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HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 4 LT 1 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: ~b-d q~-o~C) ~ PID Number: Name: ARA~ ~RKO~IA~ Wastewater System: D New ~Upgrade Address: ~ ~1 ~ I0~ ~T~. ~~' A~, ABSORPTION FIELD Phone: ~-~ ~No. of Bedrooms: ~ ~DeepTrench D Shallow Trench QBed ~Mound QOther Lot: Block: Subdiv~ion: Depth to pipe bottom from odginal grade: Gravel depth beneath pipe Township: ~ Range: ~ Section: Fill added above original grade: Gravel length: Number of lines: 10istance between lines: WELL:sx,~T]~D New ~ Upgrade Gravelwidth: ~'~' Ft. [I ~ Ft. Classification (Private, A,B,C): Total Depth: Cased TO: ~ Total absorption area: Pipe material: Driller: ~~ StaticWaterLevel:Ft. Instager~ Sy~ Date installed: SEPARATION DISTANCES ~s~.t~c ~ ,o~n~ ~ TO Septic Absorption Lift Holding ~ubfic/Private Manufacturer: , Capacity J~ gaJlo~s: From Tank Field Station' Tank Sewer Lines ~O~e~ ~ Well- ~bO'~ ~OO'+ ~ ~ ~ 9 ~ Material: ~ Number °f C°mpa~ments: Sudace -- ~ w~t~r ~'+ ~o~ __ LIFT STATION Line ~ ~ ~ Gu~ain Drain ~ 17034 Eagle Eive~ Loop Eead, Inspections performed ~1,~=¥;;,5!==~=~ Date~ 1st ~*lo*qS Department of Health ~Huma~vices approval Reviewed and approved by: Date: 72-013 (Rev. g/gl) MOA 25 Permit No. SW950202 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description:LOT 1, BLOCK 4, VALLI VUE ESTATES #2 PiDNo.:01554144 q8 5' ST2 MT1 ---- ~,~ j FINAL GRADE ~ NE~Y ~ ~- IN~ ULAT 94.0'~ 1~50 G~ ~',3.8' S.T. 9 --~-~ / ST2 -- 25' 41'  I C01 -- $1' 42' co~ ]W 1250 GA- ~ C02 -- $2' 45' ~ C03-- 44' 37' ~ / C04-- 42' 53' ~ EXISTING 4 ~ IST. / M~I -- 44' 58' ~c, BEDROOM DI ~IVE ' /  HOUSE COMMIJNITY WATER SYSTEM'~ ~ SCA~ l' 72-O13 A (Rev. 9/91) MOA 25 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 PERMIT NUMBER:SW950202 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MARKOSSIAN ARAM OWNER ADDRESS:10000 LONE TREE DR ANCHORAGE, AK 99516 PAGE 1 OF 1 (UPGRADE) PERMIT DATE ISSUED: 8/08/95 EXPIRATION DATE: 8/08/96 PARCEL ID:01534144 LEGAL DESCRIPTION: VALLI VI3E ESTATES ~2 BLK 4 LT 1 LOT SIZE: 20086 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN AMCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5o THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY- DATE: DATE: ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. SEWER&WATER MAIN E)(TE~[OI~ SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN Ju~y 28, 1995 MUNICIPALITY OF ANCHORAGE Department of H~alth and H~man S~rvic~s P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot I; Block 4; Valli Vue Subd~v~ion #2 ~otur 6e~oom ~u~e on tl~e re~e~e~e.~L A test hole was excavated and a percolation t~st performed in the ar~a of the proposed up~rade. The approximate lo~a~on of the t~st hole is located on the attached site plan. At the t~me of excavation no water was encountered and after seven day ground water mo~toring, the mor~oring tube ~ found to be dry.~ Attached is the proposed upgrade d~sign. This property is served by a Community Water System. We do not anticipate any adverse effect~ on n~ighboring w~ls, septic systems or drainage patterns by the inst~on of the proposed septic system. If you require addition~ info~ma~ion, please contact ~. Sincerely, Robert C. Cowan, P.E. ROC/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 f' =40' ~0 6.O i> © '"-] SITE PLAN ~__.~ o o t:~ oF~ i-- m u II .--' II o z~mm m (::2 ~o~:d UPGRADE o ~o m _~ 0 N__E _ T R~E_ E~_D_R_. _ 0 © Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~I~A,~ J~'I,~,~KO$ LEGAL DESCRIPTION: · ..! DATE PERFOR~E'~i~ Township, Range, Section: 5- 6- 7- 8- 9- 10- 11 13- 14- 15- 17- 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN IF YES, AT WHAT DEPTH? Depth to Water Alter Monitsring? . Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE__~, 7 (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN 5 ;//~.- ! ~ / . FT AND FT PERFORMED BY~ & f[ L~!~mN~- I Eagle River, Alaska 995~7 72-008 (Rev. 4/85) ROBERTC. COWAN, RE. ROBERTA. SHAFER, EE. SEWER&WATER INSPECTION ENGINEERING STUDIES /kND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAO OESIGN SOIL TEST PERCOLATION STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 IEFERENCE: Lot 1, Block 4, Valli Vue %2 July 28, 1995 GENERAL: 1. Se The scope of this project includes the installation of a 1250 gallon septic tank and leachfield trench to serve the four bedroom residence located on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and abandoned in place. The existing leachfield is to be abandoned such that it may be used in the future. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. Se The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP" SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 1, Block 4, Valli Vue 92 July 28, 1995 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: me Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Se Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. e Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 1, Block 4, Valli Vue ~2 July 28, 1995 Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS= Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 1, Block 4, Valii Vue ~2 July 28, 1995 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. e The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 1, Block 4, Valli Vue July 28~ 1995 ~2 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER GREi 'ER ANCHORAGE AREA BO[,, tGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME -~/~'¢1,¢~;~ /~:?,,¢?'~'-/~'~,~'-~ MAILING ADDRESS /~"~" ~.~.&'--'/ PHONE LOCATION ~-~/0~" '~'~ LEGAL DESCRIPTION /~07- I ~LOt~_/~". ~/ ~/gC~.! ~' SEPTIC TANK: DISTANCE FROM WELL ~F~ INSIDE LENGTH MANUFACTURER INSIDE WIDTH NUMBER OF MATERIAL ~/~/,,¢EZ~.~.g~' COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY /;~¢"¢GALLONS. TILE DRAIN ', TOTAL LENGTH DISTANCE FROM WELL ~-~,~'1;'~') FOUNDATION ~_o /-~-'_NEAREST LOT LINE / ''~ OF LINES NUMBER OF LINES / DISTANCE BETWEEN LINES ' AC//~'' TRENCH WIDTH ''~'~ IN. TOTAL EFFECTIVE · "'""ABSORPTION AREA ~" ¢!~ SQ. FT. LENGTH OF EACH LINE / DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE ~-~//2~2 MATERIAL BENEATH TILE'~" /L~ f I~. ABOVE TILE 4~ IN. WELL: TYPE _ ~ BUILDING FOUNDATION__ CESSPOOL APPROVED CONSTRUCTION _ NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST SEPTIC SEWER LINE__ TANK REMARKS _ DEPTH DISTANCE FROM: SEEPAGE DISTANCES: I~) INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL' LOT SLOPE: REMARKS: I~ V~ DIAGRAM OF SYSTEM Form LQ-032 ANCHORAGE AREA BOA :JGH DEPARTMEnt OF E~IVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. TYPE AND SIZE OF FACILITY TO BE SERVED P.o.E,?¢'?:-'~?,;' · DRAIN FIELD ,.,j NOTE~ THIS PERMIT iS NOT VAL'ID WITHOUT SO!L, TE$"r FINANCED THROUGH ._. ,, .// ::F ,' DISTANCES, REQUIREMENTS CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST {RON SIPHON PIPES ON SEPTIC TANK'AND SEEPAGE PIT DIAGRAM OF SYSTEM I CERTIFY THAT [ AM FAMILIAR WITH ~'~HE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDfNANCE NO. 28-68 AND THAT THE A~OVE DESCRIBED S~STEM IS IN ACCORDANGE WITH SAID CODE, ~ER ANCHORAGE AREA DEPARTMENT OF ENVIRONMENTAL QUALITY 3 ~ 30 'lC I I STREET ANCHORAGE, ALASKA 99503 DISPOSAL SYS'rEM -- APPLICATION AND PERMIT INSTALLATION LOCATION d//~/-'J / LEGAL DESCRIPTION /~ O ~- / [HSTALLAT]ON OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH 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. SEEPAGE AREA SIZE ~ TYPE '~? ~-/¢t~(_* /L MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK L.~ FOUNDATION TO SEEPAGE Pit (~ ¢ ? DRAIN FIELD SEPTiCTANK TO SEEPAGE piTWALL~K/?~ ¢~ ~C' ~-~ ~ ~ SEEPAGE PIT DRAIN ~IELD . TO NEAREST LOT LINE. AREA WELLS. DIAGRAM OF SYSTEM O' o I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED $,YSTEM S IN ACCORDANCE WITH SAID CODE. GREATER ANC}IOI~AGL fiP, EA uepartment of Environmental Qu~i~y 3330 "C" Street Anchorage, Alaska 99b03 SOILS I,OG PEROI,ATION TEST Legal 3escrip~i6~? ~-)--~2~'~' This form reports: Soils log Depth Feet 1 - 2- 4- 5- 6 - 7- 8- 9- I0- 11 - 12- 13- 14- Date Perfon,ed _~Z2__/~/?~ Percolation Lest F~'Was grou If yes, at wnaL depth? Reading Date Gross Time Net Time Depth to Water flet Drop Percolation r-~e- ....... minute. Drain Field -Pre~osed insLallation: Seepage Pit ............. ~--,-~ ................ Depth of Inlet .............. . Depth ~o bottom o, ,~]~ or trench _~_~/_~ ............... , , ~ ~Y COHNEiITS: ........................... ~L ~g~ [2~' ~ ~z~a ~ e ............................................ EQ 040 (6/74) Test Hole 4 Lot 1, Block 4 Depth in Feet From To · 0.0' 1.0' 1.0' 12.0' Elevation: 12.0' 16;5' Bottom of Test Hole: Frost Line: Free Water Level: Existing Ground Soil Description W.O. ~17378 F-4, sandy gravelly ~ilt, ML, tan, damp NFS, sandy gravel, GP-GM, grayish tan, damp, trace of silt, poorly graded, Group D NFS, gravelly gand, SW-SP, gray, damp, poorly graded, Group E 16.5' None Observed None Observed ~ Type of Sample Depth M~ Sample Group 1 5.0'-6.5' DAMP G D 2 7.0'-7.5' DAMP G D 3 10.0'-11.5' DAMP G D 4 15.0'-16.5' DAMP G E Remarks: 1. Type of Sample, G = Grab 2. Group refers to similar material, this study only MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) /O,, O~O ~,,~,,~ ~ (b) Property owner R¢,,~,',~,~,~ Mailing Address l_~/ ~¢ A¢.t (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address ~ ~Y Telephone ~ 7 Telephone Telephone: (home) $¥g - ~'¢~"¢ Business (e) Mail the HAA to the following address: (or check here ~, if hold for pick up.) List contact person and day phone number below: o ee Z? ¥6-- 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms ~ 3. WATER SUPPLY Individual Well [] Community ~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the vaJidation date shown below, I verify that my investigation of th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my 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. NameofFirm ~'/¢z~-/¢-,¢¢ 7-~c~/~;¢~/ ~'e¢',-'~¢~,, Telephone Address / Y~ Ec~o ~/~ ~c~o~ ~, ~ 6. DHHS APPROVAL Approved for Approved ~'~ bedrooms by Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 DH HS 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. 7/88) Back Page 2 of 2 (~N MUNICIPAL~.OF ANCHORAGE (MOA) ~ ¢~?^Li~,',' q~c~a~y Approval (HAA) MENTAL s~l~- FEBRUARy 1984 343-4744 t:.~.~ ~ ~ ~0 Legal Description: ~ ~., ~ ~ RECEIVED A. WELL DATA Well Classification CL(,¢~..¢ ",~" Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Date Completed if A, B, C, D.E.C. Approved (Y/N) Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest pUblic Sewer Cleanout/Manhole ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ?/1~./7,5'- Size Standpipes (Y/N) 'r' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~ To Property Line '~' h'~' To Water Main/Service Line ~' ~$ ' To Stream, Pond, Lake or Major Drainage Course :> ~'oo · No. of Compartments I Foundation Cleanout (Y/N) Date Last Pumped '7/I,~/'~ ; for Temporary Holding Tank Permit (Y/N) ~, To Building Foundation To Disposal Field Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 9 /"~/ 75- Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: 'Fo Water-Supply Well ,> Poo ' 'Fo Building Foundation ~'o ' Lot N, A, TO Water Main/Service Line _~,,~ 2_5-' To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments hto~¢ 6¢v b~e,~ occ,~tec.( a I-7 ,* s . To Property Line I~f ~ To Existing or Abandoned System on ; On Adjoining Lots ~ 3'¢,' To Cutback (if present) N,,~, D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA g.u~c~§~j~,Ln effect on the date of this inspection. Company F f~ r/ ............ · ' ~ Engineer's Seal Date Feb MOA No. Date of Payment Amount: $ 72 026 (Rev. 7/88} Back ,% ,.'... % c~ - o539 ..' ,.~';' ~ Receipt No Waiver Fee: $ Date of Payment Page 2 of 2 ANCHORAGE, ALASKA 99503 January 10, 1990 STEVE COWPER, GOVERNOR 563-6775 FOR: Mr. Ted Moore PWSID: ~210605 According to the records on file in this office, the Valli Vue Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VERA E. CRAIG~ Environmental Fie~fd Officer VEC:bas MUNICIPALITY OF ANCHORAGE DMSION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ~IMVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) (b) (c) (d) Legal Description '( in.c%udp, lot,. j01ock ,_ subdivision, section, township, range ) /-/ .... Location (add~ess or directions) Applicants Nares Applicants Ad.ess ~- _~ ApplicAnt is (check one) Lending Institution Suyer~; Other~_~ (explain); · o~.~r' uilder.~ Lending Institution Telephone Address (e) ~al Estate CxD. & Agent Address 4e Telephone TyPe of t~sidence Single-Family~ N~ber of ~edrooms Multi-Family Other describe) War_ er Supply Individual Well~-~ C~rmunity Publico Ncte: If ccrmm~nity well system, must have w~itten confirmation from the State Depa~tn~nt of Environmental Conservation attesting to the legality and status° Is the well adequate for the humbler of bedrocks specified in this HAA~) _,~ ~age Dis .posal Onsite~ Public ~-~ Community ~ Holding TapJ~ ~ ~Y~ Is the wastewater disposal system adequate fez. the number of kedrocms ) [Page 1 of 2] 2-15-84 Signed Name of Add~ess E__ngineering Firm Providin_g Inspections~ Tests, Data and Information I certify that I have checked, verified, or conformed to all ~DA HAA Guidelines in Signed by Date (ENGINEER SEAL) 6. DHEP Approval Approved for Approved ~ Disapproved ~ Conditional ~-~ Terms of Conditional Approval /he Municipality of Anchorage Depa~trent of Health and Enviror~ntal Protection does not guarantee the continued satisfactory performance of the water supply and/o~ the wastewater disposal system. This approval indicates that~ as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the rim~ber of b~drooms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to tb~ following address: KB2/d5/s [Page 2 of 2] 2-15-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT. OF HEAL,TH & ENVIRONMENTAL PROTECTION' JUrl 1984 R E C E.i. E D Well Classification Well Log P~esent (Y/N) Total Depth Static Water Level Casing Height Above Ground Cased to .4i D'"/ Date Completed Yield Depth of G~outing Pump Set At Electrical Wiring in Conduit (Y/N) Separation Distances f~om Well: To Septic/Holding Tank on Lot ~ .6 Z~ ' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected By Water Sample Test Results Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date C~t~n~nts . · SEPTIC/HOLDING TANK DATA Date Installed ~/~,~' Size /~-~ No. of Ccmpa~t~ents / Standpipes B/N) / Air-tight Caps ~N) Foundation Cleanout ~N) Depression over Tank (Y~ Date Last Pumped ~/~//~y ~/~//n~.~ Pumping/Maintenance Contract on File (Y/N) /3/4- ; for Holding Tank High-Water Alarm (Y/N) ~7,/~4-- Teapotaz~ Holding Tank Permit (Y/N) Separation Distances f~cm Septic/Holding Tank: To Water-Supply Well +6~ / To Building Foundation /~ ~ f- To Property Line 4/~ "-Ax-' TO Disposal Field /~2 To Water Main/Service Line +/~/~6- To Stream, Pond, Lake, c~ Major D~ainage co=se m/+ Covenants ~ ~4/a4;4x~&'~ / ! ! [Pa~e 1 of 2] 2-15-84 C. ABSORPTION FIELD 5~TA Soils Rating in Absorption Strata Date Installed Width of Field ,7/ Type of System Design Length of Field ~' Depth of Field __..~z Gravel Bed Thickness Standpipes P~esent Square Feet of ~)sorption A~ea Depression ove~ Field (Y~ Date of Last Adequacy Test Results of Last Adequacy Test ~/~J ~ Separation Distanoe f~omAbso~ption ~eld: To ~te~-Supply Well _ -~z~D' To P~ope~ty Line To Building Foundation Lot A3//~- ; On Adjoining Lots To Wate~ Main/Service Line ~- ~''~-- To Cutbank(if present) To St~eam/Pond/Lake/c~ Majo~ D~ainage Cou~se To D~iveway, Pa~ki~ A~ea, o~ Vehicle Sto/rage A~ea Co~Nr~nts ~ ~_~;~.~ f~ To Existing or Abandoned System D. LIFT STATION ~--~J Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fo~ Electrical Code~ (Y/N) Con]~nts Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Check Permitted Bedroom Rating Against HAA Request ** oe~tify that I have checked, verified, o~ conformed to all MOA HAA Guide] lnes in effect MOA No. ~ [Pacje 2 of 2] 2-15-84 ALASKA , OIROFlmlZFITAL COFITROL ~nClin~:~'i~§ ~, ~nuironm~nlal $1udi¢$ SEI4ulCES, InC. MAY 24 1984 BEVERLY KIRKBRIDE SRA BOX 29K ANCHORAGE AK 99507 SRr,T,~R - BEVERLY KIRKBRIDE BUYER - 2ND MORTGAGE SUBDMSION - VALLI VUE ~2 BLOCK - 4 LOT - 1 ADEQUACY TEST FOR St~NER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TREe'WITH AREA. THE SYST]~I IS CAPABLE OF ACCEPTING 6~0 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTt~ IS 1200 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROC~I HOME. ' / THE SEPTIC TANK WAS PUMPED 0N5/31/84 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME IS ADEQUATE FOR THIS 4 BEDR0f~I HOUSE. 1200 ~Jesl 33~d Avenue, Suil~ [~ · J~nchora§¢. J~lasko 99509 o(907) 561-50z40 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received ~/ ~/~- 7 ~ Time of Inspection Date of Inspection l. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Phone: Phone: 3. Legal Description: '/L,I J'~ ~j' 4. Location: ~'~~ 5. Type of Facility to be inspecte~d 6. Well Data: No. of bedrooms C. Construction t~ ~ D. Bacterial Sewage Disposal System: Analysis A. Installed ~/~ _~- B. Installer C. Septic Tank: 1. 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 seotic tank , Absorption area C, Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages ~l~e. of two pages - Re~ '~t for Appro of ~ndividual ? ~6r & Water Facilities Legal Descriptjon-~. Comments Approvedv ~ ~y~~ Disapproved Date ~/'--/ Appro~'~alid for one year from date.signed Greater Anchorage~Aq~ea Borough, Department of Enwronmental Quality DIAGRAM OF SYSTEM I 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 satisfactorily. SIGNED Date EQ-034 (1/74)