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HomeMy WebLinkAboutVALLI VUE ESTATES #1 BLK 2 LT 1 Municipality of AnchoragePage ! of 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 Permit Number: EYac/~o/dT'5- PID Number: Na.~e: Wastewater System: o New ~ Upgrade Address: ABSORPTION FIELD Phone:INo. g,e~¢roo~,: ~DeepTrench BShallowTrench ~Bed ~UOther/ Soil Rating: Cth from original grade: LEGAL DESCRIPTION GPD/Sq. Fh Bepth to pipe bottom from original~ nmd¢~grad ' Gravel depth beneath pipe Lot: Block: Subdivision: -'7~. Township: [Range: I Section: Fill added ab°ye °tilde: Ft.Gravel length: Ft. Gravel width: / Number of lines: [ Distance between lines: WELL: ~ New ~ Upgrade / Ft., Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total a~rption area: Pipe material: ~¢~ ~ Ft. Ft./ SQ. Ft. Driller: Date Drilled: Static Water Level:Ft Install~r'~¢ ~¢~ Date installed:t~ Yield:GPMI,,. [Casing Height Above Gtc.nO:Ft. TANK SEPARATION DISTANCES ~ Septic U Holding U S.T.E.P. TO Septic Absorption Lift Holding ~ublic/Pr(vate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~O~ ~ ~ Well ~t~ ~ ~ ~ Material: Number of Compartments: Surface /~¢ ~ ~ LIFT STATION Water /¢¢ ¢~ ~ Lot Size in gallons: ] ~ Line /~ t ~ Foundation ~1 -- ~ ~ ~ "P.mp on' level at: I ~ I~k,.,~ i ,,Pump cfr, le.~, ~,~ter alarm at: CurtainDrain __ i ~ 0~, r ~¢~U~ PurnpMake&Mod¢ IElectricatlnspectionsperformedby: Remarks: ~/4~¢w/¢,,/¢ / ,7~n ~ BENCH MARK  ~ Location and Description: ENGIN/ES'SxSEAL S & S ENGINEERING % ~ ~' 17034 Eagle River Loop Roa~ No. ~. ¢,;5 ........................ Inspections performed by: ....... ~a[es: ;si ~l- ;s-~ 2nd I[-13-q3 ~ Department of Health. man Services approval Reviewed and approved by: te: 72 013 (Rev. 9/91) MOA 25 Permit No. SW950475 Page £ of 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 VALLI VUE ESTATES #1, BLOCK 2 LOT1 01532211 Legal Description: PID No.: 2 COl C02 INSOLATION 9~.6'~ I 1250i GAL [~-95.4i ........................... N':T:Si ...................................... ~ ........................................ ? ...................................... i ................................................................................. CO1 coa I i la, WAT? SYST[U NO WILLS W~TH~N 200 OF ~EPTIC SYSTEM.~~ ~ ~ ~ N CO1 41BDRM HOUSE DRIV~ 72-013 A (1/93) * PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT NUMBER:SW930475 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SUMMERS STANLEY R & OWNER ADDRESS:10714 MAIN TREE DR ANCHORAGE, AK 99518 PERMIT DATE ISSUED:il/12/93 EXPIRATION DATE:il/12/94 PARCEL ID:01532211 LEGAL DESCRIPTION: VALLI VUE ESTATES #1 BLK T 1 2 L LOT SIZE: 999999 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: 1" =.40' SGALE SEPTIC TANK REPLACEtENT MAiN TREE DRIVE 0~0 ~o~Z · z~ ~m~ 0 RECEIVED NOV 1 2 19~ Mun c' ~ . Dept. ~h~,of Anchora~ - 8ervlee~ ROBERT SHAFER, P.E. ROGER SHAFER, P.E. November 12, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL iNSPECTiON & FLOW TEST SITEPLANS ROAD DESIGN SOILTEST ~ PERCOLATION TEST STRUCTURAL & ,MECHANICAL INSPECTIONS Municipality of Anchorage DEPARTMENT OF HEAL TH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Valli Vue Estates #1, Block 2, Lot I Request you issue a permit IMMEDIATEL Y to replace the septic tank serving the four bedroom home on the above referenced property. The existing septic tank collapsed during pumping. The Owners are unable to use their septic system in the current condition. Therefore, we would appreciate you expediting a permit to replace the existing septic tank. If you have any questions or require additional information for your review, please contact us. Sincerely, RA S/L S U/Isu RECEIVED NOV 1 2 19'~ i',4unicip~.lity of Anch~orag. e Dept. Health & Human 3erv~ces ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 ° EAGLE RIVER, ALASKA 99577 ON-SITE WASTEWA TER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MA TERIAL SPECIFICATIONS REFERENCE: Valli Vue Estates #1, Block 2, Lot I GENERAL: 1. 3. The scope of this project includes the installation of a 1250 gallon septic tank to serve the four bedroom residence located on the referenced property. The existing 1000 gallon and 500 gallon septic tank is to be excavated, pumped, crushed, and removed. Construction shaft be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shaft be responsible for final grading areas subsequently depressed from soft settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Aft standpipes on the septic tank shaft extend a minimum of 12 inches above final grade. Page Two Vafti Vue Estates #1, Block 2, Lot 1 November 12, 1995 Septic tanks installed with less than 4 ft. of cover shaft be insulated. A foundation cleanout shaft be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soft not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. MINIMUM MA TERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shaft be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shaft be fitted with watertight couplings (Caulder, Femco, or equal). Page Three Valli Vue Estates #1, Block 2, Lot 1 November 12, 1993 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the tank has been set; lines, cleanouts, standpipes, and insulation are in place; and prior to backfilling. 2. The final inspection is to occur upon final grading of the property. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. ,ER ANCHORAGE AREA BOk.,2GH Department of Environmental Quality 3330 C Street Anchorage, Alaska ggs03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE 1~O FROM WEL~.~.'-~AN~ FACT~ RER MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENT~S LIQUID CAPACITY.~'~¢ GALLONS, DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA q _OO SQ, FT. DEPTH: TOP OF TILE TO FINISH GRADE / TOTAL LENGTH FOUNDATION ~_~'- /~( NEAREST LOT LINE ~-~_.~ / OF LINES D,STANEE BETWEEN LINES /m/// TRENE, W,DTH~ ,N. TOTAL EFFECT,VE WELL: TYPE LENGTH OF EACH LINE ~-~--/ ' DEPTH OF FILTER // MATERIAL BENEATH TILE_~ IN. ABOVE TILE IN. CONSTRUCTION DEPTH . DISTANCE FROM: BUILDING NEAREST FOUNDATION LOT LINE NEAREST SEPTIC SEEPAGE SEWER LINE TANK SYSTEM CESSPOOl OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL' LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM Form EQ-032 ,R ANCHORAGE AREA B( , Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION MAILING ADDRESS LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH Z/ L ,~ / NUMBER OF MANUFACTURER '~:f-/~/~ ~7-~--FC, MATERIAL ~'~g--z_ COMPARTMENTS / INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /~ GALLONS. SEEPAGE Pit: NUMBER OF PITS -- / DIAMETER __ OR WIDTH LINING MATERIAL(~it'MC ~/td,,9_( CRIB SIZE: DIAMETER BUILDING FOUNDATION-~7 / NEAREST LOT LINE ~¢' lC' ADDITIONAL ABSORPTION ~/~ /~ LENGTH ~ ! DEPTH DEPTH /~ / DISTANCE FROM: WELL ~-~/¥' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~-~/o SQ. FT. WELL: TYPE CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION __ LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED J/'/ DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: ~)t/g$& ('Z77~/z~6/-E~C PIPE MATERIAL: LOT SLOPE: REMARKS: Form PW-026 3 8e~o zo G.A.A.B. · ~ ~.~~l~E~" ZR ANC~4ORAGE AREA BCE. ~Jgh ~ SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK _, DRAIN FIELD OTHER FINANCEO THROUGH SOIL TEST RESULTS /(~ COMPLETION DATE ANTICIPATED TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL FINAL INSPECTION: 2/~ 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 ~E') TYPe EEPAGE AREA SIZE TYPE CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF FOUNDATION tO ~ , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK -* SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK , SEEPAGE PIT DRAIN F]ELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK . SEEPAGE P~T D~AIN FIELD . SEPTIC TANK, SEEPAGE PIT ~ DRAIN FIELD TO RIVER, LAKE. STREAM, EXCAVATION 5 FEET INTO UNDISTURBED SOIL. ~ INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED WITH AIRTIGHT ~EMOVABLE CAPS. GREATER ANCHORAGE AREA BOROUGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT TYPE AND SIZE OF FACILITY TO BE SERVED pFI~MIT VAI IB 0NF YFAR FINAL INSPECTION~ 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL IN~ECTION BY THG MINIMUM DI~TANClES, REQUIREMENTS FOUNDATION TO SEEPAGE PIT 20 ~[e DRAIN FIELD [0 ~* SEPTIC TANK TO SEEPAGE PiT WALL [~ ~ · SEPTIC TANK 5 ft'. TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAI. TO SEPTIC TANK DRA~N F~ELD 10 ft. 10 10 ft, SEEPAGE P,T 10 E~,TIC TANK, 25 fi... SEEPAGE PIT 100 ft. , DRAIN FIELD TO RIVER, LAKE, STREAM. DIAGRAM OF SYSTEM '. OAST IRON INTO ANO GUT OF SEPTIC TANK AND INTO CRIB CROSSING gAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, ES.GU AND THAT Tile ABOVE I/0USE ~F !~ MU.IC,PAL,TY OFA.CHORAGE ~'~ ~,~-- ©C~--t ~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 26~4720 Appliestion Date ~1 ~)Iq~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, town, hi@, range) V~iI,' V')¢ ~l ~fl b/o¢...~-z- (~/ (b) (c) (d) Location (address or directions) Applicant Name '~'¢'O-n~/-- J~;l*t~ Telephone:Home ;~q~'l?q~ Business ApplicantAddress /~)~/~ ~17~/~//~-~ ~ ~ ~4/C~/' ,~/~ ~ Applicant i8 (cheek one): Lendin~ Institution ~; Owner/builder ~uyer ~; Other ~ (explain); Lending Institution ,/~¢x Telephone /~-~:742 /~,./. /:_/¢'///~'O/-'/'/.%:. Address (e) Real Estate Company and Agent Address ~.~'_9,'~0 ,..'~ <~ Telephone '~ ¢ *.7 ~ '~ ' ~ (f) Mail the HAA to the followi~ address: TYPE OF RESIDENCE Single-Family ii'Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well [] Community [~/Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAG_E.~POSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIN,_ ,NSPECTIONS, TESTS, FILE SEARCH, DA..,'AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation Qf 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 State codes, ordinances, and regulations in effect on the date of this inspection. Nameof Firm ~.~'L,~ f ~f~$O~(~'~'~ '~''' Telephone Address &~'~O ,.~6~Ft.~'~<~ ~z4"-!~. ~[~/~J~ , /3t~,~. ,~['~ lgineer's Seal Approved for ,/'~'~'~/~,) bedrooms by Approved /'X_ Disapproved 'Corzditional Terms of Conditional Approval CAUTION 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 72-025 (11/84) %?~.~/~ : MUNICIPALITY OF ANCHORAGE (MO~l ~,'~-y//2;~ HEALTH AUTHORITY APPROVAL (HAA) '%~';P~.i-.°~" ,~"d, CHECKLIST - FEBRUARY 1984 ~ ~ ~ / 'e,7o Legal Description: Vd WELL DATA Well Classification ~m~U~[~ IfA, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Wate~el Pump Set At Casing Heigh~Ground Sanitary Seal on Casing (Y/N) Electrical W~g m C~Y/N) Depression Around Wellhead (Y/N) Separation D~n~mm ~ To Septic/Holdi~ Tank on Lot ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on L~ ; On Adjoining Lots  ic Sewer To N~m~ S~ ~ on Lot ; Date To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Datelnstalled (~(~' ~" Size 15'ooff lo No. of Compartments ~ Air-tight Caps (Y/N) Standpipes (Y/N) 'y 4' ~ Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well 1" ~ TO Property Line 'Y lO ~ To Water Main/Service Line Course '~ .¢--~, Foundation Cleanout (Y/N) . "¢¢--(~ Date Last Pumped t ; for Temporary Holding Tank Permit (Y/N) II~/~' -- To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '(~) ~, ~'", / Width of Field I -'~'~ u',P~4Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area ~ '~'Z.O S~.b~ , Standpipes Present Depression over Field (Y/N)/x~(~ ,~ Date of Last Adequacy Test Results of Last Adequacy Test ~Q~ ~ ¢ ~ ~ t U Separation Distance from Absorption Field: To Water-Supply Well ¢'~ ( To Property Line To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Existing or Abandoned System on ; On Adjoining Lots "f" ~0 To Cutbank (if present) D. LIFT STATION Date Installed (' Dimensions Size in Gallons\% Manhole/Ac~N~ "Pump On" Level a"tx~ //~0~ Off" Level at High Water Alarm Level'"a~. V~ Tested for ~ "-~--~b~--mping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments '* Check P~mjed Bedro/'Rating Against HAA Request ** . I certify t ha/lff¢,Cr~eck~, ~ied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ///~/~/~4~/L"', , ' ~Date Receipt No. Date of Payment Amount: $ ~ ' ~ ~ Engineer's Seal Page 2 of 2 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 HAA# LOT 1; 8LOCK 2; VALLI VuEtSuBDzVISION; Location (site address or directions) 10714 MAIN TREE DRIVE Property owner Mailing address Lending agency DFRRTF BEAUBIEN(~in,{)~,,,.h~ay phone 346-1529 10714 MAIN TREE DRIVE, ~NCHORAGE, AK. 99516 Day phone Mailing address Agent LesLte PENSWORTH JACK WHITE COMPANY Day phone %3-5500' Address 3201 C STREET #100 ANCHORAGE, ALASKA 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well XX. Public water If community well system, provide written confirmation from State AD£C attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ×X 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 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 , ... ~ _,~HN;E;~;;.:C Address '17034 ~a~jle River Loop Road No. 204 Ea~le Eiver~ Alaska 99572. Engineer's signature Phone DHHS SIGNATURE Approved for .~_,~/,' /Z//-') bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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 th is 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~)25 (Rev. 1/91) 8ack MOA #21 A. WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) (~ Municipality of Anchorage ~ Department of Health & Human Services FNV,~ ,~ HEALTH AUTHORITY APPROVAL CHECKLIST 1 ? 1991 Legal Description: ~'~ ./ ~ ~i d ll; d,,~ ~.E, Parcel I.D. RECEIVED Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 7-- (:DO ' -~ Absorption field on lot Public sewer main Public sewer service line If A, B, or C, attach ADEC letter. Date completed Cased to. ADEC water system number Driller Casing height Wires properly protected (Y/N) AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESL~: Coliform j~ Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA / Date nsta ed ~c..T- "4- ~-- Tank size ./ Cleanouts (Y/N) ~ °'"~Foundation cleanout (Y/N) High water alarm (Y/N) ~c;~h.)/ hi Date of pumping ~r~ ~ Collected by: Other bacteria ,'/L'..')~ / Compartments ~ ~ Depression (Y/N) Alarm tested (Y/N) M/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ^J//A On adjacent lots ~.~ Topropertyline ! O t'-(' Absorption field [ O '~- Surface water/drainage [ Foundation Water main/service line I O -k 72-D76 (Rev. 3/91)Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed '%. Size in gallons (Y/N) "Pum p"~level at Vent High water alarm level Meets MOA electrical codes (Y/N) ('~ "~ SEPARATION DISTANCE FROM LIFT STATION T"~' Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length ¢"f ? Z'/209{'~e~ dth Total absorption area Depression over field (Y/N) fi.) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Gravel thickness [~ Total depth ,/ O Creanouts present (Y/N) ~ ~J- Date of adequacy test "~ - / '"¢' ' ~ I for d bedrooms /0//A l'~"~ Ifyes, givedate ¢.J/* SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water _ Curtain drain On adjacent lots ~_ E:)O '~ Propertyline / -~ To existing or abandoned system on lot Cutbank ~. )/~ Water main/service line Driveway, parking/vehicle storage area 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. Engineer's ~ }~ivor, Alaska 995Z~ HAA Fee $ / ~ O Waiver Fee: $ Date of Payment ~ ~//c~) -¢/ / Date of Payment Receipt Number C~-~.~'~Od (~¢~ Receipt Number 72-026 (Rev. 3/91) Back MOA 2~ DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 May 21, 1991 WALTER J. HICKEL, GOVERNOR 563-6775 FOR: S & S Engineering Rodney PWSID 210605 My review of the records on file in this office reveals that the Valli Vue Subdivision Class Public Water System, is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Keven K. Kleweno Lead Engineer GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Date Received October 27, 1916 Time of Inspection ~,'~) Pr/q_ Date of Inspection //~-?(~ /~)/~/. Conv. l. Approval recuested by: Alaska National Mailing Address: Pouch 7-010 2. Property Owner: Marian Nissen Bank of the North Phone: 277-5511 Phone: 344-9313 Mailing Address: 10714 Main Tree Legal Description: Lot 1 Block Location: 10714 Main Tree Type of facility to be inspected 2 Valli Vue Estates Single Family No. of be~drooms 4 6. Well Data: A. Type Community B. Depth C. Constructio~ Sewage Disposal System: A. Installed 1972 C. Septic Tank: 1. D. Seepage Pit: 1. Size Absorption Area D. Bacterial Analysis On-site system l~ ~/mm/J ~opL~cc~) B. Installer Dyess & Ziegler 1,000 2. Manufacturer Stack Steel UL 179118 456 sq.' 2. Material cast iron E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank · Absorption area Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two ,pages - Req ~t for Approval of Individual ?'-~er & Water Facilities Legal' Descriptiom Lot 1 Block 2 Valley View Comments Approved Disapproved Date 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 operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECi'ION OCT 2 ? 1976 RECEIVED 1. Type of Inspection: CMRO VA FHA 2. Property Owner: Marian Nlssen Mailing Address: 1071 ~ 3. Name of Buyer: Frank T. nnc] .T~n~-~-~ Mailin9 Address: 21 Rd rpn~h~ Day Phone: _x44-2/] gA. 4. Name of Lending Institution: AI~-. ~*iona! n?~ of t-h_e 5Tort-h- Mailing Address: Poi]ch 7-13313 5. Name of Realtor or Agent: Rob C)hrt Mailing Address: z[01 F.~st :;6~h Azm_ 6. Legal Description: Lot lr Blk 2; Valley V~ew Location: CONV Day Phone: 34/]-93Z3 Phone: 277-5511 Phone: Type of Facility to be Inspected: No. Bdrms. 4 Water Supply Type of Supply: Public Utility /~' If Individual, number of dwellings presently served If Individual, depth of well Individual Sewage Disposal System Type of System: Public Utility. If Individual, date of installation Individual (on-site) 72-003(3/76) Deb Ohrt Ha~sen-0hrt Realty 401 E~st 36th AVenUe Anchorage, Alaska 99503 'Subjeot~ I~t 1 Block 2 Valli V~e Sub~ivision In order to g~t approval for a four (4) b~ home a at 276-Z~21, ~en~ion Municipalityof Anchorage POUCH 6-650 ANCHORAGE, ALASKA 99502 (907) 278-4531 GEORGE M, SU£LIVAN, MA ¥OR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Environmental Sanitation Division (2510 East Tudor Road) November 4, 1976 Marian Nissen 10714 Main Tree Anchorage, Alaska 99507 Subject: Lot 1 Block 2 Valli Vue Estates Dear Mr. Nissen: Enclosed are a set of instructions you will need to follow in order to get your approval processed. ' If the system is adequate for a four (4) bedroom home, then the seepage pit will not need to be enlarged, even though the septic tank will need to be changed from a 1,000 to a 1,250 gallons. A permit must be obtained through this office before anY construction begins. Funds may be escrowed for the next construction season to be completed by May 1, 1977. If there are any questions, please contact this office a~ 276-2221, extension 285. Sincerely, Robert C. Pratt, R.S. Sanitarian RCP/ljh oubJect. Lot 1, t, lo.k..,~~~:~. -,-.. JOhn R, Lee :., .,~.: ...... ,-, is snld) ¢Og--qlV~ Q31~11~30 ~OJ 181 ..... L V a 1 i V u e ~, aa ~ fo ~low ;~mc.o. on other ~de R~ the num~ article .de~i~ below " ,. ~-~i ...:- ". ..... 7' 1.:, ~ '-:[., · . ,. ,:. . , ,., .