The URL can be used to link to this page

Home My WebLink AboutVALLI VUE ESTATES #2 BLK 3 LT 16 Onsite File Valli Vue Estates # 2 Block 3 Lot 16 #015 - 341 - 17 81 ,.� OCT 9& 9nio Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181211 PID Number: 015-341-17 ❑ New ✓❑ Upgrade Name: BREKENRIDGE PROPERTY ABSORPTION FIELD ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 6463 LONE TREE DRIVE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.8GPD/SF 13.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6.0 Ft. Gravel depth beneath pipe 7.0 Ft. Subdivision Block Lot VALLI VUE ESTATES #2 3 16 Fill added above original grade 0.0 Ft. Gravel length 54.0 Ft. Township Range Section Gravel width 2.5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 756 Ft2 1 Ft. Well N/A N/A N/A N/A N/A TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1250Gal. Surface water 100+ 100+ N/A I N/A Material Number of compartments Lot Line 38.6 24.3 N/A N/A STEEL 2 NA Foundation 19.4 25.6 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ 50+ N/A N/A Gal. Remarks Pump on level at Pump off level a in. High water alarm at in. model rPIPEMATERIAL Electrical Inspections performed by Installer House to tank 3034 Tank to 3034 drainlield DAN BEEK Drainfield 3034 CO/MT 3034 Inspector PANNONE ENGINEERING SERVICES BENCH MARK (Assumed elevation) 556.Oft Inspectiona q�' g/19/2018 � dates: 2 8/20/18 Location and description 3`' 8/20/18 4"' 10/19/18 NW BOTTOM OUSE TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF At.�45�� Conditional Approval: Date ��G 0 Steven 'PiIn 'ie� Approved Date �� i� CE 8149 �>��PRO ptJA,� inspection Keport_i-i-iz.doc PRIMARY` DESIGN PARAMETERS NO. BEDROOM: 4(600 gpd) TANK SIZE: 1250g PERC RATE: 3.6 MPI (USE 6-15MPI) SOIL RATING: 0.8 GPD/SF \ / �/ 1 7 AREA ROD: 750 SF SYS. TYPE: DEEP TRENCH 7.0'ED MIN LENGTH: 53.6 LF J USED: x2.5'Wx7.0' E.D.. 13.0' TO \ \ SUBDIVISION TOTAL AREA: 756 SF / SERVED BY PWS / 0 z INSTALLED ABSORPTION FIELD 54LFx2.5'Wx7.O E.D.,13.0 T.D. W/ COs & MTs ENDS OF FIELD mm �- ®® llll_ 0 '— 0 ® wl• ;; _. IN ROCK ~ cc 0 ABOVE PIPE z wZ z INV ®mw- • �_ m z z w o v o f EXISTING DRAIN FIELD / ABANDONED IN PLACE— / — ' -�71 \ / / O �. 556 556 /� / / Q 560 1 / ABANDONED 1250G I / SEPTIC TANK(E) / (/ PER MOA CODE / INSTALLED 1250G( SEPTIC TANK W/ DCO (10'+ FROM FOUNDATION, 4 I / 5'+ FROM DECK SUPPORTS) z �- 1- m 0 0 '— 0 2) o :D7 O IN ROCK ~ cc 0 ABOVE PIPE z wZ z INV z m z z w o v o f u M 4" 0 RAIN PIPE n OG.FG. 556.0 n o" nn n n OG.FG. FILTER FABRIC 556.0 ( n �. 1250 g SEPTIC I CONNECT TANK TO MIDDLE LOFFIELD PROFILE SCALE: NTS NOTES: RECORD DRAWING 7.0' DRAIN ROCK PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 VALLI VUE ESTATES #2 B3 L16 BREKENRIDGE PROPERTY FUND DRAWN ACP 6463 LONE TREE DRIVE ANCHORAGE, AK c MT w , OR OPSOIL x SM s e GM e SAND & GRAVEL e 0 DRY: 7/15/18 u u ,e to DATE PERFORMED: 25,UN18 Dote 5/20/19 Scole 1"=50' P.I.D. NO —17 PERMIT NO. OSP181211 Sheet 2OF2 ` I 1 � c I -LOT 16 ✓r�'\= �� ,/ IV !y1 %i C Zoe e /fCii. Ole i NOTES _. tear[ngs ano cis za ncc..a re re co, al ._. , cic. ,_moi} o!cZ utit�_.� 0U.e-72v 1`? no i_,.. _. Suff,cienz JCundary evidence .vas r-ecov-ered io esLa Olisli the Subject parcel cn _ controiHnE -evidence > =' nereor,. t� "�FESSIONAt��-� Farpyint hand Services, LLC LEGE,VD SURVEYING, MAPPING, LAND PLANNING, GIS 1 1 ^ 1 F. 76th Ave., 5u{te 10 1 Anchorage, Alaska 99516 - "'"° Farpoir.tAK.com • (907) 522-7770 a survey@farpoir.cak.com ASBUILT SURVEY OF:JL ( i �! N: ?pr r,;- ,C7/r- �lii'i{_." i� l [' Ras f4;'L?(. Li ,G. Lot 16. Block'). Valli VieXV SUbdivisioii, T sUr ey of t sul procerzy,he imoro, - nt __.a—' __ Plat No. 77-296 _ Anchonne. Alaska -_ L� CSL�.`icc Cf a easemcc:� C?:+cnants, or t�Stf±Ct � � � i.ie` t 'JtI Vat F. JR'vtR I�:C� ^ -E: Augu- 201S: r.:r c 18091 ,D iviE 2 3 -1739 5?, 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 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP181211 Work Type: Septic Upgrade Tax Code Number: 01534117000 Site Legal Address: VALLI VUE ESTATES #2 BLK 3 LT 16 G:2538 Site Mailing Address: 6463 LONE TREE CIR, Anchorage Owner: CHAMPERY REAL ESTATE 2015 LLC Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: De Ilia 1't1l)(.11 7/31/2018 7/31/2019 20914 Q 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 Special Provisions: 1. A portion of the proposed drainfield is not within a 30 ft radius of a An additional-pefe test Inose. shall be completed, in location shown on site plan, prior to construction of the drainfield. Please submit stamped and signed results with the inspection report. t fo cAn�'; r % ()e k r k oa,n,a Soras eN -fz rbW1c1W��" + �. The drainfield is being installed perpendicular to the slope. The maximum excavation depth shall not exceed �p�� CF 13 ft at any point along the drainfield unless a deeper test hole is provided. -1"'' 1 C 1 g/ 1 3) co(� 13 8) , V)r I aj_A �b UJA � o �vl U� 1'1 (co 0 Received By.� QO v Issued By: �Z?t'Vl Date: 9) lin % e Date: % 31 ePlAWS MUNICIPALITY OF ANCHORAGE Community Development Department ',,:_i'''';' r Phone: 907-343-7904 Development Services Division � Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-341-17 Property owner(s) CHAMPERY REAL ESTATE 2015 LLC Day phone Mailing address 2015 MANHATTAN BEACH RD #100, REDONDO BEACH, CA 90278 Site address 6463 LONE TREE CIRCLE Legal description (Sub'd., Block & Lot) VALLI VUE ESTATES #2 B3 L16 Legal description (Township, Range & Section) Lot Size 20,194 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X Septic Tank 0UP9rade 0 (w/wo ADU) Holding Tank ElRenewal Duplex (D) ❑ ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ 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. ilk • , 0 14. ,„bi I O /-- (Signat - of prop- , owner or authorize. agen. Permit/Rush Fees: 50 Waiver Fees: Date of Payment: 112ofri Date of Payment: Receipt Number: 036 Receipt Number: Permit No. 03P1 21211 Waiver No. Permit App_:-:• ::..,c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181211, Rebecca Carroll, 07/31/18 ". = L= ��^^°". �" o�uL *nwsy�asao �a� �/s JSmamO8 V38V S31---- oaVlgL-93sn//aV4er;31V,\J083a ma (naamm)v'woouoao nw -- — 'O/~ 310H iSR Hi or Smvu.x3J99. � / / / / / / [ / ` \/ [ [ / / mm0�/ ". = L= ��^^°". �" o�uL *nwsy�asao �a� �/s JSmamO8 V38V S31---- oaVlgL-93sn//aV4er;31V,\J083a ma (naamm)v'woouoao nw or ". = L= ��^^°". �" o�uL *nwsy�asao �a� �/s JSmamO8 V38V S31---- oaVlgL-93sn//aV4er;31V,\J083a ma (naamm)v'woouoao nw ~ MUNICIPALITY OF ANCHORAGE DE 71TMENT OF HEALTH AND HUMAN SER .ES {" Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Add~es~ -' ' [ t '-- ,, --. ~ SEPTIC ABSORPTION Phone(s) Permit NO. No. of Bedrooms WELL L~^L OES¢.,..,O. LOT LINE FOUNDATION Township, Range, Section TANKS M-~nutac[urer Capacdy m gallons Depth [o p~pe bottom Irom Total depth [rom original 9rede pklI added above on~nal grad~ G~avel depth beneath p~pe ~ 7~0 SO FT ~/~ FT WELLS ~ PRIVATE ~ OTHER ddentifvl C~assd~c~hon (A.B,C) ~otal Depth ET Cased to FT [ REMARKS: Uunicipal an~ 8tale guidelines in ellect on this date: ~ ~ ~ ~ ~ ~G, Health Depadmeat Approval: Date:// , MUNICIPALHY OF ANOHO.~AGE DEPT. OF HEALTH & ENViRONMiNTAL PROTECTION f4q¥ 61986 REICEIVED Consulting Engineers & Testing A.W. Murfitt ALLAN MURFITT, P.E. 13810 Venus Way · Anchorage, Alaska 99515 Telephone (907) 34%7531 AIIon W. Mur No. 49T/-E DEF:'AR'I'MEI"TF 0.,'::' HEALTH AND EB.IVIROI".!MEF~TAL PROTEC'T~ION 8~:~5 L S'TREET, ANCHk]RAGE, AK 99501 26.~'-"4720 B6()380 t..JF:'(:)RADE .~',,~ ~'.'.~',~"' 10/OS/'SE) COHTACT r'rK. ~41::.,. HOME: I:E[~LJ!T'Y / A.W. MURF]:'TI' ].300 POST OAK RiO. SUITE 95('.) t'ICitJSTON ~ TX '7'7056 349 -'? '53 LEGAl. DESCRIP: ',GU~.¢DiVISi[E)N'.' VAL. L..I VUE EST,. L.(]T: 16 BL..E}CK: 3 SECTION: 14 '['OWNSHIiP: :!.2N RANGE; 3W !.0'I SIZE~ 0.7~:~A (SQ.F'T. OR ACRES) Il'::' A l.._ :t: l::: '] :, · ~ )'~ ].~.',') :[NS'I"At..LED IN AI",I ,--',E.,- C.O....I~E,~. BY MOA BIJILDi[NG CODES, il'il:.t'i(~,) AN EL,IEC'FR]:CAI... F'EF:';.'I'II'T ~..,.,ID TI'JSPECTION MUST Jut- OBTA]:NIED~ (2) Ab--"~.I,_d. LTS WILl,.. I,~.), :E~E HFt--~d._,v~::D WI"t'!-~,OUT AN I:.L.l:..., I1:* C.-I ZN,"3PI!ECTIQN RE,,F L.~r~ I , AND ¢3) I r.l[. i::,L..I:::,.,I,~,!.L,AI.. ,.4LIRK ~ .~::I[:. L4._l~,lc. )~,, A APF:'I ....... [ ' Al'IT ~ ti ')['.1l:::' F:(]~UZ'fY / A. I.,,I ~F'. :1: T T. ....z .'.7~...G/ z~,¢~ ~1,'~.~,,¢,,~, ~,., -,~,,~,'. ~ ~ --,r ' ~/~,.,'?,',.,,,Z¢,~. ~,., ..... ~ ..... .. ~ ___ , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST 'g]x SOILS LOG [] PERCOLATION TEST 3 4 .~-5 6 7 8 9 10 11 ~:12 PERFORMED FOR: ~(~(~ ~(~[.~ ~Tt~ ~ I.~OO 11:~' 0~[~ ~D;~O DATE PERFORMED: ~G~, ~G~ ~, . SLOPE SITE PLAN I- -'"'I WAS GROUND WATER ENCOUNTERED? ~Jo E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop 18 20 '~:~'~:'~ PE RCO LAT,O N R ATE UJ,~-' ~(~ ~-/J~l/'~'("m i n u ' e s / i n c h ) O ~)~¥~gi~A~ D TEST RUN BE~EEN ~ FT AND J~ FT ~ ~ . I O '>, ' '. He~ ..MUNICIPALITY OF ANCHOR~G.. h and Environmental Prote/-~on Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 SEPTIC TANK: DISTANCE /~ FROM WEI'L~¢~/-~/~ -- MANUFACTURER ~'~-~-~.. MATERIAL NSIDE LENGIH___ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM INSIDE WIDTH _ LIQUID DEPTH NUMBE~ OF ~.~ COMPARTMENTS--~ L,QU,D C A~AC,TY/"~--Z--~qALLON S. ~ '~"/ LINE ..~ _??_. OF LINE DISTANCE [:REM WELL ~.~//~OUNDATION ¥.~'~_ _NEAREST LOT ~ of L~nes --/ ___DISTANCE BETWEEN LINES ~/~ TRENCH WIDTF~IN. TOTAL EFFECTIVE ABSORPTION AREA mO SQ. FT. LENGTH OF EACH LINE ___ OEP'[ri TOP OF TILE TO FINISH GRADE_{~ MATERIAL BENEATtt TIL6 .~ABOVE TILE_ IN. SEEPAGE, PIT: DIAMETER __OR WIDTH ., EENGI'H ,~ DEPTH ......... Log Crib Rings BUlL. DING' FODNDATION ._ , Crib Size: DIAMETER _DEPYH ,_ DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE. ABSORPTION'A~EA (WALL AREA) .._SQ. FT, Well Class:~ Depth: Well Distance To: Lot Line Bldg: ~ew~r Line: Pipe Materials: ~F6 ~,_~--~ ~. # of Bedrooms: ~Ins~ller~ _~j~~, Remarks: ~q_~>~ "One ter~ t~ ,a,or~h a ~,housand opinions" 2204 Cleveland Anchorage, Alaska 99503 Performed For T_i_m_her Enterprises 0ate Performed 7-2]-77 renal ~escriDti0n: kot ]6 810ck 3 SubdivisionVallivue Estates This ~orm Renorts Soils Loo Yes '- Percolation Test nenth Feet Soil Characteristics 8-- Slightly Silty Sand l0- (SM-S ) 14-- . 16 18-- Bottom of test bole Was fround Water Encountered? No Ie Yes, At what Denth? Readinq Date Gross Time Net Time Depth to H20 Net Dron Percolatin.n Rate ~ti nute Proposed Installation: Seenaoe Pit Drain Field Den. th of Inlet Depth To Bottom Of Pit Or Trench Cn~ENTS: 150 SC~ Ft..d__r_a__in~a~.e area req~u_i..r_~.~per bedroom. Test Performed By ~-~..~ Data Certified B~CONS~TION ~EST L~B ..... LgAVi-~-P~ u'I Date: 7-21-77 P1A 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/ Q �'1 Parcel I.D. 015-341-17 Expiration Date: [ —2O Z C/ 1. GENERAL INFORMATION Complete legal description Valli Vue Estates #2 B3 L16 Location (site address) 6463 Lone Tree Drive Current property owner(s) Champery Real Estate 2015 LLC Day phone Mailing address 2015 Manhattan Beach Blvd #100 Redondo Beach CA 90278 Real estate agent Day phone 2. TYPE OF DWELLING: Single Family(w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ 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 $ 55O Waiver Fee $ Date of Payment 5 /3R/rq Date of Payment Receipt Number Oi3Z036 Receipt Number COSA# 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. In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water 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 system.All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date //67,5-2-1 6. DSD SIGNATURE *:•49I1!•••• 1- System #1 Approved for bedrooms •'$2even• R ann e • System #2 Approved for bedrooms ��, :• • CE 8149 Disapproved � ci Conditional approval for bedrooms, with the following stipulations: ‘ P\Z`�(�tOFf f f 4,;(o, J2 ON-SITE m% WATER AND WASTEWATER oz PROGRAM � 71))))))))))110 By: r Original Certificate Date: Co--7--f(/ 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 COSA Checklist Legal Description: Valli Vue Estates #2 B3 L16 Parcel ID: 015-341-17 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled Water storage tank volume gallons Total depth ft Well disinfected for coliform test? ❑Yes ❑No Cased to ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) in. Collected by Date of flow test for COSA Date of Sample Static water level at beginning of test ft. Comments Public Water System B. TANK DATA C. LIFT STATION Age of tank(s) <1 years ❑ Required maintenance completed Tank type/material s`°"'S"' Age of lift station years Measured operating fluid level in septic tank 48" Lift station material ❑Q Standpipes/foundation cleanout per record drawing Comments: Date of pumping D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 812°/18 Adequacy test date n/a ❑■ ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 13 ft(max) Fluid depth prior to test in Measured depth to pipe invert from grade 6.0 ft(min) Water added gal ❑ N/A— pressurized field New depth in 0 Monitor tubes go to bottom of effective. If not, state Elapsed time min depth into effective 0Code-required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies:New System Less than one year old COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout >900'---- —* 0 Yes if No ft _-----DYes if No ft Neighboring Tank > 100' 0 Yes if No ft Private-Sewer/Septic Line > 25' ✓0 Yes if No ft Absorption Field on Lot> 100' 0 Yes if No : -• ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields.>-100` Animal Containment > 50' 0 Yes if No ft ------ ✓0 Yes if No ft �__–r`yManure/Animal Excreta Storage > 100' Co pity Sewer Main > 75' 0 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' 0 Yes if No ft Surface Water> 100' 0 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' 0Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' ✓0 Yes if No ft Water Service Line > 10' 0 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' D Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells >200' 0 Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION ��OF A�4 kik ,n,SNP;.• ',certify that/have determined through field inspections and review �°c0. – 9 If of Municipal records that the above systems are in conformance with *• '•7H- •*Tr/ MOA COSA guidelines in effect on this date. /c/?:s7-?2? j s a ; h. rr.;jia r COSA Checklist yellow sheet Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street 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. 015-341-17 HAA# Expiration Date: 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Lot 16, Block 3 Valli Vue E~a~ #2 6463 Lone Tree Cir o lo Zqo cj _ II- CurTent Property owner(s) Peter Flones Day phone Unknown Mailing address 6463 Lone Tree Circle, Anchorage, AK 99516 Lending agency Day phone Mailing address · Real Estate Agent Mailing Address U.S. Inspect Day phone 703-293-1499 3650 Concorde Pkwy~ Ste. 100~ Chantilly~ VA 20151-1129 Unless othenMse requested, HAA wfll be held by DHHS for pickup. HAA picked up by:. 2. NUMBER OF BEDROOMS: 4. 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. a 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 5 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) on properties sewed by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. 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 less than 30 days old. 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 e~TOrs or omissions in the professional engineer's work. 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 Health Authority Approval Guidelines for 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm .Pannone Eng. Svc. Phone 272-8218 Address_P.O. Box 1029541Anch~ AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date u ;~,~. ~')r:'tC~U In accoraance v. lth MOA/03D Guidelines & Regulations Thc rcp°rtcd z~'ttlt~ dca'ibc [he pcrforlllancc of the systcm tLndcr ibc condigo~ ~t,~ o, ;~ .;_ r we"s e-qa scpu¢ systcms ac~x~d on t~e local so~ condiQo~ gzound walc~ levels L~al may ~t~ _~.~ dura. g ae Year. and I~e wa~ usage of the family beiztg served by the ~,stem. Tb~se co~fi~ ~ _~-"/ 4~__TM outside t~c co~tzol o f Ihe evaluator o f this system. Ail systems ev~mallv ~ail a~cl saris*',,-*,,,, .,-... S'--:~-e,.~ .............. .~.....~ n°r give anY estimate ofhow long the systcm v. ill continu~ to meet ~e oocrational reaulr~t. ~r ,s. rc~uance up°n or u-~ ofthis report by ~y omer ix:~on or p:my is not au~odzed nor will it co~ ~v "~,gl~,,.s,,.v. 'r..~,,.~...' I~al tie. hr whatsoever -' 6. DSO SIGNATURE ~ Approved for l-iL bedrooms. Disapproved. Conditional approval for . bedrooms, with the followin~ stipulations: Additional Comments .. Attachments: HAA Checldist Septic System Advisory Well Flow Advisory Expiration Date: X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Reissue Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Waslewater Program 4700 South Bragaw Street "P.O. BOx 196650 Anchorage. AK 99519-6850 www.ct.anchorage.ak.us (907) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST · Legal Description: Lot t$, Block 3 Valli Vue ;__~_ les #2 Parcel I.D.: 01S-34t-17 A. WELL DATA Well type _A ~ If A, B, or C Ixovlde PWStD # Well Log Dat~ Sanitary seal Total depth ~ Cased to It ~b3gl~eight (a_b~.ve ground) __ Lin. .. FRO'~LL LOG ~ AT INSPECTION Dateoftest ' ' Static water level ~ -,~ It · Well production _J g.P.m~"'~ - . g.p.m WATER * . LTS: · B. SEPTIC/HOLDING TANK DATA ' ' ' ' ' · Tank Type/Material Greet' Steel Date installed 8111119?7 Tanksize 1260 gal Number of Compartments 3 .. Cleanouts Y Foundation deanout Y Depression over tank N High water alarm N Date of pumping ~' Pumper lsaa~:'l~ pumoinQ Date installed' 8~¶ t119:'r/ r soil rating (g.p.d./~ or fl2/txlrm) ~ : · , System type Tl~llch Length 46 & 66 It Win'th ~ It Gravel below pipe 1 ToMI depth t:~ ~ t~1 ff Effective absorption area 600 & 780 ft= Monitoring tube Y DepreSSion over field N Date of adequacy test III3012001 Results (Pass/Fail) pass For 4_ be~]rooms Fluid depth in absorp~m field before test 1~3 & 0 In Water addedl~O0 gal. Elapsed Time: t440 min Final fluid depth ID7 & ID in Any rejuvenation treatment (past i2 mo.) 0f/H & type) Ne New depthID?' & t9.5 in. Absorption rate >= 600 g.p.d. If yes, give date (Rev. 11,9)) Date installed S~ 'Pump on' level~~"~~...~er atarm level at. in Datum , ~ Cycles tested . Meets alarm &~ents? E. SEP~ANCES . . Absoq)tion field on lot Public sewer main ~~- Public sewer man~ ~~ce line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation, t6' Property line .40' Absorption field [20' Water main [25" Water service line. [25' Surface water 100'+ Drainage 1~0'+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ,, 20' Building foundation 42' Water main. 25'+ Water Service line [25'+ 8un'ace water, t00'+ Driveway, parking/vehicle storage 80' Curtain drain, t0~'+ Wells on adjacent lots 200'+ : · ~ t f /· ' - G. ENGINEER'S CERTIFICATION · rev~.w of Municipal record$ that the above sysfems are in ~. =y.~--"~f .... ~....~ conromlance wi~ MOA HAA gu/de//nes /n effect on this date. ~ ........... =~,~eers r-nme~ Name Stevert R, Pannone, P.E. HAA Fee $ ~ ~ Receipt Number ?7?? (Rev. 11/99) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date A~:>~'~'/~ l :lq GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) hoTl[,, /3K: V'A J_t tYv .gCC-iq/ Location (address or directions) property Owner ~-Iol,.!~- ~,..utt'"-/ Telephone: Home (b) Mailing Address (c) Lending Institution Mailing Address (d) (e) Business Telephone Real Estate Company and Agent "f ~t'.~ 'OZ,,/4 iT i~-; q,~-. ,j Address Telephone Mail the HAA to the followina address: or: Check here.~ if hold for pick up. List contact person and day phone number below. Number of Bedrooms WATER SUPPLY ,' [] Community,,l~' Public [] ' ' ' Individual Well Note: If community well system/must have written confirmation from the State Department of Environmental attesting to the legality and status. Conservation SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] / · Note:4f community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 tRey 8/861 Front NOI..Ln¥o ISUO!~!puoo IS^oJdd¥' leUO!l!puoo Jo suJJel pe^oJddss!(] ~ pe^o]dd¥ Xq suJooJpeq ~ JO1 pe^oJddv 'lYAOHdd¥ SHHQ '9 ,g WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Lega Descrpton L-o'F-]~,, ~1~'~ VALLI if~A, B, C, D.E.C. Approved (Y/N) / 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 Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) .'~ ~.~ o ; On Adjoining Lots "~ 2-0~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 1~.~' Standpipes (Y/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 ~ To Property Line .~ ~0 To Water Main/Service Line Size /¢~',-~- f-~ No. of Compartments Air-tight Caps (Y/N) y Foundation Cleanou,t (Y/N) Date Last Pumped t2Z/~, / ;for hZ//,'z~ Temporary Holding Tank Permit (Y/N) Course ~ o/,,/~- To Building Foundation !'7 To Disposal Field ,~'-~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72 026{11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: ? z.o o 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 Comments ~:',¢ .~. t ' ,&t/,,~44 ,~ ~"/¢c c m.4.¢..~ Type of System Design Length of Field ~'~'~ Depth of Field /~ Gr~vel Bed Thickness ~ Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line -> To Existing or Abandoned System on ; On Adjoining Lots ~ ~ To Cutbank (if present) LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA 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 the date of this inspection. Signed ~ Date Company MOA No. Receipt No. /'O Date of Payment Amount: $ Page 2 of 2 72-026 {11/84) Engineer's Seal 203 W. 15th AVE "C' SUITE 203 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: LOT 16, BLOCK 3, VALLIE VUE 6463 LONETREE CIRCLE HOME EQUITY SINGLE FAMILY, FOUR BEDROOMS CLASS A COMMUNITY SYSTEM FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. ABSORPTION SYSTEM: ~ ABSORPTION AREA: SOIL RATING: INSTALLATION DATE: ESTATE NOV. 1977 AND NOV 1986./ DATE OF PUMPING: APRIL 16, 1987. ISAACS PUMPING SERVICE. DATE OF TEST: OF N.E.W. ~RENCH IN NOVEMBER 1986.. TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED ON APRIL 1987. TA OUND FULL OF _L3~IU-LD. STANDPIPES TO BOT___Q~AND NEW TRENCH WERE DRY. T~TAL DEPTH STANDPIPES WERE FROM 12 FEET TO 15 FEET. NO TEST. RESIDENCE VACANT SINCE INSTALLATION 15, ALL OF TEST RESULT: THIS SYSTEM MEETS THE 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. '~ '~- DA~:~ RECEIVED INSPECTION APPOINTMENTS DATE DATE DATE ~ INSPECTOR I NSPECTQR INSPECTOR ) 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION ;JJi~ 9 1981 Telephone 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERg _[I 1) Duane OliYeI 344-4861~, SRA Box 36G, Anchorage, Ak 99507 PROPERTY RESIDENT II1 different from aBouel PHONE 2. BUYER PHONE I MAILING ADDRESS 4, REALTOR/AGENT [ PHONE Bonnie MehnerI 277-1553 MAILING ADDRESS Jack White Co~ 3201 C Street, Anchorage, Ak 99503 ~c[ ~ _ ! 2~ ~ ~ 5. LEGAL DESCRIPTION Lt 16, bik 3, Valli-Vue Subd # 2 STREET LOCATION 6463 Lone Tree Circle = 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [~ Four [] SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 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 ~ INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(Rev. 6/79) ~ ~_z~_~ __~.) 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 Conoection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~Septic Ta~Bn,k, or [] Holding Tank Size:_/,~. ~6~ If Tank is homemade SOILS RATING give dimensions: TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ' , PROVE[ FOR [~ CONDITIONAl APPROVAL {letter must ec~b~an~ certificetel 72-010 (Rev. 6/79)