HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 2 LT 21Valli* Vue Estates #2
Lot 2 1
#015-322-37
Municipality of Anchorage
Can -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231125 PID Number_ 01532237000
Dwelling: d Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 1_1 Upgrade
Name
WILSON CYNTHIA
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
6250 WEST TREE DR
❑ other
Phone
229-2242
Number of Bedrooms
3
Soil Rating
Total depth from original grade
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grads
Gravel depth beneath pipe
Subdivision Block Lot
VALLI VUE ESTATES #2 BLK 2 LT 21Fill
Ft.
Ft.
added above original grade
Gravel length
Township Range Section
Ft.
I Ft.
Gravel width
Beds: Number
of Lines
Distance between lines
SEPARATION DISTANCES
Ft.
Ft.
To Septic Absorption
Lift Station
Holding Sewer
Total absorption area
Number of trenches
Dist. between trenches
From Tank Field
Tank Line
Ff�
-
- Ft_
Well 100,+
na 25' +
TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ other
Manufacturer
Greer
Capacity
1000 Gal.
Surface Water 100'+
na
Material
Number of compartments
Lot Line 10'+
na NA
Plstc
2
Foundation 10'+
na
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL Mouse to tank Tank to
D3034 drainfieldD3034
A+
Drainfield D3034 CO/MT D3034.
Inspector NorthRim Eng.
BENCH MARK (Assumed elevation) 100 ft
Inspdection im 7114/23 Ertl 7/14123
tes:411'
Location and description
Front Door Landing
ON -,SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
±+P,�� OF
* A9Ei *.;4,
�; . ...
Septic System'
; Steve Eng
CE,' ��
Approved ; r -�2_- --- Date
N e, this approval does not include well permit requirements.
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231125
Work Type: SepticTank Upgrade
Tax Code Number: 01532237000
Site Legal Address: VALLI VUE ESTATES #2 BLK 2 LT 21 G:2538
Site Mailing Address: 6250 WEST TREE DR, Anchorage
Owner: WILSON CYNTHIA G
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
gent
Go Is,
r,
r
j
DeI)artmcrnt
Lot Size in Sq Ft:
Total Bedrooms:
6/9/2023
6/8/2024
20006
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
3
Special Provisions:
1. It appears that the field may have been upgraded without a permit. That will have to be checked prior to a
COSA. If it was installed, it will have to be documented prior to the COSA.
2. Per the engineer the deck shown is less than 30", the tank may be within 5' of the deck supports.
3. Prior to construction, confirm that the field is not within 5' of the proposed tank location.
egt �"B3r:
-"5; CA ern -o / d {"V1 C'M vin ! ► Date:
Issued By: Date:
MUNICIPALITY OF ANCHORAGE
Development Services Department (� Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 01532237000
Property owner(s) WILSON CYNTHIA
Mailing address 6250 WEST TREE DR
Site address same
Day phone 229-2242
Legal description (Sub'd., Block & Lot) VALLI VUE ESTATES #2BLK 2 LT 21
Legal description (Township, Range & Section)
Lot Size 20,006 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) 0
(`^i/wo AD U)
Septic Tank
0
Upgrade X
(D) E]Renewal
Holding Tank
El
Renewal❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A WAIVER REQUEST FOR:
Distance:
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:.ZZS
Date of Payment:
Receipt Number: 005 t(G Q
Permit No. t)s {��3 I /25
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
SteveEng.com VALLI VUE ESTATES #2 B2 L21
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: The current septic tank has failed- the seepage trench still
functions. This lot is close to a half-acre and on public water. No adverse impacts are
expected from tank replacement. Easements are depicted on the lot. The slope is
indicated in the area of the septic system. No conflicts to neighbor properties.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
New 2- compartment, 1000 gallon septic tank. Watertight couplings on inlet & outlet.
5 minimum between the tank and trench. 5 to property lines & 10 to house.
4 of cover or insulation is required for tank; an equivalent of 1 insulation for 1 foot
soil cover. Tank & solid pipe must be set on well compacted, stable soil.
No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per
MOA- sand or pea gravel.
4 diameter cleanouts with airtight caps are required 1 to 4 from foundation wall,
prior to any 90 degree bend in 4 inch line, in 2 nd tank compartment, and two adjacent
opposing cleanouts between the tank and the absorption field, not more than 10 from
the tank positioned to provide cleanout access towards the tank and towards the
absorption field. Manhole Riser required in 1 st tank compartment.
All cleanouts must extend to at least ground level.
In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
Insulation must be placed over any pipe installed under driveways or parking areas.
Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
Sewer Service Line is minimum 2% slope.
Septic Tank to be pumped every two years or when required.
Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231125, Deb Wockenfuss, 06/09/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231125, Deb Wockenfuss, 06/09/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231125, Deb Wockenfuss, 06/09/23
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SURVEY CERTIFICATION
Prepared by
PLOT PLAN
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4C�i ...,.... eo,
Robert E. Johns; Jr.. & Assoc.
i �Y �Y a+d t Mrs plyday v.a�M
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Professional land Surveyors
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Air (
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ANCHORAGE,
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ALASKA 89501
Soote 3.0 '
Raa Lot S.F.
Rea Piot Fife No.
FOUNDA71ON AS—BUILT
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T E. J
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ER 15, 2003
c`�a'
'• 4 1—•S
2538
23263
FINAL siRUCNIlE AS—BUILT
4 tmrt a .�ce+ns, r n.uey oaey awe (
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♦� f°�• y•v�1�
aR,.,.(en,
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BLOCK -2,,.
2, VAI,TI VUE ESTATES
a.e nKKt«mauoe e. e.o... Isrvm•
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ADDITIONC
❑ LOT SURVEY SURVEY TYPE
❑ FouNDA-noN As-auu
SYMBOLS
❑ RHAL sTN muizE As-+3un_T
• SET REBAR DRAINAGE S ASPHALT
PLOT PLAN ... As-sua.T ... LoT suRVEY ... TOPOGRAPHY
0 FOUND REBAPa--6•—e- WOOD FENCE '..:°'°•• CONCRETE
0 AS—WILT, N12=25SET00
ASSUMED ELEV, XX )I METAL FENCE DECK
PLOT PLANS &'LOT SURVEYS
N0
IT IS THE RESPONSIBIUTY .OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
EM, ARE SHOWN IN THEIR APPROXIMATE LOCATION.
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
ONLY. SNOW
MA'( PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
L DISTANCES ARE RECORD UNLESS QTHERw-:ZF* tjn�m
NO CIRCUMSTANCES SHOULD AN AS-BUILY BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVEY.
E
-UNDER
LISTED DISTANCES PREVAIL OVER SCALING. F. PRODUCTION MAY CAUSE ERRORS IN SCALE. i
GRI:!i' ,ER ANCHORAGE AREA BOk..UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE ~
FROM W E L L('~
INSIDE LENGTH
INSIDE WIDTH__ '"'"-LIQUID DEPTH '~-- LIQUID CAPACITY///~"'~'~GALLONS.
TILE DRAIN FIELD:
NUMBER OF LINES f DISTANCE BETWEEN LINES TRENCH WIDTH~IN. TOTAL EFFECTIVE
ABSORPTION AREA '~>?~ SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE ~ ~' DEPTH OF FILTER
MATERIAL BENEATH TILE ~ ~ABOVE TILE_ IN.
WELL:
TYPE
BUILDING
FOUNDATION __
CESSPOOL
APPROVED -
CONSTRUCTION
NEAREST
LOT LINE
OTPIE R SOURCES
DISAPPROVED
NEAREST SEPTIC
sEwER LINE TANK,__
REMARKS
DEPTH
SEEPAGE
SYSTEM
DISTANCE FROM:
DISTANCES:
INSTALLED BY:~
SEWER LINE DEPTH:
PIPE MATE RIAL: ~~'~,
LOT SLOPE:
REMARKS:
DI~A~RAM O F ~b'STEM
..,.f ..-:?'
[-' 0 ''-) ' f
Form EQ-032
-4,..u-,z,,z:k Ellz' ,q[::":,F::F)F)Fi'5 := :;~:
J. ¢..L. Of , r4.:. ': f" :i: L. FII3:~(:)t;~:F"f'i I;)J"~ : ~ .. I E.I ! ]; :~;:
THE i_ENG'TF~ E>IHEiqSiCIN !:E; TkiE i_.ENG'TIq <IN FEET) [)F' THE: TRIEF,!CH
'FHE E:'KF>TH Oi':' iB 'i'F4:ENCI4 CIF~: F:':!:T ;['.5 THE DZSTRF!CE BEETNEEN THE ~;LJF?.FF!E:IE OF THE{
I.]iF?,OUNi.) Fff',ll) THE E:O'I'TOt'I Oi:' THE E;:.:iCI::;i',,,'F~]'ZCiiq ,::iN F:'EET:L
TJ"~EEE Z% NO SET kilJ:.:,'i'H F:r)F;: 'TF4'.E:NCFIE:%.
THE; GF;;:FtVkL. B, EPTH IE; THE HZNIJ'dUH E:,EF'TH OF GT:R'v'EI. BE'1'NEEN THE; OLFFFRI..L F']:PE
i:~i"~i:;) 'Fi'"iE( E[OTTOH OF THE E',:<C:R',/FYFZON '::iN FEET]'.
r,m..,...h.tL.l..-~.!L EiF;' Fd'q%'
I::,!=?/zti'q:TI'iJEi"4T NiL. L. '"='
H]:i'.,!]:I'IUN t.::,I:~:;i'FII'..hZ:F.: Eh~YFt.,!EEN Fi N[E;L..i.. FiND RJ',J'-r'
:'L!:r:i~Ei ~:::E:iE'I FOi;.:.' i:~ [':'l:~:].l,/f)"J'[::: I,ilELL OF4'. ;-~[)I:ZI FEEFZT FOF.'. f:~ F'UE:L_iC: !,.IEL. I_
:!!;F'EE:):F:ZE:f~,"i'Z[Eli'~; FIND C:ONff~;Ti=:'.UE:T]:ON DiFtGF?.fzli'"I:E; F:tR1E fZI'v'¢~,.T.L.,clEit...E TO tN:-z.;I..IRE F'ROF'[EI:~:
:i: NST i:[l .I..f:t i- ): Oh!.
., ,' J , T T,LIf::iT
.................... I~"'= i.4i-}:I,L.:5 [:~; L~E"J-
:( Fill F:FiHZi. ;i:FtR I,.I]:TH THE RE[;¢JZF4:[EH[~.F-~i:=, I"~1',:~ :N"-"=;T-i'E; ,P_..1.,ER.., FIN[)
' "' i'HE
Performed For
Lenal Oescri~tion: Lot 21Block 2
This form Reports Soils Loq yes
2204 C:leveland Anchorage, Alaska 99503
Bud Jackson Enterprises Date Performed 6/1/~7
Subdivision Valley View
Perc0]ation Test
neoth
Feet ' Soil Characteristics
2--
Brown Silt
4
8--
Grey Sand [SW]
10--
12--
14~. -Bottom of Test Hole --
16--
18--
20--
Was ground Water EncoDntered? No
I~ Yes, At what Denth?
Readinq
Percolation
Proposed
Depth of
CnU~ENTS:
Date
Gross Time
Rate ~linute
Inst~llation: Seeoaoe Pit
Net Time
Depth to H20
Drain Field
Inlet Depth To Bottom Of Pit Or Trench
125 Square Feet drainaqe area~r~ired p_~r__b~roQ]K--f/~Q~ --
-4 to
Net Dro~
Test Performed By.
14^ feet..
David Paul
Data Certified ByCONSTRUCTION TEST LA~
Date:___6/2/77
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-322-37-000
Expiration Date:
Legal description VALLI VUE ESTATES #2 BILK 2 LT 21
Site address 6250 WEST TREE DR Anchorage AK 99507
Current property owner(s) WILSON CYNTHIA G
7/1/2025
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
M
Original Certificate Date:
11/13/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval June 2022
MUNICIPALITY OF
Development Services Department /
On -Site Water & Wastewater Section
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 01532237000
Complete legal description VALLI VUE ESTATES #2BLK 2 LT 21
Location (site address) 6250 WEST TREE DR
Current property owner(s) WILSON CYNTHIA
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone 229-2242
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑E Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑■ Plastic ❑ Concrete ❑ Fiberglass
Age 1 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee
Date of Payment
COSA# Osc 2,Y/�' 9
Waiver Fee $
Date of Payment
Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: VALLI VUE ESTATES #2 BLK 2 LT 21 Parcel ID: 01532237000
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
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 test for COSA
Static water level at beginning of test ft.
Comments Public Water
B. TANK DATA
Measured operating fluid level in septic tank na
Date of pumping new plastic tank*
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/6/77
❑■ ALL standpipes present per record drawing
Total measured depth from grade 11 ft (max)
Measured depth to pipe invert from grade 4 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑■ Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑■ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 7/1/24&11/4/24
Results g Pass
Fluid depth prior to test 12 in
Water added 450 gal
New fluid depth 15 in
Elapsed time 30 min
Final fluid depth 13 in
Absorption rate 450 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 84
Effective depth used 13 in
Effective depth remaining 71 in
Comments/Deficiencies:* IR & Record Drawings previously submitted
COSA Checklist June 2022
in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
J] Yes if No ft ❑ Yes if No
Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No
Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No
Neighboring Absorption Fields > 100' Animal Containment > 50' [:]Yes if No
`t
`t
ft
ft
❑ Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' [:]Yes if No ft C1 Yes if No ft
❑■ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑■
Yes
if No
ft
Surface Water > 100'■❑
Yes if No
Tank to Property Line > 5'
FE -1
Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑■
Yes
if No
ft
Private Wells > 100'
❑■ Yes if No
Water Main > 10'
❑■
Yes
if No
ft
Community Wells > 200'
Fm -]Yes if No
Water Service Line > 10'
0
Yes
if No
ft
If tank or field is under driveway
comment below
F. ENGINEER'S COMMENTS
ft
ft
ft
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation. based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm NorthRim Engineering
Engineer's Printed Name Steve Eng
COSA Checklist June 2022
Phone
694-7028
Date 10/15/24
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S 89°5451' W
I hereby certify that I have surveyed the following described
property: Lot 21, Block 2, Valli Vue Estates Unit No. 2, Plat
No.74-148, Anchorage Recording District, and that no
encroachments exist except as indicated hereon. This
As -built will only show the easements that appear on the
recorded subdivision Plat No. 74-148, AnchorageRecording
District;under no circumstances should this data hereon be used
for the construction or establishing boundary or fence lines.
152.75'
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i �n P. Boneta
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LS -10393 _
tl1 Esslorta
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15 30 Valli Vue Estates Unit No. 2 ASBUILT SURVEY APB Land Surveying
SCALE IN FEET Lot 21 Block 2 Cynthia G Wilson
1" = 30' As Depicted on: Plat No. 74-148 6250 West Tree Drive 12204 East Prince of Peace Drive
P Anchora e, Alaska 99507 Eagle River, Alaska 99577
Anchorage Recording District (9o�i) 230-4717
Surveyed: August 2, 2023 GRID: SW2538 a AFIM.R n Ta+EaKM. (907) 227-1361
7
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SIC_ G( / e_.: / Ij, = 30 1
:ASEMENTS OF RECORD, OTHER THAN
'HOSE SHOWN ON THE RECORDED PLAT,
,RE NOT SHOWN HEREON.
FE 711
R __-, 5
FA
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's'
inspection of the following described property:
(o//V/ 7" A/o. Z --
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property
lines and do not overlap or encroach on the property
lying adjacent thereto, that no improvements on prop-
erty lying adjacent thereto encroach on the premises in
question and that there are no roadways, transmission
lines or other visible easements on said property except
as indicated hereon.
Dated at Anchorage, Alaska
this day of ? () L -N 19 C
FRED WALATKA & ASSOCIATES
Engineers and Surveyors
DEPT.
MUNICIPAL TY OF ANCHORAGE .
~'~ RON, ~ENTAL
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~J
825 L Street- Anchorage, Alaska 99501 [~AY
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 2§4-4720
REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER F,~OILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing,
PHONE
2. BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION PHONE
MAI LING ADDR ESS
PHONE
STREET IzOCATION ~.~_~ ~-~ ~.~ ~ ~
6, TYPEOFRE IDENCE NUMBER OF BEDROOMS
~ One ~ Four
INGLE FAMILY ~ Two ~ Five
~ MULTIPLE FAMILY ~ Three ~ Six
LEGAL DESCRIPTION
[] Other__
7, WATER SUPPLY
[~ INDIVIDUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled
COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach Icg if available.)
[] PUBLIC UTILITY
If md~wdual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONL'/
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] 8IX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified__ LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
E~INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
[]Septic Tank or []Holding Tank
Size: f~.~"O If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holding Tank Abs'orption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~APPROVED FOR 4~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev, 3/78)
Time
r-~MUNICIPALITY OF ANCHORA(~..~.-.N
DEPARTt4EJ'OF HEALTH AND ENVIRONt4ENT. ?PROTECT!ON
823 L Street, Anchorage, Alask~ 99501
264-4?20
Date Received': November 28, 1977
~2: Time ~'3r: Time
Date
Date Date
Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Alaska Pacific Bank
Mailing Address: Post Office Box 420 99510 Phone: 276-3110
Property Owner: Charles Jackson
Mailing Address:
Phone:
3. Legal Description: Lot 21 Block 2 Valli Vue Estates #2 Subdivision
Single Family Residence: (x) Number of Bedrooms: Three
Multiple Family Residence: ( ) Number of Bedrooms
5. Well System: Individual well ( ) Cormmunity/Public System (x)
Permit # Depth of Well
Construction _~
Sewage Disposal System: On-site
Permit ~, f~_-L~ .... Installed
?
~ Well Log on File
Bacterial Analysis
System (x) Public Utility (
Septic Tank Size -L=~ ~"~{~%
Absorption Area _zo~ ~_____ Soils Rate
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
Manufacturer _~.~_~'n_~_.
to Absorption Area
Absorption Area
~Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 21 Block 2 Valli Vue Estates #2 Subdivision
Comments:
Affadavit Attached: ( )
Letter Attached: ( )
Disapproved:
Date:
Date:
Department Worksheet:
I
·
t~.~.~ C~IUNICIPALITY OF ANCHORAGE ~
3/~9~'~ Department of Health and Environmental Protectio~xcx~
//~]] 825 L Street, ~chorage, Alaska 99501
[[~)) 279-2511, ext. 224, 225
~~ques% for Approval of Individual Sewer and Water Facilitie~%
Property Owner: ~$ ~SES, ~les Jackson
Mailing Address:
Phone:
2. Name of Buyer: B~uce, Robert C. & Denise
Mailing Address:
Lending Institution: ALASKA PACIFIC BANK
Mailing Address: P.O. Box 420, Anch~orage_~ AK
Realtor/Agent: Larry Maulden, Jack white Company
Phone:
Phone: 276- 3110
Mailing Address: 3201 C Street, B_nc Phone:
**Please contact realtor for apt. time
Legal Description: lot 21, B2, Valli ~e Estates ~2
Street Location: West Tree Drive, Anchorage, AK
277-1553
Single Family Residence: ~ Number of Bedrooms: 3
Multiple Family Residence: ( ) Number of Bedrooms:
7. Water Supply: *Individual Well ( ) Public/Community System ~X~
If Individual Well, well depth
If Community System, name of system
8. Sewage Disposal System: On-site System (X~X Public System ( )
If On-site System, date of installation:
Enclosure: cashier's check for $25.00 for inspection fee
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77