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HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 3 LT 32 Municipality of Anchorage Page 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 Permit Number: SV4' ~'d~ O'~-L-~'~- PID Number: Name~ ~ ~ ~ Wastewater System: D New ~Upgrade ~ ABSORPTION FIE~ Phone:~~__~jjj No.o drooms: a Shallow Trench DBed gMound aether LEGAL DESCRIPTION SoilRating: % GPD/Sq. Ft. Total Depth from original grade: ~ ~a} Depth to pipe bottom from crt 'nal grade: Gravel depth beneath pipe Block:II ~Ft. Ft. Gravelwidth: ~Subd'vision' I I Fill added above original gra : Gravel length: Township: Range: Section: Ft. Ft. WELL: D New D Upgrade Number of lines: lBistancebetwe8nlines: Ft, Ft. Classification (Private, A,B,C): Total Depth: C~sed TO: Total absorption area: Pipe material: Driller:~ ~ Date Drilled: St~ticWater Level: Installer: Date installed: SEPARATION DISTANCES ~Septi~ I~ ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Privet( Manufacturer: Capacity in gallons: From Tank Field Stalion Tank Sewer Lines ~ '~ Material: Number of Compartments: Surface Water ~ ~ LIFT STATION Line ~ I 'I ,,Pump on,l i~y,,Pump off,, level at: IHigh water alarm at: Foundation j I / ~%~ ~ , CUDrainrtain ~ Pump Make& M~I I ~al Inspections performed by: Remarks: BENCH MARK Location and Description: Inspoctions perlormed b~: ~X~ Datos: 1st, h~n~ Hu ~S 'f: Department of He,It m~ ervices apprqval/ '. Reviewed and approved by: ,_ / Date: 72 013 (Rev. 9/91) MOA 25 Permit No. 4j~j '~ozH-~.- Page 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: IJ~; ~Ju~- ~--~'~ L-~I ~, PID No.: O{~--~l-Z~ 72 013 A (1/93)* MOUNTAIN ENGINEERING 3868 Shannon Circle Anchorage, Alaska 99508 (907) 562-1500 October 24, 1993 Mi'. John Smith On-Site Services Section Mtmicipality of Anchorage PO Box 196650 Anchorage, AK 99519-6650 RECEIVED OCT 2 6 1993 Municipahty ol Anchorage Dept. Health & H~man Services Regarding: Septic Tank Upgrade, Valli Vuc Estates #2, Lot 32, Block 3 Dear John: We were issued a permit in November, 1989 to upgrade the septic tank on the above referenced property from 1,000 to 1,250 gallons. The construction took place as planned/permitted in November ofthatyear, withBob Dean, of Dean Entesprises performing the construction. I performed the inspections as required. When Ted Moore was performing a Health Authority Certification inspection this month, he was unable to find an as-built at your department. I checked my files and was unable to confirm that I had ever submitted an as-built. For this reason, I have completed another as-built (attached) on the newer inspection report foFms. Please contact me at 562-1500 if you will need any additional information. Sincerely, MOUNTAIN ENGINEERING Mark Pearson, PE Tom Fink, Mayor January 8, Department of Health and Human Services 825 "L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 1990 Jess & Carol Reppun 6304 Red Tree Circle Anchorage, Alaska 99516 Subject: Lot 32 Block 3 Valli rue Estates Subdivision #2 Permit #890242, PID #015-341-36 The subject permit, issued, by this officg, for.a sihgle family well and/or on-site wastewater system has expired as of December 31, 1989. Permits are issued on a calendar year basis by authority of the Municipal Code of Regulations. A new permit must be obtained from this office for an well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to this office for review, approval and documentation. When applying for a new per,it, the fees are: $90.00"for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, Please call this office at 343-4744. Sincerely, John Smith, P.E. Program Manager On-site Services JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" Number' ," 8~P02q. 2 Up',.:srade "t' A Ixl K F' IE I::;~ I'd JE:SS 8x C;:~FdI... RIEF'F'IJN /:<'";OZl. I:';[t:iD 'Tl::~iiii]E C!I::~C;L.E: Pay F>h oi"le: (20A) 72L=.i, ,,7111 cap~ac::[t.y= 1~,2[.~i0 (:jallcmls,, IEac:h Depth Co Cop o£ sept.:Lc 'Lank (~s) < -~i.,,0 MOUNTAIN ENC~INEERIN~ 101E51 CRESTVIEW EAST EAGLE RIVER, ALASKA 99577 ISOTJ 891~-17OO ENVIRONE/tENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NA~?~ / PHONE J E~NEW LOCATION NO. OF BEDROOMS Well ~ ~ Liq. capaciW in Ballons I n~ide lengt~ Width Liquid depth /~ IF HOME~DE:~i O ~ ( Manufacturer / Material Liquid capacity in gallons o Well z[/~ Foundation Nearest lot line PERMIT NO. p~t~ b~ Total effective absor tioga, area g ~ To to finish grade Material e Length Width Depth / PERMIT NO, ~ P Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ Buildio~ founUation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: ' 72-013 (Rev. 3/78) ANCHORAGE AREA BC'/'m, IGH Anchorage, Alaska 99503 (C~ ) INSPECTION REPORT ON-SITE SEWAGE EN, SPOSAL SYSTEM NAME 1~,~L'~2~ '~ - - ~ ] ~.,. r.- /~N77;7:-/-1 ........ MAILING ADDRESS ~'~l~, ~/ ~)~ LOCATION~/~: ~F LEGAL DESCRIPTION ~'-~ SEPTIC TANK: DISTANCE ~'~ .. , o ' FROM WELL~-~/'!/h/(. MANUFACTURER-Ot/-~?~- '~L~r.~.;'-/~ M AT E R i A Li~' ~.C,~ ~5!.~ NUMBER OF COMPARTMENTS INSIDE LENGTH ~-- INSIDE WIDTH LIQUID DEPTH '~ .LIQUID CAPACITY /'0g© GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER ~ OR WIDTH /~'~ / LINING MATERIAL I~1;t~ f,~ CRIB SIZE: DIAMETER ~-~ DEPTH ~ / DISTANCE FROM: BUILDING FOUNDATION /-~'- NEAREST LOT LINE-~-~ ~ TOTAL EFFECTIVE , . ABSORPTION AREA (WALL AREA) ADDITIONAL ABSORPTION WELL: TYPE ~,~.~,~ ~,'~-~.;/'~'~ CONSTRUCTION (//~ ~-~',~-~ ¢ (/~ DEPTH BUILDING NEAREST NEAREST SEPTIC FOUNDATION LOT LINE SEWER LINE TANK CESSPOOL . , OTHER SOURCES APPROVED / DISAPPROVED REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: INSTALLED BY: tL//L~J(~I AYi~ PIPE MATERIAL: _~/-~/ LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM G.A.A.B. Form No. LQ-031 ~.,~.1 ,-~ flILN~ OF FIEAL. TH AND L::NVIRONMENTA~_. PROTECTION 825 L STREET, ANCHORAGE, AK 9950:[ 264-q:720 PERMIT IGC): DATE ISSUED~ 860155 UPGRADE 06/03/86 APPL I CAN]": ADDREfF)S [ CONTAC:F PHONE ,~ LEGAL. DESCRIP: LOT SIZE: LOT L_OCATION: RGGER NAMMERS 6304 RED TREE CIR ANC:HORAGE, AK 99516 563-5500 SUBDIVISION: VAL. LI VUE SEC. T I ON: 14 TOWNSHIP: 17000 (SQ,,F'T. OR ACRES) 6304 RED TREE CIR LOT: 32' BLC}CK: 3 12N RANGE: 5W I ce~-'L:i, fy that: 1,, I am f'am:[liaP with 'it. he t-equir'ements f'[)l" ctrv--~s~te sev~Jep~ ~l]d I,~el:l.~t as stet fcmth by the Muriic:ipa].ity of' Anchor'age (MOA) and the State of Alaska. :';~. I will insta].l ?.he system J.r'm accor'dance ~;i'bh axil MQA codes ancl PegLt].at.:Lorts, and in compliance with the design c['itep:[a of' this peaT'mit. 3. ]: will adher'e to ali. MOA and S'Ea'Le c~f' Alaska I'equivements fc)p the set back dis'~.anc:es fpom any E~xis'[.irig ~aE. 1].~ ua~stee~ateP disposal system oP public se~tePage sys'Lf.z,m on th:i.s of any ad.jacent (::n' near'by IF: A I_.IF:'T STATION IS INSTALL.ED IN AN AREA C[)VEI:~ED BY MOA BUILDING ]'HEN (i) AN EI~ECTRICAL PERMIT AND INSPEI])TION MUST BE OBTAINED; W]:L_L. NO'f BE APF:'ROVED WITHOUT AN EL_ECTIRICAI... INSF:'ECTION REF:'OR-F; AND II ,:~rk~(,,.-~ WORK ~"l" BE DG~E BY A LICENGED ELEC-I"RICIAIxl. AF'F:'I...:[CANT: ROGEF~ H~S y ISSUED BY , ~ ~ ~ DATE~ ~ . ~ [)ODES ~, AS-BU I LTS (3) THE GREATEr ANCHORAGE ArEA BorOUGH DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. NA~IE Of APPLICANT ~"'J'~'~:~f~ "~/{'J/~'~'~'~d~*~ ~J~ MAILING ADDRESS ~/) INSTALLATION LOCATION ~ /~~ ZNSTALLATiON OF: SEPTIC TANK ~ SEEPAGE PIT ., DRA~N FIELD , OTHER FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS NOTE: THIS 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. ~ DRAIN FIELD SEEPAGE PIT ¢;~._7~ / DRAIN FIELD -, SEEPAGE PIT MINIMUM DISTANCEB, REQUIREMENTB / FOUNDATION TO SEPTIC TANK SEPTIC TANk tO SEEPAge PIT WAlL SEPTIC TANK TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK J ~ DRAIN FIELD SEPTIC TANK, J~/ , SEEPAGE PIT TO RIVER, LAKE, STREAM, ALSO CONSIDER AREA WELLS, SEEPAGE PIT J /() ~-), DRA,N P,EL, SEEPAGE AREA SIZ~''~ ."~l~ ~j~ TYPE OIAGRAM O~ CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO 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. OR CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS JN ACCORDANCE WITH SAJ~ CODE. ' 72 . Municipafity of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~rownship, Range, Section: 4 5 6 7 8 9- 11- 13- 15- 17 18 19 20 WASGROUNDWATER ENCOUNTERED? SLOPE IF YES, AT WHAT DEPTH? DeCh to Water After Monitoring? Date: SITE PLAN PERCOLATION RATE J ~ (minutes/inch) PERC HOLE DIAMETER __ ~ ~ / TI~ST RUN BETWEEN ~ ~* ~ FT AND ('~ FT ~ PERFORMEDBY: Met ~ '~ ' I ~( ~ "CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ ~ ~ ~ ~ ~ Reading Date Gross Net Depth to Net Time Time Water Drop t~,.OZ 51~") ~MtW'~oSt~., (/ ~°~ I 0~ Iu /  Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 .SOILS LOG -- PERCOLATION TEST PERFORMED P ~ , DATE PERFORME[~: LEGAL DESCRIPTION:~(~--~'?L ,,~'2..., /~/~.-~ [/~'~11~ ~//q'~ Township, Range. Section: 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 20- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT Oeplh to Water After Monitoring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop lb:O"Z,, 5/~.'5 ~;~'SoY~ ~W?~ t~' PERCOLATION RATE '~:' (minutes/inch) RERC HOLE DIAMETER TESTf~UNBETWEEN .~ FTAND ~ FT PERFORMED BY: Nfl. , I~.~/ ~.~ ~ CERTIFY THAI THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) "' GREATER ANCHORAGE AREA BOROUGF;'' · '' t ~', DEPARTMEN-F OF ENVIRONMENTAL QUALITY Case # 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For ~_-T-~l~-~i~ ~lOTE~$~_~Dated Performed ~-1'.~-7¥ .... Legal Description: Lot.'_~Z-5~~vision Vct~l'l~ V-O<:. Percolation Test This Form Reports Soils Log~/~ Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics 14-- Was Ground Water Encountered? Yes, At What Depth? Reading I Date Gross Time Net Time Depth to H20 Net Dro Percolation Rate Hi nu'ce Proposed installation: Seepage Pit Drain Field 3e]th of ~nlet Depth to Bottom oT P~t or Trenc Test. Performed BY -~~~ ~;;;~e;]ti fiedDaIYe: J' '~artment of Environmental Qualit} , Nater and Sewer Questionnaire Date (~ .- ime Subdivision ~/.- ~/~ ~'' ? ' Owner's Name: Mailing Address: ~', Questions: 1. How many bedrooms are now in your house? 2. How many bedrooms were in the house at the time of purchase? 3. Were the basement bedroom wails "roughed in" at the time of purchase? 4. Was the basement bathroom plumbing "roughed in" at the time of purchase? 5. Did the realtor or builder inform you that you would have to enlarge the existing sewer system if you finished the basement bedroom (s)? 6. If on a public water supply, do you always have an adequate supply of water? 7. Is the pressure always adequate? 8. Who was the builder? "~-~',.,'~. ~f-~w/z-~E)/~/~3t;~ 9. Who was the home purchased from? OTHER COMMENTS: J ,,~- ~,,... - .. .~ ~ EASEMENTS O~ ~CO~D, OTHE~ ~HAN THOSE ~HOWN ON THE P~.T ARE ROT ~HOWN Anchorage Recording Precinct, Alaska, and that the improvements situaled thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no Lmprovements on prop- erty lying adjacent thereto encroach on the premises m question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska thls.c-~?~ day of '- -',~? ' 7.4'/', ,,.. ~c-,, 19 %~;F/ I hereby certify thKt I have surveyed the roi]orang described property: .~/~-32j L~TC/~ ~ This As-lmi t shall,not'e_ used for eny-purpes~ other tt,~n flinancing requirements. Un,.J~r r~o ~ircumstance~ construction ~r for es~abllsbing boundary or fence lines. WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 September 3, 1993 (907) 349°7755 Dick Dayton SUBJECT: Lot 6, Block 3 (10404 Main Tree Dr.); Valli Vue Estates #2 Class "A" Public Water System, PWSID #210605 Dear Mr. Dayton: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on August 10, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on August 13, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on Debember 23, 1992. This .does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on November 12, 1991. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water: Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. Unless otherwise noted, this letter is valid for 30 days and is for the specified legal description noted above only. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS'I' PROPERTY DESCRIPTION Lot~ Block & Subdivision or U,S, Survey Lot 6, ]~lock 3 (10404 Main 't'ree Valli Vue Es'kakes ~2 PWSIID no. 210605 Drive) .... This approval does not constitute a guarantee of any kind, explicit or. implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY · A recent water sample was tested and found to meet De partment of Environ mental Conservation drink-. ing water standards for total coliform bacteria. Name Ti~.leEnvironmenta1 Da~e IEnq. Assr.. 'ri Sept. 3 ~ ' 93 WASTEWAT ER DISPOSAL \ The domestic w"'as~water system was: ,,-...., ' ~.: nspected·by"~"~-'the D~'p. artmbnt:of EnvironmentaI.Conser~,atioh and ·fo..gu~ to be ih Complianc~ with applicable requiremer~t%~18 AAC 72; .... · [] inspected by a Professionai"En~gineer who certif~s-that/the system complies with applicable re- quirements of 18 AAC 72; · [] tested by a Profe~?on'~'~Engineer who certifiers h~.t the performance of the system is satisfactory · · ..,., . . and that the system complies with the minimum' s-'eparation' distances specified in 18 AAC 72. -.... "~.'Th~..a pp~rova, is valid fora [] single family [] mu,ti-famil~nit with atota, of bedrooms:. 18-0404 (Rev. 8/85) DISTRIBUTION; WH[TE--BANKILENDING INSTITUTION; CANARY--APPLICAN3] PINK--DEPARTMENT 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions Property owner Mailing address Lending agency Mailing address Agent N.A. Address Day phone Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 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. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: 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. 72-025(Rev, I/91) Front MOA#21 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 inw.~stigation 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 f=/~/~? TecL~'~ccd Address v Engineer's signature ~-'~'-~-¢'~- ~ ~ %7% '.... ....' DHHS SIGNATURE /-~' Approved for bedrooms. Phone Date 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 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. Municipality of Anchorage /~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: /.. ~ {- ~ Es ~ l l'~, ~.~ b',~ l h' b'.¢ #~ ParcelI.D. A. Well Data Well type '~/~" Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Total depth Sanitary seal (Y/N) Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot AT INSPECTION g.p.m. ; On adjacent lots Absorption field on lot Public sewer main ; On adjacent lots Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Ir / ~,c/ Tank size I ~ vq,~ ! Compartments Cleanouts (Y/N) 'r' (0 Foundation cleanout (Y/N) ~ Depression (Y/N) High water alarm (Y/N) N.,4, Alarm tested (Y/N) /9. Date of pumping '7 /,_4-/9-~ Pumper /R~,/-c> ~oo/-~ N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot -- On adjacent lots To property line ~ .5"' Absorption field Surface water/drainage Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION N,/f. Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed Length '~_2- ' Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) /' ~'d~ Soil rating (GPD/FF) h Width ~ ' Gravel thickness 5'0'/ z3' Cleanout present (Y/N) I0 / t,¢,/¢/ '~ Results (pass/fail) P~..o' System type ~' ' Total depth fl. ,5" Depression over field (Y/N) for After test o" If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot__ ~, 4. To building foundation On adjacent lots ~ ..~¢ ' Surface water . ~ too' On adjacent lots "~ ~oo' Properly line I~ ' ~..5-' To existing or abandoned system on lot ~ to ' Cutbank I~' ~ ¢o ¢f~..), c. fi I¢_.4 Water main/service line~. to' Driveway, parking/vehicle storage area lC, ~ Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA ~ of this inspection. Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number CE - 3589 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 I GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directio~e) Applicant Name ~)(,~ /~m6~ Telephone: Home ~-~ L~-~L Business App,oa.tAdd~.s~ . ~3C}~ /~%~ (~ Applicant is (check one): Lending Institution ~; Owner/builde~; Buyer D; Other ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the follow ng address: RESIDENCE Multi-Family [] Other WATER ' 3. ,S~JPPLY__ .. ~- IndividuSl,Wel!:[~] ~ommunityA Publico N(~te:.~ co~r~gn.(ty well system, must have written confirmation from the State Department of Environmental Conservation attesting ~,t;~ I'ega ty and status 4. SEWAGE DISPOSAL Onsite~ ~:~blic'D~ Community D Holding Tank D Note: If community~,, h,:?.~;¢,:,,-..~e I system must have wr tten conf rmat on from the State Department of Environ menta Conservabon attesting t~ ~b~e~lit~_and status. _ Pagelof2~. ' ~-~ ~ ENGINEERING FIRM PROVIDING'~'3PECTiONS, TESTS, FILE SEARCH, DA1/~'~ND INFORMATION As cedified by my seal affixed hereto and as of the validation date shown below. I verify that my Jnvestigatk~n Of/hi,sHealth · 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. J further verify that based ce the information obtained from the Municipality of Anchorage flies 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 Address Engineer's Seal DHEP APPROVAL Approved for '¢'A'"c~'.~'~)beOrooms by Approved Z'"~- Disapproved Conditional Terms of Conditional Approval CAUTION !ipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority based solely upon the representations given in paragraph 5 above by an independent professional the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending decto~satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or is issued. The Municipality of Anchorage is not responsible for errors or omissions in the WELL DATA .U.,C..AUTY OF A.C.OBAOE .EALT. AUT.OR,TY AP..OVAL CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ,~o-r ,~,~ Classification ~'~ct~ 17~ If~A, B, C, D.E.C, Approved (Y/N) Well Well Log Present (Y/N) '~./~ Date Completed .~//.A Yield / Total Depth "'~,/~ i Cased to Depth of Grouting /,//A Static Water Level p,;~, ,~./// Pump Set At Casing Height Abov~'~round Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (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 /,,1 Cleanout/Manhole Water Sample Collected by Water Sample Test Results /' Comments ; On Adjoining Lots /v,/~ ,~v//~ ;On Adjoining Lots ,~)/~4. To Nearest Public Sewer To Nearest Sewer Service Line on Lot /J/4 ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~//~?/7~ Size (o~o No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) ..~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ¢~J Date Last Pumped %Z/~/~ Pumping/Maintenance Contract on File (Y/N) "'~?.,~ ; for Holding Tank High-Water Alarm (Y/N) ..,,J,/~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~_~rn~,J ~ ¢¢~t TO Property Line .v~" To Water Main/Service Line '~ / Course ,"J/~ To Building Foundation /~- ~ To Disposal Field ~ ~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed _~/(4'/~(¢ Width of Field ~. Ar- Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To W~ter-Supply Well To Building Foundation ~--~ Lot /.5--' 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 '~E-~ '~--,~,)07/ Length of Field Z~.,~' Depth of Field ~ ~ Gravel Bed Thickness ~ ~ ~-/o ~ Standpip~ Present Y/N ~) Date of La~{'~quacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~+ ~ To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electricel Codes (Y/N) ./- Comments //- **-61~ck Permitted Bedroom Rating Against HAA Request ** Dimensions ~/ Manhole/Access (Y/N) ~d~acy Test. Meets MOA 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. Date of Payment Amount: $ ,-;... Seal DEPT. OF ENVIRON~N~ENT~L CONSERVAT][ON / / ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: Address: 274-2533 To Whom it May Concern: to records on file in this office the , According ~ /Y/~t~t~Water System is in compliance with the State Drinking Water Regulations Sincerely, unicipalitYof P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES June 20, 1986 Dale R. Merrell, P.E. Besse, Epps and Potts 2220 East 88th Avenue Anchorage, Alaska 99507 Subject: Lot 32 Block 3 Valli Vue Estates Subdivision Waiver Request, WR86-075 Dear Mr. Merrell: At the time of the septic tankins~llation there was no requirement specified in State or Municipal code regarding the separation between a septic tank and a waterline service connect. For this reason a waiver is not required for the subject lot. It is the opinion of this department that the water supply for the subject lot is adeuqtely protected from contamination with the existing water line- septic tank configuration. A ten foot separation will be required if the septic is replaced or modified, however. Sincerely, Stephen S. Morris Civil -Engineer On-site Services SSM/lw June 11, 1986 Mr. John Kennedy DHEP 825 "L" Street Anchorage, Alaska Re: Separation Distance Variance Request Lot 32, Block 3, Valli Yue Subdivision Dear Mr. Kennedy: This letter is to request a variance for water service line/septic tank separation distance. On June 3, 1986, the DHEP issued an on-site sewer permit for a new septic drainfield for the above-cited lot. The new drainfield was installed on June 6, 1986 pursuant to the permit. An above-ground locate for this community well system service line indicated a separation of seven (7) feet. This is the original installation at the time for construction and was previously approved by the Municipality of Anchorage. Further, the engineering drawing for the "proposed" new system (supporting the permit given on June 3, 1986) shows a separation distance of six feet (it was actually measured at seven feet); and the DHEP did not require the relocation of the service line at the time of the permit issuance. In conclusion, we believe that this is an existing condition which was previously approved and should be granted a variance at this time. / Dale R. [~rre¢, PE ENGINEERING, PLANNING, SURVEYING 2220 E. 88th Ave./Anchorage, Alaska 99507/Telephone 907-349-6451/344-1352 "Providing a quality personalized service to those building Alaska's future"