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Home My WebLink AboutVALLI VUE ESTATES #2 BLK 2 LT 12 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .,~L.,~ q~'C.2¢'-¢~ PID Number: ~: Wastewater System: ~ New ~pgrade Address: ABSORPTION FIELD Phone: ~ NO. of Bedrooms: ~-- ~ ~I ~ ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other Soil Bating: Total Depth from original grade: LEGAL DESCRIPTION ~GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: Gravel width: Number of lines: ~ Bistance between lines: WELL: New Upgrade ~ FL ~J FL Classaication (Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pipe materia;: Driller: Date Drilled: Static Water Level: Installer: ~ j~ Date installed: Yield:GPM J Pump Set at: Ft. Icasing Height Ab°ye Gr°und:Ft. TANK SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lifl Holding 3ublic/P¢ivat6 Manufacturer: Capacity in gallons: From Tank Field Stalion Tank Sewer Lines ~ ~ CJ+ ~ ~ Well ~/~ ~ ~ Material:~ ~ L Number°f C°mpartments: s.~c~ ~/A ~ LIFT STATION Water Lot Size in gallons: J Man~ Line ~ ~ ~% I ~/& Foundation /O( ,/¢~ ~~ ~ "P"mP °""'°'e' at: I"Pump°ff"'eve' at: J High wate'"a'm at: Curtain ~[~ ~ ~ 3ump Make & Model I Electrical Inspections performed by: Drain I Remarks: BENCH MARK Location and Description: J Assumed Elevation: / ~o~~ f~, ENG NEER'S'~EAE;~%~ Inspections oerformed by: S '*~A~¢o~ ¢¢~ Dates: 1st r-z,-,. 2nd ~--~ Department of Heal. and Human Services approval Reviewed and approved by:~ Date: ~-~ ~ 72-013 (Rev 9/91) MOA 25 AS-3UILT A-C=17,S B-C=SO.7 WASTEWATER ABSORPTIBN SYSTEM A-D=aa,O $ LOT lB, BLBCK B VALLI VUE ESTATES ~B A-E=IS,6 B-E--42,5 A-F=32,9 B-F=56,7 A G=35,5 B G=57,0 A H=52,9 D-H=22,1 c.g. A-I=30,4 B-I=24,9 G A-J=32,7 B-J=25,0 A-K=48,7 B-K=?6,9 A-L=41,8 B-L=38,0 A-M=41,8 B-M=39,3 A-N=41,O B N=40,1 J M L 2 EA C,O. F C.0. 36 L.~-, N ~ Asphalt D~ivewoy J I Exlstin9 Deck New i250 gat. Sept;~c Tank K E A Foundo.±ion B Existing 3 Bedr'oom House PREPARED FOR~ STEVEN R, PANNONE, P,E, Mr', John 8, JaVoyne Stenehjem P. [~, BOX 14202~ 6220 Corner Tree Cir, ANCHORAGE, ALASKA 99514 274 0308 Anch°r'oge'(907) 346-2537 AK 99516 Date:6~5-,95 jSco. te, l=m I AS-BUILT AS BUILT WASTEWATER ABSORPTION SYSTEM LOT 12, BLOCK 2 VALLI VUE ESTATES ' I Z 1NONV3qO W iNDN¥3q3 ND[£V~NNDJ PREPARED FOR: Mm, John & JaVayne S±enehjem 6220 Corner Tree Cfr, Anchorage, AK 99516 (907) 346-2537 STEVEN R, PANNONE, P,E] P, O, BOX 142025 ANCHORAGE, ALASKA 995]4 274-0308 DATE: 6-5 95 J NOT T~ ~LE/ AS BUILT To AlaSka Mutual Savings Bank 99510 AT Post Office Box 1120 SUSJECI Lot 12 Block 2 Valli Vue Estates subdivision DATE March 7, 19~8 system is a 1977 SyS~ The enclosed check is being returned to you. The ~herefore no ~n-site inspeotion will be needed. The water is a communit~: system~ so no need of a water sample. The approval will be coming shortly in the mail. If We do not have to make an on-site inspection; .th~n there is no fee. The fee ,pays for our inspections for getting the wat~rl an~. ~h~ inspection of the system. If yo~have, any questions, please call me. c~<c3~ LV~* SIGNED ' ~ 4S 469 SEND PARTS I AND 3 WITH CARBON INTAO' - PART 3 WILL BE RETURNED WITH REPLY MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PAGE 1 OF 1 PERMIT PERMIT NUMBER:SW950070 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:STENEHJEM JOHN E & JA VAYNE M OWNER ADDRESS:6220 CORNER TREE DR ANCHORAGE, ALASKA 99516 DATE ISSUED: 5/04/95 EXPIRATION DATE: 5/04/96 PARCEL ID:01532246 LEGAL DESCRIPTION: VALLI VUE ESTATES #2 BLK 2 LT 12 LOT SIZE: 21031 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHOPJkGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS R 0EIVED BY: DATE: Steven R. ?annone, ?.E. Consulting Engineer P.O. Box 142025 Anchorage, AK 99514 (907) 274-0308 Municipality of Anchorage Department of Health and Human Services Environmental Services P.O. Box 196650 Anchorage, AK, 99519-6650 April 25, 1995 ATTN: Mr. James E. Cross RE: Lot 12, Block 2 Valli Vue Estates No.2 Request for Sewer Permit Dear Mr. Robinson; On February 22, 1995 my firm was requested to perform an adequacy test on the existing system located at the above property for an up coming sale. An adequacy test was performed on March 4, 1885. The system fail the adequacy test. See attached report. Again my firm was requested to determine alternative to install a new system for this property. A test hole was excavated in the front yard and in the back yard adjacent to the existing system. The finding from the test holes are also attached. I would like to request a permit be issued to construct a new soil absorption system in the front yard as shown on the attached site plan and in accordance with the attached engineering plans and details. A new 1250 gallon septic tank will be installed to connect the house to the new soil absorption system. The new system will be a trench type system 79 feet long, 6 feet deep and 2 feet wide. It will be start approximately five and one half feet below the existing ground level, and will be emirely located in the material identified as silty sands with trace silts, having a peculation rate of approximately 27 minutes per inch. Mr. James E. Cross April 25, 1995 Page 2 Existing soil absorption systems serving adjacent lots are greater than 50 feet away from the proposed system. A Class A public water system serves the property, and the service line is located greater than 10 feet away from the new system. There will be no conflicts with any existing water or soil absorption system. If you have any further questions, please give me a call. Sincerely, Steven R.Pannone, P.E. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anct' orage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR; '~'~--~.) ~ .~'~,~J~'~'t'~ 5~--~__~l~_~t'~.~,t~ DATE PERFORMED: LEGAL DESCRIPTION: / ["~.~.'-~'~ '~A C! .~' ~,- t 2 3 4 5 6 8- 9- 10- 11 12 13 14 15 16 17. 18~-- 19~ 20- COMMENTS Township, Range, Section: SLOPE I IXII SITE PLAN WAS GROUND WATER ENCOUNTERED? ~'~ IF YES, AT WHAT . DEPTH? Depth to W~er After Monitoring? '----' OIt6: /-'[--I ~'.~ \ \ Reading Date Gross Net Depth to Net .~ _ .~_.~. l'~i~, .,..~ ~e~..' Time -~.~, .~_ W.~ ~ V~' Drop / ~ ~ ~ ~ ~ ~ ~[1~ ~//~ PERCOLATION RATE ~,~- (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN C~ FT AND -/' ~:~ FT PERFORMED BY: ~'~ ~:~::b~'A~'~'~"t~' ~ I ~'~C~ ~J'~o~J~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ]3ESISN WASTEWATER aBSORPTION LOT lB, BLOEK B VaLLI VUE SYSTEM ESTATES Exis~in9 House LoSs i1 No±e: Exi5¢in~ Sep¢ic sys±em is /oco¢ed F~om curren± as-Suite survey performed by DowLing ~ Assoc, Lo± ]3 LoSs PREPARED FOR: Mr, John ~ JoVcyne 3~enehjem 6220 Corner Tree Cfm, Anchora9e, AK 99516 (907) 346 2537 STEVEN R, PANNBNE, P.E. P. O, BOX 142025 ANCHORAGE, ALASKA 99514 274-0308 DATE: 4-a3-95 J DESIGN SCALE: 'K=30'~ 30' T~s~Hole R~d~us -- LOT DESIGN DETAILS WASTEW ]RPTION SYSTEM 2 VALLI ]STATES ~2 New trench Soil Absor System M,W, ~ C r THi 2LA C,O, Asph~ ~t Drive~ cy New 1250 9ol Septic Tank GENERAL NOTES: 1, REMOVE EXISTING CLEAN- OUTS. 2. ALL WORK SHALL BE DONE IN ACCORDANCE WITH MOA DHHS REGULATIONS, 3, CONNECT POST TANK LINES TO FIELD LINES WITH T's. 4. INSTALL CLEAN-OUTS AT ALL PIPE INTER SECTIONS, } Exlstln( Foundc~ion C,O. Exis~in9 3 Bedroom House NOTE: EXISTING SEPTIC TANK IS LOCATED UNDER DECK IN THIS AREA, MINOR HAND DIGGING MAY BE REQUIRED TO REMOVE OLD TANK AND INSTALL NEW PRE- TANK LINE, PREPARED FOR: Mr, John & dcVoyne S~enehjem 6220 Corner Tree Cir, Anchorcge, AK 99516 (907) 346-2537 STEVEN R, PANNONE, P.E, P, 0, BOX 142025 ANCHORAGE, ALASKA 99514 274-0308 Do±e: 4-23-95 Sro[e: l'dO' DESIGN DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM LOT 18, BLOCK 2 VALL! VUE ESTATES Z ' I Z El WZw(/~Z Ld d L F1 Q,,- [%. PREPARED FOR: Mr. John ~ JeVoyne S±enehjem 6220 Corner Tree Anchoroge, AK 99516 (907) 346-2537 STEVEN R, PANNHNE, P,E, P, O, BOX 142025 ANCHORAGE, ALASKA 99514 274-0308 DATE: 4-23-95 NOT TO SCALE DESIGN Steven R. Pannone, P.E. Consulting Engineer P,O. Box 142025 Anchorage, Alaska, 99514 (907) 274-0308 March 5, 1995 Mr. John & Jurvain Stenhjem 6220 Comer Tree Circle Anchorage, AK 99516 RE: Lot 12, Block 2, Vallivue Estates, Number 2 Dear Mr.& Mrs. Stenhjem; On March 4, 1995 my firm conducted an adequacy investigation of the existing on-site wastewater disposal systems located on Lot 12 Block 2, Vallivue Estates, Number 2. Our investigation included testing the absorption capability of the wastewater disposal system. The following are the findings of my investigation. Investigation On February 23, 1995, information was gathered from the Municipality of Anchorage, Depadment of Health and Human Services records concerning the above mentioned property. The records show that the wastewater disposal system was installed in 1978. It is a deep trench type system 66 feet long, and 5 feet deep. There is approximately four feet of cover over the system. A 1000 gallon septic tank connects the house to the soil absorption trench. During our investigation we found the foundation clean-out, tank clean-out, and one post tank clean-out. In addition, a clean-out was located at the extreme end of the soil absorption system. This clean-out was filled with rocks and gravel to within 43 inches of the top of the clean-out. From information gathered during the initial contact, you indicated that the septic tank was pumped in September, as it is every September. Testing An adequacy test is performed by adding 150 gallons of water per bedroom into the system. All added water is to be absorbed by the system within a twenty four hour period. Since the clean-out located at the far end of the system was clogged, water was added to the system through the post tank clean-out. The water rate and amount was monitored during the addition of water. Water levels in the clean-ont and septic tank were monitored. Mr. & Mrs. Stenhjem March 5, 1995 Page 2 After the addition of 79 gallons of water, the water level in the post tank clean-out was measured to be five inches deep, indicating that the system was not absorbing the water being added. At this time, we discontinued the addition of water, and measured the fluid level in the septic tank. It was measured at 57.25 inches, a rise of 1.25 inches. We decided to attempt adding water to the far clean-out to see if there may be a restriction in the line from the tank to the field. The flow rate was slowed to 3 gallons per minute. Again fluid levels were monitored in the septic tank and post tank clean-out. Again the fluid levels rose to the depths indicated before, after the addition of 15 gallons of water. After the water was turned off, the levels in the clean-out and septic tank slowly dropped to there pretest levels. Findings From information gathered during our field investigation, it appears that this system is in failure, meaning, it is unable to take the required 150 gallons of fluid per bedroom and absorb it in a 24 hour period. A quantity of 94 gallons was added, filling and backing-up the system. It appears that the system is working somewhat. We were informed that six loads of laundry was washed over a six hour period on the Monday preceding our adequacy test without backing-up of the system. Recommenda~ons A new soil absorption system needs to be installed. There appears to be a few options available for this property. Since the septic tank was installed back in 1978, there is a strong possibility a new 1000 gallon septic tank will need to be installed. Installing a new tank in the existing location will prove to be difficult, due to the presence of extensive decking over the existing tank. A new tank could be situated outside the decking limits without difficulty. A new soil absorption field could be located adjacent to the existing trench in the front yard. Per Municipal Regulations a new system must be two times the depth of the field away, or a minimum of ten feet. There may be adequate room in the from yard for a replacement system. A subsurface investigation will need to be conducted. A draw back to/he front yard is the presence of landscaping and specialty trees. These would need to be relocated before a new system could be installed. Another location for the new system could be south of the house between the deck and property line. This area has minimal landscaping, but has a large black spruce dominating the area. In addition, I am told that there is a foundation drain along that side of the house. There is not enough room to install a new system with the required setbacks from the foundation drain and property lines. The last option for a new system would be to install it in the back yard. Since the back yard rises above the front yard, a lift station would be required to move the fluid from the septic tank to the soil absorption field. There is an additional construction expense associated with a lift station as well as an operation and maintenance costs. Mr. & Mrs. Stenhjem March 5, 1995 Page 3 Before a new soil absorption system can be designed and installed, a soils investigation will need to be conducted to determine the adequacy of the receiving soils. A minimum of two test holes is expected with this type of soil. Depending on the timing you require, I would recommend that we wait for spring before attempting the installation of the new system for a few reasons. One, weight restrictions are being applied to area roads starting this weekend. With the loads reduced, the contractor will need to make more trips with his trucks hauling gravel. Two, we need to be able to reach under the deck to expose the existing septic tank. The amount of snow accumulated around the deck will make it difficult at this time. And finally, after the snow is gone, better care can be taken to preserve the existing landscaping of the yards. The soils investigation can be conducted at your leisure. If you have any questions please contact me at the above number. Sincerely, Steven R. Pannone, P.E. GRE ,,ER ANCHORAGE AREA BOk_ JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAM E<~_ .---~'~ ~-O~s, LOCATrON ~'~r~ MAILING ADDRESS~"~-(~' ~A~ L~.-27~1 PHONE LEGAL DESCRIPTION L I '~ ~:~ '3~ ~]~l,' ~J~ SEPTIC TANK: DISTANCE {JF?.4ViOA FROM WELt C~:~%~x NUFACTURER INSIDE LENGTH INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY ((~O r} GALLONS. DRAIN FIELD: DISTANCE FROM WELL Cf~D~ ~OUNDATION ~<~g~ NUMBER OF LINES I DISTANCE BETWEEN LINES ABSORPTION AREA "-~O~ ~. DEPTH: TOP OF TILE TO FINISH GRA~E I TOTAL LENGTH NEAREST LOT LINE_ ~ OF LINES ~O TRENCH WIDTH IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE ~ ~'~ [ DEPTH OF FILTE'~ (~ ~ MATERIAL BENEATH TILE '~ O IN. ABOVE TILE ~ IN. WELL: ~ TYPE e '~I'V~'.~-:A 'J~C~h~STRUCTION BUILDING NEAREST FOUNDATION LOT LINE __ CESSPOOL / OTHER SOURCES APPROVED / DISAPPROVED NEAREST ( SEPTIC SEWER LINE ,4~ TANK REMARKS DEPTH DISTANCE FROM: t SEEPAGE ~ '~_ o ~, ~3YSTE M %00 ~ DISTANCES: I SEWER LINE DEPTH: ~-~ PIPE MATERIAL: ?~-~"~ ~ LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM DATE- IGp __APPROVED G.A.A.B. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99602 276-2221 SOILS LOG - PERCOLATION TEST ~ SOILS LOG PERCOLATION TEST PERFORMED FOR: ~ ~/~ 5- 6- 7- DATE PERFORMED: ~-- ~'~ d -- 7 7 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19- 20- WAS GROUND WATER ENCODNTERED? IF YES, AT WHAT Gross Net Depth to Net Re~ding Date Time Time Water - Drop 72 0O8 (7/76) PERCOLATION RATE /~ '''j /~ i/V///~ ' minutes/inch) '~' ~ () TEST RUN BETWEEN Z..~__ FT AND COMMENTS .~-(~'~"~/~Z:'~'~~,' ~ /~ ~ ~ ~'~d. ~? ~L. /~ ~ ( ~'~ ~0~, ~ ~ /~ MUNICIPALITY OF ANCHORAGE Development Services Department o , r Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 015-322-46 Expiration Date: 1. GENERAL INFORMATION Complete legal description VALLI VUE ESTATES#2 BLOCK 2, LOT 12 Location (site address) 6220 CORNER TREE DRIVE, ANCHORAGE, AK 99516 Current property owner(s) JASON &JENNA REED Day phone Mailing address 6220 CORNER TREE DRIVE,ANCHORAGE,AK 99516 Real estate agent Day phone 2. TYPE OF DWELLING: E Single Family (w/wo ADU) n Duplex 7 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Private Septic Private Well n Holding Tank n Water Storage lJ Community ❑ Community Well A ® Public Sewer ❑ Public Water System ❑ Waiver request for: Distance: Received by: _ Date: 2/4//�j COSA to be released to the e •• eer,unless otherwise requested by the engineer. rr COSA Fee $ 567) Waiver Fee $ Date of Payment 41/9 Date of Payment Receipt Number 3 q2/o/ Receipt Number COSA# 63Gi9/437 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. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION&ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 02/07/2019 ``V.°°• ore •••.f— as 6. DSD IGNATURE . 49THNIP.4W4r •°•�ti� System #1 Approved for L( bedrooms o.".•..••• °°°' • • System #2 Approved for bedrooms : MICHAEL N. ANDERSON Disapproved t8��•• CE-.�4�&•••`�`Z�� 1 Conditional approval for bedrooms, with the followi� ' tTptitigptt> �'- 'G ON-SITE S WATER AND ' WASTEWATER 0 PROGRAM o 7 By: — Original Certificate Date: 2_-( 3 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 X Nitrate Advisory %rte% Septic System Advisory Arsenic Advisory Well Flow Advisory Other • • COSA Checklist blue sheet COSA Checklist Legal Description: VALLI VUE ESTATES#2 BLOCK 2, LOT 12 Parcel ID: 015-322-46 If more than 1 septic system on lot: COSA Checklist#_of_ Structure served by this system A. WELL DATA—CLASS A #210605 ❑ Well log is filed with Onsite (or attached) Well production at time of test .gpm Date drilled Water storage tank volume_ gallons Total depth ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to_ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate_ mg/L❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic_ ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) in. Collected by Date of flow test for COSA Date of Sample Static water level at beginning of test __ft. Comments B. TANK DATA—5/21/2012 1500-Gal STEP C. LIFT STATION Age of tank(s) 6.5 years ® Required maintenance completed Tank type/material STEEL Age of lift station 6.5 years Measured operating fluid level in septic tank 45" Lift station material STEEL • Standpipes/foundation cleanout per record drawing Comments: Pump on/off 42" & high alarm at 46". Date of pumping 1/31/2019 D. ABSORPTION FIELD DATA— 2 x 60'L x 5'W x 0.5'ED —@ 1 sf/br= 600SF Which system tested (date installed) 5/21/2012 Adequacy test date 2/1/2019 ® ALL standpipes present per record drawing Results Pass For 4 bedrooms Total measured depth from grade 3.4 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 2.8 ft (min) Water added 600 gal ❑ N/A—pressurized field New depth 0/2 in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 130 min depth into effective ® Code-required soil cover over field Final fluid depth 0/0 in ® System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced 1750 gallons If yes. enter date Comments/Deficiencies: COSA Checklist yellow sheet copy 3.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) 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' Z Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Z 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' 0 Yes if No 5'+ ft Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Absorption Field > 5' ® 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 septic tank is under driveway comment below Surface Water> 100' ® Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line> 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' Z Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water> 100' ® Yes if No ft F. ENGINEER'S COMMENTS �-.6te\tZa�.\ OFA/Q 1d. 1�''•G. ENGINEER'S CERTIFICATION rc, r- 8, /certify that 1 have determined through field inspections and review f 49TH *�Yto of Municipal records that the above systems are in conformance / rt with MOA COSA guidelines in effect on this date. I • . r MICHAEL N. ANDERSCN ;.1 ei COSA Checklist yellow sheet copy 3.docx tI i Fri..�/l Vt l•',•` ‘\\i:v..":"•>: MUNICIPALITY OF ANCHORAGE �1a...... Phone: 907-343-7904Development Services Department Fax: 907-343-7997On-Site Water & Wastewater Section Lift Station/Pump Vault Maintenance Log Owner_1 _0'' = Street Address Loi _ ye-M. V ve Phone Legal Desc.t)L . • to is ank -Sludge levelnches -Pumping: required y_.a. -Pumping completed I ift sta ions � n�, -Pump basket cleaned - • -Effluent filter cleaned -Control floats cleaned - • •Proper float settings confirmed • i• -Operation satisfactory a• Alarm Sy eir Dedicated electrical alarm circuit - no -Audible and visual alarm inside dwelling ell no •Alarm system operation a • f, • r so -t's -'iot' Manhole Bis I -Ground water intrusion at riser to tank connection -Weep hole functional vE '. �. -Ground water intrusion around pipe penetrations es p -Manhole lid: Functional Insulated ® no Properly Secured 00 nQ Oth -All manufacturer required inspections and maintenance completed C,_pmme : m..intenan a provi er:I-ak S� � c 1 ft �C' Date of maintenance _. Technician Company rS Set\Ive _ 6,4 MSignature Data., -. Mailing Address: P. 0. Box 196650 ' Anchorage, Alaska 99519-6650 ' www.muni.org 111 MUNICIPALITY OFANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services Qn-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 Old"-- ~_-z-z/~ ',1 HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Propertyowner ~.~-:~'oF~-c~,¥4,~'~ ~,-,-,=.~e.~-=-~-,--~ Dayphone ~/4.- Mailing address ~ ~ -"~ ~- Lending agency Mailing address Day phone Agent - Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: "~ ~ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site, . Holding tank Community on-site If community well system, provide written confirmation from State ADEC attest- . Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-O25(Rev. 1/91) Front MOA~21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~-7--~_~v ~.~ ~_ ,~.,~,~,~c~,,~-, Address '~- ¢,~ ~",~ /~'~¢'~',~; ,q,,¢ c-,~ t ~ I~. Engineer's signature~ ' Approved for ~ Disapproved. Conditional approval for bedrooms. DHHS SIGNATURE bedrooms, with the following stipulations: Additional Comments Date [T, he MCmc~ 2ahty of Aeehorage Department of Health and Human Services (DHHS) ssues Hea th Author ty . Approval C~flcate~[0ased only upon the representabons g~ven In paragraph § above by an ndependent professional engme~er registered m the State of Alaska. The DHHS does th~s as a courtesy to purchasers of homes and the r le ~dmg mstitubons ~n order to sat sly certain federal and state requirements. Emp oyees of DHHS do not conduct inspections or analyze data before a certificate is. issued. The Munioipality of Anchorage is not responsible for errors or omissions'in the professional engineer's work. 72-O25(Rev. 1/91} Back MOA#B1 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-'c /"z ~--P~,/.~,cl/..z. ',i~.L~ ¢O~-~z Parcel I.D. C~ t ~'-3z~~ A. Well Data Well type ~o.~,~.u,,J ,--r-? 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 level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main .g.p.m. ATINSPECTION ; On adjacent lots g.p.m, r"t~ ; On adjacent lots Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample:. Collected by: B. SEPTIC/HOLDING TANK DATA Date installed .5'-'~- q' s- Tank size Cleanouts (Y/N) ~ ~-~- ('_'~ ~ Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping Compartments '"/' ~- ~ Depression (Y/N) Alarm tested (Y/N) 1---I ~,-) ;r.~.~AUA-r-ru r.J Pumper SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK TO: Well(s) on lot ~'~//~- On adjacent lots To property line ~,' c~ ~ Absorption field ~ c~ ~ Water main/service line ~-c~ Surface'water/drainage 72-026(3/93)* Front 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) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed .,ST' - '~ ~- c~ .~ Length 85 cf ' Width Total absorption area ~ c~ ( Date of adequacy test ,,'v ~. ~ Water level in absorption-field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) '~ ~--o .System type ~ '-~ Gravel thickness ~1, .~- Total depth / o t Cleanout present (Y/N) '-( Depression over field (Y/N) .,,JO 3 Bedrooms Results (pass/fail) ~-~F:~, $_~ for After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot '~""f f~ To building foundation On adjacent lots ...~-c~ Surface water '"-" Curtain drain ~ On adjacent lots ,/¢'/,A Property line To existing or abandoned system on lot Cutbank .,v'(,¢~, Water main/service line '-~ ,~' / Driveway, parking/vehicle storage area / o t E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA Signatur~ Engineer's Name Date {~- CEo8149 HAA Fee $ ~..~¢ Date of Payment Receipt Number 72-026 (3/93)* Sack Waiver Fee $ Date of Payment Receipt Number #1: Time Date Insp ~-~ MUNICIPALITY OF ANCHORACT~ DEPARTM .T OF HEALTH AND ENVIRONMEI '~L PROTECTION 825 L Street, Anchorao~. Alaska 99501 264-4720 Date Received: March 7, 1978 ~m~m3 ~2: Time #3: Time ~-9~ ~5 Date Date ~6h~ Insp I~sp o Se REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Alaska Mutual Savinqs Bank % Ruthanne Mailing Address: Post Office Box 1120 99510 Phone: 274-3561/237 Property Owner: Ronald E./Linda Jackson Mailing Address: Star Route A Box 27C 99507 Phone: 344.1647 Legal Description: Lot 12 Block 2 Valli Vue Estates ~2 Subdivision Single Family Residence: k Multiple Family Residence: Number of Bedrooms: Three Number of Bedrooms: Well System: Individual well ( ) Community/Public System (x~ Permit ~ ~ ~\~ Depth of Well ~/~ Well Log on File Construction ~~~ Bacterial Analysis~j 6. Sewage Disposal System: On-site ~ystem ~ 7o Public Utility ( ) Permit # 77482 Septic Tank Size Absorption Area Installed 1977 Installer Hoe Unlimited 1;000 gallons Manufacturer Greer Tank - Steel 792 sq.' Soils Rate 260 Material Trench Distances: Well to to Sewer Line to Nearest Lot Line Septic Tank 200'+ Nearest Lot line to Absorption Area 200'+ Absorption Area P~g~ Two Department of Request for Approval Health and Environmental Protection of Individual Sewer and Water Facilities Legal Description: Lot 12 Block 2 Valli Vue Estates ~2 Comments: Affadavit Attached: ( ) Approved ~~~~ Disapproved: Letter Attached: ( ) Date:-~-'~/~ ~' Date: Department Worksheet: 008£ m~od $~ ~mnaav ~bJ s~O~Au]s WNOUdO (e3elsod snld) i~O£--llVRI O31JI/I]3O ~lOJ .Ld13331J . - 'MUNICIPALITY OF ANCHORAGL ~__~ Department of Health and Environmental Protection {/~ 825 L Street, ~chorage, Alaska 99501 264-4720 [~,.. ..... ~quest for Approval of Individual Sewer and Water Facilities 4. Realtor/Agent 6. "~ Mailing Aaaress: Phone: ~gg'- ~// S. Legal Description: i~K~ /~ ~ ~/~ ~ ~ Street Location: ~~ ~f ~ ~ ~%/~g4~~ 6. Single Family Residence: ~ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: * Individual Well ~ Public/Community System If Individual Well, well depth If Community System, name of system Sewage Disposal System: *~n-site System If On-site System, date of installation: Public System ( ) *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is ~ver two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77