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Home My WebLink AboutVALLI VUE ESTATES #2 BLK 1 LT 57Onsite File Valli Vue Estates #2 Block 1 Lot 57 #015-311-31 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221276 PID Number: 015-311-31 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Z Upgrade Name CABANA SERIES IV TRUST.... ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 6700 ROUND TREE DR, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 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 1 57 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 200'+ -_ 25',+- TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ -- GREER 1250 Gal. Material Number of compartments Lot Line 10'+ __ NA HDPE 2 Foundation10'+ __ LIFT STATION Manufacturer Capacity Remarks TANK FIELD VERIFED 10' TO EXISTING Gal. FOUNDATION & 5' TO FIELD Alarm location Electrical installed by Installer A+ PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1" 8/23/22Location dates: 2"d 8/24/22 and description 3rd 4th DOOR JAM ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: "' Date TH •• •••• •........ Septic System•• Approved - Curtis HuffmanCE •: �c�s� Date 3"ZZ- �� ' • s/2628�991• - * -0 / . • law l`� Note: this approval does not include well permit requirements. ROFESS Q0 � ioo., n�in�i�4� �Z PID:015-311-31 PERMIT: OSP221276 r�auuunavu KEYBOX K LOT 56 9D BLK 1 1S 1� INSTALLED 12SEP/ DCO K E ko 10 A 2 N'o MH / D / EXISTING FIELD DFD FSO GO E t T \ 10' ST TO FOUND PER VISUAL SITE \ OBSERVATIONS. 0 01 I- c��b�Ui BW DOOR JAM A—C=14.3' B—C=4.9' A—D=18.0' B—D=13.0' A—E=22,7' B—E=15.3' A—F=25.1' B—F=16,9' A—G=32.1' B—G=22,1' PAVED D/W �0 3p' LOT 57 15b�el BLK 1 VALLI VUE ESTATES #2 BLK 1 LT 57 PREPARED FOR: CABANA SERIES IV TRUST 6700 ROUND TREE ANCHORAGE, AK 99507 FIRST WATER CONSULTING SEPTIC SECTION SCALE, NTS 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmail.com DATE: 8/26/22 SURVEY. JLS DRAWN: FWCS SCALE: V, = 30' OF A44 *9 TH 1-., '*T rtis Huffman CE 128991 8/26/2022, '-�?oftssiovo' AV LOT 56 16 i<Erao� ,gyp �0. �1 / AFF` c) 4cIz' PAVED D/w P. MH j G \ SN Ge VE a T ` D. J 15.7' LOT 57 tK 1 BLK 1 h• Oo� 6'S p 0, < 7s tK .pJ LOT 58 BLK 1 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: VALLI VUE ESTATES UNIT No2 LOT 57 BLOCK 1 PLAT 77-296 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoul( any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. SEPT 24, 2022 1"=30' achuilerOakn( 22-069-2 mowN By: I CHECKED BY GMD NW _Gic A, JLS SW2539 220340 OFAL��1 ®* 49TH � . HN L. SCHULLER.: 0 t N� LS -10408 ,01 'Of essionc\ Lam® w� S0'�V�j� �� G A R. r 1831 Talkeetna Street Anchorage, .Alaska 99508 (907) 227-1455 office (907) 274-4992 fax 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://wwwmuni.arg/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221276 Work Type: SepticTank Upgrade Tax Code Number: 01531131000 Site Legal Address: VALLI VUE ESTATES #2 BLK 1 LT 57 G:2539 Site Mailing Address: 6700 ROUND TREE DR, Anchorage Owner: THORPE ARTHUR R & BETH M Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft Total Bedrooms: ��cnr S c Ucpartmrnr 8/1/2022 8/1/2023 20659 ❑ Disposal Field R1 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 (2417). 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: < „ Issued By: �e 8/2/22 Date: Date: i Q�a MUMCPA U7Y OF AHCHORAGE O- ., Development Services Department r' Phone: 907-343-7904 On -Site Water & Wastewater Section '--- Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-311-31 Property owner(s) US BANK TRUST CABANA SERIES... Day phone Mailing address 323 5TH STREET, EUREKA, CARO 95501 Site address 6700 ROUND TREE DRIVE, ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) VALLI VUE ESTATES #2 131 L57 Legal description (Township, Range & Section) Lot Size 20,659 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank 0 Upgrade (D) El Holding Tank ❑ RenewalDuplex ❑ 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: "� � 5 Waiver Fees: Date of Payment: 11 a0x) Date of Payment: Receipt Number: 1 19 (r"0 Receipt Number: Permit No. OS1 � 7 ( --) Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com July 18, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: VALLI VUE ESTATES #2 BLK 1 LT 57 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tanks on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. The lot and area are served by public / class A water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221276, Rebecca Carroll, 08/01/22 FIRST WATER CONSULTING VALLI VUE ESTATES #2 BLK 1 LT 57 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221276, Rebecca Carroll, 08/01/22 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION L ~j,~3,-rz~ ~.~/ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME _ ~RADE m~ ~ Manufacturer ~ Materia~ No. of compartments liq. c~ gallons IF HOMEMADE: Inside length Width Liquid depth , ~ Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons Well Foundation~ ~ / ~oare~l~line No. of lines L~ngth of each~ine. Total leah of lines Tren~th Material bane h tile Top of til~to fl 'sh grade Total effective absorption area ~ D Type o~ crib Crib diameter Crib depth ~ I Total effective absorption area m Well Building foundation Nearest lot line m DISTANCE TO: ~ Class Depth Driller ~ Distance to lot llne PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO; OTHER SOl TESTRATING ~ '~ ~ INSTAELER ~ . 72-013 (Rev. 3/78) Russell Oyster 694-2774 Soils 8- Foundations O Er E GE(~.'ECHNICAL Er DEVE'~OPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Earl Ellis 688-2280 Land Development I"ILIN I C. I PFIL I T"'r' C'JF FINC:HORFI~..SE DEPRRTMENT ~r-''x, HERLTH RND EN'.!IRONMENTRL ;~'~OTECT I ON 825 "L STREET, RNCHORRGE, : 264-4728 L-IEEE RI'-I[-~ 01'4--S [ TE SEL.JER PERMIT NO. ( ) BPPL ic ..rr uo LEGRL L-.S-'~ ~ ('C / q~;c..~v,,,1 ,_,~c,~ L~o~.~i T'.r'PE OF SOIL RBSORBTION .=.Y_TEM IS: MRXlMUM NUMBER OF BEDROOMS =.~ PERI'I I T SQURRE FEET SOIL RRTING (SQ FT/BR)= o°'-~' THE REQUIRED SIZE OF THE SOIl. RBSORPTION SYSTEM IS: [)EPTH= lO LENGTH= ~l-?--- GRRVEL B~EPTH= 9 THE LENGTH DIMENSION IS THE LENGTH <IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF 8 TRENCH OR PIT tS THE DISTRNCE BETWEEN THE SURFBCE OF THE GROUND AND THE BOTTOM OF THE EXCRVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET>. RE~)UIRED SEPTIC TRr4K SIZE= ~ ~]RLLO~IS PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS 8DJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TL,-IC~ ( 2 ) I I'-,~SPECT I 0 I'-,I S RRE REQLI I RE[::-, BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION AND APPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS i00 FEET FOR R PRIVRTE WELL¢ OR 150 TO 200 FEE'r FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NELL. NELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 30 DRYS OF THE WELL. COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS BND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PERM I T E×P I RES [:,EOEMGER --?-1~ 1-q- 80 I CERTIFY THRT 1: IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN 8CCORDRNCE WITH THE CODES. g: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE PERMIT NO. ~4LI~4 I C I ~iL I T'¢ OF RNCI-f ~RRGE DEPRRTMENT OK HEBLTH RND ENVIRONMENTBL P~OTECTION 825 ~L" STREET, BNCHORRGE, BK. 9~501 264-4720 0~4--~--~, I TE SEPIER IJF'GRRDE PERil I T 800154 ) BPPLICRNT LOCRTION LEGRL WBYNE BRITTON STRR ROUTE B BOX 36-B 99507 ~44-2778 ROUND TREE LOTS? BLOCK 1 ',,"8LLI VUE EsT5 ~ LOT _,I,~E 2¢'-~ra00 SQURRE FEET TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH MRXIMUM NUMBER OF BEDROOMS = 4 SOIL RBTING <SQ FT?BR)= 85 THE REQUIRED SIZE OF THE SOIL BBSORPTION SYSTEM IS: [;~EPTH= 2L£1 LF_I'-IGTH= 22 GRRVEL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRBINFIELD. THE DEPTH OF B TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE ENCRVBTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRBVEL BETWEEN THE OUTFRLL PIPE BND THE BOTTOM OF THE EXCRVBTION (IN FEET). REC-, 5]EPT I C TR[4K S I ZE= 50E4 GRLLO[4S PERMIT BPPLICBNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RD,IRCENT TO THIS PROPERTY 8ND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. T~,~CI (2) I FtSPEC:TI C, FIS RRE REQUIRED BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION BND BPPROVRL BY THIS DEPBRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTBNCE BETWEEN B NELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR B PRIVBTE WELL OR 150 TO 200 FEET FROM B PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NELL. MINIMUM DISTBNCE FROM B PRIVRTE NELL TO B PRIVBTE SEWER LINE IS 25 FEET BND TO B COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS WRY BPPLY. SPECIFICBTIONS RND CONSTRUCTION DIRGRBMS BRE BVBILBBLE TO INSURE PROPER INSTRLLRTION. F'EP-:f-1 I T E,'--::P I RES [:,ECEMBER I CERTIFY THBT t: I RM FBMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF BNCHORBGE. 2: I WILL INSTBLL THE SYSTEM IN 8CCORDBNCE WITH THE CODES. }: I UNDERSTBND THRT THE ON-SITE SEWER SYSTEM WRY REQUIRE ENLBRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THBN 4 BEDROOMS. SI, NED: ......................................... r',''x RPF'L. ICRNT WRYNE BRITTON ~~ I',~UED BY DBTE ~/ V4.0 ~GRE~'~'ER: ANCHORAGE AREA BO~,UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ' NAME SEPTIC TANK: DISTANCE FROM WELL Y NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH -- LIQUID DEPTH -- LIQUID CAPACIT~/OE;E7<:~) GALLONS. SEEPAGE Pit: NUMBER OF PITS DIAMETER --OR WIDTH LINING MATERIALC-~A~OE~ ~g~ CRIB SIZE:~X~DIAMETER__ BUILDING FOUNDATION /-//, NEAREST LOT LINE '~O (~-, ADDITIONAL ABSORPTION LENGTH DEPTH DEPTH ~"~' DISTANCE FROM: WELL ~JO~'~'~'~ ~> T o T AL EFFEC T,VE ABSORPTION AREA (WALL AREA} . FT. WELL: TYPE ~~A/V~/~ ' CONSTRUCTION BUILDING NEAREST ~/'~NEAREST SEPTIC FOUNDATION ~__ , SEWER LINE TANK CESSPOOL /, OTHER SOURCES APPRO ED'~/ DISAPPROVED REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: REMARKS: Form NO. EQ-031 DIAGRAM OF SYSTEM GReATeR ANCHORAGE Area BOROUGH PERMIT NO DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK SEEPAGE PIT , DRAIN FIELD OTHER FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS "~ NOTE: THl~ PERMIT 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 /~'~O ~-~ · Typ E ~--~/~ I~:~/'?~ SEE PAG E AR eA SIZE '/'~/~/~ TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~ fOUNDATiON TO SEEPAGE PIT ~ /., DRAIN field SEPTIC TANK TO SEEPAGE Pit WALL /~ / SEEPAGE PIT ALSO CONSIDER ^REA WELLS. ., seepage Pit SEPTIC TANK ~' / -, SEEPAGE PIT TO NEAREST LOT LINE ~. i, /~ WELL TO SEPTIC TANK DRAIN FIELD ~ WATER MAIN TO SEPTIC TANK //1~ / DRAIN F[ELD / {~ / SEPTIC TANK, ~ t , SEEPAGE PIT TO RIVER, LAKE, STREAM. CAST irON INTO AND OUT OF SEPTIC TANK AND INTO CR]B 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 BAC:KFILL CONFORM TO BOROUGH REGULATIONS REGARD]N(;; INSTALLATION. LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE TO SIGNED ,x'.':'..-~'../ ........ ;"-} ?z '/,~..~...: REPLY SIGNED DATE SEND PARTS 1 AND 3 INTACT - cBr/zl~/zl~ss POLY PAK (50 SETS) 4P472 rJF.~,....~F(~___ 4S 472 PART 3 WILL BE RETURNED WITH REPLY. MUNICIPALITY OF ANCHORAGE a Development Services Department �`�` p P ��' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 015-311-31 Legal description ValliVue Estates #2 Block 1 lot 57 Site address 6700 Round Tree, Anchorage, Ak Current property owner(s) Cabana Series Expiration Date: 5-23-2023 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: B w Original Certificate Date: — ' �Z This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaLJune 2022 MMHMPAUTY OF AHCHOFi1,AG1E Development Services Department f=`� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-311 Complete legal description VALLI VUE ESTATES #2 BLOCK 1, LOT 57 Location (site address) 6700 ROUND TREE DRIVE, ANCHORAGE, AK 99507 Current property owner(s) CABANA SERIES IV TRUST.... Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ® Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 0 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 5_5%j Date of Payment (0- /la COSA # C)( 2_3�l Waiver Fee $ Date of Payment Waiver # COSA Application—July 2022 copy.doc Legal Description: VALLI VUE ESTATES #2 BLOCK1, LOT 57 Parcel ID: 015-311-31 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA - PUBLIC / CLASS "A" 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) in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Measured operating fluid level in septic tank 58" Date of pumping NA NEW TANK ❑ Required maintenance completed, if AWWTS Comments: 1250 HDPE GREER TANK D. ABSORPTION FIELD DATA Which system tested (date installed) 6/2/1980 ® ALL standpipes present per record drawing Total measured depth from grade 13.1 ft (max) Measured depth to pipe invert from grade 6.8 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 5/26/22 date Any rejuvenation treatment (past 12 months) N If yes, enter date Well production at time of test gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L (" Arsenic less than MRL (ND) Collected by Date C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/27/2022 Results M Pass Fluid depth prior to test 38 in Water added 600 gal New fluid depth 55 in Elapsed time 1440 min Final fluid depth 36 in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 96 in Effective depth used 36 in (final) Effective depth remaining 60 in Comments/Deficiencies:MT/SUMP & DCO2 INVERT AT GRADE WITH PREVIOUS TANK. MOA SHOWS 8' EFFECTIVE DEPTH IN INSPECTION REPORT. SHOTS SHOW 8'++ ED OR 12.2' ED AT SUMP TO DCO2. SYSTEM APPEARS TO BE OPERATING IN THE MIDDLE OF THE 8' MOA ED AT LOWER END OF MT. COSA Checklist 2022.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding 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' Community Sewer Main > 75' E] Yes if No ft ❑ Yes if No ft ® N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firin FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/3/22 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS COSA Checklist 2022.docx oF A4,, -s i �• • �.• • Curtis Huffman 40 d'T • 10 3/2291 • •��'��' ll,� pROFESSION�?''�AW ' 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.# ~' GENERAL INFORMATION Complete legal description Location (site address or directions) .'~-'? OL,~ ~O~.'~?d/ '~--:Cd t~)F'-~ Property owner'~'~/~fC k/' ¢¢,d,~' ~.':C~,, ' ' ' ' /~/¢(]~',E£;i,~' Day phone Lending agency Day phone Mailing address. Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~// TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 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 Public sewer NOTE: 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 t~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 verifythat based on the information obtained from the Municipality of Anchorage fifes 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. DHHS SIGNATURE ~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 D H HS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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) E~ck MOA · ' ~ .... CE HEALTH AUTHORITY ~ ~ .'~'"' ' '" ~ ~ ' ,.~.,,- ~ , ........ CERTIFICATE .... ~,~;~_-,~,:,.,. ~,~:~-,~. ,?: , Parcel I.D.S, ~ ~ -~ ................... ,~- ....................... HAA~--~~l~ ........... .,. t ; ~' ~M~A/~IM~DDAtI~M ~,~ ~:~:"~.~ "~~.~;(~t~:; "~:- --:' ¢-~ ~r~ ~'~;'"~ "'~ q;'~:~;~¢~'~r;:~;¥~: ;~.; ~.: - ............. ~um~.~. legal uuu~lpuun.-~' ~ ~ ~es,.~ .... ,: . ?;:'?~;~'-', .. s) 5700' R~d ~ Dr~ve,-~.~.,,~=:?? .-~¢:;~;~v-~,~::~-,~,~,;~,,~;<.,.:-~z,~ ,- A LIT:Y, OF ANCHORAGE ....... ¢~ ........ On S te Sent ces Sect on ,d!~ p O B0~ 196650' ~'Anchorage A eska, 99519-6650 5. STATEMENT-OF INSPECTION B¥~ENGINEER,&~-~=.i,~F-*.~;i,i'~ As ae~ified by my seal 8~xed heroto 8nd 8sof lbo vahdstlon date oh ow, t my invasti~ation of lhis HoalthAuthod~ ~pproval ap¢ication shows that t~o on-sffo wator supply and/or wastewater disposal system is safe;.functional and adequate for the number of bedrooms and ~pe of structure indicated herein. I fu~her veri~that based on the information obtained from the Municipality of Anchorage'flieS arid f~om ~ 'hv~i~ation and inspection, the on-site water supply and/or wastewater, disposai system is m compliance with all Municipal and State codes. or0inancos, and re~ulati0na, in.o~ct on thedato of ' ...... Name of Firm ~v~o~~ag~ , ",16." .. DHHS SIGNATURE _ Date ~a Hu~na6:Servce~ (DHHS) ssues Health'~,i~tl~onty 'r'' ''' and their ending il istitutions n order t0S~t SfY certain federal and state,requirements. Employees of DHHS donot conduct inspections or analyze 'data'before a-cert f cate is issued..The Municipal!ty.of_AnchorageJs not ~.: responsible for errors or omissions in'the profess Ona eng neer's work. - . ... ...... -,- _: ..:. ::..,':.,..: L ,, .L; Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 57, Block 1, Valli Vue Estates ~2 A. Well Data Well type Class A Log present (WN) Total depth Sanitary seal (Y/N) Parcel I.D~ 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 WELL LOG AT INSPECTION 210605 Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line N/A ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: N/A Coliform. Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date insta,!led:. ~/6/73, ,6222/80 Tank size 1,000 gal, 500 gal Compartments 1, 1 Cleanofi;ts (Y/N) 'i. ¥ High Water alarm (Y/N) i. , [~ Alarm tested (Y/N) I~/A Date ~)f pumping' ~c~ J~o~'l l,C/~' Pumper ,~o']-o- l~oo4-~P SEPARATION DISTANCES FRoM SEPTIC/HOLDING TANK TO: Well(s) on lot .I.q/A On adjacent lots 200+ fl:. Foundation 3 ~t. ~rom C.O. To property line 20+ £t. Absorption field 7 £t. Water main/service line 30+ ft. Surface water/drainage 100+ ~There is c]eanout access to the house from the first septic~tm.r~ cleanout. :~ '., , ~ , ,CONTINUED ON BACK PAGE C. LIFT STATION N/A Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D, ABSORPTION FIELD DATA Date installed 6/2/80 Length 55 ft. Width Total absorption area 667 Date of adequacytect. 6/27/95 Water level in absorption field before test Peroxide treatment (pact 12 months) (Y/N) N On adjacent lots Manufacturer Manhole/Acoess (Y/N) "Pump off" Level at Cycles tested Sudace water__ Soil rating (GPD/Ft2) 85 ft2/]3~. System type Trench 2.5 ft. Gravelthickness 2.5 £t.-? ftTotaldepth 5,~ ~-~-.-1~ Cleanout present (Y/N) ¥ Depression over field (Y/N) N Results (pass/fail) Pass for 4 Bedrooms 0 in. After test 8.5 If yes, give date N/A . SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N/A On adjacent lots 200+ To building four~dation 20+ ft. On adjacent lots 50+ £t, Cutbank Sur/ace water None ObServe(-] Cudaindrain None observe~ E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA Property line __2.1 ft. To existing or abandoned system on Iotapprox. 10 ft. to abandonec~ pit ~1 ft. Water main/service line__. 2~+ ft. Driveway, parking/vehicle storage area 5fl ft. this inspection, John Earl Simpson CE.8001 HAA Fee $ Date of Payment Receipt Number 72-026 (3~3)' Back Waiver Fee $ Date of Payment Receipt Number 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. # ~\~- 5\\ - HAA # GENERAL INFORMATION Complete legal description Location (site address or directions) (0700 R0uN,~ TREE Property owner Pl/INE Mailing address o~ ? OO Lending agency G MAC Day phone /r~cl~or~v~.e~ ~$~ Day phone ~"~ -~ I~/ Mailing address 5~b'° Agent ELOlSE SCHPII~T Address ~3~ 3 DEN,~LI GOL~>EN ?'RoF£RTIE5 Dayphone 2'7~-7100 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 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 Public sewer NOTE: 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 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and es 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 ¢'L~TTOP I'ECI~. 5VC¢,. Address I H530 EC HO Engineer's signature DHHS SIGNATURE .~. Approved for Disapproved. Phone 3z~5'-1355' Conditional approval for Date /-/~,y t ¢., /') ~)_.~ bedrooms, with the following stipulations: Additional Comments Date ~- -.,2...~4-'- ~/2 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L .~7 ELK I V~LII VCE E57, Parcel I.D. A. WELL DATA Well type Log present (Y/N) If A, B, or C, attach ADEC letter. Date completed ADEC water system number Driller Totaldepth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION MiiNiCIPAUTY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION ,,.CEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ; On adjacent lots Absorption field on lot Public sewer main 'Server ~ervice line WATER SAMPLE RESULTS: On adjacent lots Public sewer manhole/cleanout Petroleum tank Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed cj(73 (~/~O Tanksize lO00 G Cleanouts (Y/N) )/ Foundation cleanout (Y/N) High water alarm (Y/N) .5'00 G Compartments I ~ J N Depression (Y/N) ~ Alarm tested (Y/N) N, A, Date of pumping Pumper ~7"~ ~ ~z ¢...~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~. ~, On adjacent lots N./~, To property line ~O' Absorption'field Surface water/drainage ~ /00¢ Foundation 'Water main/service'line CONTINUED ON BACK PAGE 72-026 (Rev. 7/91) Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level __ "Pump on" level at Manufacturer Manhole/Access (Y/N) "P~mp off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/~,/~0 Soil rating 8~' ~'/~'iP,~Yl Length_ .~'J~' Width ~'~ ~ Gravel thickness Total absorption area ~"~ Depression over field (Y/N) N Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Cleanouts present (Y/N) Date of adequacy test for ~' System type Total depth Y If yes, give date N, fi, bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N. ,/~, To building foundation Qnadjacentlots > 30 Surface water ~'/oo Curtain drain NONE Onadjacentlots [~, ~l, Propertyline ~,°/ To existing or abandoned system on lot Cutbank N.4-, 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 the date of this inspection. Signature ,¢~'~ ~ ~ " Engineer's Name '7~¢,¢~¢,,'~. ~-. ,,"~,o~"~_ Date /~-,,v /~/ /¢?'¢ HAA Fee $ _ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number (Rev. 8/91) Back MOA 2J : [: -- INVOICE lq- S8128 ,,,,.,~,~ ~. ,~,.~.~ CLEANING SERVICE P.O. BOX 112688 PHONE $45-2519 ANCHORAGE, ALASKA 99511-2688 Job Address z~E SALESMAN TE~AYS ROTC-ROOTER SERVICE CALL HRS. @ OVEBTIME CHARGE ' ADDITIO'NAL LABOR CHARGE STEAM THAWING HRS. @ TRIPCHARGE HRS. @ HRS. @ HRS. @ ~'~"PUMPINGSERVtCE//,_.~(:;2~ (GAL.) HRS. /~/@ ~' HYDRO-JET SERVICE :: ~ CAMERA INSPECTION HRS. ~MATERIALS PLEASE PAY FROM THIS INVOICE TOTAL TOTAL FOOTAGE CLEANED OR THAWED BLADES [JSED ~:' PROB BLE AUS'E OF STOPPAGE ~,~--~/~ ~/'"'~:~-"~ "~/'~ l: LINE CLEANED ~; [] JOB NOT GUARANTEED FOR FOLLOWING REASON., , THEODORE F. MOORE, P.E. May 17, 1993 PH: (907) 345-1355 14530 ECHO ST. ANCHORAGE, ALASKA 99516 Diane Ruedrick c/o Eloise Schmidt, Golden Properties 3333 Denali St. Anchorage, AK 99503 Dear Ms. Ruedrick: Per the request of Eloise Schmidt, on May 12 - 14, 1993 we conducted an adequacy test Of the wastewater disposal system serving your residence on Lot 57, Block 1, Valli Vue Estates, Unit #2, located at 6700 Round Tree Drive. We are fding an application for a Municipal Health Authority Approval 0tAA) certificate today, along with a copy of this letter. According to the as-bnilt inspection report on file at the Municipal Health Department, the wastewater disposal system consists of a 1000 gallon septic tank installed in 1973 followed by a 500 gallon tank which was installed in t980. The effluent from these tanks flows into 55 lineal feet of soil absorption ~ench which was also installed in 1980. The soil absorption trench has three separate portions with 5 to 8 feet of sewer gravel in each. To assess the adequacy of the system we ran a total of 1627 gallons of water into the system over a three day period through the cleanout for the 500 gallon septic tank, while monitoring fluid levels in the septic tank and in the soil absorption system standpipes, before, during and after the flow of water was stopped. The sump at the end of the trench was dry at the start of our test, and the maximum fluid depth achieved during the test was 57 inches. We measured an absorption rate of 0.55 gpm when the fluid depth in the sump was between 45 and 47 inches. At no time during the test did fluid back up into the septic tank. Based on our test data we concluded that the system continues to be able to accept water at an adequate rate for a 4 bedroom residence. This residence is served by the Valli Vue Estates community water system. A copy of a recent D.E.C. letter of compliance of the water system is enclosed. In conducting an adequacy test we attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the performance of the system under the conditions encountered at the time of the test, and the separation distances are measured to readily identifiable features. Septic systems do deteriorate over time and satisfactory test results do not guarantee future performance of the system under different conditions, nor do they guarantee that there are no hidden defects or encroachments. Please feel free to give me a call if you have any questions on this report. cc: M.O.A. DHHS Sincerely, Ted Moore, P.E. DEPT. OF ENVIRONMENTAL CONSERYATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 WALTER J. HICKEL, GOVERNOR (907) 349-7755 March 30, 1993 Mr. Jeff Garness 8471 Brookridge Drive Anchorage, Alaska 99504 SUBJECT: Valli Vue Estates #2 Class "A" Public Water System, PWSID 210605 Dear Mr. Garness: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results Was submitted to this Department on March 4, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on August 13, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on December 2, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on November 12, 199t. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. 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.# 1. GENERAL INFORMATION Comp.lete legal description Vf~L£t Location (site address or directions) _ (2700 ~0t/t,(b q'I~EE Property owner /~H FC Mailing address Lending agency Mailing address Day phone Day phone Day phone '5' ¥~/'-~',~o/ Agent __ : ..... Address -~ ¥~"~ /A~r/-~,ell /'~/~, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: Individual well Community well 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 Public sewer NOTE: 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~f21 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 _ F/- AT ToP' -FEcH '51/¢ ~ Address J U¢53o ECNo ~T. ~C/~,, Engineer's signature '~~ ¢ ~ Phone Date_ J DHHS SIGNATURE .,~._ Approved for Z~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~.10(-t-6/ ~,4,,t.~17-/. Date 7/Z ~'/¢//- 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 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 certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L ~7, ~ I ~//iLLI ~t/g E~,T. Parcel I.D. A. WELL DATA N,/), Well type A Log present (Y/N) Total depth Sanitary seal (Y/N) 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 WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot AT INSPECTION ; On adjacent lots Absorption field on lot Public sewer main ; On adjacent lots Public sewer manhole/cleanout Public Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ff/617~, cleanouts (Y/N) ~/ High water alarm (Y/N) ~/2/80 Tanksize /0o0 6.. 5'00 ~. Compartments Foundation cleanout (Y/N) N ~ Depression (Y/N) Alarm tested (Y/N) IV,~. Dateofpumping .7/2~ /9! ~y ~C~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ~. On adjacent lots N, ~ · To propertyline ~/0 Absorption field '7 Surface water/drainage 72-026 (Rev. 3/91) Front MOA 21 Foundation -~ F,~or~ C, o. Watermain/serviceline :~ 2,,~ ~ CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SFPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed (0/2 /~O Soil rating ~ 'Length 55" Width__.~,$-t Gravelthickness ~'~ - 7 Tqtal absorption area Depression over field (Y/N) iq, Date of adequacy test Results (pass/fail) j2~,¢~, for Peroxide treatment (past 12 months) (Y/N) Cleanouts present (Y/N) System type Total depth yes, give date N, A, bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I~,/ti. To building foundation On adjacent lots ~, 30 Surface water ~ /00~ On adjacent lots. N.A · Property line To existing or abandoned system on lot Cutbank iA./~. Water main/service line Driveway, parking/vehicle storage area ~ Curtain drain PiT' E. ENGINEI!".R'S CERTIFICATION I certify that I have chocked, uedfie~, or con~ormo~ to all MOA an~ ~AA Signature ~~ ¢~ Engineer's Name -r'/,i ¢¢~x~. Date __7/~'/' /¢/ HAA Fee $ __ ,' ~ Waiver Fee: $ Date of Payment -/2'/'~'~.~" V /~/ Date of Payment Receipt Number '~'~' /' ( '~ ~-~ ~'~ z~Z ..) ' Receipt Number 72.026 (Rev. 3/91) Dack MOA 21 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 July 10, 1991 WALTER J. HIOKEL, GOVERNOR 563-6775 FOR: Ted Moore 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 provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Keven K. Kleweno Lead Engineer 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 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) P(oc(. /,, E' e Location (address or directions) 700 (b) Property owner ~ H F~"' Mailing Address (c) Lending Institution /~, ,"~'. Telephone: (home) Telephone Business ,~ ~'Y" 0,5-0/ Mailing Address (e) Mail the HAA to the following address: (or check here Fa, 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 [~ 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 ~ 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 ~ ~.o ~ ebBd '~JOM s,JaaU!bUa iBuo!ssejoJd eH1 u! 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WELL DATA Well Classification ~' (¢~.,¢J' Well Log Present (Y/N) Total Depth Cased to. Static Water Lever 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 To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments j~ ~: ~_, ~,/~,~/~,u~{ Date Completed Depth of Grouting If'A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date nsta ed 9/~'/7_~ Size Standpipes (Y/N) ~' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~, ,4. No. of Compartments I / Foundation Cleanout (Y/N) Date Last Pumped ~.//5'-/~0 ; for /V, 4L Temporary Holding Tank Permit (Y/N) /~t, ,~,. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well -;~ 8o~,' To Property Line ~ ~O' To Water Main/Service Line ;~ ~5- / To Stream, Pond, Lake or Major Drainage Course To Building Foundation ~' ;~Cr~,¢ ('. ~.. To Disposal Field 7' Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test /¢cxcr~''' Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ ~00 ' To Building Foundation -~ Lot ~ fo' Cea (jc~f,,~o~¢eX' To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments 5~e~ ~/l~J ~,~ ToPropertyLine ~/' fl~ r ~eTa/~ c To Existing or Abandoned System on ; On Adjoining Lots ~ YO ¢ To Cutback (if present) /~l ,4. D. LIFT STATION N,/~, Date Installed Size in Gallons "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 I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~'-~-'-,¢~ Company Date ~/~ MOA No. Receipt NO c~ Date of Payment Amount: $ 72-026 {Rev 7~88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ANCHORAGE, ALASKA 99503 January 10, 1990 STEVE COWPER, GOVERNOR 563-6775 FOR: Mr. Ted Moore PWSID: #210605 According to the records on file in this office, the Valli Vue Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VERA E. CRAIG ~ ) Environmental Fie~fd Officer VEC:bas INSPECTION APPOINTMENTS ~J"~z')~ ~ J~ TIME TIME TIME - - ~ DATE DATE DATE ~UNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHO~GE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT O~EPT' OF , :7~,L~;~ & 825 L Street - Anchorage, Alaska 99501 ENVIRONMEN1AL ON ) ENVIRONMENTAL SANITATION DIVISION i~AY 9 1980 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be proce~ed, Please allow ten (10) days for processing, PROPERTY RESIDENT (If different from above) ~ PHONE MAI LING ADOR ESS V MAILING ADDRESS . 5. LE~]AL ~zESCRIPTION STREET LOCATION / 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] S)x [] Other 7. WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. A weft log is required for all wells drilled ~/_ COMMUNITY since June 1975. For wells drilled 'prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** //~'~~ ~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] OOMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified____ LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY (~ -- Connection Verified INSTALLER []Septic Tank or [] Holding Tank c-~,~, r~z'~ Size: l~)~lf Tank is homemade SOILS RATING give dimensions: feTAL ABSORPTION AREA MATERIAL ~) Di~'-~ANCES Septic/HoldiWg Tank Abso~ptlon Area 4. WELL TO: Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COTV]MENTS [_~"'~-CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev, 6/79) 2204 Cleveland Ave. / P.O. Box 10-1126 / Anchorage, AK 99510 / 277-0321 710 3rd Ave. ! P.O. Box 2540 / Fairbanks, A K 99706 / 452-1267 · 456;5156 May 20, 1980 Mr. Wayne Britton 6700 Roundtree Dr. Anchorage, AK RE: LOt 57, Block 1, Valleyview ~2 Subdivision Dear Hr. Britton: On May 15 and 16th, we performed an adequacy test on the above referenced property. The results are as follows: Absorption Rate: Average 24 hours, 0 gallons Surge Rate: 25 gallons in 1 minute If you have further questions regarding this test, please contact our office. Yours truly, CONSTRUCTION TEST LAB Bernard Nidowicz Laboratory Manager BN/bd 'Professionals working to desig~ and build a better Alaska" 825 "L" STREET ANCI4ORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR [}EPAF1fMEN'i'OF REAITH AND ENVIRONMENTAL PROTECTION May 12, 1980 Wayne Britton Star Route A Box 36B Anchorage, Alaska 99507 Subject: Lot 57 Block 1 Valli Vue Estates Subdivision Approval for your individual sewer and water facilities can not be granted until the following items have been completed: (1) The septic tank pumped with a receipt submitted to this department. (2) An adequacy test be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this department for our review. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw Cc: Alaska Pacific Bank Mortgage Loan Department 101 Benson Boulevard 99503 Patrick W. Rice % 115 West Northern Lights Boulevard 99503 ~208 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: 5. Type of facility to be inspected GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Phone: Phone: No. of bedrooms 6. Well 'Data: C. Construction 7. Sewage Disposal System: 6~ ~ A. Installed ~-~ ~ B. C. Septic Tank: 1. D. Seepage Pit: 1. E. Disposal Size /~-~-6 Absorption Area Field:_:~To_tal length of~es B. Depth D. Bacterial Analysis Installer ~/X 2. Manufacturer 2. Material2t¢-~ 8. Distances: A. Well to: Septic tank Nearest lot line , Absorption area , Other contamination , Sewer Lines 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 - Request for Approval of Individual St ..er & Water Facilities Legal Description Comments Approved Date ~ C.~ Disapproved Appr~al 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 accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) 3330 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1.. Type of Inspection: CMRO VA 2. Property Owner: ~V ?--~;~,~ Mailing Address: 6 FX -/ 3. 'Name of Buyer: r~vO~ 2'.~ / Ma~l ing Add~ess: 4. 'Name of Lending Institution: Mailing Address: ~7~ ~-- 5. Nam~ of Realtor or Agent: FHA c0Nv ~ ~7~-Das Phone Das Phone Phone ~?~- Mailing Address: Phone 6. Legal Description: Location'. 7.. Type of Facility to be inspected: ~ No. Bdrms. '8..Water Supply Type of Supply: Public Utility ~nd-i-vidu-a-t~. / If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System TYpe of System: Public Utility Individual If Individual, date of installation , .~ ~ (on-site)