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Home My WebLink AboutVALLI VUE ESTATES #2 BLK 3 LT 34Valli Vue Estates Lot 34 Block 3 #015-341-34 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: '~[,~ ~-~-~-,~ PIDNumber: ~1~* Name: ~N LON t ~OS~ ~ ~, Wastewater System: ~New ~Upgrade Address: I~11 I LoNg T~ ABSORPTION FIELD Phone: ~' ~7~ IN°'°[ ~r°°ms: ~eep Trench ~ Shallow Trench D Bed D Mound ~ Other Soil Rating: Total Depth from original grade: Block: Sufidivision: ~ Gravel depth beneath pipe Township: IRan ' Gravellength: WELL: ~ New ~ Upgrade S~aw~ ~: Number of r~nes: ~Distancebe~eenliaes: ~ Ft. ~, " Ft. Classification (PHvate. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: StaticWaterLevel: Installer: Yield: I Pump Set at: J Cas,no HoigM Above Grou.d: SEPARATION DISTANCES ~ s~ptic ~ Ho~i.. ~ S.T,E,P. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Material: Number of Compadments: Well Surface Water ~ LIFT STATION Lot Size in gallons: I Manufacturer: "Pump on" level at: ~ "Pump off" revel at: ~ High water alarm at: Foundation [ ~ I Cudain Pemp Make & Model ~ E~ectrical Inspections pedormed by: I Remarks: BENCH MARK T~ l~. ~OO~ Location and Description: ~ F~,. , ENG'INE~R'S SEAL Inspections performed by: ~ ~ DateS:2ndlSt ~/~/q~ ~ ~:,~~:~,::~ ':' .................. Department of Health and Human Services approval '~ '~'~'.. ~ ,~ ~ . Reviewed and approved by: / Date: ~,~ ~ ~ ........ ;-- 72-013 (1/91) MOA 25 ~....~ p5 o £5 50 7S I00 SCALE; I' = 50 FI, TQBBEN SPURKLAND P,E, 203 W ]STH, AVENUE ANCH, AK, 99501 LOT 34, ~L£CK ~ VALLI VUE #~ SEC 14, TIpN R3~/ JOSEPH HANLllN SEPTIC SYSTEM ASBUILT DATE, 4U6, 8% 1998 SHEET, P/$ GRID, Nonlfor Clean ou~ Diverter Valve STandard Trench; 40' LDNG TZTTAL I0' DEEP 6.5' ElF SEWER RDCK 3' mln, Cover Ctean gu~ 1250 gal Septic ~ank Fnd, Clean Eluf SCALE Cf-2225 3~ Cover Monltom Exist, Ground 4' Mm Cover Nlra £! 140 6,5' fleet o£ Septic Rock ,97. 7 1250 GAL SEPTIC TANK TOBBEN SPURKLAND P,E. 803 W157H, AVENUE ANCH, AK, 99501 BOTTOM OF TESTHOLE ELEV, 81,8 LLT? 34 ~LDCK 0 VALLI SEC 14, FI£N R3~/ JDSEPH HANLDN VUE #£ fBM 5ANAOE SLAB ASSUM£B £LEV, 100 FT SEPTIC SYSTEM ASBUUIL~ DATE, AUG £~ 1992 SHEET, 3/3 GRID, 2538 PAGE 1 OF 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMITfrbl~fTQ~ PERMIT NUMBER:SW920223 DATE ISSUED: 8/I'B~/92 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. EXPIRATION DATE: 8/~8'/93 OWNER NAME:HANLON JOSEPH A & OWNER ADDRESS:10111 LONE TREE DR ANCHORAGE,ALASKA PARCEL ID:01534134 LEGAL DESCRIPTION: VALLI VUE ESTATES #2 BLK 3 L T 34 LOT SIZE: 20100 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS UPGRADE MUST BE INSTALLED IN ACCORDANCE WITH THE APPROVED ENGINEEP~ DESIGN DATED 080-892. LOT (907) 279-3918 SEPTIC SYSTEM DESIGN ~LOC~ ~ VALLI JOSEPH HANLON rUE ~2 Llse .".:JiTandard Trench S~]J.], R,?.ting. Fr-om truest July 21,~ 1992 1,,5 rain/in ::= 1.2 ~jal/sq..ft. R~.t, qLtir~.:,d Ar'l~?a pi{st' El~;~,droom~ 150/I.2 .... 125 sq, .Fi:,, ~ E;,':i. st:ing Tank. 3 '~eet o~ c'c, ver Use 6~5 -Feet: o.F rock I..en,,]th o.f Tre,qd"~ 125 x 4 / 13 = ?]18.5 SY STE ~-~ STANDARD TRENCH TOTAL LENGTH 40 FT. TOTAL NIDTH 5 FT. TOTAL DEPTH l0 FT. ROCK DEPTH 6.5 FT. COVER 5.5 FT. SEPTIC TANK EXISTING INSTALL DIVERTERVALYE TO STEEL CRIB. EXISTING nc) residen'iz:La! w~,):lls J.n this subdiv:i.?~iol~. a c~Hfl::x~'~rfl:: var'v:i.-9 in 'I:~:)i:al heir:fl'tit: b[at:weem 4 and 6 and d:i. tc:hl:ino:, ~-~:i,]:l. I:)~:~ :J:5 c." 20% r(~2su]..I.-. 'fI-(2fn thi!is i n?s'ka]. ]. at:i. Ebpt :i. c: Sy~rt:e~n 1:),,.):?si gn l..ot 7!!:4 B3c)c:k 4 Valli Vue :t? / I 33 ~ I 30 4 / ~ × \ 13 / 36 SCALE., i" = 100 FT, TOB3EN SPURKLAND P.E. 203 h/ 15TH, AVENUE ANCH. AK, 99501 LOT 34, BLOCK '~ VALLI VUE #~ SEC 14, rl2N RDW JNSEPH HANLDN ] SEPTIC SYSTEM DESIGN DATD AUG. 8~ 1998 SHEET~ IlS GRID, £538 N SCALE; !' = $0 FT, TDBBEN SPURKLAN9 P,E, 203 ~ 15TH, ~VENUE ANCH. AK. 99501 LO[ 3,I,9L[I£K ~ VALLI VUE SEC 14, TI£N R3W JD£EPH HAflL£N SEPTIC SYSTEM DESIGN DATE, AUG, g 1992 SHEET: ,~'~ GRID, 2538 Diverter Valve Exist l£50 gal Septic tank Standard Trench: 40' LONG ?OTAL 10' DEEP 6,5' OF SEIZER 3' min, Cover Clean Out and Monitor Fnd, Ctean 0 NO SCALE Mira£1 140 6,5' Peet o£ Septic [~ock S~. Monlt:.om~ 1250 GAL SEP?]C ?ANK Exist, Ground 4' Nih Cover ~'~over Tank TDBBEN SPURKLAND P,E, 203 W15TH, AVENUE ANCH, AK. 99501 LI~T 34 ]?L[1CK ~ VALLI SEC ]4, T1BN R3IZ JOSEPH HANLON VUE #~ SEPTIC SYSTEM DESIGN ~AT~, AUG. 8, 199£ SHEET, 3/3 GRID, B538 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4- 5- 6 7 8 9 10 11 13- 14- 15 16 17 18 19~ 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST '~,~,TTo u..4 0 P [;: -' EN~JNEER'SSEAL ' DATE PERFORMED.~'- ~ ~//~ ~.. Township, Range, Section: ,~'.~. ~ I q, T'| ~ J~ [ ['~.~ ~ SLOPE SITE PLAN s L IF YES, AT WHAT DEPTH? pC E Monitoring? I~f') ~/. ~- Dale: Reading Date Gross Net Depth to Net Time Time Water Drop ~ ~ lq PERCOLATION RATE ~ ~ (minutes/inch) PERC HOLE DIAMETER GRE/ "ER ANCHORAGE AREA BOP'"t. IGH Department of Environmental C~uality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME J~ )(:G'/V'?'~ / /~/' /~/~/~/]9'}~{'' c''~' MAILING ADDRESS_-~<),\ LOCATION J~'i",]!~'i~l~>S., }~i:,~,, LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL _~.~3/~/F}, INSIDE LENGTH_ NUMBER OF MANUFACTURER--~'~I?~cZ:~>~/~(-'('!£~ MATERIAL U,l:l'llqo~(-, COMPARTMENTS / INSIDE WIDTH -LIQUID DEPTH _LIQUID CAPACITY_/-- ,2C,~ .GALLONS. SEEPAGE Pit: NUMBER OF PITS / . DIAMETER ~T~ ~ LINING MATERIAL(,' '~ , CRIB SIZE: BUILDING FOUNDATION L),()(' ADDITIONAL ABSORPTION DIAMETER.~ t DEPTH ~ / DISTANCE FROM: WELLing) NEAREST LOT LINE ~¢]) ~ TOTAL EFFECTIVE -- ABSORPTION AREA (WALL AREA) _, ~,/)-~ SQ. FT. WELL: TYPE ~_~;YYb wgc L "¢L4' ,(~' CONSTRUCTION BUILDING ~ NEAREST FOUNDATION- LOT LINE__ CESSPOOL OTHER SOURCES_ APPROVED ~-~" DISAPPROVED -- DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK___ SYSTEM REMARKS__ DISTANCES: ½i-% g' IdC~C(? I',.} INSTALLED BY: ~' PIPE MATERIAL:_~'L~{ (I,,'l ,,~;t- (/'~F'~X]_ LOT SLOPE: REMARKS: ~2~/TJ f /~_ . ~L.n~ /:~",~'~.~i~' _ Form No. EQ~O31 DIAGRAM Of SYSTEM DATE __/~/-,'5~/'?',~ G.A.A.B. GreaTEr ANChOrAgE ArEa Borough SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT pERMIT NO. NAME OF APPLICANT ,.STALL^T,ON LOOA 'ON INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED F,NANCE~ T'ROUG. /~,~ ., DRAIN FIELD . OTHER NOTE: THIS PERMIT IS 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 SE SUBJECT TO PROSECUTION. DIAGRAM OF MINIMUM DISTANCES, REQUIREMENTS / FOUNDATION TO SEPTIC TANK ~-~ FOUNDATION TO SEEPAGE PIT ~ / , DRAIN FIELD ,EpT,o TAN~ A~ . SEEPAGE "'T ~ TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD -, DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. DRAIN FIELD TO RIVER, LAKE, STREAM· 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. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. '~,' - t) ,.,,.~... OR I CERTIFY THAT i AM FAMILIAR WITH THE REQUIREMENTS OF GREAT~/~NCHORAGE AREA BOI~J~JGH ORDINANCE NO, 28-08 AND THAT THE ABOVE DAD'SC~IBEDSYSTEM IS IN ACCORDANCE WITH SAIDGODE.T/~--~F/'~'~/'~// APPLICANT'S SI®NATUR, /~~ ~L~ ~ ~ // Performed For Legal Description: This Form Re~orts ,.,xEATER ANCHORAGE AREA BOROb.~J DEPARTMENT OF EN\IIRON~!EN1-AL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Lot~q Block 3 Soils Log 'X. CASE # Date Performed S u b d i v i s i o n Nj ~ke~TN'q~ i~.x~ ~col $'ti on Test Demth Feet Soil Characteristics Was Ground Water Encountered?_ If Yes, At what Depth? Gross Time Reading Date Percolation Rate ~iinute Proposed Installa~on: SeeoaQe Depth of Inlet Net Time Depth to H20 Pit Drain Field De~th To ~Bottom Of Pit,Or Trench Test Net Dropl Data Certified Date:~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Sita Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 015-341-34 GENERAL INFORMATION Completelegaldescription VALLI vU~ASUBDIVISION ~2: LOT 34, BLOCK 3, Location (site address or directions) 10111 LONE TREE DRIVE ANCHORAGE. AK 99516 Property owner STERLING CLEMENTS Mailing address p.o. Box 21586 8AKERSFIED. CA 95590 Lending agency Mailing address. Day phone Day phone (661) ~7-2113 Agent GARY TAYLOR W./ PRUDENTIAL JACK WHITE Day phone (907) 727-4-427 Address 1101 EAST 76TH AVENUE ANCHORAGE. AK 99518 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 4 XXX If community well system, provide wdtten confirmation from State ADEC attest- ing to the legafity and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ×xx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system, 72q)25 (Rev, 1/91) Front MOA ~21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1, 100.00 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/er wastewater disposal system is safe, functional and adequate for the number of bedrooms and 'type of structure indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and ins ~ection, the on-site water supply and/or wastewater disposal system is in compliance with all Munic and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ALASKA WA;.T-EE &~W'AS'~ 'ER CONSULTANTS, INC. Phone (907/337-617!;) Address 6901 DEBARR ~OAD, ~I~I'fE~E~/A ~ORAGE, ALASKA 99504 / ~_ Engineer's Signature ~ . /J,/I;~ ~ /'o/~2//~d Date In conducting this evaluation, AWWC, ,n'"'~c./at~r~ted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MG/A DHRS Guidelines & Regulations. The reported results described 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 soils 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE ~ Approved for .L~ Disapproved Conditional approval for bedrooms bedrooms, with the following stipulations: Additional Comments By: (~"~,4//'/~'"--~.,~.--~ ~P/, ~o-"~ Date /O'-P,-F-O 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. 72-025 (Rev. 1/91) Back MOA #21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Health Authority Approval Checklist Legal Description: VALLI VUE S/D #2; LOT 34-, BLOCK 5, Parcel I.D.: 015-341-54 A. WELL DATA Well Type COMMUNI'IY If A, B, or C, attach ADEC letter. ADEC water system number 210605 Log present (Y/N) Date completed ~ Total depth. Cased to ~ound). Wires properly protected (Y/N). FROM WELL LOG ATINSPECTION Date of test .~/ ~ Static water level ~ ~ ~/ g.p.m. ~ ../'""/ g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate B. SEPTIC/HOLDING TANK DATA Date installed 11/5/74 Tank size Foundation cleanout (Y/N) Date of Pumping 10/12/00 C. ABSORPTION FIELD DATA Date installed 8/25/92 Length 40' Width Collected by: Number of Compartments 125O YES Depression (Y/N) NO Pumper NORTHLAND PUMPING I'MEASURED IN FIELD.I Soil rating ~r ft2/bdrm) 2 Cleanouts (Y/N) YES High water alarm (Y/N) **TEST WAS C.ONDUC3ED ON TRENCH ONLY. ***ROSE TO 5 WITH THE FIRST 120 GALLONS AND THEN STABAUZED AT THAT LEVEL FOR THE REMAINDER OF THE 3EST. NOTE: SEPTIC SYSTEM WAS PRE-SOAKED WITH 1981 SALLONS ON 10/13/00 I 1.2 System type TRENCH Results (pass/Fail) **PASSED For 0" Immediately after 720 - Absorption rate = N/A If yes, give date Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO 4 Bedrooms gal. water added (in.):5" 600+ Effective absorption area 520 SQ. FT. Date of adequacy test 1 O/17/00 Fluid depth in absorption field before test (in.); Fluid depth ***5" (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3~96)* Computer Version 3.0' Gravel thickness below pipe 6.5' Total depth '11.5' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on~p orr' level at*. .~~-' Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SepticJholding tank on lot Absorption field on lot Public sewer main On adjacent lots ~ublic sewer manhole/cleanout Lift station __ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 200' SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main/service line 10'+ Surface water. 100'+ Curtain drain F, ENGINEER'S CERTIFI~ I certify that I ha.v~atf~r of Municipal re, bord~ tll~a~ Signature Engineer's Nam~ Y ( NC KNOWN ~ield inspections and review systems are in conformance )n this date. JEFFREY A. GARNESS Driveway, parking/vehicle storage area_ 1 Wells on adjacent lots 2~0'+ ~ ~ ~ C[~7953 ..' ~ HAA Fee $ ,~-~' ~' ~ Date of Payment /~-') ~ ~'' '~ '- ~-{~-~ Receipt Number ~2 ~ ~ c~ (z//O -'~-~'~ 72-026 (Rev. 3/96)* Computer Version Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# ~:~,/,,%~-- :~'~/',.~ N NAA# GE.E.^.,..O.M^T,O. Complete legal description Lo-t- ._~q ,"-~,D~c(Z, ~ V~/_L_r Vc)~-/~/',7) 4_\,~ Location (site address or directions) Property owner 't~'~. ~.~"~_ ~A~Lc,,"..J Day phone .~=~_4//-//-.// Mail!r~g address /~//[ ~o/u~' ~ ~-~-'-~_,u~ r /g~'CCr A~( ~J~3~-/~ Lending agency Day phone Mail!ng address Agent 'I,A.S~ C~ Address Day phone 'ze ~t ~ ~/:,~ Unless otherwtse NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water requested, HAA will be held for pickup. '-'-" 02 1997 RECEI)ZED NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) 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 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~:)~,M.''J¢~-)~' ~'¢J~' ~",/C_ Address ~::~,C~,~-~c~c /4'~_~ / t~t~c~ Engineer's signature_ ~ Phone AlL- Date, DHHS SIGNATURE X Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date 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 DH HS does this as a ecu rtesy 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 engineefs work. 72~025(Rev. 1/91) Back MOA¢~I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES ~'~ Health Authority Approval Checklist Legal Description: /-,,~,~:~-~ Parcel I.D.: (~'~' -- 34// -- ~ q' A. WELL DATA Welltype /~ II~B, or C. attach ADEC letter. ADEC water system number Log present (Y/N) Total depth ~ Sanitary seal (Y/N) Date completed Cased to FROM WELL LOG g.p.m. Casing height (above ground) Wires properly protected (Y/N) Date of test AT INSPECTION Static water level Well production WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed /~ Tank size Foundation cleanout (Y/N) Date of PumPing <~ I ~-~C) Number of Compartments ~ Cleanouts (Y/N) Depression (Y/N) ~ High w~ter alarm (Y/N) ~ Pumper '~-,_q ~ Ac.',.~. C. ABSORPTION FIELD DATA Date installed ~ll.S'/w4 / ¢l~,~/~t ~. Soil rating (g.p.d./fF or ft=/bdrm)~ [' ~- System typ,.e Len:gth 1~ / z./~ Width/I,~/ ,~' Gravel thickness below pipe &;' /~'-~ Totaldepth Effective absorPtipn area ~,5-~(/,5'~o Monitoring Tube present (Y/N) '~' Depression over field (Y/N) __ Date of adequacY tes't (~/~'0~ ~ ~ '~ Results (Pass/Fail) X~A ~ For ~ Fluid depth in absorption field before test (in.); 't:>fz'-f Immediately after~'Co gal. water added (in.): bedrooms Fluid depth '"C3f~'~' (ins) Minutes later: Absorption rate = ~7.7~.T. ~c~c) g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date 72-026(Rev. 3/96)* '1~ c-~1~ ~x.~A~ 'l~'d ~'T"t'~'~'T'-"'/~- c,~"~P,~---r-,,~'l-~, D. LIFT STATION Date installed /1 ,,.¢~ ,/ Size i~---~'---'-' Manhole/Acces., (Y/N) p, ~t~orClevel at Pump off level at High water alar~~'~"~- / J / ~/~Datum E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot (//%./-/~/~ Sewi~r ~septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line ;~ c~: Absorption field Water main/service line ~(:~ Surface wateddrainage /~"'~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line :2. t~-~ Building foundation /~ ~ Surface water ~ ¢'0"~ Curtain drain ! ~:~'+ Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots HAA Fee $ Date of Payment_ Receipt Number ENGINEER'S CERTIFICATION ~cert~ytha~havede~erm~ned~hruf~e~dinspec~nsandreview~fMun~c~p~r~rds~"~?'~`~e`~m`sare in conformance with MOA HAA guidelines in effect on this date. Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY 0F ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIKONMENTAL PROTECTION APPLICATION F0K HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application DaCe /~-/~-~ (a) Legal De. scription (include lot, block, sub.~.~viston, sectipn, township, ra.n~e) Location '(address or directions) /ol)1 ~A~ '7-~-~ ~ ' (b) Applicants Name ~/~/ Applicants Address ~d/Il j.~,~" 7~9~- ~.' (c) Applicant is (check one) Lending Institution .BUyer ~-~; Other ~ (explain); (d) Lending Institution Address Telephone - Home Business ~ ; Owner/build~r~; Telephone (e) Real Estate C9o & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of'Bedrooms 3. Water Supply- Individual Well~ Multi-Family ~--~ ¥ Other (describe) Community ~i Public 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] 0 Engineering Firm Providing Inspections, Testst File Searcht Data and Information As certi~ied by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-s'ite water supply and/or wastewater disposal system is safe, functions1 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 Anchorag? 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 regula- tions in effect on the date of this inspection. Name of Address Date (ENGINEER SEAL) Approved for ~ bedrooms B Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES ~EALTH AUTHORITY A~PROVAL CERTIFICATES BASED SOLELY UPON TUE REPRESENT- ATIONS 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 REQULRE- MENTs. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT ILESPONSIBLE FOR ERRORS OK OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK° (DHEP SEAL) /D18 2 of 2] 7-19 -84 WELL DATA U.IC,PAL,TY OF A.CHORAGE, OA, a HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 ~-'~ ]~ '~ J_~0 264-4720 / N~lD~lO~d 1ViN~NO~IAN~ Legal Description: ~'~ ~ ~ ~ ~ HL~V~H ~O 'Idac . Well Classification resent (Y/N) __ Cased to Casing Height Above ~d__ 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 ~¢J-/~/~"~/'/7~?/' I~) B, C, D.E.C. Approved(~N) ~ Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~.j~Adjoining Lots To Neare~ Sewer To Nearest Sewer S~on Lot ;Date"'-,. B. SEPTIC/HOLDING TANK DATA Date Installed StandpipeS)N) Depression over Tank (Y(~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ,'~,~ Separation Distances from Septic/Holding Tank: To Water-Supply Well ~r//,)-'/~ To Property Line _~ O To Water Main/Servi'ce'Line(~) Course Comments ~--~ 4~/~'.~"//'~"7/ Size Air-tight Caps~N) No. of Compartments / Foundation Cleanou~)N) Date Last Pumped /(////¢ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage 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/~ Results of Last Adequacy Test Type of System Design / Length of Field Depth of Field Gravel Bed Thickness ~ / Standpipes Presen~N) Date of Last Adequacy Test /O ~-~ "~" Separation Distance from Absorption Field: To Water-Supply Well ~/gfl/'/' 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 To Property Line To Existing or Abandoned System on ; On Adjoining Lots DO TO Cutbank (if present) D. LIFT STATION size in Gal,l, ons~"'-"--~- "Pump On f.evel at ~ High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ng Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hawchedked, ye/rifled, or conformed to all MOA and HAA guidelines Signed ~--~'/2'/~7~ Date Company _ /'¢~d.~ MOA No. Receipt NO. ~ %~ Date of Payment ~ b - Amount: $ ~ ~ Page 2 of 2 72-026 (11/84) ALASKA ENVIRONiP~NTAL CONTROL SERVIC~., INC. 1200 West 33rd Avenue. Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. OF CHECKEO BY ~ATE SC^LE ALASKA e iUIROrlme[1TAL COIqTROL S RUICe$, ~nqinceri~q ~ ~nuironmenlal $ludics InC. HOME EQUITY - #200-1102 P 0 BOX 8026 WALNUT CREEK CALIFORNIA 94596 SELLER-SAME OCT 7 1985 WILL MAIL FROM OUR OFFICE 50667 LEGAL:VALLI VUE ESTATES #2/BLOCK 3/LOT 34 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-OCT 3 1985 THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN AREA OF 354 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 695 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON OCT 3 1985 . 1200 ~Jgsl 33rJ J~ucnue. Suile [~. Anchoro§~, AlonZo 99503 ~,{907) 561-5040 DEPT. OFENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BIL& ~IEFFIEID~ GOYERNOR Telephone: (907) Address: 274-2533 Pws c /Oe06- To Whom it May Concern: ~ According to records on file in this office the Water System is in compliance with state the Water Regulations Drinking Sincerely, MUNICIPALITY OF ANCHORAGE .MUNICIPALI~ OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DI=PT, OF II-~ALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P~OT~CTION ENVIRONMENTAL ENGINEERING DIVISION FEB z~.: 1980 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWI~E~C~-J'[VJ~ D ~1RECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Phillip and Lila Block 344-9276 MAILING ADDRESS 10111 Lone Tree Dr. PROPERTY RESIDENT (If different from above) PHONE 2. BUYER . / ~ PHONE John and Judith Gross MAI LING ADDR ESS Concord , California 3. 'BNO,NG ,NST,TUT,ON NBA Yevon MAILING AD, DRESS 4. REALTOR/AGENT PHONE 272-1541 Larry Eaton MAI LING ADDR ESS 101 E. International Airport Rd. 5. LEGAL DESCRIPTION Lot 34, Block 3, Valli-Vue //2 STREET LOCATION 10111 Lone Tree Drive 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other ~] SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ~ COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available,) 8, SEWAGE DISPOSAL SYSTEM [] INDIVI DUAL/ON-SITE** **If individual/on-site, give installation date__76 If system is over two (2) years old an adequacy test is required [] PUBLIC UTI LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-Ol 0(3/78) ~.~ THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME "-DATE DATE -- DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED [] PUBLIC UTI LITY Connect]on Verified INSTALLER []Septic Tank or []Holding Tank Size: I ~).~'0 If Tank is honlemade 801LS RATING'~'~- give dimensions: 'ro'rAL ABSORPTION AHEA MATERIAL / r ~(~'-~) 4. DISTANCES Septic/Holding Tank Absorption Area I~ewe,~Li.9~ Ne§rest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS I~PAPPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate} [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) /'! · --~..~.'_~ ,., . ,... , ~~'~ d~v~sfon plat, Under no ci~s:ances should any ,. data hereon ~e used for cons:rue:fan or for es:a~- ~a~ ~ ~a~.~. ~sh~n~ boundary or fence l~nes T~ ........... ?[~c~, r~Pons~bfl~ty for the initial t~ansa ti' LOT ~ BLOCK ~ 77.~f~ ~ ... ~ .0.,... :.., · . ~ ...... ANCHORAGE RECO~/NG DISTRICT GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received July 20, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER F~CILITIES FOR Conv. l. Appr-0val requested by: Dynamic Realth % Ken Calhoon Mailing Address: 501 West Northern Lights 2. Property Owner: Tim Lutman Phone: 279-7611 Phone: Mailing Address: 3. Legal Descriotion: 4. Location: //')/~/ 5, Type of facility to be inspected Single Family 6. Well Data: Comanunity Water System A. Type C. Construction 7. Sewage Disposal System: A. Installed Lot 34 Block 3 Valli Vue Estates #2 B. Depth D. Bacterial Analysis On-site system~, B. Installer C. Septic Tank: . l~' Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line LQ-034 (1/74) Page 1 of two pages Page 2 of two page's - Re~st for App~dval of Individual '~-~er & Water Facilities Legal Description Lot 34 Block 33 Valli Vue Estates #2 Comments Approved ~.,...,,~,~N DisaPproved . Date/~--,~'- Approv~lid for one year from date signed Greater Anchorage ~r~a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactor?~. · Date SIGNED EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & I~NVIRONMENTAL PROTECTION JUL :2 0 Department of Environmental Quali_t~74 3330 "C" St., Anchorage, Alaska 99503 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO __ VA' FHA 2. Property Owner: 3. Name of Buyer: ~- -- - -- ~' ---'--'--"- Mailing Address: CONV X Phone 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Mailing Address: Phone Legal Description: L~/',~ ~'/~.~ ,-~ Location: V~/" K~'~ '"~'~ go Type of Facility to be inspected: _~ No. Bdrms. ~ ~ater Supply Type of Supply: If Individual, If Individual, Sewage Disposal System Type.of S~stem: Public Utility If Individual, date of installation Public Utility Individual number of dwellings 9resently served depi;h of well ~j~/~(/.~/~ ~J~ ~j.~J4. Individual (on-site)X