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Home My WebLink AboutVALLI VUE ESTATES #2 BLK 3 LT 23Valli Vu stat s lock Lot 015-341 -10 PERMIT NO. FtPF'L i CRNI' Li_-iCR T 1 ON LEGAL ~C:P CONST DEPRRTMENT 0' HERLTH BND - , ~ , ' ' _ bN ¢ IRLNMEI4TML ~ 'TEFTI ]N 825 "'L" STREET., RNCHORRGE., RK. ~950! 264-4728 L23: B..]< ',,,'RLI ',.,'I_IE LOT SIZE '~99gg'~ =,,I_IH~E FEET T'¢F'E OF =-,UIL HE,=,uRFTION _,¢_,TEfl IS: TF. EN~H MRX, II',ILIM NUFIEER OF BEDR00HS = - ",:: S6! :t95 SOIL ~ HT I i',b FT,.'"BR ) = THE REOUIRED SIZE OF THE SF~IL MB_,ORFTION ~'r_,TEflI--,"-: [:'EF"-FH= t2 LEi'~t,..3TH= 4_c~- ,-' " ..--~F-:'R . EL [:,EPT~4I=.=. THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE ~N <IN FEET). THERE IS NO SET WIDTH FOR THE GRRVEL DEPTH IS THE MINIMUM Df ~F GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXt EET). ,]iRLL L731~S PERMIT RPPLICRNT HRS THE INSTRLLRTION INSPECTIONS OF NUMBER OF RESIDENCES BRCKFILLING OF RNY S'¢~TEM WI' [:,EF'RRTMENT WIL~ BE SI_~C:T T' MINIMUM DIS!RNC~ B~TWEE~R NE[ ±00 FEET FOR R FRI,/RTE [4~ UPON THE TYPE OF PUBLIC MINIMUM DISTRNCE FROM R [:'EF'RRTMENT [:,U,q:ING THE PF_FE~T~' FIN[:' THE RF.:E REa~Li I F-:E[) iTION RI'..ID RFFR_,HL THI_. ' ' 'FI~' ' - BY SEI.,.IRGE DI_,FI_I_,HL S',FSTEM IS FROM R FUE, LIL. WELL DEF'EN[:,ING R PRI',,,'RTE SEb~ER LINE IS '-'= ~ FEET RND TO R COMMUNITY SEWER LINE IS '75 FEET. OTHER REL';!LIIREI'IENTS i"i~LY. SPECIFIE:RTIONS RN[:' C:ON_'--iTRIJI_-:TION DIFIGRRi'IL-] RRE I --ERTIFT THHT \~'.,.__ -- ~ .~f kllTH'"'~HE~'UIREMENTS FOR ON'SI'rE SEWERS RND WELLS RS SET ::L: I RM FRMILIRF.: FORTH B'¢ THE MLINICIPFILIT'¢ OF%RNCHORRGE. 2: I WILL INSTRLL THE _,'.r_,TEM IN FICCOR[:,RNCE FILTH THE EO[E:,. Z.:: I UI'-.1DERSTRND THRT THE ON-SITE _,E~-qER _,~._,TEfl MR'-r' REG~UIRE ENLFIROEMENT IF THE RESIDENCE I=, REMODELED TO INCLUDE MORE THRN 4 E,E[ROOM-,. SIGNED: ........................................ -- - RPF'L I CFiNT H_.F F:aN'=,T ISSUED B'_ ---~ ................... [>f~TE . ","4. 0 ,~,~ S~_-.~..~?~s C-EPTH~ ~ LENOT~t= ~t~ ~RR~'EL DEPTH= ~ ~ : ~: : THE'-~,E~ OF ~ TRE~ ~ PIT IS~THE ~l~ ~ET[4E~ THE SU~F~ OF THE ~ · ~...,.,.." oGRE,-,,,.k ANCHORAGE AREA BOR_...,6,, ~ Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 NAME LOCATION INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM .... M^,L,NG ADDRESS ¢','"// .,¢//¢7' ,¢), PHONE "'V' SEPTIC TANK: DISTANCE /,~ . FROM WELL'--.~/~I,,~,!/V'~ MANUFACTURER INSIDE LENGTH INSIDE WIDTH_ MATERIAL j/~ LIQUID DEPTH NUMBER OF // COMPARTMENTS LIQUID CAPACITY /~2GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL~:~-'vl/~,-FOMNDATION ~) TOTAL LENGTH NEAREST LOT LINE ~'~ J OF LINES ,~ ? NUMBER OF LINES / DISTANCE BETWEEN LINES _/~///'4 TRENCH WIDTH~J~ IN. TOTAL EFFECTIVE ABSORPTION AREA ~-~ ~'L SQ, FT, LENGTH OF EACH LINE ~ '~ ~ ~ DEPTH OF FILTER ! DEPTH: TOP OF TILE TO FINISH GRADE .~ MATERIAL BENEATH TILE ~ ~,~'. ABOVE TILE '~ IN. WELL: TYPE~ , BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST LOT LINE__, SEWER LINE__ OTHER SOURCES DISAPPROVED REMARKS DEPTH SEPTIC SEEPAGE ., TANK__ SYSTEM DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: C"~¢-~ - LOT SLOPE: REMARKS: DIAGRAM OF SYSTEML~'~ I-,~tP G.A.A.I~ Form EQ-O32 Gte, ~ ~NChOrAgE ARea BO~ ~ .I PERMIT NO. SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT INSTALLATION LOCATION . - ' ^L ESC IPT,ON LOT J INSTALLATION OF: SEPTIC TANK SEEPAGE PIT ., OTHER . ~INANCED THROUGH TO 19~ ~NSTALLED BY ~ ~ SOIL TEST RESULTS ~ ~ -- NOTE~ THIS PERMIT I$ NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED 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 S,ZE I000 TYPE SEEPAGE A EA s,zE TYPE MINIMUM DISTANCES, REQUIREMENT~i FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PiT WALL :SEPTIC TANK, /~)~/ SEEPAGE Pit I ~L~ C . DRA,N / /~01 DIAGRAM OF SYSTEM CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP EXCAVATION 5 FEETINTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I ~ERTIFY THAT IAM FAMILIAR WITH THE REQUIREMENTS OF GREATER ~ORA REA BOROUG ORDINANCE NO. 28-68 AND THAT THE ABOVE DATE CANT'S SIGNATURE GRL,..,. ANCHORI~,6L ARIA BORO[JGh DEPARTFiENT OF ENV[RONHF,'II'AL QUAI. ITY Case it 3330 "C" Street ~ ANCHORAGE, ALASKA 99503 Performed For GaryCandee Legal Description: Lot 23 & 24Block_ 3 This Form Reports Soils Log . xx Soil Test Iqust Be Logged To 4' Depth Feet Soil Characteristics Amorphous granular peat %Pine to medium, clayey gravel GM Coarse, clayey sandy gravel GM Uniform fine sand with trace of silt SM 14--- 16 Uniform medium sand with trace of clay and silt SP Was Ground Water Encountered? No If Yes, At What Depth? Da ted Pe rfo rmed_.._~_~r. Jl___5, Subdi'vision Unit 2-Valley__V_iewEstates Percolation Test Proposed Seepage System Lot24 Lot 23 Below Reading Date Gross Time Net Time Depth to 1t20 Net Dro :?ercolation Rate Minute Proposed Installation: Seepage Pit 'xx Drain Field Depth of Inlet Depth to Bottom o¥~Pit or Trenc}~ ............ C 0 ~4H E N T S: Based on Borough standards, we recommend 195 sq._.~ lest Performed BY John Jameson/HowardJ. Grey .ALASKA MINERAl. & MATERIALS LAB Date Certified BY: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Parcel I.D. 015-341-10 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING OSPiO CO A# Expiration Date: / O GENERAL INFORMATION Complete legal description Location (site address) Valli Vue Estates #2 S/D, Block 3, Lot 23 10014 Main Tree Drive, Anchorage, Alaska Current Property owner(s) Mailing address Don and Ethann Oldham/JENN, Inc. Day phone P.O. Box 773486, Eagle River, AK 99577 242-0337 Lending agency Day phone Mailing address Real Estate Agent Mailing Address Raney Hardman, Re/Max of Eagle River Day phone 11525 Old Glenn Hwy., Eagle River, AK 99577 440-7257 Unlesso~e~ise~queste~ COSA willbeheldbyDSD ~rp~k~. 2. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Douglas T. Kenley, P.E. Address 9806 E. Northstar Circle, Palmer, Alaska 99645 Engineer's Printed Name DSD SIGNATURE Approved for '~--~ Disapproved. Conditional approval for Phone (907) 746-1073 Douglas T. Kenley Date j. bedrooms. ~_ . bedrooms, with the following sbpulabons: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev 11/05) Original Certificate Date: Municipality of Anchorage Development Services Department f. Building Safety DiVision ~' ~ On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF O.N-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: valli Vue Estates ~2 S/D, Block 3, Lot 23 A. WELL DATA Parcel ID: Well type Public If A, B, or C.provide PWSID # __ Well Log (Y/N) completed Sanitary seal (Y/N) Wires properly protected (Y/N~~ Date Total depth .ff. Cased to __ ---ff. Casing height (ab~~round)~ . in. FROM WELL LOG ~~;~IDTION Date of test Static water level ft. ft. WATER SAMPLE RES~-~'~.' Coliform ,..--"~colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL Am~enic~ mg/I Date of sample: ~ Collected by: Date installed 10/08/75' Cleanouts (Y/N) Y N High water alarm (Y/N) N/A Pumper Around the Clock Pumping B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel* Tank size 1000' gal. Number of Compartments 1 Foundation cleanout (Y/N) Y Depression over tank (Y/N) ;. ;D~ of ..puh~piri~ 10/12/2010 ,:C. ABSORI~'ION FIEL=D DATA Date installed 1.0/75'~ Soil rating (g.p.d./ft2 or ft2/bdrm) 195' System type Trench* .L.,ength," .37' ,. ..ft. Width 3* ft. Gravel below pipe. 8* ff. Total depth 9* .~! Eft. absorption area 592* ft2 Monitoring tube Y Depression over field N D~e-o,~',adequaby~e'st 10/06/10 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 457 gal. New depth 15 in. Elapsed Time: 85 min. Final fluid depth 9 in. Absorption rate >= 45o g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date .... D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at ~ in. "Pump off" level at ~ in. High water alarm level at *.~"'~n. Datum. ~ Cycles tested : Meets ala~s? SEPARATION DISTANCES ~ :::;c ll~a:lk~: s~ la: ~; ~:~:o: FROM WELL ON--dj ace nt lots Absorption field on lot; ~ Publi~ Sew~/septic service line Animal containment areas 50+ it. On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas 100+ it. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 6 ff. Property line 10+ it. Absorption field 8 it.* Water main 25+ ff. Water service line 10+ ft. Surface water 100+ it. Wells on adjacent lots 200+ it. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5 ft*** Building foundation 14 ff. Water main 25+ ff. Water Service line 10+ ft. Surface water 100+ ft. Driveway, parking/vehicle storage 50+ ff. Curtain drain None known, to exist Wells on adjacent lots 200+ ft. F. COMMENTS: *See attached letter. **See attached waiver request. -~-~,~,- -z'~,~-~;~--- G. ,ENGII~EER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Douglas T. Kenley P.E. Date [0' ~"), ~) COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ ~ Date of Payment Receipt Number Municipality of Anchorage P.O. Box 196650 ® 4700 EImore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http:llwww.muni.or.qlOnsite Development Services Department On-Site Water and Wastewater Program -fo_ell ct .5 Department **** VARIANCE/WAIVER REVIEW **** WR#: 101246 HA#: 101258 Permit/C: PI D#: 015-341-10 Legal Description: Valli Vue Estates #2 Block 3 Lot 23 Engineer: Applicant: Don 8, Ethann Oldham Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. mmm~~mmmmmm~~~~~~~~~~~m~mmmm~m~mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm~~mmmmmmmmmm~mm Waiver is Granted: X Waiver is not Granted: i: ...... rove : Namd-ef Re'~iey0er Rec~: 01576C Amount: $200.00 Date Paid: 10-20-10 **** VARIAN CE/WAIVER REVIEW **** ~o, ~o~ ~ ao, UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR OONS~UO~ON OR FOR ESTABLISHIN~ BOUND*RY OR ~NeE LINES. ~E SUR~YOR TAKES RESPONSIBILI~ FOR ~E INI~AL ~ANSAC~ON ONLY AND ASSUMES FINANOIAL UABlU~ ONLY FOR ~E OOST OF ~E SURLY. LIS~D DISTANOES PREVAIL O~R SOA~N~. REPRODUO~ON MAY OAUSE ERRORS IN SCALE. ~ LOT ~R~ SURVEY TYPE SYMBOLS ~ F~NDA~ AS-BUILT · SET REBAR ~ ASPHALT ~ ~N~ S~UC~RE AS-BUILT ~ DRAINAGE ~ PLOT P~ . . . AS-BUILT . . . LOT ~R~Y... T~HY O FOUND REBAR ~ ~ ~ WOOD ~NCE ~ CONCRE~ ~ AS--BUILT . . . NO ~NERS SET ~ RE~CA~ AS-BUILT . , . NO C~N~S SET ~ ASSUMED E~V. % % % METAL FENCE ~ WOOD DECK PLOT PLANS ~ LOT SURVEYS NOTE: IT IS ~E RESPONSIBILI~ OF ~E BUILDER OR O~ER, PRIOR TO ONLY ~OSE I~PRO~MENTS ABO~ GROUND AND ~SIBLE ~LL BE CONS~UC~ON, TO ~RIFY PROPOSED BUILDING GRADE RELA~ SHO~. ~NCES, ~LLS, SEP~C CLEANOUTS, SIDEWALKS, DRI~WAYS, TO FINISHED GRADE AND U~LI~ CONNEC~ONS AND TO DE~R~INE ETC., ARE SHO~ IN ~EIR APPROXI~A~ COCA.ON, ONLY. SNOW ~E EXIS~NCE OF ANY EASEmENt, CO~NANTS OR RES~IC~ONS ~AY PRE~NT SOME I~PRO~ENTS FRO~ BEING SEEN AND LOCA~D, ~ICH DO NOT APPEAR ON THE RECORDED SUBDI~SION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHER~SE NOTED. SURVEY CER~FICATION _~m~m_ Prepored by ~-~ OF ~/ '%~ Robert E Johns, Jr & Assoc PLOT PLAN ~ ~X~ ...... ............ ~ ~ ' ' ' '~'~'~'"~','~ ~ .,,, .,..~ ~ Professional Land Surveyors ~ ~ ~ ~, ~ ~d ~ me ~ of my ~ * * ANCHORAGE, ALASKA 99501 :'~=='~='"t'~"~'~--;~/ ~ ~ '~ s~o,~: 1" = 40' Rec. Lot S.F. Rec. Plat File No. FOUNDA~ON AS-BUILT .-o~. ~ ¢. 10/12/10 ;~i.:sw2538w.o. 1298 ""~ ~ ~"'*""--'~'"' '2~:~"~""~""-'~'- LOT 23 BLOCK 3 Douglas T. Kenle¥ P.E. 8176 9806 E. Northstar Circle, Palmer, Alaska 99645 (907) 746-1073 October 18, 2010 Municipality of Anchorage On-site Water and Wastewater 4700 Bragaw Street Anchorage, Alaska 99507 Re: Leach Field to Lot Line Waiver for Valli Vue S/D, Block 3, Lot 23, Eagle River, Alaska. This letter is a request for a Lot Line Waiver by the On-site Water and Wastewater Department. The septic system on the above-described property was installed in October 1975. At that time reference was made to a distance of 8' from the leach field to the lot line. A documented 6" sump at the end of the leach field has since been removed and replaced by a 4" monitor tube and a 4" clean-out; however, that work is undocumented. A new survey reveals that the end of the leach field is 5' from the lot line rather than 8'. A copy of the As-built is attached. Adjacent lots are not adversely impacted. The subdivision is on public water. If there is anything else you require to grant the waiver, please contact me through Fred Kenley at 243-5372 or 242-4419. Thank you. Douglas T. Kenley, P.E. Do_u_ gJ__l_a_s_ T. Kenley 9806 E. Northstar Circj_e_~P_Palme_r, Alaska 99645 907) 746-1073 October 12, 2010 Municipality of Anchorage On-site Services 4700 South Bragaw Anchorage, Alaska 99507 Re.' Valli Vue Estates #2 S/D, Block 3, Lot 23 10014 Main Tree Dr., Anchorage, Alaska Owner: Don and Ethann Oldham/JENN, Inc. Since the house on the above-mentioned property had been vacant for more than 30 days, on September 25, 2010, the system was pre-soaked with 1270 gallons. At that time water levels were monitored. There was no water in the monitoring tube initially and none appeared during the pre-soaking. Reviewing the paperwork on file with On-Site Services, it was stated that there was a 6" sump at the end of the trench; however, the 6" sump has evidently been replaced by two 4" pipes at the end of the trench, one a monitoring tube and the other a clean-out. Measurements could not confirm that there was 8' effective depth of gravel. Approximately 75 gallons of water was introduced into the foundation clean-out and then the water was moved to the after-tank clean-out, at which time the flow was increased to 6.2 GPM. At the end of the test, after 1270 gallons of water had been introduced in a three-hour period, 14-7/8" of water was in the clean-out at the end of the trench, which dropped to 8-1/2" 13 minutes later. No water ever appeared in the monitoring tube, which was next to the clean-out. It was decided at that time to have Bob Dean of Dean Construction dig a hole at the end of the trench to determine what was occurring with the two 4" pipes. This was accomplished on October 6, 2010. Again, the effective depth of gravel could not be verified. He dug to the bottom of the monitoring tube, which was 9' down from the surface. Sewer rock was observed 3' from the surface, and the bottom of the clean-out was 71" from the surface. Soil conditions in the hole revealed mostly sandy soil. It was concluded that someone had worked on the system without submitting records to the MOA. Tobin Spurkland had done an adequacy test in 1986, at which time reference was made to the 6" sump at the end of the trench. He also made reference to 8' effective depth of gravel in the MOA Health Authority Approval Check List. Contact was made with Tobin's son Ryan at Spurkland Engineering to determine if he had additional information that was not posted on the On-Site Search Website when Tobin performed the adequacy test. He said he did have notes concerning installation of the 4" pipes at the end of the field, one a monitoring tube and the other an inspection pipe. While the trench was still open on the end, it was decided to perform an adequacy test. Water was introduced into the after-tank clean-out at a rate of 6.2 GPM. No water was found in the monitoring tube at the beginning, but after approximately 400 gallons, water appeared in the excavation hole coming from the bottom of the clean-out and also from the monitoring tube. Water was measured in the monitoring tube at the end of the test at 15", then re-measured 85 minutes later at 9". Even though there were several discrep- ancies between the paperwork and what is actually there now, the system was capable of absorbing 450 gallons per day. If there is anything else you require, please feel free to contact me through Fred Kenley at 243-5372 or cell 242-4419. Sincerely, I rl // MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL 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 Descriptior~ (include lot, block, subdivision, section, township, range) Location (address or directions) (b) App icant Name ~f.~,4,,~.',~,¢~.~, Telephone: Home ~/'~¢-~ "~ Business Applicant Address 0 (c) Applicant is (check one): Lending Institution []; Owner/bui~r [~.; Buyer []; Other [] (explain); (d) Lending lnstitution ~?,~.,/~-- Telephone Address 70 / ~ ~'""t.,.,~¢.,¢' '~'~"'4"//-'~' /~ 7 (e) Real Estate Company and Agent ~ ~¢, ~-~- Address ' ~ C *' ~ ~ (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE -F/a~'~ ' ~" ' ' / '~'~ Single-Family ~[( Multi Other Number of Bedrooms / ~ / WATER SUPPLY . ~'"-~ - Individual Well [] Commun~ublic [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) /--.,~ .~'-~ , -- ENGINEERING FIRM PROVIDINg. JSPECTIONS, TESTS, FILE SEARCH, DA'h. AND INFORMATION As cedified by my seal a~fixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigebon and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State cedes, ordinances, and regulations in effect on the date of this inspection. Name of FiCm ~'-~) ~/,~ Address Date 6. DHEP APPROVAL Approved for /¢~*~a/~~-'~ bedrooms by k_ Approved ~ Disapproved Terms of Conditional Approval Conditional 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 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description' - ' - .4 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 Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results ifA, B, C, D.E.C. Approved (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Y ~ ,~-,~.~ ; On Adjoining Lots ,~ J~.D'I~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed'~/-"~/_/./__-~ Size /_~_,~t"") No. of Compartments / Standpipes (Y/N)V/--y ({z) Air-tig~aps. (Y/N) Y Foundation CleanoUtlo Depression over Tank (Y/N) Date Last Pumped -,~/"~ 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 /..~' ~- To Water Main/Service Line Course Comments ~'~ '/~"~' ,/ ;for Temporary Holding Tank Permit (Y/N) ! To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 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: Type of System Design Length of Field ' _'~'7/ Depth of Field Gravel Bed Thickness 9! Standpipes Present (Y/N) Date of Last Adequacy Test /C),'/~ To Water-Supply Well To Building Foundation Lot To Water Main/S "re'vice Line ,~.Of'/~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ~.,,/~ D, 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 ~ -~::~t~L,/~L~E¢'P'~'~/ Date ol,¢-O/~g~' / Company MOA No. Date of Payment /0~ ~ ~"~'~ ' ~' ' ~' ~' Amount: $ ~. O~ ~¢(:'49~.f~ ~ :~( ~ Engineer's Seal ,.' 72 026 (11/84) NOI~IO~d 1VtN~NOalAN] ,. ~ ~,- .-, -. ' CONSULTING ENGINEER TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOT 23, BLOCK 3, VALI VUE ESTATE LOCATION: 10014 MAINTREE OWNER: MARK SANDBURG RESIDENCE: SINGLE FAMILY, THREE BEDROOMS WELL: COMMUNITY CLASS A SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. 1000 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 592 SOIL RATING: 195 VISUAL INSTALLATION DATE: OCTOBER 1975 DATE OF PUMPING: OCTOBER 20, 1986 DATE OF TEST: OCTOBER 17, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH 3.8 FEET OF COVER AND WITH 47 INCHES OF LIQUID. 6-INCH SUMP WAS 52 INCHES DEEP, PLUGGED AT THAT LEVEL BY STICKS AND ROCKS. 1000 GALLONS OF CLEAN WATER WAS ADDED TO THE TRENCH CLEAN OUT IN A 40 MINUTE PERIOD. NO WATER SHOWED UP AT THE SUMP, THE WATER LEVEL IN THE TANK DID NOT RISE. 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. APPLI~ NT FILLS OU~' UPPER HA[ '/ONLY I ' ' Phone Buyer ~ ~ -~Zip CO~~ Address Lending lnstitullon ~'~ ~&~ ~ Phone Address /~ ~ .~ Zip Code Phone Realty Co. & Age~ Address~ Zip Code Type of Resi~nce Water Supply ~ Individual A~ACH WELL LOG. A well log is required for all webs drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ~ Individual Year Individual Installed: 19 J~ ~ PubJic Utility When Oonnected to Public Utilily: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EAOH RE~EST BEFORE ~OOESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Insp6ctor Inspector Inspector Field Notes: DEPT. OF HEALTH ENVIRONMENTAL PROTECTION JUN 2 !983 gECEI ED ( ~)~APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED C021TIONAL APPROVAL' DATE Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72-023 (3182)