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HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 3 LT 12Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211240 PID Number: 015-341-21 Dwelling: 9 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Proje Name MILES GODSAY & SARAH MOORE ABSORPTION FIELD Site Address ❑ Deep Trench El Wide Tre 6402 LONE TREE CIR ❑ Other 'hone Number of Bedrooms Soil Rating ITotal LEGAL DESCRIPTION GPD/SF Depth to pipe invert from original grade Ft. Subdivision Block Lot VALLI VUE EST #2, BLK 3, LOT 12 Fill added above original grade Ft. Township Range Section Gravel width Ft. Beds: Number c SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station n Holding Tank Sewer Line Total absorption area Ft2 Number oftrenc Well 100'+ �50 i,i., TANK ❑i Septic ❑ S.T.E.P. ❑ Hol Manufacturer GREER TANK Surface Water 100'+ Material PLASTIC Lot Line 10'+ I NA Foundation *g'+ LIFT STATION Manufacturer Remarks TANK DEMO PER UPC, " TANK OUTSIDE BLDG FOUNDATION PRISM Alarm location E Installer PIPE MATERIAL House to tank MIKE N ANDERSON, P.E. Drainfield Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) Inspdect Sn 15, 7/31/21 2�e Location and description 3rd 4'h TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Page 1 of 2 ❑ New 9 Upgrade h ❑ Bed ❑ Mound pth from origipal grade r Ft. avel depth beneath pipe Ft. avel length Ft. nes Distance between lines Ft. Dist. between trenches ❑ Other Gal. ber of compartments Gal. installed by Tank to 3034 drainfield CO/MT 3034 ft Conditional Approval: Date ,W , gJ el S/ -- �..... .......:...� I •• M HAEL N. ANDERSON :QC /0 Septic System �P �,•, cE 9�a9 4 ,.;���; Approve Date.`l�t qt . \`� Note: this approval does not include well permit requirements. (Rev 05/02/18) Permit No. OSP211240 Page 2 of 2 Municipality of Anchorage 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 Legal Description: VALLI VUE ESTATES #2 BLK 3 LT 12 PID No.: 015-341-21 MARK A B C01 30 6 TC01 27 12 TCO2 25 15 CO2 27 18 CO3 28 20 NEW 1250 GALLON PLASTIC TANK BENCH, ID MM. WATER LINE \CO2 . CT TC91 El C01 DRIVEWAY I 1� ARE< S CED BY COMM. WATER ASBUILT SCALE: 1"=50' coi Tcoi co coa o rcoz O®®®O Or 49 TH �0 95.1 .... GAALLOLLD .. N 94.8 PLASTIC TANK 9 <4 '-.MICHAEL•N. ANDERSON;® No. CE 9469 SEPTIC SECTION '> ••a�� N.T.S. ®®®t®"' MUNICIPALITY C]FANCHORAGE On -Site Water & Wastewater Program pOBox 1o6650 4700 Elmore Road Anchorage, Alaska syn1y'6sso Phone: 904 Fan: (907) 343-7997 IF!111� 11 Permit Number: OGP211240 Work Type: SepdoTankUpgoodu Tax Code Number: 01534121000 Site Legal Address: VALL|VUEESTATES #2BILK 3 L 12 G:2538 Site Mailing Address: G4O2LONE TREE C|F,Anchorage Owner: MOORE SARAH Design Engineer: GAF<NESSENGINEERING GROUP LTD This permit iofor the construction of: [] Disposal Field 10Septic Tank Holding Tank D Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms G/25/2021 6/25/2022 1711 Private Well 11 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 (18AAC8O) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.S5.Provide notification bycalling (QO7)343-79O4(Z4/7)� 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall baeithar a. Opened and Closed onthe same day, or b. Covered, sealed, and heated to prevent freezing Received Issued By 4 On -Site Water & Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Phone: 907-343-7904 Fax- 907-343-7997 Parcel I.D. 015-341-21 Property owner(s) Miles Godsey Day phone 907-715-2391 Mailing address 6402 Lone Tree Circle "Anchorage, AK Site address 6402 Lone Tree Circle "Anchorage, AK Legal description (Sub'd., Block & Lot) Valli Vue Estates #2; Block 3, Lot 12 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Date of Payment: Receipt Number: 03 15'"7 a G Absorption Field ❑ Initial ❑ Septic Tank Z Upgrade 0 Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: N/A TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) 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) ©❑ E Permit/Rush Fees: 5 Waiver Fees: Date of Payment: � q X42 Date of Payment: Receipt Number: 03 15'"7 a G Receipt Number: Permit No. O5P�2 If Q LIQ Waiver No. G1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211240, Deb Wockenfuss, 06/25/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211240, Deb Wockenfuss, 06/25/21 Lot 12 9 \ 2.0 OH rs � Lot 37 \° y \193, SCALE: V= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON UNLESS OTHERWISE NOTED. Shed 12.0 io 0 F 25.7 2 Story Frame House deck _ 2,0 OHj 2.0 OH \ /e Asphalt 6336 \\ Lot 11 0 Lot 38 OF • A4 1 'c.\;'•' ,A `?'^ 49th ! •.-Y 00 .. /- lizabetth L aIatka .` o foow ��+Js�F • • 4�1 AW 8036 - LS • • j7 AW I' RQresslow- FB 21-2, pg 46 Recert 5-16-13 BE FB 74-9, pg 52 RECERTIFIED 6-09-21 AS -BUILT N CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 12 BLOCK 3 VALLI VUE ESTATES UNIT No. 2 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 the property 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 4th day of October 1974. FRED WALATKA & ASSOCIATES, L.L.C. 907-248-1666 Engineers and Surveyors This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other Improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer Is limited to the amount of fees collected for services in preparation of this product.  : MUNICIPALITY OF ANCHORAGE ' · DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION '~Z Manufacturer ~~, Ma~ U No. of compartments 0 Z ( Manufacturer Materlal Liquid capacity in gallons --~ Z ~Z No, of lin~ Leng~h of each line[ ~ ~ Total length~°~n~ Trench wi~th ¢"inches Distanc~e oen lines ~ T°P °f tile t° finisb grade ~ Material beneath tile / ~inches Total effective aT~p~o¢ea_ Length Width Depth PERMIT NO. ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot llne PERMIT NO, ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS INST 72-013 (Rev. 3/78 PERMIT NO. ,:: 7904:1.? ) b F FL I _.Hl',l ~ LOCRT I ON LEGFIL F..FE:, r CROZIER 6402 LONE TREE CIR. Li2 B3: VFII._LI VUE EST · ' I:)t 'RR'r'r'll i:ll:iOF ,:IE LTH FIND EN'.,,'IR,:,i'.4r'IEi'. 'FfiL 'i' _ STR. EET, NC:HOR :,OE, BK. -. . ..... .-- _. :. '--. _. . _ . _ . .. . ~"-*,,;' e .,*./2 . _,F..HE,U,-., -<~-:;': .~.4,4--, t0:1...~ ~ LOT SIZE 20000 SQURRE F'EET T"r'PE OF =,LIL HE,_._RE, TI_i'J ..,-r_,IE, M IS: FFEN..H .... ,11 ....... '--,': '"'~ ':' '~' I-' (SL.':! "-; '"- i'lH,.,Ifl_fl i'gJi'flEER OF E, EE.,RLUJII_, = _,uIL FJ. tFIIqa FT. ER.- ']"HIE RE],JIRE[':, .:,I~.E OF THE :,uIL HE,_,uRF I .]'HE LENGTH E:,INENSION IS THE LENGTH ,.'.'IN FEET) OF THE TRENCH OR E.',R. FIIi'.,IFIELD. THE DEF'TH OF FI TRENC:H OR PIT IS THE DISTFINC:E BET.WEEN THE SURFFICE OF THE GROUND FIN[:.', THE BOTTOM OF THE E,'.--':CFIVFITION (IN FEET:..'. THERE I-:'; NO SET ,WIDTH FOR TRENCHES. THE GRFI',,,'EL DEPTH IS THE NINIMUH DEPTH OF GRFIVEL BETWEEN THE OLITFF~LL PIPE RND ']'HE BO.]"TOM OF' THE E::.:',CFiVRTION <IN FEET). ,;~f'llT FIPPLICRNT FIBS THE RESPONSIBILIT"r' ]'O INFORM .]'Fils DEPFIRTMENT DURING THE ,STFILLRTION ZNSF'ECTIONS OF FIN"/ WELLS RDJRCENT TO THIS PROPERTY RND THE JMBER OF RESIDENCES .]-HFIT ']'HE WELL WILL Z, ERVE. · ]r"i~.._lc", .... : 1:. - - .=:' t'~:E:,;~LI ]E F.."E[::, BFICKF:IIJ.~ING OF FIN'¢ ..,'L, TEM I,.IITHOUT FINRL ZNSPEC:T~ON RND FIF'PROVRL B'¢ C, EPFIRTMENT HILl_ BE _UE, JEL. T TG PROSECLTI iN. MINIMUN DISTRNCE BETWEEN F:I WELL RND BNY ON-SITE SEWRGE BISPOSRL SYSTEM I21 ±00 FEET FOR R PRIVFITE NELL; OR t50 TO 2'¢3(~ FEE]' FF,'OM FI PUBLIC WELL [)EPENDING UPON THE TYPE OF PLIBLIC WELL. OTHER REQUIREMENTS MFI'?' FIPF'L¥. SF'ECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE FI',,"BIL. FIBLE TO INSURE PROPER INSTRL.LRTION. I CERTIFY THFIT i: I FIH I:RNILIRR NITFI THE REQUIREMENTS FOR ON-SITE SEWERS RND WEL..L.S RS SET FORTH BY THE MUNICIPRL. IT¥ OF RNCHORRGE. 2: I WILL. INSTRLL THE S'¢STEN IN RCCORDRNE:E WITH THE CODES. ~:: I UNDERSTFIN[:, THRT THE ON-SITE SEWER SYSTEM MR'¢ REQOIRE ENL. FIRGEMENT IF THE RESi[:,ENCE IS REMO[:,ELED TO INCLUDE MORE THRN ~: BEDROOMS. ~PF:'L ~ CFINT F~,RE:~'[ C:R.C~E R . . .:'c =.~ 'RTE_ Z _._,LIE[ B'¢ ANCHORAGE AREA BOF-~JGH Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME '7~/~t3 ~'~ ~ LOCATION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL /~'~ /9~ NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY / ~ GALLONS. SEEPAGE PIT: ~m/% NUMBER OF PITS / DIAMETER OR WIDTH LINING MATERIALC¢:~ /~ '~lB SIZE: DIAMETER BUILDING FOUNDATION NEAREST LOT LINE . ADDITIONAL ABSORPTION LENGTH DEPTH DEPTH ~ DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) .SQ. FT. WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED ~ DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE ~RoM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No, EQ-031 DIAGRAM OF SYSTEM DATE G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99~03 TELEPHONE 274-456! TYPE AND S[ZE OF FACiL]TY TO BE SERVED ~.,~, ~'~'~ NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT DRAIN FIELD ~ OTHER FINANCED THROUGH TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT BOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOT[CE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE {(~C.~ TYPEv SEEPAGE MINIMUM DIBTANCEB, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~ ~ FOUNDATION TO SEEPAGE PIT ~ ( DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL /'~ ( SEPTIC TANK - SEEPAGE Pit ~ , DRAIN FIELD TO NEAREST LOT LINE. SEPT]C TANK, (O0 .. SEEPAGE PIT C~ 06 -, DRAIN ]FIELD I DIAGRAM OF SYSTEM GRAVEL BACKFILL BOROUGH REGULATION EGARDING INSTALLATION. I CERTIFY THat I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM iS IN ACCORDANCE WITH SAID CODE. ~/~ -- t GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Perform-ed For Legal Description: Lot |'{~_ Block__~ _ This Form Reports Soils Log_;~ - Soil Test Must Be Logged To 4' Depth Feet Soil Characteristics Case # ~_~-~_~[~.~ Dated Performed~ Subdivision V~%[%~ Vu~ Percolation Test Below Proposed Seepage System - m 4w 5w 8~ 9~ lO- ll- 12~ 13~ Was Ground Water Encountered? If Yes, At What Depth? Reading Date Gross Time Percolation Rate Minute Proposed Installation: Seepage Pit Depth of Inlet Depth to COMMENTS: Net Time Depth to H20 Drain Field Bottom oil-Pit or Trench Net Dro Date:_. MUNICIPALITY OF ANCHORAGE Deve-iopt Brit Services flc�i:a101-3413-79004 Wasi-e-viat e" l.C 'lr'i"i•one: r aax� fe Parcel I.D. 015-341-21 Certificate of On -Site Systems Approval Expiration Date: 1 f- 23 —Z/ 1. GENERAL INFORMATION .Complete legal description VALLI VUE ESTATES #2 BLK 3 LT 12 Location (site address) 6402 LONE TREE CIR, ANCH AK Current property owner(s) Mailing address Real estate agent MILES GODSEY SAME 2. TYPE OF DWELLING: [] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic [] Water Storage ❑ Holding Tank ❑ Community Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment _ _S///�z I r 11 Receipt Number D//Z0'LJ COSA # 0 5c� 21 1 W ?D Waiver Fee $ Date of Payment Receipt Number 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P. E. Date 8-10-21 6. DSD SIGNATURE ..may OF 49TH System #1 Approved for 4 bedrooms......... �• • . V MICHAEL N. ANDERSON ; Q / System #2 Approved for bedrooms �� f•• CE 9A49 Disapproved •�.�`�\�.� � PRK�� ~ Conditional approval for bedrooms, with the following stipulatiAixO xfti� �� pN_SITE olo WA AND m r PROGR M o Original Certificate Date: 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 Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet • Legal Description: VALLI VUE EST #2, BLK 3, LOT 12 If more than 1 septic system on lot: COSA Checklist # of 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 B. TANK DATA Age of tank(s) NEW years Tank type/material W!"' ' Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 816n9 ❑ ALL standpipes present per record drawing Total measured depth from grade 13 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel Ilb: 015-341-21 Structure served by this system Well production at time of test _ Water storage tank volume, Well disinfected for coliform tes ❑ Coliform bacteria is Negativi Nitrate mg/L ❑ Nitra Arsenic ug/L ❑ Arse Collected by Date of Sample C. LIFT STATION ❑ Required maintenance com Age of lift station years Lift station material Comments: gallons ❑ Yes ❑ No less than MRL (ND) less than MRL (ND) Adequacy test date 7131r2' i Results ❑✓ Pass For 4 1 bedrooms Fluid depth prior to test 0 j Water added 600+ gal New depth 0 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (pa 12 months) If yes, enter date 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' If absorption field is under driv ay comment below Community Sewer Manhole/CI' nout > 100' ❑ Yes if No ft I Water Service Line > 10' 0 Yes if No ft Yes if No ft Neighboring Tank > 100' ❑ Yq if No ft Private Sewer/Septic Line > 251 Yes if No ft Absorption Field on Lot > 100' ❑ Ye if No ft Holding Tank > 100' ! ❑ Yes if No ft Neighboring Absorption Fields > 100' ; MOA COSA guidelines in effect on this date. Animal Containment > 50' ❑ Yes if No ft ❑ Ye� if No ft `z COSA Checklist yellow sheet Manure/Animal Excreta Storag, > 100' Community Sewer Main > 75' ❑ Yes if No ft ! ❑Yes if No ft From Septic/Holding Tank on Lot td: (Please enter distances if less than required) Building Foundations > 10' ❑ Ye if No *g ft Surface Water > 100' 1❑✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10'✓❑ I Yet if No ft Community Wells > 200'! ✓❑ Yes if No ft Water Service Line > 10' []✓, Yes if No ft If septic tank is under driveways omment 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 driv ay comment below Property Line > 10'✓❑ Yes if No ft Wells on Adjacent Lots: Water Main >10' Q Yel if No ft _ Private Wells > 100' _ i Yes if No ft I Water Service Line > 10' 0 Yes if No ft Community Wells > 200' 71 Yes if No ft Surface Water > 100' ✓❑ Ye� if No ft I F. ENGINEER'S COMMENTS * tank outside Bldg foundation bearing area G. ENGINEER'S CERTIFICATION 01 A I certify that 1 have determined through field inspections and review O r?•'• S 1� •+'y �� of Municipal records that the above systems are in conformance with /' ; 49LH- MOA COSA guidelines in effect on this date. ddj)� MICHAEL N ANDERSON : f (j}i� •. CEPROF 4b `z COSA Checklist yellow sheet o � ...i4p 49 TH s.�, �- D O s SHANE A. HOLT �� e �p e LS -6914 LONE NOTE AMENDED SURVEYAUG 52021 TO NEW P/PE POSITION TREE THE INFORNA TION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOD ANY CONFLICTS BETUEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, INPROVENENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOIVN HEREON ( UNLESS INDICATED) NOTE= FENCELINES THAT MAY APPEAR ON THIS DRAUIN6 ARE NOT TO BE USED TO DETERNNE PROPERTY LINES OR POSITION ADDITIONAL INPROVENENTS. ANY PAVING SHOUN HEREON NAY BE APPROXIMATE DUE TO EXCESSIVE SNOU AND/OR ICE. CIRCLE AS-BU/LT SURVEY I" =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT12, BLOCKS, VALLI VUENO. 2 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 5 TH DAY OF AUGUST , 2021 15162, FB 215-19,39 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D,# 01 5-341 -21 "~ HAA # 1. GENERAL INFORMATION Complete legal description Lot 1.,3.. '>i-~c~- ,~. Vnlli V,:,~. *~state s :~ Location (site address or directions) Property owner Brad Penn MaiHngaddress 6402 Lone 6402 Lone Tree Circle Anchoraqe, AK 99516 Day phone 346-21 20 Tree Circle, Anchorage, AK 99516 Lending agency Mailing address Agent Fortune Properties Address 2525 C Street Suite 100, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: individual well Community well Public water Day phone Day phone 562-7653 Anchorage, AK 99503 MUNICIPALITY OF ANCHoP. AGE EN'VIRONMENTAL SERVICEs DIVI$10N JUL ? 6 1996 RECEIVED X NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 inves![gation 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 DHI Consulting Engineers Address 800 E.I Dimond' Blvd. Suite .3-545, Engineer's signatur Phone 344-1385 · Anchorage¢ AK 99515 Date 7- ,~. 7~( DHHS SIGNATURE ~', Approved for ~o~, (~) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspectibns or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description:Lot Health Authority Approval Checklist 12 Block 3 V, qt. gt-VO'~ Parceli. D.: A. WELL DATA Well typeCommUni ty Log prese~) Date completed Total depth ~ Cased to Sanitary seal (Y/N) ~ Date of sample: [(,~B, or C, attach ADEC letter. ADEC water system number Casing beight (above grouud) Wires properly protected (Y/N) FROM~"'~L LOG AT INSPECTION~F¢/,~ Nitrate N/~ ~., Collected by: B. SEPTIC/HOLDING TANK DATA 9;/.~'377q':~. 1000~ 2CL~ Dateinstallgdg/~6/~,¢).,~'~,~.anksize ;750f~¢ NmberofCompaflments 1 Cleanouts(Y~) Y~ mounda~i;n ~,eanoUt (Y*)~ ~*};~ Depression (Y~ Date'0fPumping '~'/~" 'Pd~per A~ Home Serv~ce~ ABSOR~ION; C. '~LD DATA ' Date installed. ~ 9 7 9~ Len~h 5 6 ' ~ W~dth 3 Effective abso~tion area 1 0 0 8 ~ Monitoring Tube present(Y~) Date of adequacy test 7 / 2 5 / 9 6~ Results ~ass~ail) P a s s© For 4 b~ooms Pit Syste~n type Trench Total depth Depression over field (Y/N) Fluid depth in absorption field before test (in.); 0 Immediately after 600gal. water added (in.): 0" Fluid depth 0" (ins.) Minutes later: - Absorption rate = > 600 g.p.d. Peroxidetreatment(pastl2months)(Y/N) Per DHHS Records ~)Per DHI Records~ N If yes, give date D. LIFT STATION Date installcd Size in gallons ~ Manhole/Access (Y/N) ~' level High water alarm level at* ~ *Dalton E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank oil lot Absorption field on lot Public sewer main _; On adjacent lots ~Pnbiic sewer manhole/cleanout Lh2station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 ~ + Property line 2 0 ~ + Absorption field Water mai~ffscrvice line 2 0 ' Surface water/drainage None Wells on adjacent lots None SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 2 5 ' + Water mailffservice lille 2 5 ~ + Driveway. parking/vehicle storage area 4 0 + Curtain drain None Wells on adjacent lots None Property line 1 0 ' + F. ENGINEER'S CERTIFICATION ~,'~..~, · HAAFee $ ~ ~J, ~ Waiver Fees Date of Payment ¢~¢/~ Date of Payment Receipt Nulnber ~/¢d~?/~ ~_/ Receipt Number Rev. 8/95 OSS: haa.wk.doc MUNICIPALITY OF ANcHoRAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH'AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location'(address or ~irec?ns) (b) Property, ownel: Madlng AddreSs (c) Lending Institution'!*,":'~ Mailing Address Telephone.: (home) ~,"~"/~"2~' Business. ,4- j ¢.z/. H/z Telephone (d) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: (or check here~b if hold for pickup.) List contact person and day phone number below: (e) 2. TYPE OF RESIDENCE Single-Family'~ Number of bedrooms /../Z 3. WATER SUPPLY Individual Well [] Community'j~ Public [] Note: If communi:ty well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL O~-site~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 ')~JOM s,Jeeu!Bue IBUO!SSoloJd eq~ u! SUOlSel LUO JO g]OJJe JOJ elqlsuodsoJ, leu ',~1. @~BJoqouv ~LO/Ii. Bd~mu. . nJAl eqJ. 'penss. s. OlBOl~l~,JeO B eJojoq B~Bp OZ/~IBUB JO sue lo~dsu~ lonpuoo leu op SHHa ~o see~oidcu~ slUeLueJ~nbeJ olB],$ pub BJepoJ Ul~]Jeo/q$IJBS OJ JopJo U sue ini~SU~ bu!puel J!eq] pub seuuoq ,[o sjesBqoJnd O) AseiJnoo B SB s!q) seep SHHQ eqJ. 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B iBes NOIJ.'ClNNO.-INI aN~f ~.L~a '1-101:1¥:1~ :111=1 '$.L$:1.1. '$NOI.LO=h'ISNI IDNlalAOI:td A. WELL DATA ' MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ,~?"/Z. Well Classification ¢.~/c/,/.y, If~B, C, D.E.C. Approved (~)'N) resent (Y/N) Date Completed Yield Cased to Depth of Grouting __ Static Water Le"~,~ .... Pump Set At __ Casing Height Abovel~ __ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (?"/'N~-- Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM To Septic/Holding Tank Lot on '~, ; On AdjOining Lots To Nearest Edge of Absorption Field on Lot ~ ; On Adjoining Lots To Nearest Public Sewer Line To Nearest P-~o~'c Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ;~Date~',-, Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~Size StanOpipes~.~N) Air-tight Caps(~N) Depression over Tank (Y(~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) No. of Compartments / Foundation Cleanout ON) Date Last Pumped /'"/3-~"~ ~J//4 ;for ./ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water,Supply Weli £ ~ '/' ~; ProPerty Line' ~. 7~ '~, ? To Water Main/Service Line /c, To Stream, Pond, Lake or Major Drainage Course /~ /~ Comments To Building Foundation To Disposal Field /O .-~ 72-026 (Rev, 7/88} Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'~(" -?~ Width of Field ..~ ' Square Feet of Absortion Area __ /~" Depression over Field (Y~ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present,N) Date of Last Adequacy Test /-/o To Property Line ?¢ c- To Existing or Abandoned System on ; On Adjoining Lots / To Cutback (if present) Comments D, LIFT STATION ~ed Dimensions Size in Gallo-"rYs-.---~_ Manhole/Access (Y/N) "Pump On" Level at ~"~ "Pump Off" Level at High Water Alarm Level at ""'"~"~~ Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) -'"'~"'"'---~~ Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on ate of this inspection. Signed Company Date MOA No. Receipt No. ~ Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No, Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF I I~ALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PP~OTECTION  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 LStreet-Anchorage, AlaskaS9501 JU~ 1 7 1979 ENVIRONMENTAL ENGINEERING DIVISION Te,epho.e RECEIMED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES 1. PROPERTY OWNER PHONE Forest. F. and Robert.a L. Crozier 344-7101 MAILING ADDRESS SRA Box 32C, k~chorage, Alaska 99507 PROPERTY RESIDENT (if different from above) PHONE Owner 2. BUYER PHONE Charles R. and Karen A. Mallary 262-9754 MAILING ADDRESS : Route #2, Box 816, Soldot.na, Ak. 99669 3. LENDING INSTITUTION Security Pacifi~ Mortgage Co. (Cheryl) MAILING ADDRESS 1011E. Tudor Rd., Anchorage, Ak. 99503 4. REALTOR/AGENT Admiral Realty - Betty Halsey PHONE 276-1933 JPHONE 279~8586 MAILING ADDRESS 930 ¥1, 5th AVe., Anchorage, Ak. 99501 5. LEGAL DESCRIPTION Valli Vue Estates #2, Blk. 3, Lot 12 TREETLOCATION 6402 Lone Tree Circle [] Other~ 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS' [~] One [~]. i~ P0ur [~ SINGLE FAMILY [] Two '[~] Five [] MULTIPLE FAMILY [] Three [] Six 7, WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~X INDIVIDUAL/ON-SITE*~ [] PUBLIC UTI LITY **If individual/on-site, give installation date ] 974 .. 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. 72~310(3/78) ~ THIS SIDE FOR OFFICIAL USE ONLY ;)ATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME )ATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DI R ECTI ONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY LOG RECEIVED Connection Verified __ 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED E~3 PUBLIC UTI L]TY Connection Verified iNSTALLER [] Septi~ Tan~k.~r Size:----~'~}~-~'~-"~ If Tank is homemade SOILS RATING give dimensions; TYPE OF TANK MANUFACTURER ~.~,~?(. ~.~-~1_~..~j~ ' TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank ~bsorption Area Sewer Line I Nearest Lot Line WELL TO: __ / Absorption Area to nearest Lot Line 5, COMMENTS APP OVEDEOR BEDROOMS [] CONDITIONAL APPROVAL (letter must ac.~..~,pany certificate) [] DISAPPROVED DATE BY (TJBe) LEGAL DESCRIPTION 72-010 (Rev. 3/78) 3601 C STREET, SUITE 316 ANCHORAGE, ALASKA 99502 STEVE COWPER, GOVERNOR 563-6775 Alaska Environmental Control Services, Inc. ATTN: Alan C. Wien 1412 West 34th Avenue Anchorage, AK 99503 DATE: January 13, 1989 PWSID: 210605 To Whom It May Concern: According to the records on file in this office, the VALLIE VIEW SUBDIVISION Water System is in compliance with the State of Alaska Drinking WAter Regulations. VEC:pkk Sincerely, Vera E. Craig Environmental Field Officer July 25, 1979 R&M No. 95]240 F. Crozier 6402 Lone Tree Circle Anchorage, Alaska Re: Adequacy Test on Existing Sanitary Sewer System; Lot Valley View Estates Subdivision, Anchorage, Alaska Dear Ms. Crozier: 12, Block 3, Per your request of July 17, 1979~ we conducted a test of the sanitary sewer system on the above described property. The septic tank was pumped prior to the performance of the test on the seepage pit. During the test the liquid level in the seepage pit was measured before and after the addition of 456 gallons of water. All liquid levels were measured below the top of the standpipe and are shown in the following table: Initial Water Second 24 hour Total Reading Added Reading Reading Drop (gallons~ 71.75" 456 64.5" 64.5" 0 The water level rose 7.25 inches with the addition of 456 gallons of water, indicating a capacity of 62.8 gallons per inch. Twenty-four hours later the liquid level was again measured and found to be 5.4 feet. This indicates an average effluent acceptance rate of 0 gallons per day for the surrounding soils. The low acceptance rate was probably caused by present wet weather conditions. If the two bedroom residence on the property is to house four people, the average load on the system can be expected to be 300 gallons per day. We can therefore conclude that the system is not disposing of effluent at an adequate rate for a two bedroom residence. We appreciate this opportunity to be of service to you. Please contact us if you have any questions regarding this letter or if we can be of additional service to you. Very truly yours~ R&M CONSULTANTS, INC. Ernest R. Rahaim Staff Geologist ERR:GS/rm/AT&SI-G