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Home My WebLink AboutVALLI VUE ESTATES #1 BLK 1 LT 16 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 ABSORPTION . FOUNDATION Township, Range, Section '. TYPE OF SYSTEM ~TRENcH ~ BED ~ W. DRAIN D OTHER Pill added above original grade Gravel depth beneath pipe Grave~ length Gravel width I T°tal abs°rpti°n ~rea ~S Distance ~tween lines l ~ PRIVATE ~ OTHER (Identify) Classification (A,B,C) Torsi Depth ~ FT Instalte~ DaLe msLalled: Municipal and Slale ,uideJin. i. effect on thin date: ¢--/~-- ¢~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Township, Range, Section: '-~Z.,,V/ .~.~z,J ~C // 5 6 7 8 9 10 11 12 13 14 15- 16- 17- 18- 19- 20- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ DEPTH? p E Depth to Waler ADer Monitoring? Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER FT AND __ FT PERFORMED BY: /~'-~ ~-' ~/~-X/~ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~"~-/Z--4¢'~' 72-008 (Rev. 4/85) M U N I C i 'P A I._ I T Y I] F A N C H 0 R A G E Department o¢ l-..le~al'Lh & Human Ser'v:i.c:es 825 L ~tveer.~ Anc:hopage~ A].aska 9950:1. ,:..I...:.-~ ~ 0 N - S I T E S E W E R P EE R M I T 05/()3/89 Eng :i. n~)el~ Ownem .q~.n .... Owner Ad clr e~-~!s.~ IEDWARD GLADW:I:N 68C)8 DOUBLE TREE ANCH[]I~A.~b., AK 995 :t. 6 Da'y Phone,: ,:.4 ......... ,~.k.., 7 I:::'ar'cel Id,", 0:1.5-311,-:1.7 I,..o'L i_e~a].~ ,Su!::)d:Lvis:Lon~ VAL[..I~ VUE EST. Sectior~: ].4 Townshipi~ 1;]~N Range: f...o'['.. S:i. ze [~.()19() (sq,,{L,, op ac:'.pes) Max Bedrooms: 'Th:Ls PermJ. t~ 4 Total Capacity: 16 B ]. oc k: IlL, TAIqI<~ I"i:i.c.:i. mum 'Lota]. septic tank capac:ity: .[~,~,. ga].].ons., Eac:h septic tal'li,:: rm.ts't, have at least. ','R compar'Lments~ D~.~pth to top of sept:it tank(s) < 4.0 ~'(.-"l~,?t p(~i:]L!iP6.![~ :i.l-i!~L!la~Liorl C)V~?p 'Lank (s). INSTAl_I,... F:'ER ENGINEERS DI.:~SIGN,, NOTIFY DHI4S PFC[OR T[) EACH INSI:::'EE.t]':I:ON BY THE EN(3INEE~R. PROVZED ADDI]'C~NAL. SOII..S F;:EPORT MITH AS-BU]:L.T, 'TH:IS PERIdZ"t- IS IS[3UED FOR THE EXISTING 4 BEDI'ROOPI S:[NC'~LE: FAMIL..Y DWEI,.,I..INB ONLY AND EXPIRES [:IN 12/3~/89~ J: CliEFR'T' I F:Y ]'HAT' ..", !,. I am -Fami ]. lac with 'Lhe v .z~ :lttJ. remen'Ls For' on-site seweps and {'c:ir'th by {he Nun:Ecipa].ity of' Anc:hoPag~}) (['lOa) and the State of Alaska,, 2. I will :[nsta:l.]. the system in ac:condance wi'Lh all M[]A codes and regulat:i, on~ and in compliance with the design criteria el' this per'mit. cJJ~5'~,strl(:]~3~ i-po!ii any = 'istin(~ well, wastewater' disposal 4. ][ u, ncJep!~taf!d '~.l"l~;~t J'.,h:i.~B i]e:epmi't, :i.s valid fop a maNimL~rfl of 4 bedpooffls. .J. a]~B(:) t..tl"ld(spstEtf'ld that the;:) capac:i,'tt.y (3{ the t. otal system J,:~ 4. [iiy:)clpoolliSli &lid any c,r ] a"..je, e ]t w:i. 1 1 p~):~]t.li ye an add i'L ional permit,, PERFORMED FOR: LEGAL DESCRIPTION: 5 6 7 8 9 10- 11 13- 14- 15- 16- 17- 18- 19- 20- SLOPE SITE PLAN /5--o WAS GROUND WATER ENCOUNTERED? cfi, iF YES. AT WHAT DEPTH? Depth to Water Aller ,,2 ~' Monilorin§? ['~t Date: Reading D~.I Gross Net Depth tO Net "-... 0 ~Jme~ /~ ~ime Water Drop PERCOLATION RATE __ (minutes/inch, PERC HOLE DIAMETER __ TEST R N BETWEEN ~.TfAND __FT COMMENTS V//'~'U)~/~' ~'-/Z/6 ~F /~'O ~/;;Z~I~ ,~)t~ ~ /~ ,~ / PERFORMED BY: .~---~5 /~t'/~)/~-/O I d ~/t~,~ ' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ALASKA alUlROnm nTAL COI1TFqOL $ I UIC S, I C. · ~nc~in¢¢rinq g~ ~nuir0nm~nt01 $1udics SPECIFICA]'IONS FOR A TRENCH-]"YPE WASTEWATER DISF'OSAI- SYSTEM LEGAL DESCRIPTION: LOT 16, BLOCK 1, VALLI VUE SUBDIVISION 1 ~ 0 GENERAL The Drawings, shee'l~s 'L '~hru 4, shall be a part of this specification ~ 1.2 All materials and ~orkmanship shall meet the requiremeots of the Municipality of Anchorage, Department of Health & Human Services (DHHS)~ the conditions of the permit, and all applicable rules and regulations corrently in effect. All elevations and depths are advisory, and are to be verified or' modified in the field by the engineer or inspectinc3 ager]cy. 1.4 It is the responsibility of the property owner or installer to adhere to approved designs for installation, maintain the specified separation distances, and have the appropriate inspections. It is the responsibility of the property o~ner' or" installer to report to the engineer any ebserved conditior~s ~hich ~ou].d put the sytem in violation of state or Municipal r'egulatic)ns~ If the installation is not inspected by an AECS engineer, AECS will not be respensible for the installed system. An engineer at AECS should be consulted pr'ior to construction to determine the number o9 inspections that will be required and to explain what these inspections w. ill involve. 2.0 SEPTIC TANK ]i;f there is an existing septic tank, it may be used it if meets the capacity r-equirement for the residence and the approval of the MOA. 2~2 "the septic tank shall be a UPC-approved t~o--.compartment tank, constructed of 12 gauge steel with bitumastic tearing and set level on undisturbed seil. if '~he tank is buried at a depth of 4 feet or less~ it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid beard insulation. The s(~.ptic tank and trench shall be a minimum of 100 feet from any private ~e]L1 or body of ~ater, 150 fee~ from []lass "C" wells, and 200 feet from Clase "A" or "B" wells, unless otherwise 2.5 2.6 specified. Less tlnan 'Lhe required separ'ation distar~ce must have prior approval or waiver by ADEC or MOA. The septic tank shall tine house 'four-~dation; the al3sorption area~ be a minimum of 5 feet from ar')d a minimum c)'f 5 'i:eet from Piping shall be fitted ~,,~itln a mec.-hanical watertight calder'" coupling on tine outlet and inlet of the septi, c tank. Piping shall be 4 inch selid PVC ASTM D-3034 or cast iron~ sloped a minimum of 1/4 inch per' lineal foot= If the piping is buried at a deptin ef 4 feet or- less, it must be insulated witln an overlying layer" of 2 inch burial '~:ype polystyrer~e rigid board insulatior~. Cleanouts shall be installed as deeignated arid capped ~ith air-tight rain caps (Jim []aps or equivalent), and extended a minimum of i foot above ground level. If a lift stat. ion is requi, red it slnall be a combination li. ft station septic tank per Anchorage Tank and Weldi. n~, Inc. design. Speci~icatior~s and design dr'a~ings are on file with the Municipality arid the engineer. 3.0 ABSORPT ]] ON AREA The gravel 'for' the trencin shal) be 0.5 to 2.5 incln.~ screened rock with tess than 3 per'cent passing tine No. 200 sieve. All substitotes must have prior' DHHS approval. 3.2 The bo¢;tom and sides of the excavation shall be faked with the backhoe blade to ensur"e that it has not been compacted during excavation. The bottom elevat±or~ slnall be level. 3.3 Monitor' standpipe(s) shall be placed as sho~r'l the drawings, and shall be 4 inch rigid PVC ASTM D.-.-3034, or cast iron. The section shewn ~ith ineles may be 0.5 inch holes drilled on 6 inch center's on opposing sides of the pipe, or a r'eguiar section of perforated se~er pipe clamped to a solid section ¥~ith either- a no Inub c:oupling or a solvent joint. A rubber' fain cap (Jim Cap or equivalent) shall be installed over' the tep of tine p i pe ~ 3.4 "Fine distribution pipe shall be perfor"ated 4 inch PVC with a minimum crush str-engtln c)f 1500 pounds 3~6 and shall meet the approval of DHk.kc~ 'for' use as drainfie!d pipe~ Ail distributien pipe~ shall be laid level. Tr'enches may be paralleled, but must have a minimum separation distance between the trenches of 10 feet or' 2 times the gravel depth (~hic:h ever' is greater)~ 75 'feet is the maximum allowed linear length o'f any trench. If the final grade over- the trench is less '!:hah 4 · feet above gravel, insulatier-~ is required, using burial type polystyrene rigid board insulation. There shall be 1 inch o~' insulation for every foot of soil less than the requir"ed 4 '~eet o9 cover", but there must be at least 24 inches ef soil (:over even though insulation is used. The solid pipe ext. ending from the septic tank to the drainfield shall also have a minimum o9 4 feet o'J' (::over or an equivalent layer of insulation to prevent freezing ef the line. :If insulation is not necessary, the gravel shall be covered with a layer of nonwoven Geotextile fabric (such as Mirafai~ Fibretex 200 grade, Poly Filter- X or- equivalent). 4. () t NSF'EC]T IONS A minimum of tt~o ir]spectiens are required for the iostaliation ef the trench~ The first inspection will be of the open excavation to assure that the system is installed in the proper- soil strata, cor"rect depth and meet m:Lnimum specified (:lesign 4.2 The second inspection ,~ill be after' placement of the gravel, mc)niter standpipe ar-~d dist_ribution pipe to verify proper installation and position prior to backfill. The inspection of the septic tank installation can be incorporated with any one of the above listed inspections. The lift statJ, on will reqoir'e either an MOA electrJ, cal inspection or- certification by a licensed electr'ician, depending on whether the building code applies to this par't o'f the city. ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 west 33rd Avenue, Suite [3 ANCHORAGE, ALASKA 99503 (907) 561-5040 CHECKED BY DATE. ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 west 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 CHECKED BY DATE SCALE ALASKA ENVIRONMENTAL CONTROL SERVICES, INC, 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 DATE GREA' LR ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION FROM WELL ~ANU~CTU RF_R ~' M~- R I AL-~ ~'/~'~ M P~R~E NTS INSIDE LENGTH TILE DRAIN FIELD~ DISTANCE FRO~ ~ELL ~FOU~ATION NEAREST LOT LINE GALL* TOTAL LENGTH OF LINES )NS. NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE IN. ABOVE TILE IN, WELL: TYPE CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION__ LOT LINE SEWER LINE__ TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE:_ REMARKS: DIAGRAM OF SYSTEM Form EQ-032 GRE'ATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED · DRAIN FIELD PHONE FINANCED THROUGH TO BE INSTALLED BY SOil TEST RESULTS NOTE= THIS PERMIT [$ NOT VALID WITHOUT SOIL 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 TYPe MINIMUM DISTANCES, REQUIREMENT~ FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, ., SEEPAGE PIT TO RIVER, LAKE· STREAM. SEEPAGE AR~:A SIZE , DRAIN FIELD ~, DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. · SEEPAGE PIT DRAIN FIELD 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 ~[PHON PIPES ON SEPTIC TANK AND SEEPAGE FITTED WITH AIRTIGHT REMOVABLE CAPS. V (l TYPE DIAGRAM OF SYSTEM ORDINANCE NO. 28-68 AND THAT THE ABOVE Frank G. Wilson, Distributor This Agreement entitles: BI-A-ROBI ALASKA 250 South Park Street Anchorage, Alaska 99504 Telephone (907) 274-3324 MAINTENANCE SERVICE AGREEMENT Addre.ss ,,? .; ' ,' to the following service for two years from the date of acceptance. Upon receipt of this signed agreement and payment in full according to the purchase agreement, BI-A-ROBI ALASKA agrees to perform the following services during the term of this agreement: BI-A-ROBI ALASKA wi!l inspect the BI-A-ROBI OXYGENATION SYSTEM twice a year· These inspections will include: * Check and clean or replace filters as required. * Check diaphram, inlet and outlet valve. * Clean unit and/or install new Service Kit as required. * Examine final Effluent for clearness and odor. * Check timer and warning light. * Inspect for sludge accumulation with arrangements for removal when build-up warrants removal. * If improper operation cannot be corrected at time of service, the Department of E.Q. will be notified. If it should be necessary to replace any parts of the equipment, tee Servicer shall make such replacements of the parts and materials required. There will be no charge for labor, mileage and parts ~nder the one-year warranty. Service calls resulting from the following reasons are not covered by this agreement and will be billed at the regular hourly current rat~ .:' (a) Power or fuse failure. (b) Flooding, freezing, tank settling, freezing of effluent line. (c) Discharge of any material, liquid or solid into the unit which could not be considered normal bio-degradeable household effluent waste. (d) Crushing of unit or piping due to overload on the ground above or area thereof. (e) Clogged inlet or effluent line. Service calls will be made by qualified mechanics representing BI-A-ROBI ALASKA. The two service checks annually will include calls for emergency repairs. BI-A-ROBI ALASKA is relieved of any further responsibilities if at any time during the term of this agreement you permit any other persons or employees of any other Company to render any service or make any adjustments or changes to the equipment, except when instructed by us. We will not be responsible for any direct or indirect damages arising from failure of system and/or equipment, but undertake under the terms outlined in this agreement to do such adjusting as may from time to time be necessary. The Servicer will not be responsible for damages resulting from fires, floods, accidents and delays unavoidable or.beyond our control. We hereby authorize BI-A-ROBI ALASKA representative to replace such parts and materials as may be required to ensure proper operation of the system. DEFAULT~ If the customer does not pay any invoices due from services rendered within 30 (thirty) days of billing date, BI-A-ROBI ALASKA may (s) refuse to continue service or (b) furnish service only on AC.O.D. basis. The customer agrees to Pay all costs and expenses of collection plus interest, including the maximum attorney's fee permitted by law. TWO YEAR SERVICE CONTRACT (Round Trip miles contract) BY: ..... ANCHORAGE AREA BOI UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ','J/aJ~?/~/}/V-7- MAILING ADDRESS ///~.~ %7~' ,~, PHONE SEPTIC TANK: DISTANCE /~ FROM WELL'''~L:;77/~'I INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL ~.;/~, ~_ / NUMBER OF COMPARTMENTS / LIQUID DEPTH LIQUID CAPACITY /'(?~> GALLONS. SEEPAGE PIt: NUMBER OF PiTS / DIAMETER __OR WIDTH /"~/, ~ LINING MATERIAL/~/]/g' -~ CRIB SIZE: DIAMETER__ BUILDING FOUNDATION ')~,~ , NEAREST LOT LINE'?~C2 ADDITIONAL ABSORPTION LENGTH/"~ DEPTH DEPTH ~ DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~'~/~/~ SQ. FT. WELL: TYPE ~-- ~,' /?'] /'}~ CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: PiPE MATERIAL LOT SL( REMARKS: DIAGRAM Of SYSTEM APPROVED~A;??) ..(. r-,,~./[t~ G.A.A.B. Form No. EQ-Oal ~1~ GreaTer ANChORage AREA BoRough . ~' ' PERMIT "~ ~'~'~SEWAGE DISPOSAL SYSTEM -- APPLICATION AND INSTALLATION OF: SEPTIC TANK ~~ SEEPAGE PIT--. ~ ~RAIN FIELD MINIMUM DISTANCES, R~'OUIREMENT$ FOUNDATION TO SEPTIC TANK , SEEPAGE PIT . ., DRAI~ FIELD WELL TO SEPTIC TANK . ~ -- SEEPAGE PIT DRAIN FIELD ~ , ALSO CONSIDER area WELLS. AREA SiZE TYPE I CERTIFY THAT [ 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. ~(~J T. H.- I 5 - 25 ORGANICS WITH .SOME SI LT 1.0' ORGANIC SILT WITH SOME GRAVEL 2.0' SILTY SANDY GRAVEL (GM) 4.51 SANDY GRAVEL TRACE SILT WITH COBBLES II.O' NO Water Table T.D. Note: Test hole excavated with tractor mounted backhoe. l~Englneerlng ~ Geological Consultants DATE 5-- 50- ,75JSCALE I" = 2' IOWN BY ~.A.W. Ulane Finn Property LOG OF TEST HOLE Anchorage Alaska W.E.D. JPRou. NO. 36617 Jgwo DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR (907) 349-7755 February 10, 1992 FOR: Alaska Associated Realty PWSID # 210605 My review of the records on file in this office reveals that the Valli Vue Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer BR/cf 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. HAA # ~-~0~ ,Q (-~ ~-~.t n 1. GENERAL INFORMATION Complete legal description Lot 16; Block I; Val~ Vue Est~t&s ¢~ Location (site address or directions) 6808 Double Tree Co~Z~t Property owner Mailing address CALDWELL BANKER RELOCATION MGMT. Day phone Lending agency Mailing address Day phone Agent Elain6 Gl~van CALDWELL AREA BANKERS 4105 Tudor ¢6rCJ~¢ Drive Unless otherwise requeste~ HAA willbe held forpickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: Day phone 561-2488 Individual well Community well XX :. Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: 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} Front MOA #2~ 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 ENGINEERING Add ress 17034 RaCe River Loop Road No, 204 E~!e ~iver, Alaska 99577 Engineer's signature Phone Date SIGNATURE Approved for Disapproved. ,/~Gedrooms. Conditional approval for bedrooms, with the following stipulations; Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. 72-025 (Rev. 1/9f) Back MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.,oT I~,! ~{~-- I: (,/~LL~. ~[/~l,~ ~/P Parcel I.D. - A. WELL DATA Well type ¢~M~md~z¥ Log present (Y/N) .A.//~ Totaldepth ~/,~ Sanitary seal (Y/N) /I,//,~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed . /~'~- Driller . Cased to /~/~-~ Casing height ,~/~ Wires properly protected (Y/N) FROM WE/I.L LOG Date of test ~,,//~ Static water level Well flow Pump level / SEPARATION DISTANCES FROM WELL TO: /~J//~ Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: IV//Jr Coliform ~ ~ Nitrate AT INSPECTION /~/'/dj ,¥,UH!C!PALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION g.p.m. RECEIV£D ; On adjacent lots ; On adjacent lots Publ~ Petroleum tank Other bacteria Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~/IF/~c~ Tank size 1,~50 ~'.,~c Compartments Cleanouts (~'N) YE~% - ~ Foundation cleanout ~N) ~/~ Depression~'~) High water alarm (Y/~_~ /~/,/Jr Alarm tested (Y/N) Date of pumping ~ ~ --~- Pumper /~'/'-~-~E SEPARATION DISTANCES FROM SEPTIC/H~L~Eh~NG TANK TO: Well(s) on lot ~J//~- On adjacent lots To property line ¢-~0 ~F Absorption field Surface water/drainage [,0(~ ' '~ Foundation ~,~ ~ Water main/Service line I0, ~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE ....~C, LIFT STATION / D"'"~a -in,tailed ~/,~r Manufacturer Size in gallons ' - . Manhole/Access (Y/N) Vent (Y/N) "Pum. p on" level at "Pu~p-~4f~evel at High water alarm level - - ~rdl~s tested Meets MOA electrical codes (Y/N) /- _ SEPARATION DISTAN~E~PFC~LIFT STATION TO: - Well on I~:~''~'-~ On adjacent lots Surface Water ~PTION FIELD DATA Date installed Length -~-~ ! Total absorption area Depression over field (Y/q~ Results a~/fsil) Width Peroxide treatment (past 12 months) (Y/~ Soil rating f~E) Gravel thickness ~ Cleanouts present~YN) Date of adequacy test for ~/,o~.,~ If yes, give date System type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots c~.~ Surface water 100 ' ~L On adjacent lots c~-(30 '~L Curtain drain Property line f To existing or abandoned system on lot Cutbank~°~JE- .Water main/service line Driveway, parking/vehicle storage area /09 E, ENGINEER'S CERTIFICATION 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 ENGINEERING 17034 Eagle River Loop Ro,~cl No. ~arj~a ~iver, Alaska HAAFee$ //~(~ ¢ o Date of Payment "~-~> ~ ~ Receipt Number ~,~--~/~ ~'/~//-/~) 72-026 (Rev, 3/91) Bsck MOA 21 Waiver Fee: $ Date of Payment Receipt Number 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# ~r-\(~'~ - I('~d .... -, 3,/¢ ~ '~ , ',' ~( ' 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Malhng ABdre~ ...... ,..-~'[,, ~ , 1~/,' · . ~ f .... , ~th ' .1~'~ ' /'~ (c) Lending Institution Telephone: (home) ~-'r--, Business ,-';_, , Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone Z--7/~ -~-?~. f Mail the HAA to the following address: (or check here, S. if hold for pick up.) List contact person and day phone number below: (e) 2. TYPE OF RESIDENCE / Single-Family"~ Number of bedrooms 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 th legality and status. 4. SEWAGE DISPOSAL On-site~L 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. 72-025 (Rev. 7/88) Page 1 of 2 ~ Jo ~ ')~JOM s,Jeeu!bue leUO!SSe~toJd eql u! SUOISSILUO JO SJOJJe JOJ elqisuodseJ ~ou s! eSeJ oqouv ¢o/~!led!o! u n I~ eq.L 'penss! s! m, eo!,u1Jeo e eJo,teq elep ez~leUe JO suoi)o~dsu! ~onpuoo )ou op SHHQ Jo sea,~old uJ~3 's~ueLueJ!nbe~ elels puc leJepej u!elJeo/gs!~es o) JepJo u! suoRnl!)su! 8u!puel J!eql pue sauJoq Jo sJeeeqoJnd oh Xsepnoo e se s!ql seop SHHG eqj. 'e~SelV jo e~elS eq], u! peJe)s!SeJ Jeeu~Sue leUO!SSejoJd luepuedepu! ue ,~q eAoqe ~ qdeJl~eJed u! ueA!b suo!)e~ueseJdeJ eql uodn ,~lUO peseq peleoiJ!Jeo le^o,lddv,~lpoq)nv qlleeH senss! (SHHQ) seoiAJes ueuJnH pue qlleaH jo lueuJ1Jedea ebeJoqouv jo,~l!led!o!unR eq.L .g qco .~, ~IPALITY OF ANCHORAGE (MOA) .¢_~O~\%~ealth Authority Approval (HAA) ~C~J CHECKLIST - FEBRUARY 1984 A. WELL DATA Well Classification __ Date Completed Depth of Grouting 343-4744 Legal Description: To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved~/'N) Yield esent (Y/N) Cased to Pump Set At Casing Above Gr~ . Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/~ Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WEL"b~ ' To Septic/Holding Tank on Lot ~_ ; On Adjoining Lots _ __ To Nearest Edge of Absorption Field on Lot ~ ; On Adjoining Lots ~o Near~eanout/Manhole ; Da~e ~ B. SEPTIC/HOLDING TANK DATA Date Installed ~""'~-?~ Size Standpipes~N) /¢,Z~'O No. of Compartments / Air-tight Cap (~N) Foundation Cleanout (Y(~ Depression over Tank (YIN)) Date Last Pumped Pumping/Maintenance Contact"-/on File (Y/N)./.' /d//~ ; for Holding Tan k~l~i~¢~C~r¢~,~ia:~ (Y/N) ~/~ Temporary Holding Tank Permit (Y/N) SEPARAT~~E~,:~SEPTIC/HOLDING TANK: TO Wat~ly ~f¢~'%~ + To Building Foundation To Proper~Dn~ /¢ ~ To Disposal Field To Water:Maio/~.Li~l ~ To Stream~ake or ~a~p~,¢hinage Course ~ /~ Comments ' ~'¢¢~¢~"" ¢ ' 72-026 (Rev. 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~, --?~ 7.~ Width of Field /~ Square Feet of Absortion Area ~'¢(¢' Depression over Field (Y(~ Results of Last Adequacy Test ,'~¢f/~crz'~' SEPARATION DISTANCE FROM ABSORPTION FIELD; To Water-Supply Well Type of System Design / ~/¢ Length of Field Depth of Field ./,/ / Gravel Bed Thickness Statndpipes Present(~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on To Building Foundation Lot /-]/~ To Water Main/Service Line /O ,~- To Stream, Pond, Lake, or Major Drainage Course ,/~ To Driveway, Parking Area, or Vehicle Storage Area ; On Adjoining Lots ~ To Cutback (if present) Comments D, LIFT STATION Dimensions Manhole/Access (Y/N) "Pump On" Level at~"'"'~'""~ "Pump Off" Level at High Water Alarm Level at '~'~"~_ Vent (Y/N) Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I fiave checked, verified, or conformed to all MOA and HAA guidelines ' inspection. Signed Company Date MOA No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Beck effect on the date of this Waiver Fee: $ Date of Payment Page 2 of 2 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) ~ Locatior¥,(add~.s~r d~r~ens) MUNICIPALITY oF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INspEcTION F°R HEALTH AuTHoRITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Telephone: (home) ~-¢,~-J~'~'7 Business Telephone Mailing Address (d) Real Estate Company and Agent ~--~-~ ~£~- ~/-'~ Address ~ ~v',4 /*r,J~-v~ ~ ,¢75'"~ . '~"' Telephone ~-7~, (e) Mail the HAA to the following address: (or check heretiC, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community'l~i~ Public [] Note: if community well system, must have written confirmation from ~he 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. 72A)25(Rev. 7/88) Page 1 of 2 '>pOM s,Jeeu!6ue leUO!SSe~oJd eq) uj suo!ssluJo Jo s Jo J J8 JOj elq!suodseJ )ou s! @6eJoqouV ~.o/{)!led!o!unl~ eq.L 'penes[ s! e)eo!t.13Jeo e eJojeq elep ez~ieue JO suo!3oedsu! lonpuoo 3ou op SHHQ jo see/,old uJB 'slue~ueJ!nbsJ e~els pus leJepeJ u!elJeo Ajs!~ss o3 JepJo u! suo!ln~!lsu! 8u!puel J!eql pus SeLUOq JO sJeseqoJnd ol /~sepnoo e se s!ql seop SHHQ eq.L 'm~Sel¥ jo elelS eq3 u! peJels!eeJ Jeeu!6ue leUO!SSejoJd luepuedepu! u~ Aq eAoqe S qdeJ§e~ad u! USA!§ suo!lelueseJdeJ sql uodn AlUO peseq peleo!jpeo IB^oJddv,qpoq~nv qlleeH sense! (SHHQ) SeO!AJeS uemnH pu~ qll~eH jo ~ueuJp~dea e§eJoqouv jo Xl!led!o!unpl eqj. leUO!~!puoo leAoJddv IP. UO)))puoo ~.o swJe.L pe^o~ddemQ pe,~ddv /~q SLUOO~peq~ ~O=~ peAo~ddv .'; '~,3v^oaad¥ SHH(] '9 'uoiloedsu! sl4~ J.o e~ep e4~ uo loejje u? suo!~eln6eJ pue 'seoueu!pJo 'sepoo pue led!o!unlAI lie q~iM eoue!ldLUoo u! s! u~e~s/,s i~sods!p Je~eMeiSeM Jo/pue ~lddns ~e~eM e~is-uo eq~ 'uo!~oedsu! pu~ uo!3eSp, se^u! ~u~ ~uoJ,t pug sel!J @SeJoqou¥ lo A~!l~d!o!unl~ @q~ uuo~j peu!e~qo uo!leuJJoju! eq~ uo pes~q 3eql Ajpe^ Jeq3~n~ I 'u!eJeq pe;eo!pu! e~nlon~]s to ed^3 puc SLUOOJpeq to ~equJnu eq~ JoJ elenbepe pue' leUO!3ounj 'ejes s! ~ue~sXs lesods!p Je~eMe~seM ~o/pue Alddne Je~eM e~!s-uo eq~ ~eq~ SMOqS le^o~dd¥ ~lpoq~n¥ q~leeH s! q~ lo uo!~eS!~se^u! ~w ~eq3 Xjpe^ I 'Moleq UMOqS e~ep uo!~ep!l~^ eq~ to se puc o~e~eq pex!jJe legs ~w Aq pe!;!peo sV NOI/¥1NI:IOJNI (]NV V/y(] 'HOH¥=I$ =1'114 '$J.S=1/~$NOI/O=1~ISNI 9Nl(]l^Oad l~lbll-I 9Nla=1=1NION=1 'g ~,~.\~'~ O~ ~'~"I\s~O;uNICIPALITY OF ANCHORAGE (MOA) ,x~\C\ ,~F,V~,'~,~ Health Authority Approval (HAA) N\~O ~ cHECKLIST - FEBRUAR~ 1984 g~ ~ ~ ~ 343-4744 ~ _~ Legal Description: ~o~/~ ~/ ~/ ~'~ Well Classification ~b ~ I~B, C, D.E.C. Approved ~N)~ resent (Y/N) Date completed Yield ~Cased to Depth of Grouting ____ __ Pump Set At C~ H~ght Ab~ __ Sanitary Seal on Casing (Y/N) El~ri~ Wir~ C~t (~ Depression Around Wellhead (Y/N) ~~~ ~ ~ ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~. ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments TO Neares~Cleanout/Ma n hole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 5'~/5"~g'~ Size StandpiPes gN) /~...~o No. of Compartments ~ Air-tight Caps~N) Foundation CleanoutgN) Depression over Tank (Y~_~ Date Last Pumped / Pumping/Maigt. en~ifi~j~o.i~act on File (y/N) ~/~ ; forr H 01 d i n g Ta~'~i~~,,~Y/N )~ Temporary Holding Tank Permit (Y/N) SEPA~ATJ~ Dinner,SEPTIC/HOLDING TANK: To Wa~e'rtS~Pr~'~lt''"~'~":~ ~ To Building Foundation To prO~e~l~.?~,~.'~,~;~:?~ To Disposal Field To Water ~g,nl~er~n~ TO St rea m, pq~,~g~/;; rainage Oou rse 1~ * Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata _ Width of Field Square Feet of Absortion Area ¢ ~ ¢ Depression over Field (Y~ Results of Last Adequacy Test ~///~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~/¢- To Building Foundation Lot /-~/ To Water Main/Service Line Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present(~N) Date of Last Adequacy Test To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ?¢ To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) Comments D. LIFT STATION "Pump On" Level at -'~'"'~-'-"~-. High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) '~"~-~"'~'-~-~ _ Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that l have checked, verified, or conformed to all MOA and HAA guid~a.~l~ ~f~ ;he date of this Signed _. Company Date ~ er's Seal MOA No. ~ Receipt No. ~//VY ~ ~Receiptl~ ~No_- -- Amount: $ ,/~ ~ Date of Payment z~-0~6 ~R~v z/es~ ~,ck Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE / 3601 C STREET, SUITE 322 ANCHORAGE, AK 99503 STEVE cOWPER, GOVERNOR FOR: ALAN OF AECS DATE: March 21, 1989 PWSID: 210605 To Whom It May Concern: According to the records on file in this office, the Valli Vue S/D Water System is in compliance with the State of Alaska Drinking Water Regulations. S inc erely, Vets E_ Craig~ ~' ~ EnVirOnmental Fie~d Officer VEC:kk DEPT. OF ENVIRONMENTAL CONSERVATION/ STEVE COWPER, GOVERNOR ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 563-6775 DATE: PWSID: TO Whom It May Concern: According to the records on file in this office, the ~//; ~ ~/~ Water System is in compliance with the State of Alaska Drinking Water Regulations. MPL:pkk Sincerely, Michael P. Lewis, PE Environmental Engineer GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received August 31, 1976 Time of Inspection ~/-~ Date of Inspection j~]yo REQUEST FOR APPROVAL OF ~L~L INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. 1. Approval requested by: Spokane Mortgage Co. Mailing Address: 3201 C Streetf, Suite 250 Phone: 277-0543 2. Property Owner: Jimmie w. Lanz & Selva J. Lanza Phone: Mailing Address: 3. Legal Description: Lot 16 Block 1 Valli Vue Estates ~1 6808 Doubletree Court Single Family No. of bedrooms 4 4. Location: J Type of facility to be inspected Well Data: A. Type Co~mmunity C. Construction B. Depth D. Bacterial Analysis Sewage Disposal System: A. Installed 8/76 C. Septic Tank: 1. Size D. Seepage Pit: 1. On-site system B. Instal]er 2. Manufacturer Absorption Area 2. Material Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line Disposal Field: Total length of lines , Absorption area , Other contamination , Absorption area , Sewer Lines __ LQ-034 (1/74) '~ Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY ~ :. , 2510 E. Tudor, Anchorage, Alaska 99503-276-2221 E×. 28~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA 2. Property Owner: JII~IE W. LAtZ A~D SELVA J. LANZ FHA CONV )LC Mailing Address: Unkno~wn ~_ Name of Buyer: DENNIS L. GLADWIN AND NYLA G. GLADWIN Day Phone none Mailing Address: 6808 Double Tree Court 4, Name of Lending Institution: SPOEA~E MORTGAGE CO. Mailing Address: 3201 "C" Street~ Sulte 250 5. Name of Realtor or Agent: 3ACK [~iITE CO. Mailing Address: 3201 "C" Street Day Phone Phone 277-0543 · Phone 277-1553 6. Legal Description: Lot 16, Block 1, Valli Vue Estates Subdivision~ Unit No. 1 Location: 6808 Doubletree Couyt~ Anchorage~ Alaska 99507 7. Type of Facility to be inspected: 8, Water Supply Type of Supply: single family Public Utility No. Bdrms. 4 Individual Community If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation 8-76 UNKNOWN UNKNOWN Individual (on-site) Septic EQ-O37 (1/74) Page 2 of two pages - Re(~t for Approval of Individual ~)r & Water Facilities Legal Description Lot 16 Block 1 Valli Vue Estates Comments Approve,.~,,,'~~~ D~sapproved Date 9-1-76.. ( ~ u \.J Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 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 o~erating satisfactorily. SIGNED Date EQ-034 (1/74)