HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 2 LT 13Valli Vu
stat s N2
lock 2
Lot
13
015-$22
-45
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191276 PID Number: 015-322-45
Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade
Name
ROBERT LUCINA
ABSORPTION FIELD
❑ Deep Trench I Wide Trench El Bed El Mound
Site Address
6210 CORNER TREE DRIVE *ANCHORAGE, AK 99507
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-223-8284
4
0.8 GPD/SF
10 MAX Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
SEE DWG. Ft.
Gravel depth beneath pipe
3.05 & 3.02 Ft.
Subdivision Block Lot
VALLI VUE ESTATES #2; BLOCK 2, LOT 13
Fill added above original grade
SEE DWG. Ft.
Gravel length
47 & 48 Ft.
Township Range Section
Gravel width
5 & 5 Ft.
Beds: Number of Lines
-
Distance between lines
- Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
775+ Ft2
2
10+ Ft.
Well
*200'.}
25+
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
Surface Water
100 1 +
Gal.
Material
Number of partments
Lot Line
10'+
NA
Foundation01+
LIFT STATION
Manufacturer
Capacity
Remarks *TO VALLI VUE SUBDIVISION WELLS.
Gal.
Alarm loca '
Electrical installed by
PIPE MATERIAL House to tank N/A drainfield Tank to
D3034
Installer
A+ HOME SERVICES
Drainfield D3034 CO/MTD3034
Inspector TIM ECKLUND AND DAVID GARNESS
BENCH MARK (Assumed elevation) 100.00 ft
Inspection
15` 8/27/2019 nd 8/27/2019
Location and description
BOTTOM OF TRIM AT POINT "B"
3b 8/28/19 4th -
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineers Stap
Qo6oOpd�
o�OFA �Op
Conditional Approval: Date
a / 950
ooA, DO
9
./:.. \ .......p
.Je' ey .. Cairness.,
�4p��/
Septic/Ste � i
Approved I"- 1���!� Dater �� ��
yC� �c�000
Note: this approval does not include well permit requirements.
Pap 6 o
#AECcse4o f e skO
(Rev 05/02/18)
PERMIT NUMBER: PARCEL ID NUMBER:
OSP191276 RECORD DRAWING 015-322-45
\Zx-
A I B C
MTI 45.1 19.2 85.9
MT2 61.3 46.7 40.8
MT3 73.5 53.5 54.1
MT4 73.0 47.1 95.9
C01 46.0 20.1 85.8 R FREE �R1vE
CO2 59.5 45.4 40.8 1GpFtNE
CO3 71.4 51.5 53.4
C04 75.1 49.2 96.8 VALLI VUE ESTATES #2;
DC01 44.8 19.9 91.4 BLOCK 2, LOT 12
DG02 45.5 20.5 91.6
FD 35.9 55.9 71.8
/ DRIVEWAY :•o:. NEW DRAINFIELD
APPROXIMATE LOCATION OF WATER
SERVICE LINE PROFESSIONALLY LOCATED ;
PRIOR TO TESTHOLE EXCAVATION
EXISTING 4
/ CO T3 APPROXIMATE LOCATION OF
BEDROOM HOUSE CO T2 ORGANICS, APPROXIMATELY
4' IN LENGTH
�
PATIO
T. .#1 04
VALLI VUE ESTATES #2;
BLOCK 2, LOT 14y / T4
/ D M 01
/ APPROXIMATE LOCATION OF
/ B DC 02 ORGANICS APPROXIMATELY
A_ _ _ _ _ _ _ 4' IN LENGTH AND VARYING-
- - - FROM 1-3 FEET IN HEIGHT
10' SCREENING , NON -ACCESS, AND UTILITY EASEM T L
APPROXIMATE LOCATION OF EXISTING SEPTIC TANK; PER CONVERSATIONS WITH
FORGE ENGINEERING ON 9/10/2019 RECORD DRAWINGS WERE SUBMITTED IN APPROXIMATE LOCATION OF
JUNE OF 2019 (NOT SCANNED IN MOA RECORDS AT TIME OF THIS DRAWING) SEWER LINE TO DRAINFIELD
DURING THE EXCAVATION OF THE EAST AND WEST TRENCH AN "ORGANICS" PILE WAS ENCOUNTERED
ON ONE SIDE OF EACH TRENCH. THIS WAS DISCUSSED WITH THE MOA ONSITE DEPARTMENT DURING
CONSTRUCTION AND THE BOTTOM OF TRENCH WAS INSPECTED BY MOA ONSITE EMPLOYEE TIM
ECKLUND. IN SHORT, THE TRENCHES WERE LENGTHENED TO ACCOUNT FOR THE ORGANICS.
OMALLEY ROAD
L ... --wjIj \mac ---- - -- ----- -
GARNESS ENGINEERING GROUP, Ltd
ENGINEERING -SALES -CONSULTING
3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE. AK 99507-PHONE(907) 3376179' FAX (907)338J246 ' WEBSITE: vnvw.gamesseng,neenng.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
ROBERT LUCENA 907-223-8284 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
VALLI VUE ESTATES #2; BLOCK 2, LOT 13 D.J.G.
TYPE OF WORK: DATE:
SEPTIC TANK RECORD DRAWING SITE PLAN 9/11/2019
1" = 40'
0000lklklk eo1
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;................. ..................::....0
; b--1", I ......................� :
0 �; Jy A�Garness �r
#
#' CE"
E 795
LICENSE °°°pR�FESS��o so
#AECC884 1,valklm • /
$127719 60h
N,"°""`F MUNICIPALITY OF ANCHORAGE
j
\
On-Site Water& Wastewater Program �t�enr.
�° S
PO Box 196650 4700 Elmore Road
iN ' Anchorage,Alaska 99519-6650 Phone: (907)343-7904 Fax:(907)343-7997 `
4f,;, A`` http://www.muni.org/onsite v
\ cpartrncnt
4NC HORAG�
On-Site Wastewater Disposal System Permit
Permit Number: OSP191276 Effective Date: 8/26/2019
Work Type: Septic Upgrade Expiration Date: 8/25/2020
Tax Code Number: 01532245000
Site Legal Address: VALLI VUE ESTATES #2 BLK 2 LT 13 G:2538
Site Mailing Address: 6210 CORNER TREE DR, Anchorage
Owner: LUCENA ROBERT & Lot Size in Sq Ft: 21499
Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4
This permit is for the construction of:
0 Disposal Field ❑ Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: Any required vegetation that is damaged or removed shall be replaced in accordance with
AMC 21.07.080E and Table 21.07-1 for Type L3 landscaping.
Received By: ✓�.(" /$1- """� Date: S'A //
, GIssued By: /10f/(/e—A ( tea/ Date: 8 026 / ""
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On-Site Water & Wastewater Program
Mayor Dan Sullivan
On-Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 015-322-45
Property owner(s) ROBERT LUCENA Day phone 907-223-8284
Mailing address 6210 CORNER TREE DRIVE *ANCHORAGE, AK 99516
Site address 6210 CORNER TREE DRIVE *ANCHORAGE, AK 99516
Legal description (Sub'd, Block & Lot ) VALLI VUE ESTATES#2: BLOCK 2. LOT 13
Legal description (Township, Section & Range)
Lot Size Sq.Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
([8]all that apply) Initial ❑ Single Family (SF)
Absorption Field ®
Upgrade (w/wo ADU)
Septic Tank ❑ Duplex (D) ❑
Renewal ❑
Holding Tank Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
N/A Distance: -
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 4 551 Waiver Fees:
Date of Payment: 1- N a 0 Date of Payment:
Receipt Number: Receipt Number:
Permit No. (SP tci(ck Waiver No.
(Rev 01111)
GARNESS ENGINEERING GROUP, Ltd
ENGINEERING SALES CONSULTING
July 1, 2019
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic System Upgrade for Valli Vue Estates #2; Block 2, Lot 13
To whom it may concern:
The existing 4-bedroom house is served by a community well and private septic system. The
septic tank was installed in 2018 and the drainfield was installed in 1977. A septic adequacy test
was performed on 6/6-7/2019 and the drainfield was found to be in a state of technical failure.
We are proposing to utilize the existing tank and install a new dual trench type drainfield. One
testhole was excavated on the property and the driainfield is designed within its 30-foot radius.
Comments regarding the design are summarized as follows:
1. SOILS: See attached 2019 testhole by Garness Engineering Group, Ltd. which shows, soil
classification, percolation test and groundwater monitoring.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface water concerns.
4. TOPOGRAPHY: There are no topography concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
In rely,
f
U1 .
Jeffre t: ess, ' .E., M.S.
Presi e
3701 East Tudor Road,Suite 101 *Anchorage,Alaska 99507-1259
Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com
/
/ / a
DESIGN CRITERIA: GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER
THAT PERTAINS TO THIS DESIGN.BY PROCEEDING NOTE:THE CONTRACTOR SHALL HAVE THE
NUMBER OF BEDROOMS:4 FORWARD WITH THIS INSTALLATION,THE
GALLONS PER DAY(GPD):600 GALLONS/DAY ENGINEER,WELL DRILLER,CONTRACTOR AND NORTHEAST LOT LINE AND SOUTH LOT LINE
PERCOLATION RATE/S:8 MIN/INCH PROPERTY OWNER AGREE THAT THEY HAVE FLAGGED BY A REGISTERED LAND
PROPOSED APPLICATION RATE:0.8 READ THESE SPECIFICATIONS AND AGREE TO SURVEYOR PRIOR TO CONSTRUCTION.
MINIMUM DRAINFIELD SO.FT.:750 FT' ACCEPT THE TERMS AND CONDITIONS OUTLINED. J\
DRAINFIELD DESIGN: ORNE \/
DEPTH:10 FEET ER FREE
WIDTH:5 FEETCORN
LENGTH:90 FEET(2 @45 EACH)
EFFECTIVE:3 FEET
REDUCTION FACTOR:0.58 VALLI VUE ESTATES#2;
ACTUAL SO.FT.:775 FT' BLOCK 2,LOT 12
_APPROXIMATE LOCATION OF EXISTING
TESTHOLE PER MOA RECORDS
i
. •DRIVEWAY.'t�11.11
PROPOSED DUAL TRENCH
\ !, :• ,�,,, _� ^• . TYPE DRAINFIELD
APPROXIMATE LOCATION OF WATER ON
SERVICE LINE PROFESSIONALLY LOCATEDPRIOR TO TESTHOLE EXCAVATION O /J
-I / 'SUMP EXISTING 4 --„\
/
i BEDROOM HOUSE
i
Hii �) T
VALLI VUE ESTATES#2; ��/
� it DECK C•
BLOCK 2,LOT 14 Y/i
Y/
0/ �T
O\�i S�7 D •
M
-V
\.. -
0
EXISTING DRAINFIELD TO REMAIN SHED
IN PLACE FOR FUTURE USE 10'SCREENING,NON-ACCESS&UTILITY EASEMENT
/
EXISTING SEPTIC TANK TO REMAIN IN INSTALL DOUBLE CLEANOUTS
PLACE(INSTALLED IN 2018) OUTSIDE OF EASEMENT
PROPOSED SEWER LINE TO DRAINFIELD
OMALLEY ROAD )(
N
S ALE:
1"=40'
44...10011111 1 1,
•• E OF ��t
�' ' A •* • •
GARNESS ENGINEERING GROUP, Ltd = *'� 4' '• .��:'���•
ENGINEERING:SALES ,CONSULTING .�, i 0
3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179•FAX(907)338-3246•WEBSITE:www.gamessengineenng corn ••. 0
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: # • (e "SS ' •
ROBERT LUCENA 907-223-8284 2 OF 2 �• Y C5-7* 2 i
♦ J'..•.
PROJECT/LEGAL DESCRIPTION: DRAWN BY: # 1 •
VALLI VUE ESTATES#2; BLOCK 2, LOT 3 D.J.G. �h�FO.'�p'��(,J,�_ !' P� .�•
TYPE OF WORK: DATE: LICENSE ,,gyp\11\�s�*�••
DESIGN OF SEPTIC TANK UPGRADE 7/9/2019 LICENSE
I001001 1144,4
41 'LImi\ ar •
GARNESS ENGINEERING GROUP, Ltd " */ i\
ENGINEERING SALES CONSULTING / / • • •
3,01 E TJDCR ROAD S.TE''01'ANCHORAGE,AK 99507'PHONE(9071337-6179•FAX 9071 338.3246'WEBSITE.vmw garnessengmeenrg Corn 3 . • .1.4. ;
SOIL LOG - PERCOLATION TEST �o�,� = 'Y farness '�
♦ t•. CFS-1953
LEGAL DESCRIPTION: VALLI VUE ESTATES#2:BLOCK 2.LOT 13 �..F�•..• 1 l I •.*/<zr.•
4.
PERFORMED FOR: ROBERT LUCENA �O•••..............
'
DATE: 6/2v2o1s �1��pROFESS\�**�
DEPTH LICENSE •1ii„`,v�
#AECC884
(feet) ORG TEST HOLE #1
1
SOIL CLASSIFICATIONS SITE PLAN
2 LOAM
-:d �.C. GW :_ ORS;
':>°.: a-: GP j ^ MI
• GM J�� Cl
4 • GC , 0L Q.
• V. �o�o a SW MH �Q\/
• '•''•:; SP CH \�
5 j G,
• 1 t • SM / ,,M OH �O
6 — • qSC G.Z•
7 I DEPTH TO
• GROUNDWATER
DA ( �C�
8 • DRY 6/21/2019
•
111
GM TO ML DRY 6/27/2019 SCALE: +
9 DRY 6/28/2019 1"=100'
•
10 •
•
DATE READING CLOCK NET TIME WATER LEVEL NET DROP
11 — • TIME (MINUTES) READING (INCHES)
•
12 • 6/27/2019 1 1:30 - 6" -
I 2 1:40 10 1.75" 4.25"
13 — • 3 1:40 - 6" -
el 4 1:50 10 3.75" 2.25"
14 • 5 1:50 - 6"
•
• 6 2:00 10 4.25" 1.75"
15
I 7 2:00 - 6" -
16 • 8 2:10 10 4.75" 1.25"
8.0.11. 9 2:10 - 6" -
17 10 2:20 10 4.75" 1.25"
11 2:20 - 6" -
18 12 2:30 10 4.75" 1.25"
19 PERCOLATION RATE 8 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4 FT. AND 5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: E YES •`.::
SOILS LOGGED BY: PIERCE BLEWETT PERCOLATION TEST PERFORMED BY: DAVID GARNESS
COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH.
PERFORMED BY GEG, Ltd. I. JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P R RMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: -1)I / iq
Frontier Surveys,LLC Project No: 19-193 Date:06/10/2019
Z4 Ordered By: Jennifer Flannagan Plat:77-296 Grid: N/A
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Carroll, Rebecca M.
From: Fern, Richard A.
Sent: Tuesday, July 9, 2019 3:24 PM
To: Carroll, Rebecca M.
Subject: RE: Screening and Non-access Easement
I've not heard from them and I don't see a problem as long as they replace any required vegetation that is damaged or
removed.
From: Carroll, Rebecca M. <rebecca.carroll@anchorageak.gov>
Sent: Monday,July 8, 2019 2:08 PM
To: Fern, Richard A. <richard.fern@anchorageak.gov>
Subject:Screening and Non-access Easement
Rich,
Has Garness Engineering contacted you regarding whether routing a sewer pipe through a Screening & Non-Access
Easement requires any approvals or permits? I have attached the drawing that shows what they are proposing.
This is for Valli Vue Estates#2 Block 2 Lot 13 at 6210 Corner Tree Drive, Anchorage, AK 99507 (015-322-45).
Thank you,
Becca Carroll
Onsite Water and Wastewater
Municipality of Anchorage
343-7908
1
Sonja Blewett
From: Right of Way Requests <MOAROWRequests@muni.org>
Sent: Tuesday,July 02, 2019 11:12 AM
To: Sonja Blewett; Right of Way Requests
Subject: RE: Drawaing for Vallie Vue Estsates#2 B2 L13
Attachments: Drawings and asbuilt.pdf
Sonja,
This is not an issue that needs to go through MOA Right of Way. However, Lynn McGee suggested that you check with
Rich Fern in MOA Land Use Enforcement. His contact info is: richard.fern@anchorageak.gov or 907-343-8039.
Sincerely,
Martha Robinson
Right of Way Plan Reviewer
Municipality of Anchorage
4700 Elmore Road
907-343-8240
Original Message
From: Sonja Blewett<Sonja@garnessengineering.com>
Sent:Tuesday,July 2, 2019 10:37 AM
To: Right of Way Requests<MOAROWRequests@muni.org>
Subject: Drawaing for Vallie Vue Estsates#2 B2 L13
Hi Martha! Attached is drawing showing sewer line and it encroaching in 10' screening and non-access easement.
Would they need to go through right of way?
Sincerely,
Sonja Blewett
Corporate Secretary/Treasurer
Garness Engineering Group, Ltd.
3701 E.Tudor Road, Suite 101
Anchorage, Alaska 99507
Phone: (907)337-6179
Fax: (907)338-3246
Mobile: (907)748-6179
Website:www.garnessengineering.com
Original Message
From: Scan<Scan@garnessengineering.com>
Sent:Tuesday,July 02, 2019 10:31 AM
1
QUBMITTAI
Municipality of Anchorage V ME
UN 0 6 2019 e 1 of 3
On -Site Water and Wastewater Program • (907) 343-790 Page
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181061 PID Number: 015-322-45
Dwelling: F91 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade
Name:
Robert Lucena & Nilar Thein
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
6210 Corner Tree Dr
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-223-8284
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 2 13
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
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
FtZ
Ft.
Well
>100'
N/A
N/A
>25'
TANK❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer ICapacity
Infiltrator Water Technologies
11537 Gal.
Surface Water
>100,
N/A
N/A
Material
Polyethylene
Number of compartments
2
Lot Line
>51
N/A
N/A
NA
Foundation
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
None
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
Wilco Contractors
Drainfield CO/MT
Inspector J. Mlllette
BENCHMARK (Assumed elevation) 100 ft
Inspection
4/28/18 nd
Location and description
n15'
2
date3,d 4,h
Bottom of siding on SW wall of house
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
_,,-'o ®a
OF A4
gcS
Conditional Approval: Date
Age . • .,f.
� 49
Benjarrb/Schiller
•`��
�� ��''•
G�
Approved Date '
CE 12592
�sl • . 6/6/19 • . •�v��' w
!l,®�, PROFESSI��P-`
Inspection Report_9-1-12.doc
VALLI VUE ESTATES #2, BLOCK 2 LOT 13
PERMIT # OSP 181061 PID # 015-322-45
REMOVED EXISTING
1250 GAL STEEL iCQIf 1�l
SEPTIC TANK
�-
r
L ofc)
t
EXISTING SEPTIC
TRENCH(APPROX)
2C01 39.4 24.3
SV1
38.0
26.0
SV2
37.0
31.5
2CO2
33.8
34.3
MT
34.3
29.7
\ y Lot 13
MT � o
co
1 acrd sV •v B SHED o
10' SCREENING; NON -ACCESS'& LILTIL. ESMT
NEW 1537 -GAL POLYETHYLENE TANK
ENGINEERING
s���49 TH
t9: • fig, �¢
Benjarcf!nvSchiller
CE 125922019
l,�F� pROFESSiON �����
O'MALLEY ROAD
NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE LEGEND
PROPOSED SEPTIC SYSTEM
CO - CLEANOUT
ALL PROPERTIES ARE ON COMMUNITY WATER SYSTEM. NO WELLS 2CO - DOUBLE CLEANOUT
ARE WITHIN 100' OF THE PROPERTY LINE. FCO - FOUNDATION CLEAN(
FS - FLOW SPLITTER VALVE
0 50 100 MH - MANHOLE
FEET SLOPES > 25% MT - MONITORING TUBE
SLOPES > 46% SV - SEPTIC VENT
1"=50' TH - TEST HOLE
VALLI VUE ESTATES #2, BLOCK 2 LOT 13
PERMIT # OSP181061
PID # 015-322-45
(NO SCALE)
n� Rj
'FOAM INSULATION
e/ L-T,1
N,".'_,, MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program N, <
�, 'n.',i,S
c.PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
1. http://www.muni.org/onsite 0 ..
``` "/ Department
41'C-14-0-11:(''.
On-Site Wastewater Disposal System Permit
Permit Number: OSP181061 Effective Date: 4/27/2018
Work Type: SepticTank Upgrade Expiration Date: 4/27/2019
Tax Code Number: 01532245000
Site Legal Address: VALLI VUE ESTATES#2 BLK 2 LT 13 G:2538
Site Mailing Address: 6210 CORNER TREE DR, Anchorage
Owner: LUCENA ROBERT & Lot Size in Sq Ft: 21499
Design Engineer: FORGE ENG Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field 2 Septic Tank 0 Holding Tank 0 Privy 0 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 the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: L��/ �� - Date: `C ,
Issued By: (-)Thr ---L---, _ Date: ASIFS
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division �0 Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-322-$ L{ S.-
Property
Property owner(s) Robert Lucena Day phone 223-8284
Mailing address 6210 Corner Tree Dr
Site address 6210 Corner Tree Dr
Legal description (Sub'd., Block & Lot) Valli Vue Estates #2, Block 2 Lot 13
Legal description (Township, Range & Section)
Lot Size 21 ,499 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(El all that apply)
Absorption Field E Initial ❑ Single Family (SF) ❑
(w/wo ADU)
Septic Tank 0 Upgrade ❑X Duplex (D) Fl
Holding Tank ❑ Renewal
Multiple Dwellings H
Privy ❑ (SF and/or D)
Private Well H
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/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: o; IS — Waiver Fees:
Date of Payment: --,96--/f Date of Payment:
Receipt Number: Cf-Ft -2? D Receipt Number:
Permit No. QSP `&.1 0 L 1 Waiver No.
Permit App__- :_.,:c_: N 5
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
April 24, 2018
Municipality of Anchorage
Development Services Dept- On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Valli Vue Estates #2, Block 2 Lot 14 – 6210 Corner Tree Drive
Septic tank replacement application
Dear On-Site Services Engineer:
The owner of the above lot has a 4-bedroom home on the property, but the septic tank has failed.
We are submitting this permit application for a replacement tank. The attached site plan identifies
the location of the home, septic system, and existing tank. The entire area is served by a community
water system, so there are no wells on adjacent properties.
According to on-site measurements, as shown on the plan view, the existing tank location meets
all separation distances. It is more than 10’ from the foundation and the existing field. The owner
plans on installing a fiberglass tank, so a groundwater monitoring tube will be added next to the
tank. A double cleanout will also be installed both before and after the tank. There is already a
foundation cleanout, but it is close to the existing tank, so we feel it is better to install a double
cleanout there.
Please refer to the attached plan for the septic tank location. If this plan is followed, there will be
no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
4/24/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181061, Deb Wockenfuss, 04/27/18
5 92.0
594.
0
596.0598.0600.0602.0604.0
7.
6%
5.0 %
5.0%
6
.
7
%10050 0
FEET
1"=50'4-BDRM HOMENOTE:
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
VALLI VUE ESTATES #2, BLOCK 2 LOT 13
Apr 27, 2018
SLOPES > 25%
SLOPES > 46%
O'MALLEY ROAD
10 ' SCREENING, NON-ACCESS & ULTIL. ESMT10' S T R E E T LIGHT ESMTEXISTING SEPTIC
TRENCH (APPROX)
REMOVE & DISPOSE
OF EXISTING 1250-GAL
STEEL SEPTIC TANK CO/MT
2COSV
SV
MT
INSTALL NEW 1500-GAL FIBERGLASS TANK
WITH DOUBLE CLEANOUT ON EACH SIDE AND
GROUNDWATER MONITORING TUBE
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL PROPERTIES ARE ON COMMUNITY WATER SYSTEM. NO WELLS
ARE WITHIN 100' OF THE PROPERTY LINE.
2CO
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181061, Deb Wockenfuss, 04/27/18
GRE~.,ER ANCHORAGE AREA BO~,_JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
PHONE
LEGAL DESCR,PT,ON .Z I.~
SEPTIC TANK:
DISTANCE
FROM W E k L~¢¢/~
INSIDE LENGTH
MANUFACTURER *'~
INSIDE WIDTH
MATERIAL ~
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY /~)GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WEL FOUNDATION . /KNEAREST LOT LINE /' OF LINES ~(
NUMBER OFL'NES t D,STANCEBETWEEN L,NES T BENCHW,DT t<N. T OTALEFEECT'VE
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE__ ~4~ABOVE TILE IN.
WE L L: ~¢~//~"~"'~
TYPE CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE SEWER LINE TANK SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED -. DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
~ I/
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
Form ED-032
PER. MIT NO.
DEPARTMENT O~ HEALTH AND ENVIRONMENTHL Z~3TEC'FION
o~,=i c " .... 4C RAGE., AK. 99, ~.
( ~ ....... ~1
APPL I CAN'T'
LOCATION
LEGAL
qCHFICHLE EXC
CORNER TREE
L:L]~ 82: VAI_LI VUE SUBS
~126 EAST 72ND
LOT SIZE
~44-2911
2±499 SQOARE FEET
I'YPE OF SOIL. FIBSORBTION SYSTEM iS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4
SOIL. RATING (SQ F]'?BR)= 268
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
?-5
'THE LENG]"H DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SORFFICE OF THE
GROUND AND 'THE BOTTOM OF THE EXCA',/ATION (IN FEET).
THERE IE; NO SE]" WIDTH FOR 'TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAYEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF' 'THE EXCAVATION (IN FEET).
F-;E ~).L~ X F..:FTZtZ:. SEP'T % ii: -['RI'-.I i-;1 :5; ]] 7_E= i2-~5 -~-]'~
R PACKAGE PLANT MAY BE INSTAL. LED BT THE PERMITTEE"S OPTION SUBJECT TO THE
FOLI_OW;[NG CONDITIONS:
:t. EITHER R CI_R~S ~ OR II NSF APPROVED PLANT MAY BE INSTALLED.
2. ~ CONI"INUOIJS MAINTENANCE 8GREEI',IENT IS REQUIRED. IF A MRINTENRNC:E
AGREEMENT' IS NOT KEPT CURRENT YOU MAY BE REQOIRED TO ENL. RRGE THE SOIL
RBSORP'rION SYSTEM AND/OR YO0 MAY BE SUBJECT TO PROSECOTION.
BACKFILLING OF RNY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENI' WILL. 8E SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL FiND ANY ON-SITE SEWAGE DISPOSAl_ SYSTEM IS
.t.(,]~:~ FEET FOR A PRI',/ATE WELl_ OR 200 FEET FOR A PUBLIC WELL.
OTHER REQUIREfqENTS MAY APPLY. SPECIFICATIONS FiND CONSTRUCTION [:,IBGRAMS ARE
AVAIL. ABI.E TO INSURE PROPER INSTALLATION.
F" 'EF~'_'D'i X 1" E>.-=:P X F;;:Ei~ST [:,EEC:EPIE:EER ~:: :1.-- :1..--'-9- -}'~'¥TM
I CERTIFY THAT'
t: I AH FAMILIAR WI'TH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH 8Y THE MUNICIPALITY OF 8NC:HORRGE.
2: I WILL INSTALL. THE SYSTEM IN ACCORDANCE WITH THE CODES.
24: I UNDERSTAND THAT ]'HE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
S I GNE[:,: __,~¢.~/~,, ~ ,_.,~,,. ........ ;~ ............................
F~F~F'L l CANT SCHAI~..E E%C
SOILS LOG
DEPARTMENT OF HEALTH AND ENVIRONMENTAl PROTECTION PERCOLATION
TEST
Pouch 6-650, Anchorage, Alaska 99502 '276-222'[
SOILS LOG - PERCOLATION TEST
3
4
5-
6-
7-
8-
9-
10-
13-
14-
15~
16-
17-
18-
19-
20-
WAS GROUND WATER
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE "'~ ~'~ (minutes/inch)
72-008 (7/76)
GERT F ED B ~ , ATE:
5678gE
Municipality ®f Anchorage
On-Site Water and Wastewater Program
(907) 343-7904 z�SA
SEP
Certificate of On-Site Systems Approval
Parcel I.D.015-322-45 Expiration Date: 01
1. GENERAL INFORMATION:
Complete legal description Valli Vue Estates #2; Block 2, Lot 13
Location (site address) 6210 Comer Tree Drive *Anchorage, AK 99507
Y\
Current Property owner(s) Robert Lucena Day phone 907-223-8284
Mailing address
Real Estate Agent Yvan Corbin Day phone
2. TYPE OF DWELLING:
Z Single Family (w/wo ADU)
❑ Duplex
7 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
.4
4., TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
z
Individual Water Storage
1:1
Holding Tank
1771
Community Class Well
1:1
Community
E]
Public Water System
D
Public Sewer
0
WaiverNariance request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
M
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: Cl 2
k?
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and 0000� 00
industry practices. The reported results describe the condition of the system/s on the date/s of the o
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or o .. ' •
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and Q T OQ
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and " "" " "' "' "' . "' ...
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of . • • • • • • • • •
the well or septic system. GEG makes no representation whether an alternative well or septic system �O �, '•J y ess.:
can be installed on the property in the event either of the current systems fail to perform adequately in Q 9. CE-795�(
e O
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right 40� professio� o
whatsoever.
�DO000��
#AECC884
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapprovedtr" ON-SITEConditional approval for bedrooms, with the followig ipu�jti R AND
C] WASTEWATER z
!^
PROGRAM1
By: Original Certificate Date: 1
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 engineers work.
7. ATTACHMENTS:
COSA Checklist_ Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: VALLI VUE ESTATES #2; BLOCK 2, LOT 13
If more than 1 septic system on lot: COSA Checklist # of
PUBLIC WATER
A. WELL DATA
❑ 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 testoA
Static w vel at beginning of test ft.
Z—ofi la's tit;
Parcel ID: 015-322-45
Structure served by this system
Well production at time of test gpm
Water storage tank a gallons
00
Well disi ed for coliform test? ❑ Yes ❑ No
��oliform bacteria is Negative
Nitrate mg/L [:]Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
*PER CONVERSATIONS WITH FORGE ENGINEERING RECORD DRAWINGS WERE SUBMITTED IN JUNE OF 2019
B. TANK DATA C. LIFT STATION
Age of tank(s) years ❑ Required maintenance complete
Tank type/material *HDPE Age of lift station y
Measured operating fluid level in septic tank *NEW Lift station materia
ON Standpipes/foundation cleanout per record drawing Comment
Date of pumping *NEW
D. ABSORPTION FIELD DATA
Which system tested (date installed)
❑ ALL standpipes present per record drawing
Total measured depth from -grade ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A ..pressurized field
F-1 Monitor tubes go to bottom of effective. If not, st
depth into effective
❑ Code -required soil coverover
❑ System presoaked
(Required if va or greater than 30 days prior to
date of
dons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
NEW DRAINFIELD - SEE ATTACHED RECORD
DRAWINGS BY GEG
Adequacy test date
Results ❑ Pass Foredrooms
Fluid depth prior in
Water gal
ew depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
L11
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'
❑✓
Yes
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑ Y ft
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/ ne > 25' ❑ Yes if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
ft
olding Tank > 100' ❑ Yes if No ft
Neighboring Absorption Fields > 1 '
if No
ft
Animal Containment > 50' ❑ Yes if No ft
Yes
if No
ft
Yes
if No
ft
Community Wells > 200'
Manure/Animal Excreta Storage > 100'
nity Sewer Main > 75' ❑ Yes
if No
ft
0 Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑✓
Yes
if No
ft
Surface Water > 100'
❑✓ Yes if No ft
Property Line > 5'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100'✓❑
Yes if No ft
Water Main > 10'✓❑
ft
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
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' ❑✓ 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
*WATER LINE WAS PROFESSIONALLY LOCATED PRIOR TO TESTHOLE
EXCAVATION; SEE ATTACHED RECORD DRAWINGS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and review ��
of Municipal records that the above systems are in conformance with C� . T
MOA COSA guidelines in effect on this date..:'......e.. ....
COSA Checklist yellow sheet
_� . ...................
Je f Go ess,-
� %' E 75 J3 •'• �; �
�DV,rofessio�
#AECC884
oFrontier
Surveys, LLC Project No: 19-359
Date: 09/9/2019
'L d
Ordered By: Jennifer Flannagan
Plat: 77.296
Grid: N/A
I
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I
Lot 11 'ss
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SHED
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Lot 12
I
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/ Lal 13, Brock 2 VaN Vue
Esfsfes No. 2 Suborvision
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L=70.28 21,499 S4. FL
Q- R=50.00 \ acrcbos>
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azo, FFr��
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Lot 15 Lot 14\ \
175,
1
R.O.W.
I
"y Electric Meter/Outside Power M, Telephone Pole O Metal Post
y Gas Meter ® Deck -o- Fence -E- Light Pole
i
($) Septic i W) Water Well ; Mailbox �E� Elec. Pedestal
r LiTel. Pedestal
Genal Notes:
0
20 40 80
1. This document is created for the purpose of a single property transaction and is subject to Federal copyright Laws.
2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3.
3. All measummentslsetbacks to
in Feet
are the visurVapparent building footprint.
4. All dimensions to property lines are pluwminus 3,111.
1111
conis S�rvey n f lips at compliese ASKS survey represents
me of he surveyLThsodocum not does not cors itut a boundary survey and issubjectto any is and
' P� • '' qs f l)
JJJ
inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the
existence of any easements, covenants, or restr ol::on which do no appear on the record plat. Under no circumstances
=� '. •7
should INS document be used for construction or for establishing
a boundary or
fence line.
47TH '* JJi
As -Built Survey of.
_
Lot 13, Block 2 Valli Vue Estates Unit
No. 2
i T •. n.0.'s.•vnF o, a;�
/J ��,, ', Nd. LS: 9ei6 � ��
I, Frederic Wagner, hereby certify that this Mortgage Inspection Survey was performed by me, or
JJy `ry •'. 9/9/2019.• ��=
Z.
Jyt�9F0
under my direct supervision on September 5th, 2019.
•• •' O45
Frontier Surveys, LLC
O�1 jER �
rtiry
650 W. 58th Ave. Suite E Anchorage, Alaska 99518
yN
907.460.1686 - info@frontiersuweys.com
PROFESSIONAL SEAL
www.frontiersurveys.com
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
~ P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
'~ (907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-322-45
GENERAL INFORMATION
Complete legal description
Location (site address)
COSA # (~----,
Expiration Date:
Lot 13, Block 2, Valli Vue Estates No. 2
6210 Corner Tree Drive Anchorage, AK 99507
Current Property owner(s) Richard and Deborah Weems
Mailing address 6210 Corner Tree Ddve Anchorage, AK 99507
Day phone
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four (4)
TYPE OF 'WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class A Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 vedfy that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspectiOn, the on-site water
supp!y and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
-,~*~Name of Firm Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
DSD SIGNATURE
',~ Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 522-7773
Date 11/03/2010
A
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
(Rev. 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type Class A
Date completed ~
Total depth ~
Lot 13, Block 2, Va!Ii Vue Estates No. 2
Parcel ID: 015-322-45
IfA, B, or C provide PWSID #210605
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
g,p.m.
g.p.m.
Coliform colonies/100 mL
Arsenic: mg/I
B. SE~WI'IClHOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,250 gal.
Foundation cleanout (Y/N) Y
Date of pumping No Sludge
C. ABSORPTION FIELD DATA
Date installed 8/13/77
Length 75 ft.
Total depth. 9.5 ff.
Nitrate mg/L
Date of sample:
Number of Compartments Two
Depression over tank (Y/N)
Pumper
Soil rating (g.p.d./ft2 or ft2/bdrm) 260 SF/BDRM
Width 3 ft.
Eft. absorption area 1,050 ft2 Monitoring tube
Date of adequacy test 10/30/2010 Results (Pass/Fail) Pass
Fluid depth in absorption field before test 37
Elapsed Time: 235 min. Final fluid depth 37
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Other bacteria
Collected by:
in.
colonies/100 mL
Date installed 8/13/77
Cleanouts (Y/N) Y
High water alarm (Y/N) N
System type Deep Trench
Gravel below pipe 7
Y Depression over field .N
For 4 .. bedrooms
in. Water added 728 gal. New depth
in. Absorption rate >= soo
If yes, give date
in.
g.p.d.
Eo
LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off" level at~
Datum Cycles tested
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Animal containment areas
in.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main N/A Water service line >10'
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field >5'
Surface water >100'
Property line 10' Building foundation >10,
Water Service line >10' Surface water >100'
Curtain drain None Noted Wells on adjacent lots >200'
COMMENTS:
Water main >10'
Driveway, parking/vehicle storage >25'
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 11102/2010
COSA Fee $ ~ q O Waiver Fee $
Date of Payment 1 ~ -- / ~ - [ ~C) Date of Payment
Receipt Number ~) ~' / ~ ~ Receipt Number
(Rev. 11/05)
Municipality of Ancho.rage
Development. Services Department
Building Safety Division ..
On-Site Water and Wastewater P~:ogram
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR a SINGLE FAMILY DWELLING
Parcel I.D. 2C_.)l $-- ~'?_ Z. - ¥,.C'
GENERAL INFORMATION
Complete legal description
Location (site address or di~'ections)
Expiration Date:
Current Property owner(s).
Mailing address
Lending agency
Mailing address
;"/~ &'~ t"lea~'~,,~ Day phone
~ Z; ! ca C'or,, er- '7'r.~' Dr'~,,.¢ ./ /t-,, c4)
-(-~'~/<', . Day phone
7 qB' -ZOO7
Real Estate Agent I'c~,..,,~
·.Mailing Address
... Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDRooMs:
3. TYPE' OF WATER SUPPLY:
Individual Well
Individual 'Water Storage
Community Class °A"
Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] -Individual Holding tank
.. [] Community On-site
[] Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
e
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 Health Authority 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 numbe~' of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm ~*l~/-4-of 7-~¢4 .; ¢~/ .~',",~¢~.f
Address I~.I~.~O ~'c4¢ .5"~.., ~r~c4or~'¢~ /~'
Engineer's Printed Name "7-A ,,o ~..~'o ,~t F~'. /-/oo ~
J--~ .' bedrooms.
· DSD SIGNATURE
~ Approved for
Disapproved.
- Conditional app"oval for
bedrooms, with the fOllowing stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow AdvisOry
By:
////,. ,, ..
(Rev. 01/02)
X
Maintenance Agreements ~
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety DiVision
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lc>~
WELL DATA
Well type. '~"
Date completed.
Total depth ft.
Date of test ·
IfA, B, or C provide PWSID #. ?-IO ~a>6" Well Log (Y/N)
Sanitary seal (Y/N). Wires properly protected (Y/N)
Cased to ft. Casing height (above ground)
FROM WELL LOG AT INSPECTION
in,
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~.colonies/100 mi.
Arsenic: mg./I.
SEPTIC/HOLDING TANK DATA
ft. ft.
g.p.m, g.p.m.
Nitrate rog.II. Other bacteria
Date of sample: Collected by:
Tank Type/Material 5'.ep/.-,a /.('/--.~,a!
Tank size I'~,-O gal. Number of Compartments. '~.
Foundation cleanout (Y/N). Y' Depression over tank (Y/N)
Date of pumping ~-/2-~'(' O'f Pumper
ABSORPTION FIELD DATA
~ colonies/100 mi.
Date installed
Cleanouts (Y/N) ~'
High water alarm (Y/N).
Date installed ~/..~/"z? Soil rating
(g.p.d./ft2 or ft2/bdrm) '~do~.~.,~ System type. 7"~e,~c,5
Length '7..c' ft. Width :~ ft.
Total depth 9,~- ft. Eft. absorption area ,1o~-o ftt Monitoring tube
Date of adequacy test 3/to/o¥ -.~/n/a~/ Results (Pass/Fail)
Fluiddepth in absorption field before test .'~ ~ in. Water added. Id'Z.7gal.
ElapsedTime:~/, min. Finalfluiddepth/.."/J'in.~/t~'') Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type).. /,,!o~
Gravel below pipe 7 fL
Depression over field. /~'
For./t' bedrooms
Newdepth.~.~ .~,~,.
= ~ ~:::~,-¢ g.p.d.:
If yes, give date Az. ,4-.
,,%
LIFT STATION /%/. '~,
Date installed
"Pump on" level at in.
Datum
Size in gallons
"Pump off' level at ~
Cycles tested
in.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
· On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main
Wells on adjacent lots
Property line. ~ ~-~'~ Absorption field
Water service line '2' t~' Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water Service line
Curtain drain
Building foundation ~ '?- 3' ' Water main '~ to '
Surface water ~ ~ c.,o' Driveway, parking/vehicle storage
Wells on adjacent lots ~, Zoo ~
.F.
COMMENTS
ENGINEER'S CERTIFICATION
I certify/hat I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Date ~¢,_.,~c~ t ~
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12101)
Waiver Fee $
Date of Payment
Receipt Nuh~ber
~ ~ "; MUNIOIP.AL!~.9,F,A.N .C.H.OR.A,GE.., :.,--.,! :i-:..: ..;~ ....';a/~,,.':;:.~'?~:.:.:';':;~ :'
'., .' t'.~,~' DEPARTMENT OF HEALTi~ & HUMAN SERVICES. :-4~'~ ~.: "'. '
..-... ;......,.; ...;.;:: ~.~;~/4J, ~.~';:,:,:.:-., Division of Environmental Services :,,.?....?::~,.~'i;~,'/:,~.A ,~ '
..' ... .... i .,'.:.. L.:.,.~:;..,.;:.[.iL,.;;..~ iOn-Site Services Section ~-..~.. ~:';:,.:~-,~..,.~ ,~., ,,.-. '!~-=-.. :.~/) ~
.... ' ....... , ..... ..--.; .~. P.O. Box 196650 / Anchorage, Alaska , 99519-6650 ~ '%.:::'. i-.'-~/. - ~. //'~'/"
. . '.,..;' .. ~.'.,.:. i ""-:"~i"'" ":"'; "::;'i;::' ~"-'~%"' 343-4..7, , ,'.:' "::';.' ..... · :'_:.',.. :..'... !....L..L ..' ', .....
", ,"' ~ .... ~';-;. ;'"'/ '':' · '.'" ?'.:-"' '"',': .T,~ .'.".:" ~ · ': ;'"" !": ' ~' !' - ,' .".';" .... .... " "":: ' ·
- , . ' . . ". ';-:::. ':'CERT~F~OAT~OFUEALTi~AUTaOR~TY ;' '"'" · ".""' '""-:
' ,',.::.'~ APPROVAL FOR A SINGLE FAMILY DWELLING ,:';.,' .'!'-: · "':/' '.
.... q-o
Parce~ ~.D. # ~)/~'-":D 2.7-- - ' ~" ' ' :'" '" .;"
';L .,.~ t .',. . .....
GENERAL INFORMATION " ' "':'-"- ":' '"' ~'''"
1,
... .... .. :~s...-.~zo~~- v~z4z . , .-?.~
~ompiete'. legal description
'" . ................... : .. ' : 2' '.i~ 'i")"
Location (site address or directions)
Property owner
Mailing address
Lending agency.·
B210 Corner Tr~ Driv~
Anchora~ AK '.
Day phone '$46-1041
Anchor~q~.~ 'AK' 99516
Day phone
2. NUMBER OF BEDROOMS: 4 :.: : ... . .
3.
~PE
OF
WATER
NOTE: If community we/l system, provide wri~en confirmation from State ADEC attest;
DISPOSAL:
'" :' .': NOTE: 'v.:lf commoni~' ca~tewater syste~?provid~ wki~en confirmation. from State ADEC ':.'-': -'
'5, STATEMENT'OF INSPECTI0N~B¥ ENGINEER'* :'!::'*':'*" '-'**::' ' *".'
· . ' * '. ~': ,*,' ' ? '* ~ . · . ' -'~ '.* ,*~',;*.V "~ ......... .*',.~, ' ~ '.' · .:
As certified by~, seal affixed heret° and as Of thb validatioh date sho~vn I~l°w, I' verify that my
investigation of this Health Authority ApPrOval application shows that the On-site water supply
and/or wastewater di~0Sal system iS sJ~fe'~ f'uncti°nal ~'~ 'a'dequat~ ~or the number Of bedrooms
and type of structure indicated herein. I further verifythat based on the information obtained from
the Municipality of Anchorage files and from my inves.tigati0n 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: *'..~':-*-.
.............. .,. ...... :~ ~..,*.'.*i . ,. ~ '-, ' . .: .. .., :. :.
Name of Firm " ..... ':- . on .
~. ,~,~ / .':-:-.,.,.~.. :...~:,:,":~.. ,'.:: !,.;~:? ..... ..-.
Address -, ,,
Engineer's signature ~ ' :~ '"": ' 'D
........ , ...... ....... ,,~.:/~/ _ ,..... ..~ ...... ..':
;_..:.'., .... . L~-~ J ........ , · ,., .
. ~'...'..
_.... .. . _ ..,,,, . ......" ,: ..... . .... . ,~'~Z'""- '/.&_ '"',,
.... ....... .... _ ..... .:.:-..
.............· ~"~-'-?".~.-.",.-:.. .... ~", ' :.-:'.'.:. ,'~.4~_~i~,~'" ~ ' :,~-~ .-
...-......... ... ......
.:-;:::,~:.... .... ., .... .. :....,.... ..... .... ~I2Z..~..:,.~.', ~. ~
..?., ,, ..,. . .. . . ... ...... ..~,~_,._:..,,.:,?,.,~.,:: ~-.,
:.' ......... ~/~t.~,_ '.'~,~ ,~ ~',,~'_,~ z.~' ~.'
.... ~'¥;~ ~-' ...... :t'+-T"; '-~:":: ?:':' ': '-' ~ ';~ . ' ""
-'~ ................ ....
..:. .. ... - . ~, ,~ ,~- .:.
.... =,..;_; ........... ;. ........ . .... ..........._.._ _, ........... ~....._ ....... ~~:
6. 'DHHS .SIGNATURE .... ' ",~,-~,,~;r,,,~.~-'- :- - :"~ '
:~:...:-,:, ,,.~::* -,: ~, ,=,.--,,. t.;~.%~.~:.'_ x '....' ,,.. . ... ...... , . :~......, . : ..~.,.:, .~., .>',~,,..~':.':~,
.... ~"' -~-.- " ' ~' - .............. . ........... -..,:....- ........ :_,z~.~: ,: "' ~;'/~"~f",t . '; .
· o.v.
':: ' Appr for. ;. : bedrooms... .... , :.'.:;.,'., ' ...-",.. '
...;~: ~'~.; · ,.~,...,'
.,~_._... :/..='.;:~;~..'... " .. .?_ :..¥. :_-.: .: .:--.::?,~. :-':,-'.' :'.:;.': .. ' ... -.....: '.. ..:;~.'~ -' z..:.,..:...-.:;. .. :, ,~;,f:, ~ '~.';j~;~: ....
...... · '. Disapproved. -."- - "~''
· . . · . -, :-" . . : :,-., ·
.. :" Conditional approval for' bedrooms, with the following"~t, iPulations:
....;..:. . ."~ :-.:.'.- . :..,,...~. ,' :-. ,,.- ..... ', ...., .... ,.~-, ,.;~.~.,.~.,..-
..,... . .. -. . .' -. - .- --- ....... ..~ ...... .'.~...,,...'~:~ ·..-, ,,,~-.!'.?,. ,;.,...... -:~..,.:, ~....... -'~.
· 2: '. '::" · -.. ' ....
'""'~" .".,.~',':.. .".'.;5'/--'."~ . '::: -'. ".- ,. -- ;: -.' :"?¥c:..L.~;~;.',.;~."h~; .... ' ....· :
- ...... . .... . ..'.;:~'.",.:'~. '.L."~": :..:
· . , .L'. '. -:~- '
,. -~ ,~.-'; :,.t~, _ , :.~...,,:. . · .. · :",D',;;,':~-~V,:~;~,-.
":: : ,: ,'k.'~. . . - ,'"t.o~r. ,.. ..- . . " , .....~
~,..; .-. · , . .. :.., . . '?. ' .:-'.;:.'_i_. ..;" ... ¥ ...... -,: ' ....
... . '.', .? Add~bonal Comments' "':' "' ' ' - '"'" "":"'"' ' :'-"'
..... ~" ' ' "~- ' -: ' ' '""~' ' "'~"':':'?.~-. · '.:' :" . . .:.' i
, ,..,..,.,-.. :- .. ,~ ~',:-..' - . ..:-... . .. . ....
· ., . , .-~2,-,,,,~ / ,/ ...
,,..... .,.,?., . , . ........... . ..... ....
'' '' ......... '.:. - Date ,,'- .
By: z' ..
· · . .;" .' '. ' ' ' . .... -'"": .... ; :' ..... : ....... ;~"~"V "~ :~','.'..:'/ ' '~'.' .. .
:'.'.:,, ...:.~'i:,-..". '... . .:'..... - - ";. . .. · - '.'-' .': . ':..'~:'.._ '..':;:;'.':,~'~ . ~ ...:,:? f ': ' .. '.-.,'
..... · .'. :'.' .: ''4'7'. .' . ' . . ;- . . . : :..t'."..,·r-~'hF,' '-';:.'¥.~,';~'Ct...,~ .' . :'..... "- ' ·
The'Mufi'icipality of Anehorage Department of Health and Humafi sedices (DHNs) 'issues Health AUthoritY .'.
· 'Approval....Ce .rt. ificates b.aSed only .upon the representations gi~e'~ 'in'pa~g~aph'$ fib~)ve by an Independent '
-:- professiona! .engineer.r~istered in the State of Alaska. The DHHS does this asa courte~yto Purchasers of homes .- ' ...¢.
· :'.~.n..d.t ,h.ei.r !.ending !n. stitu, tions i.n order to sari .sflycertain federal and sYate requirem, en, ts.' Emi~!~oyees 0:[ DHHS do n'ot' '." i .
. . ... :. :.conduct'inspecti0'ns 'o? ' analyze 'data' before a 'certificate 'i~ iS~i. ied.'.The~uhi¢ip~lity 'of A~Ch~rage iS not . t:~...-'
- ....~ .!, ~:,~'d~'responsib'l~'for errorS' b~ Omissions Iff-the professional engineer's V;,ork.~)?~'~.~' .;~":~, ~b~;~,~ ~":-;" :~. ::':.': -.."":-'.~':?~ '. '-'.': :,:'"'
:.,: . ",~;::;-..,'-.~.;;..;. ~ ., ¢, ,.: _,,'- ~,, '~,~;'-,:,'3~-' ..... ~ .. . ' ...... · , '"';~" · . ...,..,.~...:~.. -....' , ~'~-,'7; ....... ' '.~.-,.~.'?-'...t.'.' . .:x":; '.' -~' .' " !. ' .:''.'''
· ,. :':- .. ,:.~: ~!.;.:~,.':.: ',-i:, ~, 2;.:..~:'; ... F. ~,-'~;?'t..' ?;:'::~',t:~.::; t .:".':' . ?;!." "! -. "..?..~':t-?.'.." ': .::: :.? :'::',: L.: '. ,":~ .:.'.'; ~:'.,::,::~.,?: 'Z":. ';;-:'.'.'"~".';,:..; :: '.. :-- ' ."'~ ;~ :':~: i: :'? ':':
..... · .:.~.o~.~.~ s,~ ~o~ -:-:,."7,'... .... '. ',":'" i . '..v ;:;.'J'~.:~' -,i ' · : -. :.-.-.. .': '."'.'"" '.'.'.'-':--" ": :":""';':" :'.,i:'-~;t:.~.:'~:!:'.:??' '""-'"': '.'.:? :'t'."~'.'-~"~-':' ' ' ,:-;-'";', ....... ~ :' ."
._ .........,.:..:..t~F;;::~!.:. ~.'.:7i~.;.?.;-:.._-.~..::,,..,...',-;.-",.:~-? ......... ., . ....; ... :': ;-...... :;.. ',.',. :.' ...... :.... , ........,.. ...... ~.,...:.. ....... . .... ,.. ........ ...,.:
~.5' ';:.:":?." '."' "°' · - ' '" .' ... '. ':V';.;~ :".'. "' : ' ' ' ;"' ~:'~:':'~""'~';';~'," '? '" -. . -,..'.~.i'.::,k'.'.".'. '
MunicipalitY of Anchorage... ,
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
Ao Well Data
Well type C...{__~4 ~,~ ~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Z~Lo~c[~._ 7_ [/~i¢C~T' /./u~' Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system numl~e'r
Static water level
Date completed Driller
Cased to
FROM WELL LOG
Wires properly protected (Y/N)
g.p.m.
Wellflow, ~
SEPARATION DISTANCES FROM WELL TO:
Septic/~tank On lot
Absorption field on lot
Public sewer main
SeWer service line
Casing height
g.p.m, l-'r-f
' '; .On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank ,d,~,~&:
II'1
WATER SAMPLE RESULTS:
Coliform
Nitrate
Date of sam.~__eL.._--
B. SEPTI~TANK DATA
Date installed
Cleanouts(~) "~'~--__--.~
High water alarm (Y~,~
Date of pumping
,_ ~---------'-"-:'"'-~, ot h e r bacteria
Collected by:
//~ G~..o/J,.[ ' Compartments
Depression ('~
Ala~;m tested (Y/N,)
Tank size
Foundation cleanout (Y/N)
SEPARATION DISTANCES FROM SEPTIC/H~cDiN~?r-TANK TO:
Well(s) on lot /L]/~ On adjacent lots ~ -~ (~-/A // Foundation ._~ r,./...
To pm~y line [~ r~ Abso~tion field ~/~
Sudace water/drainage ~ 0O [~
72026 (3/93)* Fro~t
Water main/service line
CONTINUED ON BACK PAGE
C. LIFT STATION /U~"L)~d' /°/Z.~J'E'"/,j~-.. ' "~"'
Date installed Manufacturer
Size in gallons
Vent (Y/N) "Pump on" level at .
High water alarm level --
Meets MOA electrical codes (Y/N) ~
....... ' r :' '. On adjacent lots
ABsoRpTION 'FIELD DATA
- ~
.,.D'.a;te installed o~/3 / ? ~) Soil rating (GPD/FF)
Manhole/Access (Y/N)
Surface water
System type
. Gravel thickness ,, Total depth
~e'roxUetreat~:~(pa~12months)(Y~) ~W~ ~~' - ifyes, g~edate //~ ""
'- SEPA~TION DISTANCE FROM ABSdRPTION FIELDTO: ~uE H~u~ ~ ~j~
Well on lot O/~ On adjacem lots ~O '~ Prope~ line / O
To bu~iq~ ~oundatio~ / D t~, 1o eXiSting or aBandon~ ~ystom on lot ~/~
On adjacem ~ts ~ o i~ -' Cutbank ~O t~ .... Water mai~sewgeiine /o %" '
__su~a~ Water' _/Oo r~ Driveway, ~n~ehicle st0mge area '"~'r~ ,. '
E. ENGINEER'S CER~FiCA~ON
I ce~'~ ~at I have checked, vefified,~~ed to ~1 MOA ~d H~ guidelines in---effect ~q~h~ of ~is"inspecObn.
H~Feo$~-
~ ~02/24/2004 14:15
9872737358
'" KEUIN T~YI_OR
.' P~GE 01/01
.U. C PALITY'OrA"CHORAGE
DEPA.T.E.T Or HEALTH A.D ENwRO.ME.TAL PROTECTIO"
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
GENERAL INFORMATION
(a)
(b)
Application Dato
Legal Description (include lot, block, subdivision, section, township, range)
LoT !'~:
Location (address or directions)
Applicant Name
Applicant Address
(c) Applicant is (check one):'Lending Institution []; Owner/builder [~; Buyer []; Other [] (explain);
(d) Lending Institution J-'~O~ O-~a..~i ~,~-~ Telephone
Address
(e) Real Estate Company and Agent
Address
(f)
Telephone.
Mail the HAA to the following address:
'TYPE OF RESIDENCE
Single-Family]~ Multi-Family []
Number of Bedrooms !7/
Other
WATER SUPPLY
Individual Well [] Community~' Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and statues.
SEWAGE DISPOSAL
OnsiteJ~ 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.
Page 1 ot 2
72-025 (I 1/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 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 '
'Address
Engineer's Seal
Approved for .~z''/'~ bedrooms by
Approved .~_~.,,./ Disapprov~/ Conditiona~'~l
Terms of Conditional Approval
Date
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasel;s of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72,025 ( 11/84)
Ao
WELL DATA
Well Log Present (Y/N)
If A, B, C, D.E.C. Approved (Y/N)
Date Completed Yield
MUNICIPALITY OF ANCHORAGE (MOA)~
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST-FEBRUARY 1984
Legal Description:
Total Depth Cased to
Static Water LeVel ~ ~'
Casing Height Above Ground;
Electrical Wiring in Conduit (Y/N) --
Separation Distances from W(~ll!
To Septic/Holding Tank on Lot:
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~ Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
SEPTIC/HOLDING TANK DATA
Date Installed t~/:5/~ ~ i Size
Standpipes (Y/N) ~ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contraci on File(Y/N)
Holding Tank High-Water Alar'm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~
To Property Line
To Water Main/Service Line
Depth of Grouting -: Pump Set At"
Sanitary Seal on' C.~sing
Depression Around iWellhead {Y/N)
; On Adjoining Lots
; On Adjoining LOts
To Nearest Public Sow0r
To Nearest Sewer Service Line on Lot
; Date · '
Course
Comments
Page 4 of 2
No. of Compartments
tv'fA
Y
Four~ation Cleanout (Y/Ni
Date Last PumPed . _
Temlsorary Holding Tank Permit (Y/N)
To Building Foundation ~,~
To Disposal Field: ~
To:Stream, Pond, Lake, orlMaj~)r Drainage
72-026(11/84)
Co
ABSORPTION FIELD DATA
Soils Rating in Ab. sorption Strata'
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N) '
Results of Last Adequacy Test
Separation Distance from Absorpti~>n Field: '
To Water-Supply Well ~'
To Building Foundation
Lot "
" Type of System Design "~'r~.
Length of Field 7'~...~ '
Depth of Field J
Gravel Bed Thickness '7
Standpipes Present (Y/N)
Date Of Last Adequacy Test
To Property Line ~ ,'q- ~
To Existing or Abandoned System on
; On Adjoining Lots ' ,~' ~
To Water Main/Service Line
To Stream/Pond/Lake/or Major ~rainage Course
To Driveway, Parking Area, or Yehi61e Storage Area
i .
Comments
To Cutbank (if preslent)
N oNI
NoN
LIFT STATION
No t,t '
Date Installed
Size in Gall~)ns
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Company
Receipt No. ~,~ ~"
Date of Payment
Amount: $
Dimensions
;
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N) :
Pumping Cycles'during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA I~equest ** ~
,,
I certify that I have checked, verifiefl, 0r conformed to all MOA and HAA guidelines in effect on the date of this inspection
signed ~I!I Date L//. :[O.--(3~, '
MOA No.
Page 2 of 2
72-026 (11/84)
Engineer's Seal
CONSULTING ENGINEER
, 203 W. 15th AVE "C" SUITE 203
ANCHORAGE. ALASKA 99501
TELEPHONE: {907) 279-3916
SEPTIC
SYSTEM
ADEQUAC~Y
TEST
LEGAL:
LOCATION:
OWNER:
RESIDENCE:
WATER SYSTEM:
SEPTIC SYSTEM:
LOT 13, BLOCK 2, VALLI VUE
6210 CORNER TREE DRIVE
MICHAEL BALICH
SINGLE FAMILY, FOUR BEDROOMS
CLASS A COMMUNITY SYSTEM
FROM MUNICIPAL RECORDS:
TANK: GREER STEEL, TWO COMP.
1000 1250
ABSORPTION SYSTEM: TRENCH
ABSORPTION AREA: 1050 SQ. FT.
SOIL RATING: 260
INSTALLATION DATE: AUGUST 1977
DATE OF PUMPING:
SEPT. 6, 1985, A+ HOME SERVICE
DATE OF TEST:
APRIL 30, 1986
TEST PROCEDURE: SYSTEM WAS MEASURED AND INSPECTED. TANK HAS
FOUR FEET OF COVER. WATER DEPTH IN TANK IS.49
INCHES. CLEAN OUT TO TRENCH WAS FOUR FEET DEEP WITH THREE INCHES
OF LIQUID OBSERVED IN CLEANOUT. SUMP AT END OF DRAIN WAS BROKEN
AND NOT ACCESSIBLE.
WATER WAS ADDED TO THE TRENCH AT A CONSTANT RATE OF 5 GALLONS PER
MINUTE. THE WATER LEVEL IN THE TANK WAS MONITORED. THE ADDITION
OF 180 GALLONS OF WATER CAUSED THE WATER LEVEL TO RISE 6 INCHES.
THE INFILTRATION RATE WAS THEN MONITORED FOR 40 MINUTES. 145
GALLONS WAS ABSORBED DURING THIS PERIOD. THIS EXTENDS TO 200
GALLONS PER HOUR.
TEST RESULT: THIS SYSTEM MEETS ~HE CODE REQUIREMENTS OF
THE MUNICIPALITY OF ANCHORAGE.
The operational life of all septic systems depends on the local
soil conditions, groundwater, levels that may fluctuate during the
year, and the water usage of the family being served by the
system. These conditions are outside the control of the evaluator
of this septic system. We can therefore not give any estimate of
how long the system will continue to meet the operational requi-
rements of the Municipality and State.
r"~, MUNICIPALITY OF ANCHORA(~3'~
DEpARTM~...-F OF HEAbTH AND ENVIRONMEN..,~L PROTECTION
825 L Street, 'AnChoraa~.. Alaska 99501
#1: Time Anyt~ime.'
':Date 1-1:0-78
Insp Buehh01Z
: 264-4720 .
Date Received: January 10, 1978
[Time #3: Time
Date Date
Iqsp
Insp
Se
0
4:
Se
e
e
REQUEST~FOR APPROVAL OF ~INDIVIDUAL SEWER AND WATER FACILITIES
Lending IhStituti0n Request: Peoples Bank andl.Trust.' , -
:Mailing Aadr~ss: P°uch'7-007 99510 Phon0:
Property Owner: ~Ober,t Cousineau
Mailing Aadress
Legal DesCription::
Single Fa~,ily Residence: '(x)
Multiple Family Resl. dence: ( )
Well Syst ~':~ Individual well ( )
Permit #
Construction
i~t 13 Block 2 Valli
Phone:'
Vue i,Estates SUbdivision
Number of BedrOoms:
Number of BedroOms:
Community/Public System (x)
Depth of Well ~ Well ,Log on File
Bacterial: AnalYsis :
~.~ i PubliC ~UtilitY (
Material ~~
Sewage DiSpoSal. System: On-site System (x)
Permit # !~ 96l~ Installed 1977 In~t~ll~ . ,
Septic Tahk 'Size :i~ Manufactu~e~
Absorptio~ : '" '
~'ea Soils Rate ~
istances ~ ii
~Wel'l
to Sewer Line
to Nearesll Lot Line
Septib
Tank
Nearest Lot.line
to AbsorptiOn Area
}AbsorptiOn Area
Page Two ~
~ Department of Health. and Environmehtal Protection
Request for Approval of Individual Sewer :and Water Facilities
'r,egal Description: ~'.ot5~ 13 Block 2 Valli Vue EstatkS Subdivision
Affadavit Attached: (")
Disapproved: ,
Letter AttaChed:
( )
Date:
Date:
Department Worksheet:
ii¸