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Home My WebLink AboutVALLI VUE ESTATES #1 BLK 1 LT 28 oGRE['"' R ANCHORAGE AREA BOR IGH Department of Environmental O. uality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM I'--I~/~ LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL~/~ ~ INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL '~/-/'~"¢-" NUMBER OF COMPARTMENTS ,. ~. LIQUID DEPTH ~ LIQUID CAPACITY '/~'-~ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL ~'~wf~'f~, FOUNDATION ~.~ ~ ~ TOTAL LENGTH NEAREST LOT LINE ,~'0 ( OF LINES NUMBER OF LINES _~- DISTANCE BETWEEN LINES ABSORPTION AREA ,~ ~/' SQ. FT. LENGTH OF EACH LINE · ~'J~ ~z~ /. DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE . MATERIAL BENEATH TILE TRENCH WIDTH-~ IN. TOTAL EFFECTIVE H'~TABOVE TILE lYF'th/' ~-~ IN. WELL: T Y P E ~_~)"/z~/--~"l'(-/,,' ~/~ C O N S T R U CT ' O N __ /~p~¢'¢'~¢ '?"/' ;~'/// DEPTH BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION__ LOT LINE SEWER LINE , TANK SYSTEM CESSPOOL APPROVED OTHER SOURCES DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: ~'~'~1 INSTALLED BY: PiPE MATERIAL:C~/~'/'~',/'~ ¢"/L~zJz~") LOT SLOPE: REMARKS; ~ ~'~'~' DIAGRAM OF SYSTEM Form EQ-032 QGRE ' 'ER ANCHORAGE AREA BO? UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM. LOCATION MAILING ADDRESS LEGAL DESCRIPTION PHONE SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS .LIQUID CAPACITY GALLONS· SEEPAGE ~FT': NUMBER OF PITS __ LINING M/~TERIAL /' BUILDIN~ FOUN D,~,TION ADDITIONAL~/~BSO RPTION ~.-- DIAMETER__OR WIDTH LENGTH DEPTH ; CRIB SIZE: DIAMETER DEP~,H__ DISTANCE FROM: WELL ·' TOTAL EFFECTIVE ~ NEAREST LOT LdNE ABSOF~,PTION AREA (WALL AREA) SQ. FT. WELL: TYPE BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION _ DEPTH DISTANCE FROM: NEAREST NEAREST SEPTIC SEEPAGE LOT LINE SEWER LINE TANK SYSTEM OTHER SOURCES DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: DATE APPROVED G,A,A.B. Form NO, EQ~031 GREATEr ANCHORAGE ArEA BorouGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK SEEPAGE PIT , DRAIN FIELD OTHER ~~, 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. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION ~ FEET INTO UNDISTURBED SO~L. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTI~:: TANK AND SEEPAGE PIT FITTED WITH AIRTI{~HT REMOVABLE CAPS. TYPE DIAGRAM OF SYSTEM CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHOR~A~E ARE~BORO~IGH ORDINANCE NO~/~O8 AND THAT THE ABOVE OF ESTABLISHMENT GREATER ANCHORAGE AREA BOROUG' .~ DEPARTMENT OF ENVIRONMENTAL QUALITY ANCHORAGE. ALASKA 99503 MAILING ADDRESS LOCATION pERMIT NO, TYPE OWI~ER OR OPERATOR Date HAS REVIEWED THIS INSPECTION WITH ME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING LO.f' ¢8'. B£aoh 1: Fa££1',~. quo\_qufldiu~zicm Location (site address or directions) 10625 Main Tree D~ve Property owner Mailing address Lending agency Mailing address Mary Wester Day phone 346'25?5 10625 Main Tree D~ve Anehoraqe, Alaska 99516 Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from Stat~ ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bed rooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves_ti_gation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature s & S ENGIN£E.~ING~ 17034 Ea.gle'~iver L/~p Road No, 204 Phone Date DHHS SIGNATURE X Approved for Disapproved. bedrooms. Conditional approval for // '/ bedrooms, with the following stipulations: Additional Comments By: ~.-c,~*-- ~~ 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 DH HS 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~J25(Rev. 1/91) ~ck MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~7- 7~ ? A, Well Data Well type ~-~<~..~/~u,'JlT"~ I~, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly~ FROM WELL LOG ~AT INSPECTION Date of test ~ Static water level We""0w SEPARATION DISTANCES FROM WELL TO: Septic/h~tank on lot g.p.m. .g.p.m. ; On adjacent lots Absorption field on lot ~--~O(--~. / _/L- ; On adjacent lots ~ ;: bwl ieCr SseeWrv~': er ~ :i: P u-b ' "~°..Pet r~o, e u m tank ut_ WATER SAMPLE RESU~ Coliform ~ Nitrate Other bacteria ~ Collected by: B. SEPTIC/H~cBhN~ TANK DATA Date installed / f//' oP/'~ ~-- Tank size ~/~__ _~-d__~ Compartments Cleanout Ys~ ~"~'-,~ Foundationcleanou (Y~) ~'("" ') Depression(Y/~_ High water alarm (Y~--~/~' Alarm tes~ted (Y/N) Date of pumping ~'/?/ 7~ Pumper SEPARATION DISTANCES FROM SEPTIC/~TANK TO: Well(s) on lot ~k,,k~c,-~"- On adjacent lots ~-~'~,~"~(-'~' ~ T'~ To property line ~O('/'-~ Absorption field ~ ( -~ Surfacewater/drainage ('"("..~ f7 Foundation Water main/service line (/(D f.~ CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTA~ROM LIFT STATION TO: Well..pJ~Idf''''''~ On adjacent lots D, ABSORPTION FIELD DATA Date installed /I/ (' o(>/'~ f~- Total absorption area Manufacturer Manhole/Access (~ ~ump off" Level at ..~Cycles tested Date of adequacy test Surface water Soil rating (GPD/FF) ~'~'"--/,~:¢~ System type ~-"~'~¢-Jc/~L £' Width ~ f'' Gravel thickness 4 / Total depth /4~ / ,~(~- ~ Cleanout present(¢~4) . ~ ¢~-.~ Depression over field (Y/(~.-~J'~ ?/2~/~..~ Results~,,) {O,¢£ ..~ for ~ ~"O¢.¢L-._ Bedrooms Water level in absorption field before test /~'/(' After test Peroxide treatment (past 12 months) (Y/N) /,(/'o..~'~- ,/¢¢Do~3,,d If yes, give date SEPARA'FION DISTANOE FROM ABSORPTION FIELD TO: ZOO/'¢~ Well on lot /{20 ~J E~ /¢/ZE;.~-2..].?- On adjacent lots ~ O.4.4./L4 C~/~/7'T' Property line /O / ~ To building foundation On adjacent lots Surface water Curtain drain To existing or abandoned system on lot /{-////~ Cutbank .,~o.,,..Jb-~ .fc-ZEJ'&~-"'~---Watermain/serviceline Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION in effect HAA Fee $ ~-~:~ Date of Payment Receipt Number Waiver Fee $. Date of Payment Receipt Number 72-026 (3/93)* Back GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Recelved~.¼, ~ o ~0 Time of Inspection c.~}~O~-)~ Date of Inspection~.tC~% REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR l. Approval Mailing Address: 2. Property Owner: Mailing Address: requested by: ~l~r~ ~q~lF~nn~ Phone: Phone: 3. Legal Description: hOqm~ Sk~ ~)o~c~ \ 4. Location: ~fJ ~. ~ ~(~hJ ~ 5. Type of facility to be inspected~,,~Jo J~q~,~,, 6. Well Data: ~ A. Type ~j,~,n. C. Construction No. of bedrooms B. Depth D. Bacterial Analysis 7. Sewage Disposal System:(]~)~-c~J~ ~m A. Installed ~S~oq, lqqq B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines Material 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines Nearest lot line B. Foundation to septic tank , Other contamination , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re~ ~st for Approval of Individual .~ ~er & Water Facilities - Legal Description ~ ~ ~lo~l I~0~ (~,,~ JS~,~-k~-~,~v~. Comments Approved -jj _ Date /--~ . Approval.~lid for one year from date signed Greater Anchorage A~eaXBorough, 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 operating satisfactorily. SIGNED Date EQ-034 (1/74) Department of Environmental Quality~NWRON,~ENT/~L~O~'~ 3330 "C" St., Anchorage, Alaska 99503 - 274-4561~ JAN161976 .E~UEST ~OR APP,OVA~ O~ I,DIVIDUAL SEWER & .^TER ~ACILITIES RECEIVED I. Type of Inspection: CMRO VA 2. Property Owner: ~Z~/~/¥-F--~ ~ Mailing Address: ~m/ .~, ~-~/~a 3. Name of Buyer: ~/t~ /m/y~7~ Mailing Address: /~/J? ~-.~- 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: FHA CONV /~ DaS Phone ~-~-2z/~t Das Phone ..uA ~-/ ., x.'.4 / Type of Facility Water Supply Type of Supply: If Individual, If Individual, to be inspected: ~x~/~Y/½/J~No. Bdrms. ~ Public Utility ~ ~ Individual number of dwellings presently served depth of well Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation EQ-037 (1/74)