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Home My WebLink AboutVALLI VUE ESTATES #2 BLK 3 LT 9 ~ MUNICIPALITY OF ANCHORAGE DEl: I'MENT OF HEALTH AND HUMAN SERV~ e Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Address TANK FIELB Township, Range, Section /~'j ~' : ~, /~ dri~B~ay,A~'BUILT DIAGRA. (Showlocat,o,,ol.ell, septicsystem, properlyl,nes, loundalwater bodies, arc) .... TANKS . Material / NO. ol Compa~ment8 ":/ TYPE OF SYSTEM DepthtOplpeboHomlrom Total depth from odgJnal grade ~ ~ j : [ original grade : -- ¢ FT / / ~Otal 8bso~ptlon erea / Distance between~n e5I~J _ WELLS REMARKS: I () --::: cedily thai Ihis inspac(J0n was peff0rmed according la dj Municipal and Stale guidelines in died ~n Ihis date: [~ -~ ~ ~ 72-013 (3/85) DEPAR'TMEN'T' OF HEAL. TH AND ENV:ERONMEN'TAL PROTECTIOI'~ 825 L S]"REEET, ~NCHORAGE, AK 9950 ~64-4720 F:'ERM ]: T NO: 85()688 DATE} ISSUEED: 10/21/85 ~, AF'PL :i CANT: MAR I A SORDELL I ADDRESS: P.O. BOX 1].-].6E~1, AK 995 1]. CONTACT F'HONE: 346'-2~.587 ~ I.~:(.~4L .OE:,.:~ _,f~ Ik: L.d t S I ZE: I-b~ :, ,EdE;[}R[]OMS: SLJBDIVISION: VALLI VUE EST. LOT:' 9 SIECTION: 14 TGWNSHIF': :[2N RANGE: 3W .54A (SQ. FUT. OR ACRES) 4 BLOCK:.:,~" I...is'Led .be].c:)w are the op'Lions available 'Lo you in designing ycur septic -':~ystem. (.I cxa.:~e ~he option tha'L Le._.~ fi~s DErp'I"H TO F'IF:'E BOTTCIM (F:'T.) 4.0 4.. 0 GRAVEl.. DEF'TH (FT.) 7~0 0,,5 TOT'AL. DEPTH (F=T',,) 11.0 4~5 [~)RAVEL WIDTH (FI".) 2.5 23.0 GRAVEL.. L. ENG"FH (FT.) 50.0 45.0 GRAVEl... VGLUME (CU. YDS. ) :~4,, 8 38,, 4 ]'ANK SIZE (GALS) ].,250.0 '~'* 1,250.0 *'~ SOIL RATING (SQ.F'T. /BR) 172 172 4.0 7.5 5. C 75. C 55.6 25'). - .~.e lAN.-. IdUS'I" HAVE A'I' LEEAST TWO COMPARTMEN"FS ][ c:ertif'y tha'L: ].. I am f'amili~p wi'Lb the requirements for' on-site sewers and wells as set Forth by 'Lhe Municipality of Anchopage (MGA) and the State oF Alaska. I will install 'Lhe system in accordance with all MOA c. odes and regula'tions, and in compliance with 'Lhe design critepia oF this permit. 3~, I wi].l adhere to all IdOA and St'ate of Alaska requirements' for' the set back distarices from any exist:Lng well, wastewater disposal system or public ~;ewerage sys'Lem on this of any adjac:ent or r'~ear'by lot,, '4. ]: understand that this I:)ermi{: is valid for a maximum of 4. bedrooms and any en:largbmen'L' will require an addit:Lonal permit. ]:F A LIFT STATION IS INSTALLED IN AN AREA I~;OVERIED BY MOA BUILDI'NG CODES, THEI"4 (~) AN ELECTRICAl... PERMIT AND INSF'ECTtON MLIST BE OBTAINED; (2) AS,-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSF'E[]TION REF'GRT; AND (3) THE ELIECTI~'.ICAL. WORK I"]US'F BE DONE BY A LI'CIENSED ELECTRICIAN. AF:'F'f_ICANT: MAIRIA S[]RDELL.]: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~¢- LEGAL DESCRIPTION: Vue 1 3- 4- 5- 6- 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS --~'~l~ ~ Township, Range, Section: DATE PERFORMED: (ENG~EAL) SLOPE WAS GROUND WATER ~t ENCQUNTERED? IF YES, AT WHAT DEPTH? pO E De,th to Water ARer Monitorino? Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop I010 .- -. ioz. o .-- q. , ~ 0 - - /cdc -- 4. ~ 0 /~¥~ ~ ~ ,~ - PERCOLATION RATE / f (minutes/inch) PERC HOLE DIAMETER __ PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUiDELiNES IN EFFE~tZON THIS DATE, DATE: if~ ~f t~ .-,?~,~- 72-008 (Re~_~.4~85) ~ MUNICIPALITY OF ANCHORAGE , I · 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 MAI LIN G A D DR ~.F~. j~) ~.~ ~,~ LOCAT,ON/d ~z INSTANCE TO: J w~ I Absorption area Uwellln. ~ ~ Manufacturer ~ ~ Material~[~~/ No. of c~a~ments~_ Liq. ~t~in gallons IF HOMEMADE: Inside length Width Liquid ~pth ~ g DISTANCE TO: Well Dwelling PERMIT NO, O ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO, ~ ~ ~ No, of }ines Length of each line Total length of lines Trench width Distance between lines -- inches ~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area ~ inches Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Slass Depth Driller Distance to lot line PERMIT NO, ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER APPROVED ~) DATE LEGAL Vo 72-013 ~ /78) PERMIT NO. £4'LINICI~-'RLI T'Y i]F DEPRRTMENT OF HERLTH RND ENVIRONMENTRL PROTECTION 825 ~L~ STREET~ RNCHORRGE, RK. 9950± 2~4-4~20 ( 8000?8 ) _SE~.IER'. ~JPGRR[)E PEF:M I T 8PPLICBNT LOCBTION LEGRL SHBRON ROGERS 10214 MBIMTREE L 9 B ~ VBLLI VUE S. R. A. BOX ~2-R LOT SIZE ~49590~ 20000 SQUBRE FEET TYPE OF SOIL RBSORPTION SYSTEM IS: DRBINFIELD MRXIMUM NUMBER OF BEDROOMS = 4 SOIL RRTING (SQ FT?BR)= i00 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: ~~lI WF IELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFRCE OF THE GROUND 8ND THE BOTTOM OF THE E)KC8V8TION (IN FEET). THE TRE~qC:H ~.-I I C. TH I S Et OE~E~ FEET'. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION ,-'.IN FEET). F~ E,~ Li I E:ED SEP'T I F:_. TF~-~}( S I ZE= -J0~u~LLOt~_~ -' -- - ':- PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. T~C, (2) IF~-~PEC:TIC~$ RRE RE~.L"IRE[) BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS t00 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEEl' RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. F'EF-.I"I I T' E>(F" I F-:ES [:,EC:E~iBER 3~L.. :lL98L--~ I CERTIFY THRT t: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH B'Y THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTBLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~:: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM WRY REQUIRE ENLFIRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. , ............... ANCHORASE AREA BOi J6H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ('~(')~?~j¢~ /'~'(~'~ MAILING ADDRESS~"~'~P~ '~C).'~ ~'1'0 2~'7 PHONE,:::~-~-/ ~ (~"~-"/q LOCATION /~").,Z~//~-~'-~.L-~,: -,/)/ZI~C~ LEGAL DESCRIPTION /~7- () ,~L~ ~'_~ ~,]/~'/~/' ~,~ "£/~2~ SEPTIC TANK: DISTANCE FROM WELL['"~))/2~"~ MANUFACTURER INSIDE LENGTH '--~- INSIDE WIDTH MATERIAL NUMBER OF COMPARTMENTS LIQUID DEPTH --- LIQUID CAPACITY /' OD ~ GALLONS. SEEPAGE PIT: NUMBER Of PITS / DIAMETER --- OR WIDTH ~c). LENGTIZl LINING MATERIAL~L~/~'!~- ~--((¢ /~)¥?~RIB SIZE: DIAMETER z~' DEPTH ~ DISTANCE FROM: WELL ~:.977~J¢~-? . BUILDING FOUNDATION~?,~l/ NEAREST LOT LINE ':'~') ! TOTAL EFFECTIVE - , ABSORPTION AREA (WALL AREA) ~-~ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ~/~/]/~))/~..J.L.~L, CONSTRUCTION .~./~t-L-/~-Z~/ DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION __ LOT LINE SEWER LINE TANK SYSTEM OTHER SOURCES DISAPPROVED REMARKS CESSPOOL APPROVED DISTANCES: ~d ,/~¢,/~-~.~_1~ DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. ED-031 DATE ti/zfl / 7z/' APPROVED G.A.A.B. GREATER ANCHORAGE AREA BOROUGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION LOCATION PHONE LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK / TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS /~'~'~//L~f~ COMPLETION DATE ANTICIPATED TO BE NSTALLED BY .~/~'X~ NOTe~ THIS PERMIT IS NOT VALID WITHOUT FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL ]BE SUBJECT TO PROSECUTION, SEPTIC TANK $1ZE~J~[:~ -~:~ TYPE MINIMUM DISTANCES, REQUIREMENT~ FOUNDATION TO SEEPAGE Pit ~ , DRAIN FIELD SEPTIC TANK TO SEEPAGE P~T WALL ~ ~'~ / sePTiC TANK ~/ _, SEEPAGE PITj~2 : ., DRAIN field WATER MAiN TO SEPTIC TANK /~ : , SEEPAge PIT SEPTIC TANK,/~ SEEPAOE Pi , DRAIN FIELD SEEPAGE AREA SIZE TYPE DIAGRAM OF SYSTEM I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-6E AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, DATE APPLICANT'S SIGNATURE > . Performed Legal Descrintion: This Form "On~ t~t i~ ~orth a thousand op n s For Glacier Excavating Date Performed Lot 9 Bl,ock 3 Subdivision Valley View Renorts Soils Lo~ YES 10/26/74 Percolation'Test Perth 2 3 4-- 5-- 6-- 9-- lO-- Was I¢ Yes, Soil Characteristics Seepage pit inlet (actual) (9 ft. rings) Silty Sandy Gravel F1 - F2 Bottom of test hole Ground Water Encountered? At what Depth? NO · i i ' [ I Readinq Date Gross Time Net Time Depth to H20 Net Dron Percolation Rate Uinute Proposed Inst~llation: Seeoaae Pit Yes Drain Field Deoth of Inlet Dep%h To Bottom Of Pit Or CAM!AENTS: 2~0 sq. ft. drainage area required per bedroom no bedrock or water table 4 ft below ring Trench Test Performed By Jim Mack _ Data Certified. Bg:C°nstructi°n_ =:,--x-r,-~T Test Monitoring Summary for Va~.,1~. vue 8lb Waeer 8yseem (2'10605) December 3, 1998 Total Coliform Bacteria ~8x~c8o.6o5 Quarterly 10-16-98 By March 1999 Old Regulated lnorganics (orse,,~c,~ ..... 1 staple per cycle2 08-13-92 Between 01/01/2002 cadm~u,,, chromium, fluoride, ,heretic sele,,i,,n) No WZ~*r 1 sample per period~ and 12/31/2010 Phase Vlnorganics (a,,a,no~y, bestti~,,,,, O'a,ade. 1 sample per period 04-16-98 Between 01/01/99 nickel, thallium) 18~C80.201(c) ~ORG2'036 / 01-01-93 and 12/31/2001 Nitrate ~mcso. 2o~(d) Annually 04-16-98 Before 12/31/99 > u2 ~ Quarterly Nitrite 18~c8o.2o1(e) 1 sample in first period 06-03-96 None Gross Alpha Radiation~ ~c8o. 2oo Table B Qumterly for one year, then once every 4 Last sample 02-04-96 Single s~ple will ~ requk~ ~fore Ye~s 03-01-2000 Volatile Organics ~8~c~a2o~ Annual for 3 years then once period. 02-08~96 Before 12/31/99 Lead and Copper~ ~8~c~o.~5o Eve~ 6 Months 07-01-98 Next sample set due Annually between June 2001 Every 3 years and September 2001 Sanita~ Sumey 18~C 80.625 Sanit~y Survey every 5 years from last 09-12-96 Before 10-01-2001 surve7 date Pesticides & Other Organics ~t~ ~ no testing Waiver approved for Waiver should be 18~c8o.2o2 w/ow~ver Qu~terly starting in 1995 1996-1998 period applied for 1999- 2001period when available frown ADEC. Asbestos ~8~c8a2o~(~ ~ ~r no testing Waiver approved for Apply for waiver ~o,~ 1 sample by Dec 95. 1993-2001 period after 12/31/2001. ~ The periods are three years in length and start in 1993. The periods are I/1/93 to 12/31/95, 1/1/96 to 12/31/98, 1/1/99 to 12/31/2001, etc. 2 3'ne cycles are nine years in length m~d start in 1993. The current cycle is from 1/1/93 to 12/31/2001 ~ In the first round of testing four consecutive quarters must be co~ected. The four samples con be saved in a refrigerator and combined into a single sample for analysis. After the initial round of testing, a single sample is required every foul- years. 4TheLeadand Copper rulerequiresidentificationofworst case sample sites and collection andtesfingof5, 10, or 20first draw samples (depending on population served). Different from the other testing is a requirement for the water supplier to fill out data forms and submit them to the State. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Se 'wces On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# ~"~/',Z')- '~L~/-~-~'L~ HAA# ~[-~-~O~( 1. GENERAL INFORMATION Complete legal description Location (site address or directions) ! /'_'~ ~'~ ~ .z:~.. ~/~. ~/,.-) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. ~NUMBER OF BEDROOMS: "~ TYPE OF WATER SUPPLY: NOTE: TYPE OF WASTEWATER DISPOSAL: NOTE: Individual well Community well /'~ Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25 (Rey. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and aS of the validation date shown below~ I verify that my investigation of this Health Authority Approval application shows that the On-site water sUpPly and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm J~/~C-~ .~/~z~,~'~.~ J/~, Phone Engineer's sig natur~~~~ Date Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based on~y upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~)'25 (Rev. 1/91) Back MOA ~1 MuniciPality of Anchorage /.~.~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 34~.~7C4~ I V E 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) DEC 07 1998 Health Authority Approval Checklist Legal Description: L~ ¢~ -~J- ~2 ~/rogi'j/~ ~CJ~-- ~/:~,?/C-.~Parcel I.D.: A. WELL DATA Well type ~::~J~,C/U'/.C/~)/'~If/-/A, B. or C, attach ADEC letter. ADEC water system number MuNICiPALITY O1: ANCHORAGE ENVIRONMENTAl- SERVICES DIVISION Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static waterlevel Well production WATER SAMPLE RESULTS: Coliform g.p.m, g.p.m. Nitrate Other bacteria Date of. sample: Collected by: B1 SEPTIC/HO LDING T. ANKDATA Date installed // 13,-~Tanksize ~OOO NumberofCompa~ments~Cleano,ts~/N) ~ Foundation cleanout ~/N) ~ Depre~ion ~/N) ~/ High water alarm ~/N) Dateof Pumping ~ ')~ ~ Pumper ~-" C. ABSORPTION FIELD DATA Date installed / O -~7_~.~)"?'~ r'~¢ Soil rating~ (g.p.d./~ or ~d~) J 2~ /''3, System ~pe --~~ ~/~¢ Lenmh ~?/ Widthj '~ C~/¢ (~ravel thickne~ below pipe '¢' Total depth //' Effe~ive~so~onarea ~0~ MonitofingTubopresent~) ~ Deprossionoverfield~) ~ Date of adequacy test ~0¢ /?~esults(Pq~¢ail) F~ For ~ .bedro~s / ~ ~ t' ~ Fluid depth ~, ~ (ins) Minutes later: ~ ~ Abso~tion rate = ~ ~ ) g.pld. Peroxide treatment (past 12 months) ~) ~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed >'"--, ,~f-Si~ in gallons Manhole/Access (Y/N) ~n" level at* High water a~ at* Datum "Pump off" level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~ On adjacent lots Absorption field on lot '-. J On adjacent lots Public sewer main ~'-~.. Public sewer manhole/cleanout Sewer/septi SO'device line ~-- Lift station SEPARATION DISTANCES FROM SE'PTIO/HOLDING TANK ON LOTTO: Foundation 7 Property line '~--.~-~ Absorption field Water main/service line ! '~ Z~::~ ( ~Jurface water/drainage /~0~//CWellson adjacentlots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line //(¢'?f Building foundation (~ / (' Water main/service line Sudace water /'~) E2'¢~ '~-'' Driveway, parking/vehicle storage area ,-/O Curtain drain /¥/G2 ~-~ ~',/~C~__.~/? Wells on adjacent lots ~ (~,~.~/~"'~/,~Z?~Y F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that the in conformance with MOA HAA g~u~delin~s?n effect on this date. Date J ~-- '--' HAA Fee $ Date of Payment /-~/~/¢ Z Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONE/IENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264;4720 Application Date GENERAL INFORMATION (a) Legal Description (include, lot, block, subdivision, section, township, range) Location (address or directions) (b) App]icantName ,/~/>~'b ~¢'X-¢~'~' Telephone:Home F~-,,-~=7 Business (c) Applicant is (check one): Le~ding Institution []; Owner/builder I~; Buyer []; Other [] (explain); (d) Lendinglnstitution t-'~' ¢2 ~L~'~'~ ~'~*~' Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the followin~d~: ~_ TYPE OF RESIDENCE Single-Family~Multi-Family [] Number of Bedrooms ~'/ Other WATER SUPPLY y~PPu Individual Well [] Communit blic [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL · Onsit.,e,~Public [] Community [] Holding Tank [] Note: if community well system, m~st have written confirmation from the State Departmen[ of Environmental Conservation attesting to the legality and status. 72-025 '11/84] Page 1 of 2 "5. 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 shews that the on-s te water supply and/or wastewater disposal system is safe functional arfd ad~,quate for the number of bedrooms and type of structure indicated herein. I further vedfy that based on the information obt~'ined 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. NameofFirm /~-~/~ .~ Telephone ,~~('~5-~c/'<~ Address /¢-'2.¢"~ ~ ~ ~ ~c~¢~ ~ Date /~ ~-¢% DHEP APPROVAL ~, ,Approved for, bedroomsby Date Approved . /~ .' ! Disapproved Conditional Terms of Conditi'onal AD'l~o~al 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 purchasers 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 (1 ~/84} WELL DATA MUNIC]PAUTY OF ANCHORAG,5 ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (NAA) ,~'-; ~ ,~ Ig8~! CHECKLIST - FEBRUARY 1984 Legal Description: ~/~ Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absor To Nearest Public Sewe Cleanout/Manhole Water Sample Collected by Water Sample Date Completed Depth of Grouting Pun" lf~A, B, C, D.E.C. Approve(~) Sanitar on Casing (Y/N) n Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~/'-.2-.~- ~ Standpipes~N) Depression over Tank (Y('N~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~T To Property Line ~" To Water Main/Service Line ("~ T Course ~- Size No. of Compartments Air-tight CapstaN) Foundation Cleanout (Y/~ Date Last Pumped /(~' ~"~"~ ; for Temporary Holding Tank Permit (Y/N) ! To Building Foundation To Disposal Field /~' To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/S4) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Z/- ~e~t~ J Width of Field ' °0-5- Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~'~ ¢~.d~ To Building Foundation Lot TO To Water Main/Service Line f Depth of Field Gravel Bed Thickness -~--~'~ ~4~ Standpipes Presen (t~N) Date of Last Adequacy Test /~ r To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~'~- (f To Cutbank (if present) ,,'~//'""¢ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions ~ Pumping Cycles during Adequacy Test. Meets MOA 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 the date of this inspection. Signed ~ ~ Date Receipt No. Date of Payment Amount: $ ineer's Seal Page 2 of 2 72-026 (11/84) 'ALASKA IIUIBO[/mE[1TAL CO[1T[ OL ~n§in¢¢rin§ ~, ~nuironmCdrJI Slu~i~s S Bu E $, IFIC. MARIA SORDELLI 10214 MAIN TREE ANCHORAGE ALASKA 99516 SELLER-MARIA SORDELLI MARIA SORDELLI 10214 MAIN TREE ANCHORAGE ALASKA 99516 tO/lO/85 50689 LEGAL:VALLI VUE ESTATES BLOCK 3 LOT 9 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-10/08/85 THE TYPE OF ABSORPTION SYSTEM IS A CRIB-~ITH AN AREA OF 792 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTIN~50~LLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM 1~0 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 4 BEDROOMS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1500 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. -' THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ,ON 10/4/85 1200 LUcsl 33r(l Auenue, Sui]e B · J~nchore% Alosko 99503,(907) 561-5040 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE ¢37 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 ,%. BILL .SHEFFIELD, GOVERNC~ Telephone: (907) Addre~: 274-2533 ~,ws I.D.~ oJ/C)~05~ According to records on file in this office the ~~ Water System is in compliance with the Stale Drinking Water Regulations Sincerely, · · DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE ~ ~ NSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE D~.P,, OF I:~,,L;;! & t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOF~VIkOj~M~i~1,':~L ?..~:i'~CTION 2 8 t980 ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES 3. LENDING INSTITUTION. .' /,~::, 1 PHONE STREET LOCATION 6. TYPE OF RESIDENCE [~ SINGLE FAMILY ~ MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One ~ Four [] Two [] Five [] Three [] Six [] Other 7, WATER SUPPLY [] I NDIVI DUAL' * 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 ~ INDIVIDUAL/ON-SITE** ~'~,;~:L~ .YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 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 UTI LITY Connection Verified__ LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLICUTILITY / /~ ~ Connection Verified. iNSTALLER Size: ~ -- If Tank is homemade SOILS RATING give dimensions: ~:~ ~)' O TOTAL ABSORPTION AREA MATERIAL (~ [ 4, DISTANCES Septic/Holding Tank Absorption Area IBewer Line Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS ~'/~PPROVED FOR ,~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) REID ENVIRONMENTAL ENGINEERING SRA BOX 1584R ANCHORAGE, ALASKA 99507 (907) 344-1205 276-:1.361 AF'RZL 8 1980 SHARON RO[.~ERS SRA E:OX 32X ANCHORAGE At-( 991507 SAME S UE~:DZ Vi[Si[ON..-V ALIi VUE E:L.OCK-.3 LOT-? THE; 'I'YPE OF AE:SORi~:T;[ON SYS'¥EH ~S A t::';~T NL~TH AN AREA OF 792 SQFT, 'I'HE QUANTITY OF HATER AE:SORE:EED DLJI:~ZNG THE TEST WAS 360 GALLONS+ THE S(]ZL.S RAT];NG OF THE SYSTEH AT CONSTRUCT~;ON NAS 250 AND NON ]ZS 9~ SQF'T/ THE R[EQUZRED AREA FOR Afl EiEDROOH HOUSE IlS 376 SQI::'T. THZS HC)HE HAS 792 EIASED UPON THE TEST DATA THE SYSTEM ~S ACCEPTAE:LE FOR A -/O - ~//?/ o~ ' o' . ~ e:: ~~~..~:~~ . I hereby certify that I have surveyed the following described property: /_,/)7- c~. /=.?/.fJ~'f/15 ,-~/ Anchorage Recd~ding Precinct, ~aska, and that the improvements situaled thereon are within the properw Iines and do no% overlap or encroach on the proper~y lying adjacent thereto, that no improvements on prop- erty lying adjacen~ thereto encroach on ~he premises in ~uestion and that there are no ~'oadways, transmission hnes or ether visible easements on said property except as indicated hereon. ~ Dated at Anchorage, Alaska FRED W~AT~ & ASSOCIA~S Engineers and Surveyors