HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 1 LT 62Valli* Vue Estates #2
Block 1
Lot 6 2
#015-311-36
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP251035 PID Number: 015-311-36
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
KEITH &STEPHANIA LEE
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
6750 ROUND TREE DRIVE, ANCHORAGE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
GPDlSF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
LEGAL Block Lot
VALLI VUE ESTATES #2 1 62
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
;Absorption
Holding
Lift Station
Sewer
Total absorption area
2
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft
Ft.
Well
I
i 200'+--
i
25'+
TANK ® Septic [:1S.T.E.P. ElHolding ElOther
Manufacturer
GREER
Capacity
1500 Gal.
Surface water
100'+
__
Material
HDPE
Number of compartments
2
Lot Line
10'+
--
I
NA
Foundation
10,+
--
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks Tank insulated w/ new field COs & MTs.
Deep -burial HDPE tank.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 Tank to 3034
Installer PCN
drainfield
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspection 1" 3/4/2025Location
dates: 2"d 3/5/2025
and description
3`° 4'h
ITOP OF MH
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
-= OF'-:9`��l
•
Conditional Approval: Date
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- ---_...._ _ -- -- _
.. .. .......
---- --. ... _.._ ............ .........._.--_ _--_ ...............-
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.. .... ..........
Septic Syste;
Approved; '�
Date
Curtis Huffman
��•. /
�c� ' •.Co3/t28991• • ����r
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F ..
t ,pF40 .. • NP���
l>> ROFESSIO _
Note: this approval does not include well permit require ents.. /"Z"
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\\\\t11
(ReV- 5/02/18)
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HOUSE
LOT 62
20,132 sq. ft.
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LOT 63
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PID:015-311-36 PERMIT:OSP251035
FIRST WATER CONSULTING
VALLI VUE ESTATES #2 B1, L62
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP251035
Work Type: SepticTank Upgrade
Tax Code Number: 01531136000
Site Legal Address: VALLI VUE ESTATES #2 BLK 1 LT 62 G:2539
Site Mailing Address: 6750 ROUND TREE DR, Anchorage
Owner: LEE KEITH &
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
2/26/2025
2/26/2026
20132
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either --
a. Opened and Closed on ovethe�same�yr-o---------�
b. Cred, sealed, and heated, to -prevent freezing
Special Provisions:
1. All standpipes are to be found and repaired if necessary.
2. RD to show the water service line.
,Reeewed=B : ,1-- 5i tAe c� %o "k)C- Date:
Issued By: G�J,� /rt/�� z-- Date:2 26/Z S
4
MUNICIPALITY OF
Development Services Department
On -Site Water & Wastewater Section
Parcel I.D. 015-311-36
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Property owner(s) KEITH & STEPHENIA LEE
Day phone
Mailing address 6750 ROUND TREE DRIVE, ANCHORAGE, AK 99507
Site address 6750 ROUND TREE DRIVE, ANCHORAGE, AK 99507
Legal description VALLI VUE ESTATES #2 BLOCK 1, LOT 62
Number of Bedrooms 4
Engineering Firm FIRST WATER CONSULTING
Building Permit Number
Not Applicable X
APPLICATION IS FOR: APPLICATION IS AN:
((E all that apply)
Absorption Field
❑ Initial ❑
Septic Tank
Upgrade
Holding Tank
❑ Renewal ❑
Privy
❑
Well
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Permit/Rush Fees:
Date of Payment:
Permit No. 0-'2 P? -,1510 3 -5 -
Waiver Fees:
Date of Payment:
Waiver No.
Phone.- 907-343-7904
Distance:
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / FirstWaterAK@gmail.com
!
!!
February 21, 2025
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: VALLI VUE ESTATES #2 BLOCK 1, LOT 62
The owner has requested that we obtain a septic permit to upgrade the existing aged fiberglass
septic tanks on the above referenced lot. We propose to install a 1500-gallon HDPE deep-burial
septic tank per the attached design to serve the existing 4-bedroom residence.
Groundwater was not noted in the MOA on-site file and is not anticipated to affect the septic
tank installation. If groundwater is encountered during installation that may affect this septic tank
upgrade, an epoxy coated steel septic tank or other action may be required.
All deck supports of an existing deck more than 30” will be 5’+ from the new tank. The lot and
area are served by public water and the waterline and other easements or property lines, … must
be staked prior to construction. 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
OSP251035, Deb Wockenfuss, 02/26/25
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4BR
HOUSE
LOT 62
20,132 sq. ft.
10' UTILI
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LOT 61
LOT 63
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FIRST WATER CONSULTING
VALLI VUE ESTATES #2 B1, L62
DESIGN DETAILS:
NO WELLS WITHIN
200' OF PROPOSED
SEPTIC TANK. AREA
SERVED BY PUBLIC
WATER & WATERLINE
MUST BE LOCATED
PRIOR TO CONST.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251035, Deb Wockenfuss, 02/26/25
\ S '011 \ \ --ROIJAID TRF
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BRASS7<
CAP — —
TRACT A
NOTE
DRIVEWAY LOCATION IS
APPROXIMATE DUE TO
SNOW AND ICE COVER.
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (77-296) ARE NOT SHOWN HEREON.
THIS DOCUMENT DOES NOT CONSTITUTE BOUNDARY SURVEYAND
IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT
BOUNDARY SURVEY MAY DISCLOSE.
UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE
USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR
ESTABLISHING PROPERTY BOUNDARIES.
THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY
PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION
SURVEY STANDARDS.
THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY
TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR
ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR ISA
VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED,
THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES
COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT.
JOB # 25033 1 NO CORNERS SET THIS DATE I SCALE 1" = 30'
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 62, BLOCK 1, VALLI VUE ESTATES SUBDIVISION UNIT
No. 2
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST EXCEPTAS INDICATED.
DATED THIS 19th DAY OF FEBRUARY, 2025, AT
ANCHORAGE, ALASKA.
FIXED HEIGHT, LLC C.O.A.122554
Land Surveying Services WWW.FIXEDHEIGHT.COM
600 W 41 st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949
' -":R ANCHORAGE AREA BOf' ,IGH
~'~'X. \_'~ Departmen3t5;f0 .~nuVdiro;n~oean~ Quality
Anchorage, Alaska 99507
lo:¥
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~__.LL/D£
LOCATION
SEPTIC TANK:
DISTANCE
FROM WELL ~'t*'r~ ~0
INSIDE LENGTH
TILE ~
NUMBER OF
· MANUFACTURER ~ - ~'~(~-/J'~'~MATERIAL /~/~'~-~¢:~ COMPARTMENTS
INSIDE WIDTH . LIQUID DEPTH LIQUID CAPACITY ~"~' {~ GALLONS.
DISTANCE FROM WELL
NUMBER OF LINES ~
FOUNDATION
DISTANCE BETWEEN LINES
NEAREST LOT LINE
TOTAL LENGTH
.OF LINES
T~ENCH WIDTH ~'"'--~{~. TOTAL EFFECTIVE
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE
IN. ABOVE TILE IN.
WELL: L'~'~/~l ~-7
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE__
OTHER SOURCES
DISAPPROVED
NEAREST SEPTIC
SEWER LINE , TANK
REMARKS
DEPTH
SEEPAGE
· SYSTEM
DISTANCE FROM:
DISTANCES:
INSTALLED BY: ~L~/2~/~/~r
SEWER LINE DEPTH:
PIPE MATERIALr ~'~-~ T- ~/-~,~'/t/j
Form PW~027
DIAGRAM OF SYSTEM
GREATEr ANCHOragE ArEA Borough
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456!
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
INSTALLATION OF: SEJ~T-IC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
!
SOIL TEST RESULTS
SEEPAGE PIT .. DRAIN FIELD
TO BE INSTALLED BY
NOTE= THIS PERMIT IS NOT VALID WITHOUT SOIL
COMPLETION DATE ANTICIPATED /,/~ '2~"~('~' ,'
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS
· DRAIN FIELD
., SEEPAGE PIt
ALSO CONSIDER AREA WELLS.
SEEPAGE Pit
-, DRAIN FIELD
CAST IRON iNTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
/
DIAGRAM OF SYSTEM
I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
[NANCE NO. 28-68 AI~D THAT THE ABOVE
/
/
· GreATER ANCHORAGE Area BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
FINAL iNSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUT
MINIMUM DISTANCES, REQUIREMENTS OF SYSTEM
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT ~ , DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
WATER MAiN TO SEPTIC TANK ., SEEPAGE PIT
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
I CERTIFY THAT I Am FAt41LIAR WITH THE REQUIREMENTS Of GREATER ANCHORAGE AREA BOR(~UGH ORDINANCE NO, 28-68 AND THAT THE ABOVE
/>
/
Test Pit No. 1
Depth in Feet
From To
0.0 0.5
0.5 2.0
2.0 13.0
13.0 14.0
Elevation: Exist. Ground
WO 17168
Soil Description
F-4, P~at, Pi, brown, wet.
F-4, Sandy Gravelly Silt, ML, wet, occasional cobbles and/or
boulder, to 18", sharp,'
F-l, Silty Sandy Grave_l, GM, tan, damp to wet, occasional cobble~
(sharp) to 8".
NFS, Sand, SP, light brown, damp, medium dehsity, few thin
silt lenses.
Bottom of Test Hole:
14 ft.
Frost Line:
Free Water Level:
8 inches
Very slight seepage at 10 feet.
Sample Depth
I 6'-13'
2 13'-14'
Blows/6"
Type of
M% Sample
....... Grab
....... Grab
Dry
Strength
4040 "B" STREET;
ANCHORAGE, ALASKA ~9503
PHONE: 007-279-2581
25 November 1974
WO 17268
Custom Homes, Inc.
3430 Hooper Circle
Anchorage, Alaska
Attention:
Project:
Subject:
Mr. Clyde Hass
Lot 62, Block 1, Valley View Subdivision
Subsurface Investigation
Gentlemen
Transmitted herein are the results of the subsurface investigation performed
on thb'above property on November 2§j 1974.
The test pit was excavated by others. The logging and sampling was performed
by Mr Bruce Kenworthy, technician of our staff.
The soils were visually classifed~ in the field~ in accordance with sheets 1 through
3, following the text. This field Classification was verified by visual r'eview
of samples, based on the same criteria, in the laboratory. The test hol~ was logged
as indicated on Table AD soil description.
Summary
Bottom of Test Pit:
'Frost Line:
Free Water Line:
14 feet
6 inches
Very slight seepage at J0 feet, probably not a free
water table.
Sample Depth . Type of Sample
1 6'-13' Grab
2 13'-14' Grab
Remarks:
1. Test pit located 20 feet south & 20 feet west of southwest corner
of existing house.
2 .: Elevation: Existing ground
3. Date of Exploratidn: 25 Nov. 1974
Mr. C~lyde [lass
Valley View L62, B1
Page 2
25 November 1974
The seepage area required per bedroom by soil type (per the Greater Anchorage
Area Borough) is as follows..'
Soil Type
(Unified Classification)
Seepage Area Required
ML
SM
SP
SW
GM
GW
275 ft.2/bedroom
250 ft.2/bedroom
150 ft.2/bedroom
125 ft.2/bedroom
225 f~.2/bedroom
85 ft.2/bedroom
Soils reqmring greater than 250 f~.2/bedroom are not allowed in seepage pit
area calculations (per the Greater Anchorage Area Borough),
The seepage area required at depth can be expressed as follows:
Depth Unified Soils Seepage Area
Feet Classification R, eq~ired
0.0-2.0 ML 275 ft.2/bedroom
2.0-13.0 GM 225 ft.2,bedroom
13.0-14.0 SP 150.ft.2fbedroom
Enclosed are some excerpt8 from State and Borough ordinances which may be
of value to you. For further restrictions, particularly with reference to location
of the seepage pit, we call your attention to the Greater Anchorage Area Borough
Ordinance 28-68.
If 'there should be any questions on the above please contact our office.
Very truly yours,
ALASKA TESTLAB
Kenneth W. Bl~so~
Laboratory Superintendent
Approved r~~
: .~~ .~Lae, PE
Laboratory Manager
KWB: mm
Enclosures
01-~8-1884 08:5G 80756~15~1 ENVIROMENTAL MANAGEMENT IN~. P.0~/0~
.] 7/4
INVOICE
SEWER AND DRAIN
".,.~,~x.~ ~o ~ CLEANING SERVICE
RD. BOX 112688 PHONE345-2513 ANCHORAGE, ALASKA~511-2~
Job Address
DATE SALESMAN
ROTO.ROOTER SERVICE CALL HRS.
STEAM THAWING HRS.
TRIP CHARGE HRS.
OVERTIME CHARGE HRS.
ADDITIONAL LABOR CHARGE HRS,
HRS.
PUMPING SERVICE
HYDRO-JET SERVICE
MATERIALS
PLEASE PAY FROM THIS INVOICE
TOTAL
TOTAL FOOTAGE CLEANED OR THAWED. BLADES USED __
LINE CLEANED
[] JOB NOT GUARANTE~I. POR FOLLOWING REASO~
INCORPORATED
January 10, 1994
On-Site Service Section
P.O.Box 196650
Anchorage, AK 99519-6650
Subject: Lot 62, Block 1, Valli Vue Estates
Dear Sir or Madam,
The public well on this property is owned by the Valli Vue Home Owners Association
(VVHOA) (Public Well ID# 210605). If an ADEC letter attesting to the legality and
status of the system is required, please contact the WHOA.
After your review/approval of the adequacy test for the septic system, please mail form
or contact myself at Environmental Management, Inc., 907 E. Dowling Rd., Suite #21,
Anchorage, AK 99518, Phone 562-2580.
If you have any questions please feel free to give me a call.
Sincerely,
Environmental Management, Inc.
Stan Dolloff, E.I.T.
Civil Engineer
907E. DOWL[NG, STE.21 * ANC~ORAGE,ALASKA99515 · (907)562 2580 · FAX {907) 562-1561
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC251078
Parcel ID 015 -311-36 Expiration Date:
Legal description VALLI VUE ESTATES #2 BLK 1 LT 62
Site address 6750 ROUND TREE DR
Current property owner(s) LEE KEITH &
X The On-site system(s) is/are approved for 4 bedrooms
By:
3/5/2026
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
Original Certificate Date:
3/14/2025
This�C,rtificate of On-Sft Se ystems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
,Development Service 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 submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
Development Services Department 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. 015-311-36
Complete legal description VALLI VUE ESTATES #2 BLOCK 1 LOT 62
Location (site address) 6750 ROUND TREE DRIVE ANCHORAGE, ALASKA 99507
Current property owner(s) KEITH & STEPHENIA LEE 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 NEW - 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 $ _6 ()
Date of Payment �3 �I l A y
COSA # OS G 2 51078
Waiver Fee $
Date of Payment
Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: VALLI VUE ESTATES #2 BLOCK 1 LOT 62 Parcel ID: 015-311-36
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA - PUBLIC &/OR 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.
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
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping NA
Required maintenance completed, if AWWTS
Comments: NEW TANK
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 3/3/75
ALL standpipes present per record drawing
Total measured depth from grade 10.3 ft (max)
Measured depth to pipe invert from grade 4.7 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective (ED).
If not, state depth into effective 5.6’
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 3/7/2025
Results Pass EAST / WEST Trenches
Fluid depth prior to test 2 / 7 in
Water added 1050 gal
New fluid depth 7 / 16 in
Elapsed time 180 min
Final fluid depth 1 / 7 in
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 72 in (MOA 6’ ED)
Effective depth used 6 / 12 in (Final Fluid Depth + missing ED)
Effective depth remaining 66 / 60 in
Comments/Deficiencies: New MTs and COs installed at beginning of trenches. Approximate total measured depths from
existing grade. ED per elevation measured shots appears approximate with 5.6’ED – 0.4’ED or 5” missing / not measurable.
COSA Checklist.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’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
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
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ 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 Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 03/11/2025
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 &
03/11/25
\ S '011 \ \ --RoIJAID TRF
%
964, 6
BRASS
CAP)K- -
TRACT A
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (77-296) ARE NOT SHOWN HEREON.
THIS DOCUMENT DOES NOT CONSTITUTE BOUNDARY SURVEYAND
IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT
BOUNDARY SURVEY MAY DISCLOSE.
UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE
USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR
ESTABLISHING PROPERTY BOUNDARIES.
THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY
PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION
SURVEY STANDARDS.
THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY
TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR
ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR ISA
VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED,
THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES
COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT.
JOB # 25033 1 NO CORNERS SET THIS DATE I SCALE 1" = 30'
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 62, BLOCK 1, VALLI VUE ESTATES SUBDIVISION UNIT
No. 2
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST EXCEPTAS INDICATED.
DATED THIS 10th DAY OF MARCH, 2025, ATANCHORAGE,
ALASKA.
FIXED HEIGHT, LLC C.O.A.122554
Land Surveying Services WWW.FIXEDHEIGHT.COM
600 W 41 st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949
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. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
('~\~)- ~_/-' .%Ir) HAA# ~-~I2~qL\C',C~\O~/
GENERAL INFORMATION
Complete legal description
Lot 62, Block 1, Valli Vue Estates
Location (site address or directions) 6750 Round Tree 'Dr., Anchorage
Property owner Je~ Wycl~a
Mailing address 6750 Rot~td ~ee Dr., Anchorage
Day phone 346-2598
Lending agency Not Applicable
Mailing address
Day phone
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4 N
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well ¥
Public water.
If community well system, provide written confirmation from State ADEC attes!-.
lng to the legality and status of system. ., '
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
STATEME:NT 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 ail Municipal and State codes,
ordin.ances, and regulations in effect on the date of this inspection.
Name of Firm Enviro?~e. nt al Management ~
Address ._907 E. Dowlz~/~//~ Suite 21~chorage,
Phone (907)562-2580
AK 99518
Date
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of 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 p~'ofessional engineer's work.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 62, Block 1, Valli Vue Estatie~rceI I.D. Well ID #210605
A. Well Data
Well type Cormmrd-ty Well If A, B, or C, attach ADEC letter. ADEC water system numberWell ID :#210605
Log present (Y/N)
Date completed Driller
Total depth Cased to Casing height
Sanitary seal (Y/N)
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 1000 Et. +
g.p.m.
AT INSPECTION
; On adjacent lots
g.p.m, r"rl '"'
1000 ft. +
Absorption field on lot 1000 ft. +
; On adjacent lots 1000 ft. +
Public sewer main
Public sewer manhole/cleanout
Sewer service line
Petroleum tank N/A
WATER SAMPLE RESULTS: N/A
Coliform Nitrate Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed June 1~ 1975 Tank size 2 @ 1000 qallons Compartments Unknown
Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y
.Depression (Y/N) N
High water alarm (Y/N) N
Alarm tested (Y/N) N
Date of pumping 8-30-93
Pumper Roto Rooter
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot On adjacent lots Foundation .5 £1;:,
To propertyline 50 ft. + Absorption field 10 ft.
Water main/service line .50 ft. +
Sudace water/drainage None observed
72-026 (3/93)* Front 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
N/A
On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Sudace water
D, ABSORPTION FIELD DATA
Date installed Ju'L_ ..1,
Length 70 ft._ Width
3 ft.
Soil rating (GPD/FF) 200 sq. ft./BR
Gravel thickness 6 ft,
System type Wench ~pe
Total depth 9 ft.
Total absorption area 840 sq, ft.
Date of adequacy test 1-6-94
Water level in absorption field before test
Cleanout present (Y/N) Y
Results (pass/fail) Pass
4 ft. 8 in. from G,L.
Peroxide treatment (past 12 months) (Y/N) N
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot N/A On adjacent lots N/A
To building foundation 10 ft.
Onadjacent lots 100 ft. + Cutbank
Sudace water
Curtain drain
Depression over field (Y/N) N
for 4 Bedrooms
Aftertest4 ft. 8 in. from G.L.
If yes, give date
None observed
None observed
Property line 50 ft. +
To existing or abandoned system on lot N/A
None Water main/service line 50 ft. +
Driveway, parking/vehicle storage area 62 ft, +
E. ENGINEER'S CEFmFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines
Engi~.-9'Name Jo~ Simpson, P.E.
Date /-/~ff/) f/
CH-8061
HAA Fee $ ~DC9
Date of Payment
Receipt Number .
Waiver Fee $
Date of Payment
Receipt Number