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Home My WebLink AboutVALLI VUE ESTATES #2 BLK 1 LT 66Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211091 PID Number: 015-311-40 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name LON JOHANNES ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Site Address 6790 ROUND TREE DRIVE *ANCHORAGE, AK 99507 ❑ Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-947-6783 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot VALLI VUE ESTATES #2; BLOCK 1, LOT 66 Fill added above original gr Ft. Gravel length Ft. Township Range Section - Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well _ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 1001+ Material HDPE Number of compartments 2 Lot Line 51+ NA Foundation 10 1+ LIFT STATION Manufacturer Capacity Gal. Remarks OLD TANK DECOMMISSIONED PER UPC PER CONTRACTOR Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 drainfieldTank to D3034 Installer A+ HOME SERVICES Drainfield 03034/EXIsTING CO/MTD3034 Inspector MOA AND GEG BENCH MARK (Assumed elevation) 100.00 ft Inspection151 4/15/2021 - Location and description 2 nd TOP OF MH LID 41" _ ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp � 00600 � o � Conditional Approval: Date ...... oo 9P Qr� oo IT 00 '•1 �IE-- 3 •' �p� Septic System Approve Date 9•f/ •• `� -• �� •''ltf�ZZ �g �Ao Note: this approval does not include well permit requirements. vre�& o� #AECC884Pro fesson��4O000Q�� (Rev 05/02/18) PERMIT NUMBER: PARCEL ID NUMBER: OSP211091 RECORD DRAWING 015-311-40 FCO 8.8 18.6 MH 28.4 21.1 ST1 33.0 22.5 DBL1 33.7 22.0 DBL2 33.8 21.4 SWING -TIES OBTAINED FROM AS -BUILT SURVEY PUBLIC WATER VALLI VUE ESTATES #2; BLOCK 1, LOT 65 PER THE CONTRACTOR (A+ HOME SERVICES) THE OLD SEPTIC TANK WAS FILLED WITH CONCRETE EXISTING 3 BEDROOM HOUSE GARNESS EN PUBLIC WATER VALLI VUE ESTATES #2; BLOCK 1, LOT 67 ROXIMATE LOCATION OF KEYBOX PER GEG "SWING TIE" MEASUREMENTS APPROXIMATE LOCATION OF WATER LINE PER PROFESSIONAL LOCATE COORDINATED BY CONTRACTOR (A+ HOME SERVICES) - DISTANCE BETWEEN SEEPAGE PIT AND WATER LINE IS UNKNOWN XACT LOCATION OF EXISTING 1975 SEEPAGE PIT 1S UNKNOWN. ASSUMED 5'+ TO LOT LINE BASED UPON SEEPAGE PIT DIMENSIONS IN MOA RECORDS ,0. Vf111SY NG GROUP, Ltd ENGINEERS »m:wm,.xe»rrs„xr /3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 ® Fax: (907) 338-3246 Website: www.garnessengineering.com GARNEESSENGINEEERINIG ""'ROUP, Ltd ENGINEERING::, SALES =^ CONSULTING _::,. ��.;,zb..._:, PREPARED FOR: I PHONE NUMBER: LON JOHANNES 907-947-6783 LEGAL DESCRIPTION: VALLI VUE ESTATES #2; BLOCK 1, LOT 66 TYPE OF WORK: � SEPTIC TANK RECORD DRAWINGS PAGE NUMBER: 2OF3 DRAWN BY: D.J.G. DATE: 4/20/2021 NEW 1250 GALLON HDPE GREER TANK (OVERSIZED) N = 40' ®®aaww �0 'W 0 o 00.--f Vi.... • ........................... 0 re ness ' W ® ®®% QF -79 Z s Dz ! , ��®4 LICENSE 44 ®S®�®®®® #AECC884 / PERMIT NUMBER: PARCEL ID NUMBER: OSP211091 RECORD DRAWING 015-311-40 MH1 TOP OF MANHOLE = 100.00 FINAL GRADE = 99.60 2" INSULATION PER CONTRACTOR TOP OF TANK AT INTLET = 97.43 TOP OF TANK AT OUTLET = 97.43 INVERT OF BUNG AT INLET = 96.75 INVERT OF BUNG AT OUTLET = 96.60 NEW 1250 GALLON H.D.P.E. SEPTIC TANK li ON A-21 IfflA 1 !' )807)336.3246'WEBSITE: w.w.gamessengeecrng.<om dl 9 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: , •,,••,,•,• ••••,•„",,•,,•- � �.... ...// /` LON JOHANNES 907-947-6783 3 OF 3 � �CA 9 ess '•;_® LEGAL DESCRIPTION: DRAWN BY: ®®®,fiF�}•,• 1# 2p2 �.�, �� VALLI VUE ESTATES #2; BLOCK 1, LOT 66 D.J.G. p 9 TYPE OF WORK: DATE: ®®®O p+iQFE\"' P®®�� SEPTIC TANK PROFILE LICENSE®®4'asass'®�� 4/19/2021 #AECC884 / MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 188850 4m0Elmore Road Anchorage, Alaska g951y-V$5O Phone: ) 04 Fax: (907)34a -79s7 On -Site Wastewater Disposal System Permit Permit Number: OSP211091 Work Type: SepUoTonkUpgnyde Tax Code Number: 01531140000 Site Legal Address: VALL|VUEESTATES #28UK 1 L 88 (3:2539 Site Mailing Address: G7SOROUND TREE DR, Anchorage Owner: JOHANNES LON R & MARY SAGE Design Engineer: GARNESSENGINEERING GROUP LTD This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 4/5/2022 El Disposal Field 0Septic Tank El Holding Tank 171 Privy El Private Well F1 Water Storage All construction shall beinaccordance 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 (18/VlC72)and Drinking Water Regulations (i8AAC8U) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.G5.Provide notification bycalling (&U7)343 -7Q04(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: o. Opened and Closed onthe same day, or '�Wj Special Provisions:b. Covered, sealed, and heated to prevent freezing 1. The water service line is tobalocated prior toconstruction. If the location requires adesign change, construction ofthe system will stop pending On -Site mavievmandapproval. 2. Show the waterline onthe Record Drawing. 3. Locate the edge of the seepage pit toconfirm that the 5' separation between the tank and field will be met. Received 61 Issued By: 3 MUNIUPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-311-40 Property owner(s) LON JOHANNES Day Phone 907-947-6783 Mailing address 6790 ROUND TREE DRIVE -ANCHORAGE, AK 99507 Site address Legal description (Sub'd., Block & Lot) VALLI VUE ESTATES #2; BLOCK 1, LOT 66 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (ED all that apply) Absorption Field ❑ Initial F1 Single Family (SF) nX (w/wo ADU) Septic Tank nX Upgrade nX Duplex (D) ❑ Holding Tank ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I 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: $225 Waiver Fees: Date of Payment: Date of Payment: Receipt Number: (1) Receipt Number: Permit No. OSP211091 Waiver No. GAIDevelopment Services\Building Safety\On Site Water and WastewaterTormsVient FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211091, Deb Wockenfuss, 04/05/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211091, Deb Wockenfuss, 04/05/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211091, Deb Wockenfuss, 04/05/21 MORTGAGE SURVEY X SCALE 1" 330' GRID SW 2539 Project No. 21-149/RM1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 0000ppp0 (907) 522-4625 Fax o— OF 4 Professional Land Surveyors kenOlangsurvey.com Y F............. 9 4 jonathanOlangsurvey.com DOP •• s QO I hereby certify that I have surveyed the following described property: LOT 66, BLOCK 1, VALLI VUE ESTATES UNIT No. 2 (Plat No. 77-296) o 491H*QQ Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a ••"•'•"••" '•"••' •� representation of the conditions that were found on the date the survey was performed. F G This survey does not constitute a boundary survey and is subject to any inaccuracies Q • • • • that a subsequent boundary survey may disclose. The Information contained hereon shall QQ •. KENNEfIi G. not be used to establish any fence, structure, or other improvements. Q' 3`29y1�1 �°Op '••.LS-5202.••'•c,JO Dated this the Day of MI Kk1 L" of Anchorage, Alaska o doo It is the responsibility of the owner to determine the existence of any easements, 40oRaFESSIONAI. �Oppp000� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 QGRE,~ ANCHORAGE AREA BOk..~,dGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL L/../~ MANUFACTURER MATERIAL Z INSIDE LENGTH NUMBER OF COMPARTMENTS .LIQUID CAPACITY ./ ~ GALLONS. SEEPAGE PiT: NUMBER OF P,TS / . D,A~ER '_ OR W,DTH /~ LENGTH/F,' DEPTH LINING MATERIAL lB SIZE: DIAMETER k-~ DEPTH ~ DISTANCE FROM: WELL ~ BUILDING FOUNDATION ~ , NEAREST LOT LINE~O/ ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ~W~/.~'/7 ' <~'"~--~ CONSTRUCTION _ DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION __ LOT LINE SEWER LINE TANK , SYSTEM CESSPOOL OTHER SOURCES APPROVED__ DISAPPROVED DISTANCES: INSTALLED BY: .~-//~ > LOT SLOPE: REMARKS: REMARKS GtE; '~r ANCHORAGE ArEA BOb, DEPARTMENT OF ENVIRONMENTAL QU/~LIT~ SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT LEGAL D ESCR'pT'O" PHONE 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 SEEPAGE AREA SIZE MINIMUM DISTANCES, REGUIREMENTB S / FOUNDATION TO SEPT]C 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 ~) /, DRAIN FIELD · SEEPAGE PIT ALSO CONSIDER AREA WELLS. DIAGRAM OF SYSTEM CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDJSTUR[~ED SO~L. 4 INCH DIAMETER CAST IRON SIPHON ~IPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVA[~LE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. GREATER ANC E AREA BORO. UGH OqEDINANCE NO. DESCRIBED SYSTEM IS IN ACCORDanCE WITH SAID CODE. DATE C._~--'"-~ (~' 7~ APPLICANT'S SIGNATURE FORM NO, EQ-0f 6 28-68 AND THAT THE ABOVE GREATER ANCIIORAGE AREA DOROUG, Department of Environment. al Quality 3330 "C" Street Anchorage, Alaska 99503 SOILS I,OG - PEROI,ATION TES'[' Performed for -¥0o~.- o7~"(_~ .......... Date Perform~d .5'-)-)~S~ Legal Descrip~-i-o]~?~]~!L ~_~L~(~ ( 0 c~ ~ This form reports: Soils log_~ Percolation test Depth Feet 5- 6- 7- 8- 11 - 13 - Was ground water encountered? If yes, at wha~ depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation 'r-a~ ~- .......... in3 ~-u-~-e-. -Proposed 'installation: Seepage Pit Drain Field Depti) of Inlet '. OeptJ~-t-6'-b-o~-t~o~n~o:~-~pit or trench co~.~TS: ..... S:ZL:: :.::-_-~_~_. ...................... .__ t5-~-fif~):m+e-d- - -] Certi fi ed By: Date EO-040 • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D.015-311-40 Expiration Date: 1. GENERAL INFORMATION: Complete legal description VALLI VUE ESTATES #2; BLOCK 1, LOT 66 Location (site address) 6790 ROUND TREE DRIVE *ANCHORAGE, AK 99507 Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3 •Z 6 •Z3 Day phone Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -5 50 Date of Payment Receipt Number (� �j,�Z q (� COSA# OSG Z 1 11 $8 Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 (:Z Engineer's Printed Name: Jeffrey A. Garness Date: w In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the �O U evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and % �:�� workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and""` "' "" " are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future pEaE�i�l��1(�f� the well or septic system. GEG makes no representation whether an alternative w,e�l� _8e�?�1, t ��y/ '•Je r- Garn _ss;� can be installed on the property in the event either of the current systems fail to �N� \�equately i F y�_ CE -79"3 Z the future. The content of this report is for the sole benefit of the person/partYetained GEG to j(` . i� perform the evaluation. Reliance upon the information provided in this report`any of er nor art (including subsequent property purchasers is not authorized, nor willjk, hfej aX,i r�jfi 'UU� profess:on a party (• 9 q P P Y ) <! (v ^I��R �� O��DO�oq whatsoever. 6. DSD SIGNATURE Joo RY, gTFR m� System #1 Approved for bedrooms �� q4 �? System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: ByT Original Certificate Date: L/^ ZZ -V The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: VALLI VUE ESTATES #2; BLOCK 1, LOT 66 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA I COMMUNITY WATER ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) Date of flow test for COS Static water lev eginning of test ft. B. TANK DATA Age of tank(S) NEW years Tank type/material SEPTIGHDPE Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping N/A D. ABSORPTION FIELD DATA Which system tested (date installed) 8/26/75 ❑ ALL standpipes present per record drawing Total measured depth from grade 10.5 ft (max) Measured depth to pipe invert from grade * ft (min) ❑ NIA — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: THIS IS A SEEPAGE PIT COSA Checklist yellow sheet Parcel 1D: 015-311-40 Structure served by this system Well production at time of test Water storage tank volume gallons Well disinfected f iform test? ❑ Yes ❑ No �itr�ate bacteria is Negative mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance complete Age of lift station ye Lift station material Comment Adequacy test date 3/26/21 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 19 in Water added 626 gal New depth 56 in Elapsed time 135 min Final fluid depth 45 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date N/A E. SEPARATION DISTANCES COMMUNITY WATER From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No UNK ft Community Sewer Manhole/Cleanout > 100' Property Line > 10' Yes if No ft ❑ Ye f -H ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/S > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft ing Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Co ewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' QQ Yes if No ft Water Service Line > 10'[j✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No UNK ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No UNK ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' [✓ Yes if No ft Water Service Line > 10' ❑ Yes if No UNK ft Community Wells > 200' 0 Yes if No ft Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS SEE ATTACHED RECORD DRAWINGS WHICH SHOWS THE ASSUMED SEEPAGE PIT LOCATION AND THE WATER LINE THAT WAS PROFESSIONALLY LOCATED G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet •'� 111 � ....... .. J f y Gorne S. —795 9 Q e�V V • '�•�. Zv c � FAQ ro f essio��o #AECC884 m z 00 r F - (n Lij o z Ld Mw LLI tTC 0� ¢2W CL 00 x > F - _j Of C) < a- < o to V)Z < - U) Tract F-1 S 00*06'46"E 40.00' Tract C z Ln L n C) A Elf &0 0) 'o O O 0 C 0 0 X 0= a L_ j a- LZ :3 E C 0 0 Co o > r� N � Wlt 'lotymy.123_1 to f I a LO C4 C4 "a N O N N mc tn U') C to 0 1-, r, 0 In 0 0 C M Cn 0 0 ii sl 0 >1 a) V) 00 C) rz 0 V) < C3 C: 0 4d�i. V) C: 0 . = M 0 a _V 0 -C E 0 0 o O BT ar ffiE.- Cn r C C*4 0 ffi 0 A C3 v r- E L_ 0-C 1>0 CL 6, -Sip o -0 z , .4 :3 E W %_ 0Op -a E CL dfvO.0 0 C11 :2 - C Qr O.0 C I- 0),SM 0 Z C Z 00 J. -0 -:03 0 E a 7UL 6 -C -0 0 C OM >- w C 43 C Cl — E AU 0 a C0 C_ 0,3 . > Ji p os p 13 0 < _C 0 C 0 0 0 :] = 0 .0 IM -a o x C-) >,o o o :3 0 C-0 o U Co 0 Co 'DI— i� (a :3 U C C o CL a 0 2 it 4 C 0 C 0 0 C 0 CL 00 00 13 0 0 C 0 0 to CL 0 ms 0 U MUNICIPALITY OF ANCHORAGE DEPARTE'IENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMEklTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date _ GENERAL INFORMATION (a) Legal Description (iaclude lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~[///-Z/P z~o~{¢'~'~ Telephone: Home _34(,,-Zo75' Business ~- Applicant Address /~ 7 ~'0 ,'~.OOA/Z~ 7'~'~,____~ DZ~/tF.~ (c) Applicant is (check one): Lending Institution []; Own..__._~er/builder'~; Buyer []; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 9?_..<.'-/o TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms .-~ Other WATER SUPPLY [] Community'~ Public [] individual Well Note: If corn m unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~' Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Depar[ment of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 (1~/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORI~ATION As certified by my sea[ affixed hereto and ss of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal syst. em is sate, 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 ~ ~:]~,~ Address Engineer's Seal Approved for ""~'"~,--~- bedrooms by ~¢~'"~"'~¢~-- ate Approved /~. Disapproved Conditional%.~J 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 MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ~'~"~] ENVIRONMENTAL PROTECTIC,-- BEC 2 01985 RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Lega~ Description: ~.O'7- WellClassification 5,~¢'-~--~" ,4j~E~. /..ET-r~~Z- IfA, B,C,D.E.C. Approved(y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot - Date Water Sample Test Results Comments B. SEPTIC/~ Date Installed ~/-~'/?.---~ Size Standpipes (Y/N) Depression over Tank (Y/N) Al Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ..5'~)O / To Property Line 54 ~- To Water Main/Service Line Course /) 000 ~ ,~,', Air-tight Caps (Y/N) No. of Compartments / ~/ Foundation Cleanout (Y/N) y Date Last Pumped 1~5 Y ; for 1~'~' ~' Temporary Holding Tank Permit (Y/N) /¢,~ To Building Foundat!on '¢~ To Disposal Field ~' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026(11/84) C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: Type of System Design ~:~[T Length of Field /¢' · Depth of Field ¢ ' Gravel Bed Thickness ~ Standpipes Present (Y/N) Date of Last Adequacy Test'~ To Water-Supply Well To Building Foundation Lot A/OXf~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots ?'7' To Cutbank (if present) NO LIFT STATION Date Installed Size in Gallons Dimensions Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA ~,nd H~A ,g u,.~idelines in effect on the date of this inspection. Signed' ~,~-4'_,~9.f.~,~.~2.._6~" ' ~&~:~Date Company ~¢~ &P~b. MOA No. Receipt No. ~.O~ Date of Payment ~--~ "-~ ~ Amount: $ ~ OO Engineer's Seal Page 2 of 2 72 o26 m/84) DElta'!'. O!~ ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA qgSO! BILL SI.(EFFIELD, COVEI~ION Tele,ohone: (907) Addre~; 274-2533 According to records on file in this office the State Drinking Water Regulations Sincerely,