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VALLI VUE ESTATES #2 BLK 3 LT 35
DOL Du L "4vo *a ks5 "mss-3u�-33 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 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241078 Work Type: SepticTank Upgrade Tax Code Number: 01534133000 Site Legal Address: VALLI VUE ESTATES #2 BLK 3 LT 35 G:2538 Site Mailing Address: 10121 LONE TREE DR, Anchorage Owner: MARSHALL CATHLEEN Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: c cka Department 5/13/2024 5/13/2025 22918 ❑ 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:_ The waterline is to be located and shown on the record drawing. _RBGek'ed-By: (A e.A - " /—W G Date: Issued By: Date: S/3 Z 1-1 4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-341-33 Property owner(s) CATHLEEN MARSHALL Day phone _ Mailing address 10121 LONE TREE DRIVE, ANCHORAGE, AK 99507 Site address 10121 LONE TREE DRIVE, ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) VALLI VUE ESTATES #2 BLOCK 3, LOT 35 Legal description (Township, Range & Section) Lot Size 22,918 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank El Upgrade ❑ X Duplex (D) ❑ Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Z Z Waiver Fees: Date of Payment: _S 4 120Z Date of Payment: Receipt Number: Permit No. 0 SI"/� 2 `� 0 Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! May 6, 2024 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: VALLI VUE ESTATES #2 BLOCK 3, LOT 35 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. We would recommend a 1500-gallon HDPE tank be installed for current functionality and future consideration or flexibility. No groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank may be required. The lot and area are served by public water and any encroaching water lines, wells, easements, … must be staked prior to construction. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241078, Deb Wockenfuss, 05/13/24 FIRST WATER CONSULTING VALLI VUE ESTATES #2 BLOCK 3, LOT 35 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241078, Deb Wockenfuss, 05/13/24 1� R ----------- --------- 4C� A� AO ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: VALLI VUE ESTATES UNIT Not LOT 15 BLOCK I PLAT 71-285 * = FND 5/8" REBAR Atil SUR SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a OF •L A AW 0 S1 physical survey of this property as shown on this drawing and that the A W_ io improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should 491H•,' ¢ :� 4 any information on this drawing be used for construction of fences, ................. ......, structures, improvements, or for establishing boundary lines. ?A ?. . . A EXCLUSION NOTES: It is the owners responsibility to determine . . . . . . 47 a . . . . . . . . . . . . . . . . .* JOHN L. SCHULLER.-0 A0 � �, ' the existence of any casements, covenants, or restrictions which do not appear on the recorded subdivision plat. LS -10408 AW 1831 Talkeetna Street WORK ORDER NUMBER: DATE- SCALE; E—MAIL:- Anchorage, Alaska 99508 MAY 5, 2024 1 =40' schuilerakOgmail.com AW DRAWN BY. ICHECKED BY: GRID NUMBER: Bose AGE: Of \'0 'iew (907) 227-1455 office 24-037 e scion G\ 44W jLS SW2538 240152 ►(907) 274-4992 fax Municipality of Anchorage Page of7z-- 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: atS�J9l�� Name Wastewater System: ❑ NewUpgrade Address:-17/vC�>�i ABSORPTION FIELD r 10 L� �A Ip aA, S3 Phone: No. of Be rooms: 9beep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 72--GPD/S Total Depth from original grade: t � . Ft. Lot:22 Block: Subdivision: -✓15 3 V, u, \/dgf 1. Depth to pipe bottom from original grade: ( Ft. Gravel depth beneath pipe / f ✓ Ft. Township: Range: Section: Fill added above original grade Gravel length: / �6 Ft. Ft. WELL: C1 New LJ Upgrade Gravel width: 2� Number of lines: DistaFoe?,as fines: `Ft. Ft. I Classification (Private, A,B,C): Total Depth: Cased To: Total absorption are a: Pipe material: (Q� Ft. Ft. %r/C/ SQ. Ft. Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES septi El Holding ❑S.T.E.P. To Sepfic Absorption Lin Holding Public/Private IM�anufacturer:;�p./ Capacity in gallons: From Tank "aid Station Tank Sewer Lines IP Well 2�t.}- 2� �- __ "1 l f� L --b Material �.C� Number of Compartments: Water �"�" h LIFT STATION Lot f I �� _ ]Size in gallons: Manufacturer:Line f mp on" level at: "Pump off' level at: High water alarm at: Foundation i D I Curtain Pum a &Mad., Electrical Inspections performed by: Drain — lcj 1� �tii0 SE — J(7 BENCH MARK Remarks: S /'Jl lac', A -No sE (c 714N AAfl7vQ6tj&P Location and Description: –R --p Z,r –Coh1G– IUFA& CE 6 LIE . Assumed Elevation: � 6D—Ft ENGI%SCL k9 •pOeO.O.B.apO i�• V a ep � ° ®p`6 ��� 5 & s ENGINEERING No. 204 loop 77034 Eagle River Inspections performed by: fit River Alaska99577 Dates: 1st�2 .nolo. nes se goo J.. s 8.e0A. O effe mss. aoG d SHAFER a ®� 0. No. 15 a � Department of Health and Human Services approval 4�'N' dp0,poeeDBpepp,®°°��� Date: �����® Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 Permit No. �y�L�2o2�D Municipality of Anchorage Page -2 ' of Z— 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 VP'wt 41zk-u'E MT A r tFw� t 4 - No. APIG 72-013 A (Rev. 9/91) MOA 25 col COZCa3 Com' cod t -'n' !v A 1,2° 1,1 IqS 3 lo= lg5 los Zv re Ih� I A r tFw� t 4 - No. APIG 72-013 A (Rev. 9/91) MOA 25 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMEDFOR: CLIFF C%4elQeV DATE ft -K 3 LEGAL DESCRIPTION: I1�-L%T VUE _ UOgjownship, Range, Section: _ SLOPE SITE PLAN DEPTH — (FEE 1 ✓`v 6� 2 3 - l W GRA-Orr✓J SRAI�y G-RA0Er- 4 SAi-JO, 4 6� 81 9 10-0 11 12 13 O 14 15 Jo 18 19 20 WAS GROUND WATER V1 ENCOUNTERED? N�/ S IF YES, AT WHAT 0 DEPTH? P E Depth to Water After Monitoring? Date: PLRCULA I IUN HA I t tminuiesimml rCMU nULc Uiruno i �n TFST RUN BETWEEN FT AND FT PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. 4 ACCORDANCE WITH ftjgEAjN�jI�,} rIT{�� �UIDELINES-IN EFFECT ON THIS DATE. DATE: 1 72-008 (Rev. 4/85) PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE 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) PERMIT PERMIT NUMBER:SW920250 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:CHENEY CLIFFORD D & OWNER ADDRESS:SNORE PASS HWY. 108 DARDANELLE, CA 95314 PARCEL ID:01534133 LEGAL DESCRIPTION: VALLI VUE ESTATES #2 B 3 L 35 LOT SIZE: 22918 (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: DATE ISSUED: 8/28/92 EXPIRATION DATE: 8/28/93 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: ADDITIONAL TEST HOLE TO BE PERFORMED PRIOR TO TRENCH EXCAVATION. VERIFY SOILS AND NO IMPERMEABLE LAYERS TO -17' OF EXTQMTMn noAnF RECEIVED B ISSUED BY: DATE:"'�J Z� ` ? 2 DATE : Z� Z Ij— August 6, 1922 F9C' F kIV E P. P PSµP HEALTH AUTHORITY APPROVALS Municipality o6 Anchonage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stneet P.O. Box 196650 SEWER &WATER Anchorage, Atasha 99519-6650 MAIN EXTENSIONS REFERENCE: Lot 35; Btoch 3; Vatti Vue Estates 02 ROBERT SHAFER, P.E. ROGER SHAFER. P.E. CIVIL ENGINEERS (907) 6942979 FAX 694 1211 Request you issue a permit to upgnade the septic system serving the SEWER &WATER ne6eneneed pnopenty. Also, we +request you .issue a 2' pnopenty tine INSPECTION waiver in olden to maintain a 10' separation distance 64om the water Zine. An adequacy test was pe46onmed on the existing system and the ENGIN EERING STUDIES absorption capacity o6 the system was Sound to be inadequate. AND REPORTS A test hate was excavated and a percotation test was pen6onmed in the area o6 the proposed upgnade. Attached is the proposed upgnade design. WELL INSPECTION This pnopenty is served by a community waters system. Thele ane no &FLOW TEST pnateetive wett %adi,i which encroach upon the pnopenty. As can be seen 6rom the site plan this tot is targe enough bon another 6utune upgnade. We do not anticipate any adverse eb6eets on neighboring pnopen#i.es by the instattation o6 the proposed septic upgnade. SITE PLANS 16 you have any questions on require additionat in6onma.ti.on bon your review, ptease contact us. ROAD DESIGN Sincenety, ROGER J. SHAFE , P.E. SOIL resr IP(U/LSU/gm PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 W LEGAL VALLI VUE ESTATES UNIT No. p\ DRAWN L. S. ULSHER CKD. R.J.S. DESIGN CRITERIA: r 0 IZ1'1 4 BDRM HOUSE \ A m —\ D EXIST CR RJ BE � 3 ABANDONED T. SOLID PIPE WITHKEY OQ NO JOINTS IO' EA eox SIDE OF WATER LI � 4 BDRM 600 GPD SOILS l.2 �D/FrZ 600 l.2 = 500 sq. f1. REOD DEEP TRENCH. D iIVER, PI'PS� ll' DEEP 5' EFFECTIVE 50'LONG EX/ST. 1250 GA SEPTIC TANK VER \ CO .y.. CO 18 1 C LOT 34 BLOCK 3, LOT 35 DATE 8/4/92 sHT. / OF l No. LOT 35 FCO 2nd T.H. TO BE EXC. a SOILS TESTED /0' UT/L. ESMT. M' CO AT TIME OF CONSTRUCTION AREA RELATIVEL,Y/ / / g%. 25V.± FLAT j0 ^"/ ./ /PROPOSED 50' TRENCH l0' MIN. WATER LINE LOCATION ESTIMATED BY DEPRESSION WHERE TRENCH EXC. SETTLED. LOT 36 ` PROPERTY SERVED b w BY A COMMUNITY �r j WATER SYSTEM THERE ARE NO SEPTIC WELLS WITHIN AREA 200'OF PROPOSED SEPTIC SHAPER a@ �9F °0i�e. •°w°°°°a 'oPOFESS6O�Q LOT 30 A/t JUYYLItS 150208 LOT /3 m.. LEGAL VALLI VUE ESTATES UNIT No. 2, BLOCK 3, LOT 35 ap DRAWN CKD. DATE SHT. �+/ p� L. S. ULSHER R.J.S. 8/4/92 ` DESIGN CRITERIA: 4 BDRM = 600 GPD SOILS = l.2 CPo/FT2 A 600 + 12 = 500 sq. ft. REOD f9C�E HIV ER, AnPsµP N SOLID PIPE NO JOINTS F SIDE OF WA A/E SUPPLIES iso,oa =_Pt J. No. I BY A COMMUNITY WATER SYSTEM THERE ARE NO G SEPTIC WELLS WITHIN AREA 200'OF PROPOSED SEPTIC PERFORMED FOR:— LEGAL DESCRIPTIO 1 a� - e// 9 `V 2 U " J` 3 4 CQ .. 6 e P - 7 G. 8 9 d - Ga 10 F3 � O- 11 e 12 - a .aa, 13 a. 14 0 Y b, 15 16 17 18 19 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST C?. 44 . I \/t,(E DATE F -A;VZ ,c;�ownship, Range, Section: SLOPE WAS GROUNDWATER ENCOUNTERED? d S IF YES, AT WHAT L O DEPTH? P E Depth to Water Aheh Monitoring? V�Y Date: SITE P 20 Lj PERCOLATION RATE � (minutes/inch) PERC HOLE DIAMETER U/ ']�.t� @, TEST RUN BETWEEN __J""1/iYT ANDCL�c'FT COMMENTS1��G PERFORMED BY: S & S E.'NGINFERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 77034 Eayio l717er Loop Read No. 20 ACCORDANCE WITtBID K*PN(� Njf7�-GUIDELINE IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) c �1GREi - R ANCHORAGE AREA BOF"! GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 yI INSPECTION REPORT ON—SITE SEWAGE DISPOSAL SYSTEM NAME//%U�-�T«N�/�' I AV T(�.'�P i�k�ISt�S MAILING ADDRESS t%n 35/ �j �lSC� / PHON E.3C'V LOCATION//7Q I,U'GZ bi.'. LEGAL DESCRIPTION AUT��" I SEPTIC TANK: DISTANCE �� NUMBER OF FROM WELL %I�iltb%K� MANUFACTURER MATERIAL G{G7f=.�U��IS(J' COMPARTMENTS 1 INSIDE LENGTH -" INSIDE WIDTH -" LIQUID DEPTH – LIQUID CAPACITY /5� GALLONS. SEEPAGE PIT: NUMBER OF PITS / _ DIAMETER OR WIDTH 1 LENGTH—//,' ENGTH� /,,' DEPTH LINING MATERIAGa'`i I CRIB SIZE: DIAMETER �� 7DEPTH b r DISTANCE FROM: WELL �I TOTAL EFFECTIVE BUILDING FOUNDATION %I , NEAREST LOT LINE �ABSORPTION AREA (WALL AREA)=' E SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE6i CONSTRUCTION BUILDING NEAREST FOUNDATION—,LOT LINE CESSPOOL OTHER SOURCES DEPTH NEAREST SEPTIC SEWER LINE—,TANK_ APPROVED DISAPPROVED REMAR DISTANCES: ���� DIAGRAM OF SYSTEM INSTALLED BY: 44r ire t4) 4 3E` 90)_ •?J t �nj t �il, 16�S�ILL PIPE MATERIAL; CG C(Fli%� i --"�+^-P , LOT SLOPE:`'-- �7 REMARKS: DATE ��c.�t). •�7, /i7��APPROVED! Form No. EQ -031 DISTANCE FROM: SEEPAGE SYSTEM _ n u`s III�II�I�'°c NAME OF APPLICANT -FAl INSTALLATION LOCATION LEGAL DESCRIPTION _ GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FA FINANCED THROUGH PERMIT NO. MAILING ADDRESS `s 4JPHONE V� e� DRAIN FIELD OTHER COMPLETION DATE ANTICIPATED NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST 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 SIZE TYPE SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS. FOUNDATION TO SEPTIC TANK �f FOUNDATION TO SEEPAGE PIT .>r 9rp DRAII FIELD SEPTIC TANK TO SEEPAGE PIT WALL f �a� P SEPTIC TANK /0 . SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD ALSO ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK,—1��-�, SEEPAGE PIT 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. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. a /IfG.A.A.B. OR L SED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF DESCRIBED SYSTEM IS/INI /N ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE AREA DIAGRAM OF SYSTEM ORDINANCE NO. 28-68 AND THAT THE ABOVE ATER ANCHORAGE AREA. BOROL, s DEPAP,TMENT OF ENVIRONMENTAL QUALITY CASE # 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 / Performed For lk41c,WJs7vvv-, r:v, Ar,'� :2C',< Date Performed t' L ( A Legal Descrintion: Lot '3S Bloc: 3 Subdivision This Form Renorts Soils Log _Percolation Test_ _ Oenth Feet Soil Characteristics Was Ground Water Encountered? �nG If Yes, At what Depth? Reading Date Gross Time Net Time Depth to H2O I Net Dron t _ i Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth To Bottom Of Pit Or Trench COMMENTS; Raz -fit cw� � ':10 (•� �� Test Performed By Data Certified By: Date: 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 Parcel I.D. 015-341.33 1. GENERAL INFORMATION Expiration Date:IV 2-02_ Z_ Complete legal description _VALLI VUE ESTATES #2 BLOCK 3, LOT 35 Location (site address) 10121 LONE TREE DRIVE, ANCHORAGE, AK 99507 Current property owner(s) CHARLES & VASTYL MANGOLD Day phone Mailing address 10121 LONE TREE DRIVE, ANCHORAGE, AK 99507 XXXXXXX 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. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: Received by: 4 TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic: ❑ Holding Tankl ❑ ® Community ❑ ❑ Public Sewer ❑ i Distance: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J 5� / C1 12 n Date of Payment (o/lQ 13LOab Receipt Number 30a 11q;4 COSA # i 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/18/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to A�sli� these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q:'� • • •,9}I for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & Fblf.S �/ *. -49 .TM , . , ..:* . . .. .. VM.. - 6. DSD SIGNATURE i'. Curtis Huffman System #1 Approved for bedrooms ���9IFF/1$/291 0���`�`� System #2 Approved for bedrooms l�l�`=OFESSIOi�� Disapproved Conditional approval for bedrooms, with the following stipula`* J.fC� O46, ON-SITE VATER n eTEVIATFR 6:z PROGRAM 9 1 11)8EKlll_ Vl By: 4 1ytil t Wet' (A� Original Certificate Date: 1 , " .2 —20Z.O 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 T'ov/, Legal Description: VALLI VUE ESTATES #2 BLOCK 3 LOT 35 Parcel 1D: 015-341-33 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA — PUBLIC WATER ❑ Well log is filed with Onsite (or attached) Date drilled Total depth _ft Cased to _ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) _in. Date of flow test for COSA Static water level at beginning of test _ft. Comments B. TANK DATA Age of tank(s) 28 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 48.5" ® Standpipes/foundation cleanout per record drawing Date of pumping 6/10/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 9/25/1992 ® ALL standpipes present per record drawing Total measured depth from grade 11.9 ft (max) Measured depth to pipe invert from grade 8 ft (min) ❑ N/A — pressurized field Structure served by this system _ Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate _mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: SEE ATTACHED MOA TANK ADVISORY. BUYER AWARE TANK IS APPROACHING 30 YRS. Adequacy test date 6/10/2020 Results Z Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 850 gal New depth 34 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1080 min depth into effective 3.9' INTO THE 5' ED ® Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: FES E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) NA — PUBLIC WATER Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® 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' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *8.5 ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *MOA WAIVER G. ENGINEER'S CERTIFICATION l 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. Adw •�� TH •, i. . ........ Curtis Huffman 9x T ,CE 128991 OFESS O�PLti�� ft ft ft Septic Tank Advisory Certificate of On -Site Systems Approval #OSC201266 Subdivision: Valli Vue #2 Blk 3 Lot 35 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 28 years old. Typical replacement costs range from $8,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. �� Ma�lmg Address' P O Box 196650 *Anchorage, Alaska 99519 6650* www muni org � �' Parcel I.D. 015-341-33 Municipality of An( On -Site Water and Wastewater (907)343-7904 Certificate of On -Site Systems 1. GENERAL INFORMATION JUN 11 2015 Expiration Date: Complete legal description Valli Vue Estates #2; Block 3, Lot 35 Location (site address) 10121 Lone Tree Drive, Anchorage AK 9951t, Current Property owner(s) Irma Cox Mailing address Real Estate Agent Day phone 346-4242 10121 Lone Tree Drive, Anchorage AK, 99516 Jamey Wood (Jack White) Day phone 273-7245 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: Individual Well ❑ Individual Water Storage ❑ Community Class A Well Public Water System �_❑ WaiverNariance Received COSA to be i Individual 10 Holding Tank ❑ Community ❑ Public Sewer ❑ otherwise requested by the engineer. )91v- Mr. Date: 0 sb COSA Fee $ 524- t 3115(-" = fttl• (mob Waiver Fee $ 2t5-- -h JA_ Mq., Date of Payment (011111-T C t% Date of Payment (a I r t I IT Receipt Number C)noa a Receipt Number 01t015G COSA# 65C161Z1S Waiver# 0S)(1 51051 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. Name of Firm Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road Suite 101, Anchorage AK, 99507-1259 Engineer's Printed Name Jeffrey A. Garness Date )r Is - In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the dates of the evaluation. Separation distances were measured to readily identsable features. Hidden defects or encroachments may exist that were not idenb'iied during the evaluation. The operational life of all wells and septic systems depend on a variety of variables Including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These Conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be Installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the persoeparty who paid for this report. 6. DSD SIGNATURE System #1 Approved for /"bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the following Original Certificate ((tkl TFI ,nicipality 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 ertors or omissions in the professional engineer's work.. 7. ATTACHMENTS: . COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue shee[_9-1-12.Coc If more than 7 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: VALLI VUE ESTATES #2; BLOCK 3, LOT 35 Parcel ID: 015-341-33 A. WELL DATA Well type A Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE Coliform ug./L. COMMUNITY WATER If A, B, or C provide PWSID# 210605 Well Log (Y/N) Sanitary seal (Y/N)_ Cased to ft. FROM WELL LOG ft. 00 ml. Nitrate mg./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Wires properly protected Casing height AT Collected by: in. Tank Type/Material SEPTIC/STEEL Date installed 9/25/1992 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 10/6/14 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA *eELow EXISTING GRADE Date installed 9/25/1992 Soil rating (g.p.d./fibr /bdrm 1.2 System type DEEP TRENCH Length 50 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth *12.16 ft. Eff. absorption area 500 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/30/2015 Results (Pass/Fail) PASS _ For 4 bedrooms Fluid depth`in absorption field before test 23 in. Water added 965 gal. New depth 39 in. Elapsed Time: 120 min. Final fluid depth 28 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump air level atm Jff. — E. SEPARATION DISTANCES ManholetAcoess water alarm level at in. Cycles tested_ Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent On adjacent lots Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5' Properly line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water-----! —00'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line *$•5' Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS ON 6/10/15 WATER SERVICE LINE WAS RE—ROUTED BY NORTHERN UTILITIES TO MEET 10'+ SEPARATION DISTANCE *SEE ATTACHED WAIVER REQUEST G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are In conformance with MOA COSA guidelines in efled on this date. Engineer's Printed Name JEFFREY A. GARNESS Date /W 14 l s (Rev. 11/05) M ality of Anchorage ¢ent s epartment Development Services Division On -Site Water and Wastewater Proaram **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV161067 COSA#: OSC1 51276 Permit#: PID#: 015-341-33 Legal Description: Valli Vue Estates #2. Block 3. Lot 35 Engineer; O ra mess Engineering Group- Applicant: roupApplicant: Irina Cox Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the building foundation has been approved. The approved separation, distance is & feet. This waiver approval applies to. the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver; ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ....... .............................. ................... Waiver is Granted: X Waiver is not Grant Date: g ! J`~ Approved Name of Reviewer ..r......c..• .............................1.....................r............. .: GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS June 10, 2015 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, AK 99519-6650 ATTN: Jay Crewdson, P.E. Ref: Valli Vue #2; Block 3, Lot 35 — Waiver Request for separation from drainfield to building foundation Mr. Crewdson We request that your department grant a waiver for a separation distance of 8.5 feet from the drainfield to the foundation. The sewer line that exists under the daylight basement runs underneath the footing. In short, if the drainfield was in failure, sewage would show up in a floor drain before lateral migrating sewage from the drainfield could penetrate through the basement wall. This encroachment has existed for 23 years. If you have any kestions, please contact Jeff Garness or Rob Campbell at (907) 337-6179 .E., M.S. 3701 E. Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com 3, EXIST➢NG HOUSE Mr Co 4 ► D Q:V, Lill )11� Pok- , ,•v. -S.Dy< 3 uina ?3c,s�-."'1-CbLD aid a3 oDiL, DE 35c:. ...:•a.;: ..r : o .uu=ri �m -sur i?7 ih - R' _ -s-- AND ASVJtX" F:N,,"ii Ai GABIUrY MILY FOP THE a CET Os Y•.$ E�.3PIE!B . .� .591;.;eL TRANSACT= CHL. dZ:f:N arlPj FCfl T.f US= DZTV±CES PKIJAIL OVER SCAL'NG. REPRO'OtlC'OCN A9A7 CAUL ERRORS 7N SC,+L�. STsA8GL5 L WT Svc, Si.1RNIVe TYPE i C3 AS - SET REBAR W DRAINAGE � ASPHALT -=DA= sus: m a.=-ys:_r 0 FOUND RMAR _ 'a _ WQCD PENCE a ..: CONCRETE _ PI.Aw... '..m= - is W, W, ...��i �fc'l.Ff:Y Zoo ASSiN1EI) &ZY. ACETAL FiEICE L:2.d.:3 woo DEQ NOTE. a P�aa,$) `SvR11Ei 9ae..—o Of ;E4,FJsR R 13",MER, RRJOR �0 CHLY THOS£ 9MPR9VgMENTS ASOVE GROUND ?.TIG '+fl5'®6< LW6L �E TF'� ormsesz+A of NE 3aRIPY PROPOSED �1J@9=91i�ia° RADS RELAaVE -SMC%N. FENCES, 'AMJ-SS. SEPTIC CTs ANCUTS, SIDE°IMALYS DR JMA�. '+°N➢SY<E3 t,�D 6:7ILid r OCP9NEx.r LNNrA`r-a aPc M 5 @Ti � OVEMEHTS FROM BRING S EN AND LOCATED :'.. u'RAUE MAIM "EsVVITO_ l���..y cnd T 35 BLOCK 3 0 10 05-10- M a• ��w T 35 BLOCK 3 MUNICIPALITY OF ANCHORAGE • `� DEPARTMENT OF HEALTH & HUMAN SERVICES AiiL Division of Environmental Services On -Site Services Section P.O. Box 196650Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. If ') HAA # d (ClE1�l1 1. GENERAL INFORMATION Complete legal description Lot 35, Bi_eck'3, Valli Vue Estates fi2 Location. (site address or directions) 10121 Lone Tree Dr., Anchorage, AX 99516-6719 Property owner Jay & Betsey Lewis Day phone (907) 346-1493 Mailing address 10121 Lone Tree Dr., Anchorage, AN 99516-6719 Lending agency Mailing add Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 `, Day phone Day phone 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4.. TYPE OF WASTEWATER DISPOSAL: Individual on-sitp X 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 (119v. 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 Environmental Mona` emen d+. Phone ( 907) 272-9336 Address 206 E. Fireweed/in., hora& AK 99503 Engineer's signature Date (�, R John Earl Simpson p' 6. DHHS SIGNATURE*za 9a` Approved for Fou"- y bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: a Additional Comments 4l 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 orderto 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(Aw.1/91) Back MOA1121 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage MAR 2 0 1997 DEPARTMENT OF HEALTH & HUMAN SERVICES r� Environmental Services Division R kC 4 �v E D 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907kg 4 44 Health Authority Approval Checklist Legal Description: Lot 35, Block 3, Valli Vue Estates Parcel #2 A. WELL DATA Well type Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: If A, B, or C, attach ADEC letter. ADEC water system number PV1 SID 210605 Date completed Cased to FROM WELL LOG Coliform Nitrate g. p. m. Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Other bacteria g.p.m. Date installed 9-25-92 Tank size 1250 Gal. Number of Compartments 2 Cleanouts ©N) Y Foundation cleanout (DN) Y Depression (Y@N N High water alarm (Y/N) NIA Date of Pumping 10-7-96 Pumper Northland Pumping C. ABSORPTION FIELD DATA Date installed 9-25-92 Soil rating (g.p.d.ff or ft2/bdrm) L-_2 clPd/fAystem type Trench,,""i Length 50' Width 3Gravel thickness below pipe 5' Total depth 11 ' Effective absorption area 500 1. Monitoring Tube present ON) Y Depression over field (Y© N Date of adequacy test 3-1.1-97 Results ((as Fail) Pass For 4 bedrooms Fluid depth in absorption field before test (in.); 32 Fluid depth 32 (ins) Minutes Peroxide treatment (past 12 months) (Y® 72-026 (Rev. 3/96)' 60 N Immediately after633 gal. water added (in.): 37.5 Absorption rate = 6o C g.p.d. If yes, give date N/A D. LIFT STATION N/A Date installed Manhole/Access (Y/N) High water alarm level at* "Pump on" *Datum E. SEPARATION DISTANCES N/A SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Size in gallons "Pump off" level at* On adjacent lots On Public sewer manhole/cleanout Se c service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 10' Property line *30' Absorption field 15' Water main/service line 10' Surface water/drainage 100'+ Wells on adjacent lots N/A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 10, Building foundation 10' Water main/service line 10' Surface water 1001+ Driveway, parking/vehicle storage area 101+ Curtain drain None Observed Wells on adjacent lots N/A * = visually confirmed due to snow cover F. ENGINEER'S CERTIFICATION z�aa�ig�QCa 1 certify that 1 have determined t u field inspections and review of Municipal record$"7(0 �7h pc?Ue Mrs are in conformance th MOA HA g idelines in effect on this date. Signature n Date D __/_0 HAA Fee $ 4-0 ' Waiver Fee $ Date of Payment 3 ae, 4&e Date of Payment Receipt Number C>;2-L1w �� U �� Receipt Number 72-026 (Rev. 3/96)* in :Earl 5impson' h 0. - CE - 8061 .:CE-8061 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. # HAA # hl f�goi 1�h1 1. GENERAL INFORMATION ��''' �o�u Complete legal description Lot 35;..B2uck 3; VaUi. VuelSubdiv.ie.ion #2 Location (site address or directions) 10121 Lone Tnee D)tive Property owner Ct i44 and Joanne Cheney Day phone Mailing address Hwy. 108 DaadaneUe, CA 95314 Lending agency Day phone Mailing address Agent Rick GkZZXaM1UULvwtLL ISANKtK Day phone Address 4105 Tudors CewteA V)tive Aneho4age, AK 99507 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water N 4a -z-7 (209) 965-4355 561-2488 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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 H21 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 syst m"i in compliance with all Municipal and State codes, ordinances, and regulations in�ffect orytl5e date of this inspection. Name of Firm - Address S&SANG1N •RIN 17934 -gag ,WRlver oop Road No. 204 Engineer's signIAliHt n_,_AWAtQ_y9477 6. DHHS SIGNATURE Approved for 4 bedrooms. Disapproved. Conditional approval for M Additional Comments Phone Date //Z 2 bedrooms, with the following stipulations: 411TIr 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 orderto 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. 7M25)Rw1,91) Back MOAM21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L6 -F 3S aK 3 VALL I WC Parcel I.D. r ` 3 I ^ 5 ES7?Aj�sZ A. Well Data Well type (AMM UNr i� N A, D, or C, attach ADEC letter. ADEC water system number / ,,uo Log present present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow completed Driller Cased to Casing FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Wires properly M. AT INSPECTION Septic/holding tank on lot rt ; On adjacent lots Absorption field on lot Z C' C) ; On adjacent lots _ Public sewer main Sewer service line WATER SAMPLE RESUL' Coliform sample: B. SEPTIC/N TANK DATA Nitrate tank Collected by: Other bacteria Date installed —Tank size /ZSO KAP Compartments 2 Cleanouts (Y ) _Foundation cleano (Y ) _Depression (Y6 N High water alarm (Y/) /-)/AAlarm tested (Y/N) �A -SYSr�_ C ! YLilt oc r> /i0 C OGcv x/60 Date of pumping 2t�K5 Pumper SEPARATION DISTANCES FROM SEPTIC/He6 **&TANK TO: Well(s) on lotOn adjacent lots �J�� Foundation �U To property line 30 Absorption field �S / Water main/service line �y Surface water/drainage Agn / 7z-ozs(a/s9)'Front CONTINUED ON BACK PAGE C. LIFT STATION /00,,)6- rK 4t�SL--_AJT— Date installed Size in gallons— Vent (Y/N) allonsVent(Y/N) High water alarm level Meets MOA electrical codes "Pump on" level at SEPARATION DISTANCE FROM LIFT STATION TO: tM On adjacent lots anhole/Acces r� Pump off" Level at O ? Cycles tested 9` N � m Surface water G, Z D. ABSORPTION FIELD DATA G Date installed[ Z Soil rating (GPD/Ft') ZGr°v —% System type �Nc� Length _0 r Width 3 Gravel thickness S r Total depth / Total absorption area .S� Cleanout present Y/) Depression over field (Y/160/v Date of adequacy test Results (pass/fail) SS for c "Z Bedrooms Water level in absorption field before test After test IUM Peroxide treatment (past 12 months) (Y/N)c%t/GCw DG_ J /C,/ If yes, give date A/M_ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ti�L—� t /Ceyl{t�n adjacent lots ��� � Property line i To building foundation To existing or abandoned system on lot b y— r On adjacent lots 3d Cutbank /GbN5_ /�2�SG�ater main/service line Surface water 10Q / Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that l have checked, verih Signature v Engineer's Nam ENNEERI 17 g e RIVeI Date Eagle fuer HAA Fee $ �(�D to all MOA and HAA guidelines Loop Road No. 204 Date of Payment Z" a a — 7 3 Receipt Number 72-026(3/93)' Back Waiver Fee $ — Date of Payment Receipt Number. �Orfi gt o�e dat of this inspection. • T MUNICIPALITY OF ANCHORAGE ga&;�Vl 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. # .L 1 fS - Lil 1 - 3 1. GENERAL INFORMATION Complete legal description Location (site address or directions) HAA# 00�')QCGIL-) Btock 3: Va22i Vue Eh.tatee Subdivi6ion 02 10121 Lone Txee Drive, Anchorage, Ataska Property owner CPi44 Choneg Day phone 209-965-4355 Mailing address Snore Pa33 Highway 108, Dan.danette, Cat 6wLnTa 95314 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water A XXX Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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. ]2-025(Rev. 1191) 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 furtherverify 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 Phone ENGINEE:RINQ Address 17034 Eagle River Loop Road No. 209 2agla River. Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments NO 1IITIC Date HAPER a 'r a0 raac¢.mna to a:1 a woww l.attant u aaeo at 'TM 15 , bedrooms, with the following stipulations: 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 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. 7M25 (Rev. 1191) Back MOA 421 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST �/r��l�t Ju.t✓ EST��S#Z Legal Description--&-OrI/. r/�r L-D"r lJt2 Parcel I.D. b1k�7vt) Zf1 �7�J A. WELL DATA Well typ6�:�n,, nJ I f A, B, or C, attach ADEC letter. ADEC water system number_ l --, f C) -Z" 0(,p� Log present (Y/N)t v/ref Date completed � Driller MI Total depth N% Casedto Casing height IVIA Sanitary seal (Y/N) NLA Wires properly protected (Y/N) WATER SAMPLE RESULTS: 0114 COA/LMI U/`Jf 7 % WIRP2 Coliform 1\/, /A — Nitrate Date of sample: N/A Collected by: — B. SEPTIC/HOLDING TANK DATA — S E tE CF77FIL or Other bacteria eCMP(,I/Wnf_7 Date installed �t'7�-�2 Tank size 11-50 61E'y Compartments Z Cleanouts (Y N)((Foundation cleanout/N) Depression (Ye J - High water alarm (Y N � Alarm tested (Y/N) �2�. Date of pumping %,I t-1 Pumper albL, . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot wh�! - —On adjacent lots 2zO 4- Foundation �Of t To property line ZAbsorptionfield (`J Water main/service line 4 Surface water/drainage t5D -I-- 72-026 72-026 (Rev. nst) Front - - CONTINUED ON BACK PAGE m FROM W LL LOG AT INSPECTION �k c Date of test CD ZZ m � � Static water level a o R� m O0 Well flow g.p.m. g.p.m. C < v w n Pump level [Zi r" r4_1 N o ® SEPARATION DISTANCES FROM WELL TO: G) n Z Septic/holding tank on lot -fit ; On adjacent lots Absorption field on lot 20D `~ ; On adjacent lots Public sewer main � Public sewer manhole/clean�olu/t7 N� n Sewer service line I u Petroleum tank /�/1 WATER SAMPLE RESULTS: 0114 COA/LMI U/`Jf 7 % WIRP2 Coliform 1\/, /A — Nitrate Date of sample: N/A Collected by: — B. SEPTIC/HOLDING TANK DATA — S E tE CF77FIL or Other bacteria eCMP(,I/Wnf_7 Date installed �t'7�-�2 Tank size 11-50 61E'y Compartments Z Cleanouts (Y N)((Foundation cleanout/N) Depression (Ye J - High water alarm (Y N � Alarm tested (Y/N) �2�. Date of pumping %,I t-1 Pumper albL, . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot wh�! - —On adjacent lots 2zO 4- Foundation �Of t To property line ZAbsorptionfield (`J Water main/service line 4 Surface water/drainage t5D -I-- 72-026 72-026 (Rev. nst) Front - - CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical SEPARATION DIS Well on lot Manufacturer Manholo/Ac,Cess (Y/N) "Pump on" level at E FROM LIFT STATION TO: D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date installed I" 2G✓'�17� Soil rating 1.2�'TIer� System type7l: �9 ib� , Length �O I Width �✓/ Gravel thickness G✓ / Total depth ( / Total absorption area ��L✓O6 Cleanouts present (Y ) Depression over field (Ypivl f F Date of adequacy test Results (pass/fail) I�Ie� G✓��✓�11`� for !!q bedrooms Peroxide treatment (past 12 months) (Y N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: i Well on lot On adjacent lots Property line To building foundation l To existing or abandoned system on lot On adjacent lots Cutbank I�[5 tJ� Water mai n/servicelino Surface water � C�_o 1 _t__ Driveway, parking/vehicle storage area Curtain drain 00 t,_« E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on S 8, S ENGINEERING Signature 17034 Eagle River loop Road No. 204 Eagle Rivet" Alasica Engineer's Name Date — I�Vii HAA Fee $ Z 70 -0 Date of Payment /2, Receipt Number�7- 72-026 (ReV. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number -N J. No. i Imo/ 0'_+- ltwof this inspeon. TA. I $s WALTER J. HICKEL, GOVERNOR �,u J DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE (907) 349-7755 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 September 17, 1992 Mr. Roger Shafer S & S Engineering SUBJECT: Valli Vue Subdivision Class "A" Public Water System, PWSID 210605 Dear Mr. Shafer: 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: 1. The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on August 10, 1992. This does meet the provisions of 18 AAC 80.200(a) of the State Drinking Water Regulations. 2. 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). 3. The last Radioactive Contaminants Sample results were submitted to the Department on October 12, 1988. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were submitted to this Department on November 12, 1991. 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. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Enviornmental Eng. Asst. II ?i a9cd on rocqian paper 6 y G.I i�'UNICIPALITY OF ANCHG. / b DEPARTMEh JF HEALTH AND ENVIRONIN'Eiv[. PROTECTION +. 825 L Street, Anchor.aae. Alaska 99;0]. 264-4720 _ Date Received: November 28, 1977 41: Time Lj Pn-\ _ 42: Time ( Public Utility ( ) Date1_� iCnS Date 1-1Z %ice! Ins Nn ,A Insp 43: Time )VLL�AM Date _- �� l/ -)LDLll.S Insp _1JLlt.Lr . REOUE:ST FOR APPROVAL OF INDIVIDUAL SERER AND WATER FACILITIES 1. Lending Institution Request: Amfac Mortgage Corporation`_________ Mailing Address: 705 West 6th Avenue, Suite 201 Phone: 277-8588_ 2. Property Owner: Allen Beckham _ Mailing Address: o Alaska Associated Realty, Phone: 3 Moser 274-355 3. Legal Description: Lot 35 Block 3 Valli Vue Estates Subdivision 4: Single Family Residence: (x) Number of Bedrooms: Four _ Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System. Individual Well ( ) Community/Public System (x) Permit # Depth of Well _ Well Log on File ( ) Construction Bacterial Analysis 6. Sewage Disposal System: On-site System ( Public Utility ( ) Permit A Installed Installer. Septic Tank Size Absorption Area Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank _ to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Two V r� Department of Health and Environmental. Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 35 Block 3 Valli Vue Estates Subdivision Comments: 01 . 1"'!�\\f VI C' iF1- V\ 0() 1 ( // If Af.fadavit Attached: /n Letter Attached: { ) I � i Approved: -C _ Date: Disapproved: ate: Disapproved: _ Date: Department Worksheet: j sse-ss-oreg,:odon 71tlW 1VNOI1tlN831N1 803 ION (epos saylo eag/—0301A08d 3OV83AOO 33Ntl80SNI ON 008E 1w6o�JSd "" ^- -^^- ^--(pwln6w ooI D11 AN3All30 1tl103dS tlOS """""""""'••'--- AINO 33S53tl00V Ol 83A1130 _o fi58 61uo eassaippe 01119n110p 411M 9SS " paseel19P a184M pug algp 'W64M 01 SM04S Z S301Atl3S 359 " 6100 aasswppg 01 AJOANap 411M 1d13038 •,-..,p 95i"""' palaeilap glop pug W04M 01 SM04S '1 Mau S331 1tlN011100tl 801 S3 IMS 1VNOI1dO 3009 dIZ ONr 31tl1S'-0'd 'ON ONtl 133815 (Wi1N35 sod snld)� 000—lim 031A11833 MOA 1d1O13338 i 1. 2. 3. 4. 5. MUNICIPALITY OF ANCHORAGL DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 — 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES Type of Inspection: CMRO VA FHA CONV xxxx Property Owner: Allen -Beckham Mailing Address: C/o Alaska Assoc Realty Day Phone Name of Buyer: Clifford D. Cheney Mailing Address: 3544 DeBarr Day Phone 274 1686 Name of Lending Institution: AMFAC MORTGAGE CORPORATION Mailing Address: 705 W. Sixth Ave., -Suite 201 Phone Anchorage, Alaska Name of Realtor or Agent: Cloyd Moser of Alaska Associated Real' Mailing Address: 4446 Business Park Blvd Phone Anchorage, Alaska 99503 6. Legal Description: Lot 35, Block 3, Valli Vue Location: 10121 Lone Tree Drive Anchorage, Alaska 274 3556 7. Type of Facility to be inspected: septic No. Bdrms. 4 8. Water Supply community . Type of Supply: Public Utility Individual If Individual, number of dwellings presently served n/a If Individual, depth of well 9. Sewage Disposal System Type o.f System: Public Utility Individual (on-site) xxxxxx If Individual, date of installation EQ -037 (1174) December 2, 1977 Allen Beckham % Alaska Associated Realty Cloyd Moser Alaska99503 4446-Businessk Boulevard Anchorage, Subject: Lot 35 Block 3 Valli Vue Estates subdivision Because we have no records of the sewer system being installed, inspected and approved by this department we can not approve the request for sewer and water facilities. Before approval may be granted, the following will need to be accomplished. (1) Expose the tank and have it pumped to verify the size and its existancse. (2) Have a percolation test run on the existing seepage pit to see if it is adequate for a four(4) beddoom single family residence. if the sewer system requires an upgrade, a permit must be issued prior to any construction. if there are any further questions, please contact this office at 264--4720. Sincerely, Robert -C. Pratt, R.S. Sanitarian ACP/ljh CC . Amfine ?Mortgage Corporation 705 west 6th Avenue -- suite.201 99501