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Home My WebLink AboutVALLI VUE ESTATES #1 BLK 1 LT 14 "I gi, I Municipality of Anchorage NLJV On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231346 PID Number: 015-311-15 Dwelling: X Single Family (SF) El with ADU R Duplex (D) M Two Single Family Project: Fj New F&I Upgrade Name MATTHEW REGAN ABSORPTION FIELD RN Deep Trench El Wide Trench n Bed F-1 Mound I Site Address 6726 DOUBLE TREE *ANCHORAGE, AK El Other Phone Number of Bedrooms Soil Rating Total depth from original grade- 907-529-4675 3 1.2 GPD/SFI 12 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 6.5 Ft. Subdivision Block - Lot VALLI VUE ESTATES #1; BLOCK 1, LOT 14 Fill added above original grade SEE DWG. Ft. Gravel length 40 Ft. Township Range Section Gravel width 2.5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 520+ Ft2 1 Ft. _ Well - TANK 9 Septic El S.T.E.P. 171 Holding El Other Manufacturer INFILTRATOR Capacity 1530 Gal. surface Water 100'+ 100'+ Material Number of compartments Lot Line 10'+ 10'+ NA PLASTIC 2 Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Remarks PER CONTRACTOR, OLD TANK WAS DECOMMISSIONED PER UPC Gal, Alarm location Electrical installed by Installer PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 A.C.E.S. Drainfield D3034 CO/MT D3034 Inspector GEG AND M.O.A. BENCH MARK (Assumed elevation) 100.00 ft Inspection 1st 10/25/2023 10/26/2023 dates: 2nd Location and description 31d 10/27/2C 41h - BOTTOM OF VERTICAL TRIM AT SOUTHEAST CORNER ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date -.Po 0, . 49 A .. ..... .... ........... Septic System Approved Date 2, f ey rness.* ri CE-7953 4 11 �vpaP'Of Note: this approval does not include well permit requirements. ess'O)"o #AE k — v.nvu rv1 PERMIT NUMBER: OSP231346 NOTE: PIPE LOCATIONS AR SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN AUTOCAD. VALLI VUE ESTATES #1; BLOCK 1, LOT 13 - SERVED BY PUBLIC WATER SYSTEM. E D DRAWING R fj /` /I PARCEL ID NUMBER: 015-311-15 DOU13LE FREE- _ _ WATER KEY COURT •• a �'' DRIVEWAY r r If r EXISTING HOUSE r NEW IM-1530 INFILTRATOR SEPTIC TANK B C01 r MT1 O r DBL1&2 O H1 U r wi A ST1 c � � r w (r 0 m ►-- r r I c� r CO2 MT2 Z:) r LRESERVE SITE o NEW DRAINFIELDr ISPIGOT r F r r I PRIVATE WATER LINE PROFESSIONALLY LOCATED r AND SHOWN ON AS -BUILT SURVEY (ATTACHED) ----- 10' UTILITY ESM'7_I---------- r t SPIGOT , N VALLI VUE ESTATES S ALE: #1; BLOCK 1, LOT 25 ill =30' ESS ENGINEERING IJ , ��............................ ..... ENGINEERING 4 SALES o CONSULTING a 3701 E TUIX7R ROAD, SUITE 101 • ANC GE, ALAS3CH • RkONE (�� 337-6179.4V265ffE mrm.ga .awn yl..• ....... PHONE NUMBER: PAGE NUMBER $ j/ A 2f 8SS wCA MATTNEW BEGAN 907-529-4675 2 OF 3 �j C -7 53 � V PROJECT/LEGAL DESCRIPTION: DRAWN BY: VALLI VUE ESTATES #1; BLOCK 1, LOT 4 D.J.G. ♦c •••''••• .. TYPE OF WORK: DATE: E+�fiESS�o +4 SEPTIC SYSTEM UPGRADE RECORD DRAWING 11/1/2023 # LICENSE 4 A\\��►�� From:A.C. E.S. To:Townsend, Curtis L. Subject:Re: 6726 DOUBLE TREE CT decommissioned seepage pit Date:Wednesday, December 18, 2024 3:36:03 PM [EXTERNAL EMAIL] Hey Curtis, yeah we can confirm that we decommissioned the seepage pit as well. It was already caved in, but we re-excavated and broke it up some more and then backfilled and compacted it. Jordan Anderson Owner/Operator A.C.E.S. 907-223-2305 www.aces907.com On Mon, Dec 16, 2024 at 3:33 PM Townsend, Curtis L. <Curtis.Townsend@anchorageak.gov> wrote: You folks installed a new tank and field for this property in Oct 2023. Garness was the engineer of record on this permit. They report that the old tank was decommissioned. They didn’t report on whether the old seepage pit was decommissioned. Can you confirm for me if this pit was decommissioned? That means the top would have been removed, and the pit backfilled and compacted. Owner Name: REGAN MATTHEW D &ISHII-REGAN SUZANNE K Site Address: 6726 DOUBLE TREE CT Anchorage AK 99507 Parcel Number: 01531115000 Legal Description: VALLI VUE ESTATES #1 BLK 1 LT 14 Curtis Townsend, PE Onsite Water and Wastewater Municipality of Anchorage 907-343-7908 PERMIT NUMBER: RECORD DRAWING I N G PARCEL NUMBER: OS P231346015-311-15 TANK INSULATED PER CONTRACTOR TH#1 TOP OF MH1 = 100.34 MH1 TOP OF TANK AT INLET = 96.05 INVERT OF BUNG AT INLET = 95.46 FINAL GRADE = 99.74-99.91 IM-1530 2-COMPARTMENT INFILTRATOR SEPTIC TANK ORIGINAL GRADE AT HIGHEST POINT = 100.38 6.5' RELATIVE ELEVATION AT BOTTOM OF T.H. = 82.38 (T.H. DRY ON 10/25/2023) ST1 - TOP OF TANK AT OUTLET = 96.04 ' INVERT OF BUNG AT OUTLET = 95.19 FINAL GRADE = 99.78-100.47 TER FABRIC OF DISTRIBUTION PIPE = 94.88 BOTTOM OF TRENCH = 88.38 4 PER CONTRACTOR DRAINFIELD WAS INSULATED WITH 4" HIGH DENSITY INSULATION ♦.fir\\\\r III III F AV �� .••" . , Ar P ,W SS N U f ' � ENGINEERING,, SALES s CONSULTING 3701 E. TUDOR ROAD, SUITE 101' ANCHORAGE, AK 99507 ' PHONE (907) 337G179 -FAX (907) 335.3240' WeESSITE: w+rw.pamessenpineennp com PREPARED FOR. PHONE NUMBER: PAGE NUMBER: MATTHER REGAN 907-529-4675 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: VALLI VUE ESTATES #1; BLOCK 1, LOT 14 D.J.G. TYPE OF WORK: DATE: I,,_ SEPTIC TANK PROFILE 11/2/2023 ro LICENSE, ,� ESS �► `+ #AECC8e4 , PROP. LINE UU1 TR ® YARD LIGHT 0 Sf WFRP/Pf o WATER VAL VE A"U/LTSURVEY Pr = SD' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLL(Yi(ING DESCRIBED PROPERTY LOT14 BLOCKI VALLI VUE1 THE INFORMATION HEREON 15 FOR THE USE OF LENDING 1NSTITUTZONS SPECIFICALLY TO SHOD ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE CONFLICTS BETUEEN EXISTIXG STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS ViSIBL'c IN4PROVEFtEAtT$ SITUATED THEREON ARE 4N?TNiZN4 NOT TO BE USED FOP. POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FEWCELINES• VIS PROPERTY LINES A SITUATED VISIBLE ENCROACHMENTS WITHIN EASEMENTS OF RECORO,OP. ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT THE ARE NDT SHOWN HEREOX( UNLESS INDICATED) 'EXIST OTHER THAN NOTED. NOTE.- FEMCELIXES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE DATED AT ANCHDRAGE,ALASKA THIS 1 ST DAY OF PP, OPERTY LINES OR POSZTIOX ADDITIONAL IMPROVEMENTS. NOVEMBER , 2023 ANY PAVING S. U HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AHD/OR ICE. ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON TH£SURYEYDATA ON7H6LWAV1A69PREPAREDf0R 7HE0WNER0fRK0RD OA4Y. HOLT LANOSURVL)%NG AVYCOPi74 ORUTdTZPJGTHER4TAHE7RAVTSPROI{IggMUAJD57COPYRAgfrLgW 9309 GROV<R DRIVE ANC-f"GEAK 99507 Li59 233-5 235-10 223-8615 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231346 Work Type: Septic Upgrade Tax Code Number: 01531115000 Site Legal Address: VALLI VUE ESTATES #1 BLK 1 LT 14 G:2539 Site Mailing Address: 6726 DOUBLE TREE CT, Anchorage Owner: REGAN MATTHEW D & Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: �l�,enr f t)epar dent 10/10/2023 10/9/2024 20610 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By:7D �l Issued By: Date: Date: o t 0-7,b Z�Z� 3 fi'UFhWKHiUPAUTY OF ANC F-41'OR"AWE , Development Services Department Phone: 907-343-/904 � On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-311-15 Property owner(s) MATT REGAN Day phone 907-529-4675 Mailing address 6726 DOUBLE -TREE COURT *ANCHORAGE, AK Site address 6726 DOUBLE TREE COURT *ANCHORAGE, AK Legal description (Sub'd., Block & Lot) VALLI VU E ESTATES #1; BLOCK 1, LOT 14 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Q Initial ❑ Single Family (SF) Septic Tank x❑ Upgrade x❑ (w/wo AD U) Holding Tank ElRenewal ❑ Duplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: certify that the above information -is correct. -I -further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 9 �-?_ Waiver Fees: Date of Payment: =0, 0 Date of Payment: Receipt Number: Receipt Number: Permit No. 05f Z Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231346, Curtis Townsend, 10/10/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231346, Curtis Townsend, 10/10/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231346, Curtis Townsend, 10/10/23 PROP. LINE Dqq,6z F TRS o"•<<G.�F'AL�gsi4p 0 YARD LIGHT 0 SEWER PIPE 0 WA ER SAL !£ THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICAIL T TO SHOW ANY CONFLICTS BETWEEN EXISTING TS; AND IS NOT TO BE USED ED FOP 0a FOS 1 TONING ING ADDITIONAL STRUCTURES IMPROVEMENTS OR FENCELINES . ' RECORD 'OR ANY LEG EASEMENTS OF ENTITY, 0 THER THAN STRUCTURES, APPEARING ON THE RECORD PLAT ARE NOT BY S NO W N HEREON( U N L IS S INDICATED) NOTE: FENCELINES THAT NAY APPEAR DRAWING ARE NOT TO BE USED TO DETERMNE ON THIS PRO RTY LINES OR POSITION ADDITIONAL INP R OV TS. ANY F AVING S HOWN HEREON H AY BE A pp NO X! HATE DUE TO EXCESSIVE SNOW ANDIOR ICE. ONLY VISIBLE IMPROVEMENTS AR E S HOWN HEREON SHANE A. HOLT ASBUILTSURVEY 111 =301 NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWItZ DESCRIBED PROPERTY LOT14 BLOCKI VALLI VUEl ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AM NO VISIBLE EKPOACHMENTS 'EXIST OTHER THAN NOTED. DATED AT &NCHORAGE,ALASKA THIS 20TH DAY OF SEPTEMBER , 2023 h� TLAND SLIRVEYTAIG )WEA RVEYDA rA ON rHS DRA ",16 IS PREPAINE) FOR rM 0*7" alkFCOW aW Y GROID? DRIkE ANY COPYflVa OR UTXIZN6 7hT DA rA HDW-aV 15PROHRITED LWR C0PYRAGHrLAW AlvCH"SEAK 39507 1 15929 233-6 223-8515 O£'~iTER ANCHORAGE AREA BOROi"--~H / GAAB-HD- I DErARTMENT OF ENVIRONMENTAL OUALI', f 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /~Z ,f'/,/~'- /~//~'X/ LOCATION MAILINGADDRESS ~X LEGAL DESCRIPTION SEPTIC TANK: NUMBER OF DISTANCE FROM WEU ~,'~/~',4//77~ MATERIAL ~7-~-.,~'~Z.-' COMPARTMENTS / ~,~ ~E~ o~ ~ ~ ~ /~7 LIQUID CAPACITY /~ GALLONS. INSIDE LENGiH INSIDE WIDTH LIQUID DEPTH.__ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH /'-~ / ., LENGTH ~'0 / , DEPTH LINING MATERIAL / ,/..~ ~/~ ~'~'.~,,t( 7 DISTANCE FROM WELL ~'~')~)/~g , BUILDING FOUNDATION NEAREST LO1 LINE ~ / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) J~/~ ~' / SQ, FT, T I L~"E'"-BR.~d.~ F I E L D: DISTANCE FROM WELl NUMBER OF LINES DISTANCE BETWEEN LINES ABSORPTION AREA SQ. FT. DEPTH: TOP OF TILE TO FINISH GRADE . NEAREST LOT LINE TOTAL LENGTH , OF LINES TRENCH WIDTH IN. TOTAL EFEECTIVE LENGTH OF EACH LINE ~ DEPTH OF FILTER MATERIAL BENEATH TILE ~ WELL: Ty p E d~,.,.~/~2 . DEPTH. NEAREST SEPTIC LOT LINE , SEWER LINE TANK DISTANCE FROM WATER , BUILDING FOUNDATION. SAMPLE , NEAREST SEEPAGE OTHER , SYSTEM , CESSPOOl , SOURCES DISTANCES: F~ f r DIAGRAM OF SYSTEM DATE 7-/o'¢- Y~' APPROVE~(~~~ /~ G.A.A.B. GREA1 Er ANChOF~AgE.AREA BORuUGH SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT PERMIT NO. 2145 INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SEEPAGE PIT ~;~ , DRAIN FIELD ., OTHER. NOTE: THIS PERMIT I~ NOT VALID WITHOUT ~O1~ FINAL INSPEC~TION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE EUSJECT TO FROSEGUTION. DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEEPAGE PIT ~/~ ' , DRAIN FIELD SEPT[O TANK TO SEEPAGE PIT WALL .//~/ TO NEAREST LOT LINE, WELL TO SEPTIC TANK '~/ . SEEPAGE Pit DRAIN FIELD ~ , ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK /~ , 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 lEON SIPHON PIPES ON SEPTIC: TANK AND SEEPAGE PIT FITTED WiTH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUTHORITY OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA E~OROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM ES IN ACCORDANCE WITH SAID CODE, T.H.-i 6-19-72 SILTY SAND W/SOME GRAVEL TRACE ORGANICS (SM) 0.0~ I GRAVELLY SAND W/SOME S LT (SW) ;5.0' FROZEN ? GRAVELLY SAND W/SOME S~LT (SW) 7,51 FINE GRAIN SAND W/SOME SILT (SP) Note: { 2.0' No table water Hole excevoted with tractor ~oante~l backhoe. Ulane Engineering ~ Geological Consultants LO G OF ANOHORA(3E FAIRBANK9 ALASKA ~u~E^u. Anchorage Finn Property TEST BORING Alaska 26529 ow~ NO. A-OI R&M Civil Engineers ENGINEERING '& G-EOLOGICAL CONSULTANTS 229 EAST 51st. AVE. - P.O. BOX 6087 - ANCHORAGE, ALASKA 99503 TELEPHONE 907--279--0483 TELEX 090--35419 Geologists Land Surveyors JAMES W. ROONEY, P. E. MALCOLM A. MENZIES, P.E.. L.S. JAMES U. WELLMAN, June 19, 1972 Mr. Ulane Finn P. O. Box 2027 Anchorage, Alaska R &IV[No. 26529 RALPH R, MIGLIACCIO RE: Test Hole and Soil Log Report ~or Sanitary System Lot 14, Block 1, Valley View Estates Dear Mr. Finn: We are submitting herewith the test boring results and our comments re- garding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of June 19, 1972; and those procedures outlined in a letter dated September 13, 1971 by ]VIr. Roll Strick- land of the Greater Anchorage Area Borough Department of Environmenta~ Quality. A single test hole was put down within the Lot 14 area ~or 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. One sam- ple was recovered from the bottom of the test hole and retained ~or grain size analysis. The sample will be held in storage, up to approximately one month, for possible testing before ~t is discarded. The ~inal log prepared ~or 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 do not hesitate to contact us. Very truly yours, R & M ENGINEERING & GEOLOGICAL CONSULTANTS JWR:wb ce: Greater Anchorage Area Borough MUNICIPALITY OF ANCHORAGE - DEPARTMENT OF HEALTH & HUMAN SERVICES · ' Division' of Environmental Services' On-Site Services Section P.O~ Box 196650 Anchorage, Alaska 99519-6650 ! i . : ; ~; i 343-4744 CERTIFICATE OF HEALTH AUTHORITY ,~PPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# ~1..~ '--~lt--I~- HAA# 1. GENERAL INFORMATION Complete legal ?escription L. oT Location (site address or directions) Property'owner ' Mailing address Lending agency Day phone ~lc ~,.S'-/~ Day phone Mailing address ~ Day phone Agent . Address Unless otherwise requested, HAA.will be held for pickup. NUMBER OF BEDROOMS: '~ 3. TYPE OF WATER SUPPLY: NOTE: lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site . HOlding tank Community on,site Public seWer '~'! ~:i~; Individual well ~ Community well ~c Public water If community well system, provide written confirmation from State ADEC attes~t- 72-025 (Rev. 1/gt) Front MOA#21 NOTE:" If community wasteW~e~'sySiein'i' Pr°vide written COnfirmation from State ADEC attesting to the legalit~ ~nd S~'a~us o.f Si/Stem. STATEMENT OF INSPECTION BY ENGINEER ,.~[~: ;.r~; : AS certified by my seal affixed hereto and as Of the validation date shown below, I verify that my investigation of this Hearth 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 structu re 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. N a m e o f Fi r m %~""""""""'~A ~ ,,,.~c~ ,,,~ ,~ Address s signature Engineer' Date DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ~>- 'The Mun]e~pahty nchorage Department of Health and Human Services (DHHS) issues Health Authority · ...Approval Cert~[qates based only upon the representations g~ven in paragraph 5 above by an independent .. i~refe§.si~?.al en~lineer registered in the State of Alaska. The DH HS 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 certifloatelis Issued. The Municipality of Anchorage is not responsible for errors or omissions tn the professional engi,nee~s ,work, . , 72~25(Rov. 1/95) Back MOA~F21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (90~} 343-4744 Health Authority Approval Checklist Legal Desctiption: Low' [ t{t-~ I Y~t./,t \l{j t~ Parcel I.D.: _CO [ ~'~ ,~I~[,- A. WELL DATA Well type ~co ~4~u~{¢ A, B, or C, attach ADEC letter. ADEC water system number Log present (YfN) Total depth Sanitary seal (Y/N) Date completed Cased to Casing height (above ground) Wires properly protected (YfN) FROM WELL LOG g.p.m Date of test Static water level Well production WATER SAMPLE RESULTS: AY~ta~ Coliform Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Collected by: AT INSPECTION Other bacteria Date installed c~-~'~ Foundation cleanout (y/N) Date of Pumping ~ -- ~ --~'_~-- Pumper C. ABSORPTION FIELD DATA Date installed Length Zo t Width Effective absorption area Tank size ~_.c> avo Number of Compartments ~-- Cleanouts (Y/N).__ Depression (YfN) b[ High water alarm (y,qq) A J/~A Date of adequacy test ~:~ - 78 - q.-q' Results (Pass/Fail) ~¢-~.5 For ~ bedrooms Fluid depth in absorption field before test (in.); '2.~ ~,~ Inunediately after.ff~b gal. water added (in.): 7__ c~ ~/¢, Fluid depth /~gt/o Minutes later: 'Lc,t/?. (in.) Absorption rate = _%~ 7/~ g.p.d. Peroxide treatment (past 12 months) (YfN) /',4 ~ if yes, give date Soil rating (g.p.d./ft2 o ~(,~ 1'3,5' System type 1 3 Gravel thickness below pipe ~ ~ Total depth I I' Monitoring Tube present(Y/N) 'T~ Depression over field (y/N) __ D. LIlT STATION Date installed ~ / Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption fiekl on lot Public sewer maio Sewer/septic service line Size in gallons "Pump on' level at* *Datunl On adjacent lots On adjacent lots Public sewer manbole/cleanout Lift station "Pnmp ofF' level at* SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation /' c~, / Property line L/O ~ Absorption field ~ Water mai~qservice line ~ '± Surface water/drainage ..~-o '~ Wells ou adjacent lots SEPARATION DISTANCE FROM ABSORPTION HELD ON LOT TO: Water maio/service line Z, ~ d-- Driveway. parking/vehicle storage area Wells on adjacent lots A.~/A Bnilding foundatioa .~'-~ t Surface water / mc:, t.q. Curtain drain / crc ~ ~- ENGINEER'S CERTIFICATION I certify that I have determined thrufield inaI)ections and review, m conformance with MOA H'M guidelines in effkct on this date, S ig nat u re._~-~,~ Eaginecr's Name .-%7-~.',z~,o ~>~-,K~:zh~o,,om,42~ ~ ~.. Date HAA Fee $ Date of Payment Receipt Nulnber Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Nombcr GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quelity 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received . rl /7~ Time of Inspection REQUEST FOR APPROVAL OF INDIVIDUAl. SEWER & WATER ?ACILIT~ES FOR -" 1. Aoprovet Requested By: , Address~ 5. Type of Facility to be Inspected: ~/~- ' Number of Bedrooms.' A. Type Phone, Depth C. Construction D. Bacterial Analysis Sewage Disoosal.Syatem:~. A. Inst~lled ~ ~/~' ~ B, Installer. ~,.~ C. Septic Tank: 1, Size /~-' 2. Manufacturer ~C233.-~h, ~ .... D. Seepage Pit: 1. Size Zf~ ~' 2. ~aterial ~ ~ ? ' E. Disposal Field: Total Length of L~nes ~ 8. Distances: A. Welt To: Foundation to Septic Tank /~ '* "~ Absorption Area Absorption Area to Nearest Lot Line ~- ~ /¥- Septic Tank ~-- ..... , Absorption Area -~ , Sewer Lines Nearest Lot Line --'~ , Other Contamination ~/j- / Rsqu~st for approval or l~,~vl(lUal ~ewer (~ ~al, el~ r~Olll~l~.~x · ~ Page~Two 9. Co.e tS.' / Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM ~ certify that the tnformatfon contained in this request for appreval to be a true and accurate representation of the subiect ~ewer and water facfllt~es located at: Signed Date