE 3, 2004 49M MICHAEL N. m DESIGN CRITERIA: MOUND OVER 4 BDRM X 150 = 600 GPDo (THft) GRADE -APPLICATION RATE: 0.8 GPD/S0. FT. 2.0' DEEP TRENCH _2 ORG FILTER FABRIC 4'0 PIPE 600/0.8 = 750 SQ. FT. REQURIED —3 —4.0 REDUCTION FACTOR: 0.70 SM SEWER ROCK 750/12 = 63.0' REQUIRED TRENCH -7 TRENCH: 10.0' DEEP SP -10.0 6.0; 2 0' EFFECTIVE 2.0 WIDE -17 (1) 63' LONG -D0U8LETREE COURT_ LOT 15 / � 1250 GALLON T K _� SINGLE FAMILY R ' ' MT RESIDENCE i6 0 'o TA .0. i I � UBLE C.O. ,' w GO Co_ � A PPROvep O!VlKT'ER X>E _NOTE: V'���t XISITNC C IB SURROUNDING PROPERTIES SERVICED BY PUBLIC WATER. \ �w K LOT 16 LOT 21 I K Septic Design Prepared For JOHN SMITIMISLER VALLI VUE ESTATES #1 LOT 15 DLK 1 Prepared Dy MICHAEL N. ANDERSON, P.E. 4640 SIIOSIIONI DRIVE (907) 345-3377 / FAX (907) 345-1391 SCALE: 1"=30' JUNE 3, 2004 49 E i} P. IAEL N. No. CE Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 'Iohv, -"-+ 14416S1,t I DATE LEGAL DESCRIPTION: G0-� IS Ua DEPTH o.q., t 4 1 2- 3- SHt 1�,, S., 14 4 C7..� 5 C 7 81I'r P Ll..„ s.^L 10 11 12 13 14 15 16 18 19 V►e_ Township, Range, Section: WAS GROUND WATER _ ENCOUNTERED? r'J v IF YES, AT WHAT DEPTH? Depth to Water lllter / moiWringT tea^ Date 20 { I 2 ' IL_�I PERCOLATION RATE ti �•B Iminutesnnchl PERC MOLE DIAMETER / TESTRUNBETWEEN S'S FTAND ("5' FT COMMENTS 11T re(\TY/'1 S0. S PERFORMED BY: NII SIS wt I CERTIFY THAT THIS T ST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE �C 72-008 (Rev. 4/85) .1 MUNICIPALITY OF ANCHORAGE r . �t P DEF TMENT OF HEALTH AND HUMAN SERV S Se;e Tan On 82Environmental Health Division r 5 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name maru A n DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL AddressI (OAO(o 0 1 C WELL y l a0( T a co Phones) 31 -33 Permit No. 8200Bo No of Bedrooms _// LOT LINE SOI 5 i LEGAL DESCRIPTION Lot Block I Subdivision Valli e5 I d1'(•.•L•TI L„ FOUNDATION Township, Range, Section �' p! ^ ` `Yt{ ) I AS -BUILT DIAGRAM (Show location of well, driveway. water bodies. etc.) septic system, property lines, foundation, TANKS DI -SEPTIC ❑ HOLDING Manulacturer R �Q Capacity in gallons CCa J� ADDxr� Material . of Gomp mems a AADa TYPE OF SYSTEM ❑ NCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bol from original grade FT Total depth from original grade y FT m } k �.X.Ise I I _ Q 50 I 1 Fill added above original grade T Gravel depth beneath pipe FT Gravel length FT ravel width FT Total absorption area SQ FT Distance be en lines FT Number of lines Sal rating SQ FT Pipe material Installer Date Installed WELLS ❑ PRIVATE ❑ OTHER (Identitvl Classi6cat, A,B.C) Total Depth FT Cased to FT Installer Date Installed: REMARKS: uba Jnr iOlyf, on 2Scale: d y -on M NTS Inspections 14 Date: l l g8� ENGINEERSSEAL A }, ., ° r -J f ' Cr ice . Corwin, 6_<, ';, bo 1 `i a QA c ia4 EaK. � l ertily that Is inspeclian was perlgrmetl according Is allj Date:'yZF/'-`�—� Municipal and State guidelines in effect on this date:. � Health Department Approval: 72-013 (3/85) k ^,-~~ PERMIT NOt PATE }SSUED: 8P0LlUAW 1: ADDf : CON[ACT PHON& LEGGL DES[�0I1": WILIPA �k: 40 2. WOOD_ 1 -1 _"v 3 F=_ low AJ ED A ET FT e4 E3 E:E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-472O � 3710A`W K 1-111 W En UAA HE Fy F" HEFT P1 K W / 870080 ITARYANNCA5[ '-766 DOUDiETREE COURT ANC�D�AGE, AK 79516 346-3301 SUBDIVISION: VALLI YVE ESTATES 01 LOT: 15 BLOCK: 1 SECTION: 14 TJWNSMIP: 12N 1�31OR ACRES) I certify that: 1" 7 am lamiliar with the ruquirements fop on-site sewers and wells as sn'r �. I wi�l ins�all the �ystem in � regulations, and in compliance with the de/sign criteria of this permit. 3. l will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerQge system on this or any adjacent or nearby lot. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA 9VILDrNO COgE% TKEN (1> AN ELECTRiCAL PERMIT AND INSPECTION MU9T BE OBTAINED; (2) AW9UTLTS W�LL NO! BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WOR!( Mik3T BE DONE BY 8 LICENSED ELECTRICIAN, � »1 AFPLICANT: MARY ISnUED CY DATE: � 3-87 DA F0 _ NAME 1110f1� LOCATION GF:7ITER ANCHORAGE AREA BrDUGH Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS &)-`� 202 LEGAL DESCRIPTION_ SEPTIC TANK: DISTANCE. - NUMBER OF FROM WELL 2"i,W- MANUFACTURER 6h�o-k iS{ /l7 a)MATERIALWZ J/_ 16 76r COMPARTMENTS INSIDE LENGTH _ INSIDE WIDTH "� _ _LIQUID DEPTH —'—LIQUID CAPACITY �GY�O GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER _—OR WIDT4 �/� LENGTH DEPTH /Z /o''/ LINING MATERIAL Cha% CIZL- l CRIB SIZE: DIAMETEF"� DEPTH DISTANCE FROM: WELL - -BUILDING FOUNDATION 3� NEAREST LOT LINE ZG TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) T5's�- SQ. FT. ADDITIONAL ABSORPTION - WELL: TYPE —CONSTRUCTION DEPTH - - DISTANCE FROM: BUILDING - NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE __, SEWER LINE TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED - REMARKS DISTANCES: _ DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: POJ) lh6h LOT SLOPE: REMARKS: cn.,., PW_n9a NAME OF APPLICANT GREATE=R ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE. ALASKA 99502 TE;,EPHONE 2..79.66666 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT PERMIT NO. MAILING ADDRESS D�'—x'0.2{--- /✓LI>✓ PHONE INSTALLATION LOCATION �jJ� — LEGAL DESCRIPTION / S IJIbt / Op __ INSTALLATION OF: SEPTIC TANKL� SEEPAGE PIT__ rv�J/� DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED TO BE INSTALLED By SOIL TEST RESULTS PEN01,Y6 NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED / ^ PFRMTT VAIiO 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 /000 TYPEQt -ja OY COYICYP.t PSEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK S ft° FOUNDATION TO SEEPAGE PIT 20 fte . DRAIN FIELD 1.0 ft, SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK 5 ft, , SEEPAGE PIT 20 ft, • DRAIN FIELD 10 ft. _ TO NEAREST LOT LINE. l / WELL TO SEPTIC TANK�q���!" SEEPAGE PI "1' Mo. DRAIN FIELD i-"-� / 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 TYPE DIAGRAM OF SYSTEM I I ' 4' CAST IRON SIPHON SEPTIC PIPE NI TH AIRTIGHT CRIB CAPS levrl3 - 10 iA':K- OO" HOUSE CAST IRON I N10 GRAVEL BACKFILLcn•-n%' WILYCAST IRON SDIER UNDISTBCBED SOIL LINE 1'1'IE 5'IRur, I!III!IRB11 11111LIC II.TSiO H.• �--- ol l!P. E.CD —) ,- SOIL Ill tll l!UN 111 - zoo' in Pli I -IT - 200' �\ 1p9' -YM' Univ �p� CA`t 12411 Sr'AER L� r� A L 12Rui red vl:mever l(ne crosses (CRIB L TABLE) under drive,,. HEALTH AUTHORITY I eila'IUH V!fIL UITiAcI(S CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF - l w -I P I!IL'.1_L EXCAVATION 3 FEET INTO UNDISTURBED SOIL. ID't,,o' to PIT -T- loo' IR SCITER LlitE- 10 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT SN:i-PUBLIC 4 INCH SEWER JIT. CDNSICYR ARU BELLS. SEEPAGE PIT EXCAVATION BASER ON SOIL TEST. FITTED WITH AIRTIGHT REMOVABLE CAPS. - 10 iA':K- OO" HOUSE 1I In 1;0 '.f CER LINC- AA GRAVEL BACKFILLcn•-n%' WILYCAST IRON SDIER UST )PON, ,T SEPTIC LINE 1'1'IE 5'IRur, CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. 11111LIC II.TSiO H.• �--- ol l!P. E.CD —) SOIL _ 111 - zoo' in Pli I -IT - 200' �\ 1p9' -YM' Univ �p� CA`t 12411 Sr'AER L� r� Inc.'. Ro snueE[ OF L '.nv'N 1101 lR-- HEALTH AUTHORITY I OR Po' NININUH LICENSED DESIGNER I ' AYEL BAcKFILL" DuRo CRIB. ' ' NININUH ABOVE WATER Grade: V -Per NO, or 1/4' P r foot except 10' Prec,,dinO UnR A tna. should I not exceed 2%' G' Per 10 on flat terrains. 4 INCH CASE IRON SIPHON PIPE iSEEPAGE PIT CRIB GRAVEL BACKFILL 1 CERTIFY THAT 1 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, �y_� DATE /® _ 1,5-7 APPLICANT'S SIGNATURE ) M Ulane Finn- Property Engineering a Geological Consultants LOG OF TEST BORING ; 1 ANCROaAG£ FAIRBANKS ALASKA JUNEAU Anchorage Alaska i DATE 110-26-72 SCALE I" = 2' OWN BY G.A.W. CHKO BY W.E.D. PROJ. No.26540-46 DWG N11o. A-01 '. ,.. SAND SOME ORGANICS� _ - 2.0* Wo,- Q�O op. a p: °o:Q o b: SANDY GRAVEL - TRACE - °a0 TO SOME SILT (GW) 0.0 .- t ,o a 2i 6Ljlr C' O n '� 8.0'� I t % r SAND SOME GRAVEL (.SW -SP) - - 12.0, - . No Water Table - Note: Hole excavated with tractor mounted backhoe. - Ulane Finn- Property Engineering a Geological Consultants LOG OF TEST BORING ; 1 ANCROaAG£ FAIRBANKS ALASKA JUNEAU Anchorage Alaska i DATE 110-26-72 SCALE I" = 2' OWN BY G.A.W. CHKO BY W.E.D. PROJ. No.26540-46 DWG N11o. A-01 '. J�21 R&M ENGh -4EERING & GEOLOGICf CONSULTANTS 229 EAST 51st. AVE. — P.O. SOX 6087 — ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 TELEX 090-35419 Civil Engineers Geologists Land Surveyors JAMES W. ROONEY, P. E. RALPH R. MIGLIACCIO Engineering Geologist MALCOLM A. MENZIES, P.E., L.S. JAMES H. WELLMAN, P.E. October 26, 1972 R & M No. 26540-46 Mr. Ulane Finn P. O. Box 2027 Anchorage, Alaska Re: Test Hole and Soil Log Report for Sanitary System Lot 15, Block 1, Vali-View S/d Dear Mr. Finn: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of October 24, 1972 and those procedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anch- orage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 15 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor -mounted backhoe and the test hole was extended to a total depth of 12 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. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please don't hesitate to contact us. Very truly yours, R & M ENGINE/EERRIIN'G & GEOLOGICAL CONSULTANTS James W. Rooney Partner JWR:wb Enclosure xc: GAAB oa *"(,ho Gi Baa R.4?? je'+I ANCHORAGE FAIRBANKS - JUNEAU Parcel I.D.015-311-16 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of &R -Site Systems Approval 1. GENERAL INFORMATION: Expiration Date -.1I2-//-3/ Z I Complete legal description Valli Vue Estates #1 • Block 1 Lot 15 Location (site address) 6766 Double Tree Court *Anchorage, AK Current Property owner(s) _Ashley Dunbar Day phone Mailing address Real Estate Agent Dagny Smith Day phone 802-9989 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ _550 Waiver Fee $ _ Date of Payment _ �s A Date of Payment Receipt Number_-z6g2_Ga Receipt Number COSA # � S C 7 1 I rtJ-( Waiver #, nl! 5. STATEMENT OF INSPECTION 13Y EMGINEE R AS Certified by my seal affixed hereto and as of the validation dates 'l based on procedures outlined in the Certificate of On -Site Systems SNOWS that the dune water supply and/or wastewater Sitdisposal shown below, I verify that my investigation, for the number of bedrooms and type n structure indicated herein Approval Guidelines for this application, obtained from the Municipality of Anchorage files and from system is (are) safe functional and adequate my I further verify that based on the information supply and/or wastewater disposal system is(are) in compliance investigation applicable Mpunicipal and on-site water ordinances, and regulations in effect at the time of installation, ate codes, Name of Firm: Garness En ineedni Grou Ltd GEG Address: 3701 East Tudor Road Suite 101 -Anchorage Alaska 99507 Phone: 907-337-6179 Engineer's Printed Name: JefFr w A. Garness _ Date: � •� �t In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the ';; evaluation. Separation distances were measured to readily identifiable features. Hidden defects or during The life r�,.• .'�`s encroachments may exist that were not identified the evaluation. operational of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, - _ Y'• groundwater levels (that may fluctuate during the year), quality of construction (materials and J ...... .. . - . ............... . .. " workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and '? are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of/ c.. . ........... the well or septic system. GEG makes no representation whether an alternative well or septic system of the current systems fail to perform adequately in J. �r l can be installed on the property in the event either the future. The content of this report is for the sole benefit of the person/party that retained GEG to s r J, i•` ��,1 �}' .3'1 G perform the evaluation. Reliance upon the information provided in this report by any other person or is not authorized, nor will it confer any legal right \i`;,7� party (including subsequent property purchasers) whatsoever. 1EAECC884 6. DSD SIGNATURE L��` .� OF ANC, X_ System #1 Approved for `_ bedrooms ``��� O���i�� System #2 Approved for bedrooms N Disapproved o Conditional approval for bedrooms, with the fdl�Xir4 f�t�FBA JAG P � i p�T By: Original Certificate Date: Z The Municipality of Anchorage evelopment 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 i, Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 0 Legal Description: COSA Checklist VALLI VUE ESTATES #1; BLOCK 1, LOT 15 If more than 1 septic system on lot: COSA Checklist # of COMMUNITY WATER A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) Date of flow test for COS Static water le eginning of test ft. B. TANK DATA Age of tank(s) 17 years Tank type/material �=` Measured operating fluid level in septic tank 48_' H Standpipes/foundation cleanout per record drawing Date of pumping 8/23/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 6/2004 ❑ ALL standpipes present per record drawing Total measured depth from grade 10.5 ft (max) Measured depth to pipe invert from grade 3'75 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5.91 Parcel ID: 015-311-16 Structure served by this system Well production at time of test Water storage tank volume gallons Well disinfected f orm test? Ll Yes El No ❑ Col' acteria is Negative Itrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station _ year Lift station material Comments: Adequacy test date sn80 Results [DPass For 4 bedrooms Fluid depth prior to test 0 in Water added 951 gal New depth 12 in Elapsed time 120 min Final fluid depth 3 in ❑� Code -required soil cover over field 600+ Absorption rate _ gpd 0 System presoakedNO (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) If yes, enter date NIA 2141 Gallons introduced _gallons Comments/Deficiencies: PER CONVERSATIONS WITH RYAN AT WILCO EXCAVATION ON 8/25/2021, THE OLD SEEPAGE PIT WAS FILLED WITH GRAVEL AND THE PIPE WAS REMOVED. IN SHORT, THE SEEPAGE PIT COULD NOT BE LOCATED AND CANNOT BE USED FOR A COSA, IT IS STILL CONNECTED TO THE "SYSTEM" BUT ITS FUNCTIONALITY IS UNKNOWN. SEE ATTACHED EMAIL FROM ARM SEPTIC SERVICES PREPAIRS TO DTO OLD SEEPAGE OUBL THFLOW IT SHOULD BE NOTED THERE THERE IS A SLIGHT REVERSE GRADE FROM COSA Checklist yellow sheet / ' VZ E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic TanklLift Station on Lot > 100' ❑✓ Community Sewer Manho nout > 100' ❑ Yes if No ft ❑ Yes if No _ ft Surface Water > 100' _ Neighboring Tank > 100' ❑ Yes if No _ ft P ' ewer/Septic Line > 25' ❑ Yes if No _ ft Absorption Field on Lot > 100' ❑ Yes if No Holding Tank > 100' ❑ Yes if No _ ft Neighboring Absorption Fields > Yes Animal Containment > 50' ❑ Yes if No_ ft ❑Yes if No _ ft Manure/Animal Excreta Storage > 100' ❑✓ Cc Sewer Main > 75' ❑ Yes if No _ ft ❑ Yes if No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No_ ft Property Line > 5'✓❑ Yes Yes if No _ ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No _ ft Private Wells > 100'r❑ Yes if No — ft Water Main > 10' ❑✓ Yes if No _ ft Community Wells > 200' ✓❑ Yes if No _ ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No _ ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No _ ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No _ ft Private Wells > 100' Yes if No _ ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' [2]Yes if No _ ft Surface Water > 100'❑ Yes if No _ ft F. ENGINEER'S COMMENTS *PER MIKE ANDERSON, P.E INSPECTION REPORT DATED 12/29/09 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. COSA Checklist yellow sheet A. arness; 3 c�G "rofes #AECCe84 %/A--LL.t VtjS Y�j I 'Zlt Lis r n DOUBLE_T/�EE COURT OF A 49 TH , s-- "�' 114&1 -- SHANE A. HOLT �15 � LS -6914 SSG °fessiona\ �o AS-BU/LTSURVEY III =301 NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT25, BLOCKI, VALLI VUENO. 1 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUL TURES, IMPROVEMENTS, OR FENC ELI NES. EASEMENTS OF REC0RD,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT EXIST OTHER THAN NOTED. ARE NOT SHOWN HEREON( UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS 4 TI -1 DAY OF NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE SEPTEMBER , 2021 PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. HOLT LAND SURVEYING THE SURVEYDATA ON THIS DRAWING IS PREPARED FOR THE OWNER OFRECORDONLY 9309 GROVER DRIVE ANY COPYING, OR UTILIZING THEDATA HEREON IS PROHIBITEDUNDER COPYRIGHT LAW ANCHORAGE,AK 99507 11041, FB 136-40, 216-11 345-5513 David Garness From: Nathaniel swanberg <Swanberg.n armservices@outlook.com> Sent: Monday, September 6, 2021 10:48 AM To: Arm Services Subject: 6766 Doubletree Report To whom it may concern: I completed a repair to install a bull run valve out at the subject property on 9-3-21. After carefully excavating the area around the tank and pipes, including lots of hand digging around the utilities, I exposed the existing piping. In preparation for plumbing, it was found that the outlet pipe of the tank and the pipe to the old crib were completely level, despite being a 5' plumbing run apart (should have approximately .10' or greater). The 2009 drainfield pipe was approximately .10' below the outlet of the tank. Per a conversation with David Garness while I was onsite, I installed the valve with appropriate fall from the tank to the valve and 2009 drainfield. Doing so meant that there was a bit of backgrade from the valve to the pipe to the old crib. This was approved by David Garness. All pipes were properly bedded in compacted soil and back filled carefully to avoid damage to the pipes and utilities. Please see the attached pictures to see the before and after of the repair. Let me know if you have any questions. Thanks! Nathaniel Swanberg Septic Technician ARM Septic Services Ph: (907) 688-9433 Cell: (907) 854-1684 Email: armservicesAK@outlook.com Pers: swanberg.n_armservices@outlook.com Website: www.ARMServicesAK.com Facebook: www.facebook.com/ARMServicesAK/ Before: (notice the "sweeping t" fitting providing the "splitting" of effluent in the center left of the photo.) David Garness From: Ecklund, Timothy J <timothy.ecklund@anchorageak.gov> Sent: Thursday, August 26, 2021 1:17 PM To: David Garness Subject: RE: Valli Vue Estates #1; Block 1, Lot 15 Yes you can leave it connected however it needs to be noted I can't be used for a COSA. I misunderstood your earlier email. I thought it was decommissioned and the divertor valve went to nowhere land. My mistake, Tim Ecklund Onsite Water and Wastewater Municipality of Anchorage 907-343-7905 timothy.ecklund@anchorageak.gov From: David Garness <David@garnessengineering.com> Sent: Thursday, August 26, 202112:08 PM To: Ecklund, Timothy <timothy.ecklund@anchorageak.gov> Subject: RE: Valli Vue Estates #1; Block 1, Lot 15 [EXTERNAL EMAIL] Tim, The diverter valve can be decommissioned if desired. However, in the past the department has allowed seepage pits filled with gravel to remain in place. Please let me know if you would like it disconnected or would allow it to remain connected. From: Ecklund, Timothy <timothy.ecklund@anchorageak.gov> Sent: Thursday, August 26, 20219:42 AM To: David Garness <David@garnessengineering.com> Subject: RE: Valli Vue Estates #1; Block 1, Lot 15 Is it possible to disable the divertor valve with a concrete plug? Tim Ecklund Onsite Water and Wastewater Municipality of Anchorage 907-343-7905 timothv.ecklund @a ncho raeea k.gov From: David Garness <David@aarnessenzineerine.com> Sent: Thursday, August 26, 20218:32 AM To: Ecklund, Timothy <timothv.ecklund@anchora¢eak.aov> Subject: Valli Vue Estates #1; Block 1, Lot 15 [EXTERNAL EMAIL] Tim, Wilco Excavation decommissioned the 1987 seepage pit per the request of the homeowner in the beginning of 2021. In short, there is no pipe for the seepage pit and it was filled with pit run gravel (per Wilco Excavation). There is a diverter valve, and the system is still "connected". Will you approve the COSA with the system connected and no MT for the 1987 seepage pit? Sincerely, David Garness, P.E., M.S. Civil Engineer Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507 Phone: (907) 337-6179 Mobile: (907) 632-4528 Website: www.garnessengineering.com GARNF;5ti ENGINEERING GROLP, Ud [NGINELRING SALES CONSULTING anics Qu AeroCe[] XERXESO CORPORATION 411.1a A.rtnnr:,r>.^.rv.,. AXhWQPd ANskl DdViWo Municipality of Anchorage • Development Services Department' Building Safety Division .. .. On -Site Water 8 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. !9 / S — 3 / / — / % COSA# O L7 D 14 K tv 1. GENERAL INFORMATION Expiration Date: /a - 3 0—Z O Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address VALLI VUE A1• BLOCK 1 LOT 15 6766 DOUBLE TREE CT • ANCHORAGE, AK • 99516 JOHN do CAROLYN SMITHHISLER Day phone 6766 DOUBLE TREE CT * ANCHORAGE. AK • 99516 Day phone DAR WALDEN W/ KELLER WILLIAMS Day phone 240-2804 101 W. BENSON BLVD #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: Individual Well ❑ Individual Water Storage ❑ Community Class A Well ll• Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ 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 homeowners. 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 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 riles and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Date 6 2 Io Engineer's Comments: In conducting this evaluation, GEG, LtD. 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 idontifiable 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 fam)1y being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory lest results do not guarantee future performance of the system, nor do they guarantee that 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 DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _!_Z Approved for 1� bedrooms. Disapproved. Conditional approval for bedrooms, with the flowing stipulations: Attachments: L/ COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other ,,1 �,...... I' .. c. a: ONSITE WATER AND WPROGRAMR By: "mow J w /'oq­e.,� Original Certificate Date: /'Z - 3 p- O 2 (Rw. I IMS) . _ 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 /' �-1.— e� / ��✓ _ www.munl.org/onsit/onsite (907) 343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. i 4. 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD. SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. 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 lost, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the tical soils condition, groundwater levels that may fluctuate during the year, and the wafer usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that 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 DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. 337-6179 Date 12 1 O q _X_ Conditional approval for _L" bedrooms, with the flowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (� Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: )Rw. 11105) Original Certificate Date: / 2 — 3 O' 0 �j Municipality of Anchorage 0, • 4'�` Development Services Department _ Building Safety Division tiff -- On -Site Water 3 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 S/D; BLOCK 1, LOT 15 Parcel ID: A. WELL DATA ICOMMUNITY WELL Well typecOMMUNRY If A, B. or C provide PWSID# 210605 Well Log (YIN) Date completed Sanitary seal (Y/N)_ Wires properly protected (YIN Total depth ft. Cased to ft. Casing height (ab round) in. Date of test Static water level Well production WATER SAMPLE Coliform FROM WELL LOG AT ft. ft. g.p.m. _ . -9-P.M. RES colonies/100 mi. Nitrate mg./L. Other bacteria colonies/100 ml. Arge-nic: ug./L. Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA (� Gid WO S P4 L Tank Type/Material SEPTIC/STEEL Date installed 6/5-7/2004 Tank size 1250 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (Y/O. ES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 12/14/2009 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA ow EXISTING GRADE 10/24/1972 85 Fr2/80RM - CRIB Date installed 6/5-7/2004 Soil rating (g.p.d./ft�or ft=/bdrm) 0.8 GPD/Fr= System type DEEP TRENCH g g 8 Length 64 ft. Width 2 ft. Gravel below pipe 6.1 ft. •12.3 552 Total depth '10.5 ft. Eff. absorption area 706 ft' Monitoring tube YES Depression over field NO Date of adequacy test "'12/15/2009 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test E In. Water added 1245 gal. New depth 116 in. Elapsed Time: 220 min. Final fluid depth E in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date - **HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD PRE-SOAKED W/ 1000 GALLONS ON 12/14/2009.TESTED 2004 DRAINFIELD. NOTE: TANK HAS ONLY ONE POST TANK CLEANOUT D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump un" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service areas COMMUNITY WELL 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'+ Welts on adjacent lots 200'+ PUBLIC/100'+ PRIVATE 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'+ PUBLIC/100'+ PRIVATE F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and a review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. yI� Engineer's Printed Name JEFFREY A. GARNESS Date r41710 ci 0�04vvv// COSA Fee g y% b + Z (,(I e'ond i 'ion- I Date of Payment)- # 13010 11) Receipt Number D o 3 3 Sm (Rev. 11105) Waiver Fee $ Date of Payment �I Receipt Number N95 ss.-oci �--'a'Ofir - C I N 82e3 646'W 1 16.00' i ' wee �2 I � n a ct�✓ No•� e l7 w fF. 00 N I fVA pP le � 0 I e N i r e W c� e W �wno N e I a n e Z i r n w w --- ASE ILT SURVEY (NO CORNERS SET THIS DATE) 1'.3a KJ y,west Blvd. Suite ty well system, provide v !gality and status of syst )TER. DISPOSAL: attesting to the iegality and status of system. --72-M(Rw•11%1) Front MOA M21 - - Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription:4c 'S /9ek / YALL/ VVo¢, ksl.ParcelI.D. A. Well Data C0,1snU'.iry 0f,�--3//-/6 Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller Total depth Cased to Casing I Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump levell SEPARATION DISTANCES FROM Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service lin WATER S PLE RESULTS: Wires properly protected AT On adjacent lots ; On adjacent lots sewer manhole/cleanout Petroleum tank Other bacteria of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed /o / - I- 3-/67 Tank size )QUO `� s ° ° Compartments / Cleanouts.(O/N). Foundation cleanout (Y/6) Depression (Y/a High water alarm, (Y/N) !� �� Alarm tested (Y/N) 1A Date of pumping r/'19 s^ Pumper SEPARATION DISTANCES FROM SEPTIC/Me6BIN6 TANK TO: Well(s) on fot N ' ` On adjacent lots ti 1.4 Foundation S / To property line 3'- / f Absorption field ° Water main/service line ° t Surface water/drainage ' rs .+ .I ,-0 72-026(3M)'Frml CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons— Vent (Y/N) allonsVent(Y/N) High water alarm level "Pump on" level %ss (Y/N) "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTA FROM LIFT STATION TO: Well on to _ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed / ° 7 2 Soil rating (GPD/FtIK) ? S r'F'Ld/k' System type c �V) 1 6 Length /s Width 6 - s a v c- Gravel thickness V / Total depth 13 Total absorption area S P X Cleanout present ON) Y C s Depression over field (YS) v ° Date of adequacy test 7 a s /`% S— Resultsass/ ail) "11 5f for e/ Bedrooms Water level in absorption field before test s i After test G a Peroxide treatment (past 12 months) (Y/N) N 0 r I,- KN 0 w ',-' If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot A On adjacent lots N �� Property line ` To building foundation t 0 To existing or abandoned system on lot ^ `' is w%" On adjacent tots Cutbank v Water main/service line / o Surface water 1 6,) Driveway, parking/vehicle storage area 1 F Curtain drain ^ a V r, K N0 u , / E. ENGINEER'S CERTIFICATION 1 certify that / have checked, verified, or conformed to all MOA and HAA guidelines in effect on Lba.9Q_Qf this inspection. Signature��✓— Engineer's Name I�d Qi°t : o �✓Ar� Date -7 HAA Fee $ _C5 b0 ` (/P Date of Payment ReceiptNumber 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt -A X ROBERT C. COWAN `�' N CE -8801 MUNICIPALITY OF ANCHORAGE n 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 -L1 n , q87 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) �101l Vf Q #► 'Lo+ i5, 61 cci Location (address or di (b) Applicant Name PqaV hilf\ l LLS.Q Telephone: Home 34L- Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ '(explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDEN E 'Single. Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well ❑ Community LAY Public ❑ Telephone acu" t QfW` rl .r 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 01 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 (11/84) 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 Stale codes, ordinances, and regulations in effect on the date of this inn1pection. Name of Firm / 11 �`�` �a�� i �� IAC• Telephone J -(0 5 Address " fqb IS�y�C7S� 'j,44 -1c ajyd. gjc� ftti[_f'1�1fQCiP. �� 7g5G"j Date � � Mme/ 6. DHEP APPROVAL Approved for har—� bedrooms by Approved Disapproved Conditional _ Terms of Conditional Approval Qkoelp CAUTION ngineer's Seal Date L� 2 i 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 i'025 (1 1184) MUNICIPALITY OF ANCHORAGE (MOA, a� pmodEALTH AUTHORITY APPROVAL (HAA) �IVI§I©N CHECKLIST - FEBRUARY 1984 VOY,$����b�E §O ( 284-4720 / ( LOT _ p `, MAY Legal Description: `j ,+ Q I`I V U.R-*( LOT 154 W k A. WELLDATA SlS 10� Well Classification IYYi U If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Date Water Sample Test Results Comments B. SEPTIC/HOLDm I TANK) Uy�7 ATA Date Installed Ag) Ig,7f Size 1000Q01 No. of Compartments a Standpipes (Y/N) _�i—Air-tight Caps (Y/N) ms_ Foundation Cleanout (Y/N) O Depression over Tank (Y/N) A10 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) N. for Holding Tank High-Water Alarm (Y/N) Af' A. Temporary Holding Tank Permit (Y/N) N• A Separation Distances from Septic/Holding Tank: To Water -Supply Well +r)0D1 To Building Foundation �! To Property Line —y To Disposal Field b To Water Main/Service Line W, To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I Type of System Design Q 0. Date Installed �C a� r ��� Length of Field Width of Field �(O t �r �7 (* v Depth of Field �a r Gravel Bed Thickness 81� Square Feet of Absorption Area 55c Standpipes Present (Y/N) U p5 Depression over Field (Y/N) No Date f Last Adequacy Test � 9 7 f Results of Last Adequacy Test �� T �O�W� ou-S-f w Separation Distance from Absorption Field To Water -Supply Well ��� To Property Line — 1;26 To Building Foundation ��r To Existing or Abandoned System on Lot N• A . On Adjoining Lots X501 To Water Main/Service Liner To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course + I co r To Driveway, Parking Area, or Vehicle Storage Area Comments,* Prom l* > kiki- D. LIFT STATION Date In talled Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes Comments Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check4ae ating Against HAA Request " Icertify tfied,orconformedtoall M A and HAA guidelines in effect on the date of this inspection. SignedDate 1 , O ` Compan�� MOA No. Receipt U U 2G Date of Payment Amount: $ s/2Q���/ ,! 9Engineer's Seal r'o o� : , /�O t Page 2 of 2 72-026 (11/84 t�. Corwin CE -5283 cr 'i �o g�:PLO IA%YALH •`qy� GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received /a- /.2-' fY / Time of Inspection G G 1/.1367 Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 1-�2 D moa: a/-� Phone: 50,1-6 f-�J� 2. Property Owner: ,c� �+� _ / Phone: Mailing Address: -733o Xk&de-Lr �. _ In'�Qy�!''� 3. Legal Description: �P / tyZ-�a %G� U � 7��a.-c-'Y `r* yy�J jj 4. Location: 5. Type of facility to be inspected _gym No. of bedrooms 3 �"- 6. Well Data: A. Type B. Depth C. Construction Cl_j�«-cea� D. Bacterial Analysis 7. Sewage Disposal System: A. Installed /g %�a_ B. Installer "' C. Septic Tank: 1. Size lA-V2. Manufacturer< keQ D. Seepage Pit: 1. Absorption Area ���p 2. Material ' E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area Sewer Lines Nearest lot line Other contamination V �6r B. Foundation to septic tank g Absorption area C. Absorption area to nearest lot line 2 �/ EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Rey ... j'st for Approval of Individual .(er & Water Facilities Legal Description o�" /S - Comments S Comments 0 Approved Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74), Date