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Home My WebLink AboutVALLI VUE ESTATES #2 BLK 4 LT 4Onsite File #0 15 34 1 4r47: Municipality of Anchorager"" ` On-Site Water and Wastewater Program • (907)343-79 b_-"� $ ,agt Art 3 ON-SITE WASTEWATER INSPECTION REPO FEB 112019 Permit Number: OSP181435 PID Number: 015-341-47 Dwelling: ❑I■ Single Family(SF) [' Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade Name: ABSORPTION FIELD Blase & Brenda Burkhart Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 10100 Lone Tree Drive, Anchorage, AK, 99507 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-240-1638 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. Valli Vue Estates #2 4 4 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line Ft2 Ft. Well >100' >100' N/A N/A >25' TANK ❑a Septic ❑S.T.E.P. 0 Holding 0 Other Manufacturer Capacity Surface Water >100' >100' N/A N/A Anchorage Tank 1250 Gal. Material Number of compartments Lot Line >5' >10' N/A N/A 1 Steel 2 NA LIFT STATION Foundation >10' >10' N/A N/A Manufacturer Capacity Curtain Drain None Noted Gal. Remarks Pump on level at Pump off level at High water alarm at No insulation was used. in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank Exist. Tank to D3034 Installer drainfield AK Underground Drainfield Existing CO/MT D3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection 1$` 1/29/19Location and description dates: 2n° 3rd -- --- 4'" Bottom of siding. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp 40.-\ --..OFtritai '4 �i Conditional Approval: Date =:.,(\ .• ��' •• 1"1 49th i\ •••••"• til0 ;MICHAEL E. ANDERSON L�g ♦��, , No. CE-4381 • Za ...,________, _ t / •I.T(„QF 2/07/19 •o �� Approved t t wk Date 3--1 I -h„PROFEss t••�� r_o+r ZC'.. Inspection Report_9-1-12.doc VALLI VUE ESTATES #2 BLOCK 4 LOT 4 PERMIT # OSP181435 PID # 015-341-47 LOT 3 LOT 6 Lit LOT 4 Cl 1.--A-1 L11 -BDRM HOMW Z O. 0 0 FCO LOT 7 sv2# \ - 2C0 \, �EWYE -SGM1 \ SEPTIC TANK \ EXISTING \ ABSORPTION TRENCH LOT 5 far GE I_f. ►-.Heiu.e.iee �4.��"`*ii1.s A B LEGEND �.4�F:.�C......�s..j� SV1 13.1 30.3 CO-CLEANOUT -),.• • SV2 18.7 37.3 2C0-DOUBLE CLEANOUT • ` 49th �.•••\*0• 200 • 20.5 40.1 • FCO-FOUNDATION CLEANOUT 11'.. ,�� -' , � ' FS FLOW SPLITTER VALVE ms's MICHAEL E. ANDERSON 4 ■ 0 50 100 MH-MANHOLE .0 % NO. CE-4381 _`"a MT-MONITORING TUBE ♦sr'••.,, = = = = = FEET &F,pFQ,,..2/07/1 s....�.� SV-SEPTIC VENT •44PROFESS\c1 1"=50' TH-TEST HOLE VALLI VUE ESTATES #2 B4 L4 PERMIT # OSP181435 PID # 015-341-47 O cv O o > > 0 LL Cl) CO (V 99.4 — — — 95.1 A 94.5 1250 GAL 94.3 SEPTIC TANK 90.2 a f 49th •� smii_it • 0 el #�`L,MICHAEL E. ANDERSON:tV et '-GF PROFILE AS—BUILT '•.;�� .. o. CE-9 :..�.: - 1NGINEIRING (NO SCALE) 11 F0 ................�� /11hrsw..\•�. 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 http://www.muni.org/onsite Permit Number: OSP181435 Work Type: SepticTank Upgrade Tax Code Number: 01534147000 Site Legal Address: VALLI VUE ESTATES #2 BLK 4 LT 4 G:2538 Site Mailing Address: 10100 LONE TREE DR, Anchorage Owner: BURKHART BLASE A& BRENDA Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 12/11/2018 12/11/2019 21329 ❑ Disposal Field E) 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 Received B '�� r BY. u �,/,�,�1. i/� i) � J� Date: Issued By: &AA Date: l°2 / r ;20l S' MUHM PAUTY OF AHCHORAGE Community Development Department `'; = Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 015-341-47 Property owner(s) Blase & Brenda Burkhart Day phone 907-240-1638 Mailing address 10100 Lone Tree Drive, Anchorage, AK, 99507 Site address 10100 Lone Tree Drive, Anchorage, AK, 99507 Legal description (Sub'd., Block & Lot) Valli Vue Estates #2 Block 4 Lot 4 Legal description (Township, Range & Section) Lot Size 21,329 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade X pg ❑ Duplex (D) El Holding Tank El Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / 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) 9 Permit/Rush Fees: bWaiver Fees: Date of Payment: l A/16/1 '? Date of Payment: Receipt Number: U3IQ10 Receipt Number: Permit No. OS��i✓qWaiver No. Permit App__- : .' ., c December 11, 2018 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 12/11/18 Subject: Valli Vue Estates #2 Block 4 Lot 4 Septic Tank Replacement Dear On-Site Services Engineer: The septic tank on the above lot is 43 years old, and the owner has decided to replace it. The existing home is a 4-bedroom. We are submitting this permit application for the placement of a new septic tank. The attached site plan identifies the location of the existing home and septic system, as well as the location of the new septic tank. The neighborhood is on a community water system, so there is no well. The drainage pattern in general will not be changed by the construction. The existing tank will be pumped dry and decommissioned per code. It is a 1250-gallon tank and currently sits outside 10’ of the house foundation. It will be replaced with a 1250-gallon tank and will be positioned 10’ away from the foundation of the home. After the new tank, we will install a double-cleanout and connect into the existing absorption bed. A foundation cleanout already exists and will not be altered. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181435, Rebecca Carroll, 12/11/18 10050 0 FEET 1"=50' NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND VALLI VUE ESTATES #2 BLOCK 4 LOT 4 Dec 11, 2018 10' UTI LI TY EASEM E N T LONE TREE DRIVE4-BDRM HOME FCO 2CO DECOMMISSION AND REMOVE EXISTING SEPTIC TANK REPLACE W/ NEW 1250-GAL TANK PROVIDE DOUBLE CLEANOUT MAINTAIN 10' FROM FOUNDATION EXISTING ABSORPTION TRENCH Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181435, Rebecca Carroll, 12/11/18 ~I I I I·· ~ I 1-' :~ I C) ...... -. f/99 °58' IS" E .,.., , .. 2._-sro.Ry , Fte.AME lfO£/.f t I~ .: ., l ·;_-pro, o \ \ \ THE INFORMATION HEREON IS FOR ,:n-IF. US£ Of. l fl.:~! Nil INSTIT\JTlONS SPECIFIC.ta.t..LY IC •;H!)W A~.r ·~C·lr.ll( TS . BETWEEN EXISTING STRUCTI.!Bi:S AND PLAl :w LilT lf\!<~. .SC.A L E I " ~ ~0' OR EASWENTS AND IS NOT TO 0( USED FOfi POSifiOiili~u . AODITIONAl.. flRUCTUPiS OR FEHCEUNf.S.., \., F.ASfMf.NTS OF R(CORD, OTHER THAN 1 H(l~E SHOWN ON TH! RI:(ORDEO PlAT , ARE NOT SHOWN HfiHO~. "ASBUILT" No corne-rs set hereby certify tl·lot I hove lllrity_ed the following dttcrlbtd property, Lot___£_ BIDck_!l:_ '(ALL/ -VUe EST;4TEJ' #2 ,4c:<.,..:r .t'j< recordino ,1 .srr .:f Alotka, and thai the rnproveme1111 11tvottd lhttton art wookln tht propttty llnu o<~d do not overlap or encroach '" lht property ly ino odiactnl lhettto, that no imptovemtnh 011 property lyi"O adioctnt lhtrtro o11crooch on the premhtt In qVtll ion ond that there are no roadway1, lrantmiulon llntt or >lhtr vhiblt taltments on 1old property txetpl 01 Indicated htrton. AnthOtOQt, Ala1k0 II /1 t.l~ · /9 9 7 Sook ,,,,,,, --'(_ oF A( \\\ .,-t-.,.-<.. .......... 4 .r. •• 'A..,r ,•' *'•,v+ • , '? .• · '• '?'I :• /49lli \ 1f ~ ~· ··=···~· ~·d0.··················. I. rAA.I(/ ~~ /.i7U.--z-r__ ~ ··~·· •• • •••••• t ••......... ~ ~ \ I ' ~ f'~ ~ ~ ran11 Holdontol / ~J "" ~ • • .>; "_. ":'r_... '• No . D0&-5 ,• ~~ 11 """'• .. ~, ' -91: • • • • .,.., . ' () pll. t ••••••••• ..._y.f::> __ ,., '\ 0 'rss•:~~._~ '-.,..- ···. '"'"'"'' GRE/,' ANCHORAGE AREA BOR? tGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~ ~v~'- ~'~tX'¢',Or-,'~'~ MAILING ADDRESS . ~ (~' PNONE'-~'~- ./"~Z~ LOCATION LEGAL DESCRIPTION ~/~...~. ,~) /~L_O¢~./C. 4./ (,.)~//J/' (,/£{'~. SEPTIC TANK: .~.~O~ fi- NUMBER OF DISTANCE FROM WELL ~ MANUFACTURER ,..~,,~/.~-7~ MATERIAL ~/f~7~(_~/..~)~ COMPARTMENTS INSIDE WIDTH INSIDE LENGTH LIQUID DEPTH LIQUID CAPAOTY/''~'~Z) GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OFTILE TO FINISH GRADE FOUNDATION NEAREST LOT LINE DISTANCE BETWEEN LINES __ ,A.//~ TRENCH WIDTH SQ. FT. LENGTH OF EACH LINE / DEPTH OF FILTER MATERIAL BENEATH TILE_ TOTAL LENGT~,~. ,~ / OF LINES IN, TOTAL EFFECTIVE IN. ABOVE TILE IN. WELL: TYPE. ~ ~t ~,~ BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION DEPTH NEAREST NEAREST SEPTIC SEEPAGE , LOT LINE__ SEWER LINE TANK , SYSTEM. OTHER SOURCES DISAPPROVED REMARKS _ DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE:__ ~ REMARKS: _ V~,OI/t DIAGRAM OF SYSTEM DATE ~/(2'/Z'F'~ APPROVED ~ ~,.A.,~ G.A.A.B. Form LQ-032 GREATER ANCHORAGE AREA BOROUGH JUNK CAR REMOVAL LIABILITY RELEASE I, the undersigned, certify that I am the ( ) owner, ( ) occupant, ( ) manager of the property described as '('street add r6~t-l~6liT Greater Anchorage Area Borough, and also described as Lot Block j , Subdivision -~i~f Anchorage. I hereby agree to save the Greater Anchorage Ar~'a Borough, its agents and employees~ harmless from any~al action~r other claim arising from ally injurY,to persons or p~operty as ~/~esult of the Greater Anchorage Area Bi, rough remowQg junked vehicles from the above described property,, prov~ded~houever, that the undersigned wi]'l not save the Greater Anchora§e great-Borough harmless for any injuries caused by negligent acts of ~Commission or ommission by Greater Anchorage Area Borough agents or employees. Date: Greater Anchorag~ A'rea~B~rough Witness: Name: Agent Owner, Occupant. ~r Manager Type of Vehicle (s): PLEASE RETAIN ONE COPY OF THIS FORM'~OR YOUR OWN~FtLt~s-~r; R~ TIlE OILIER COPY TO THIS OFFICE WITH REMITTANCE. THANK YOU. EQ-042(8-74) GrE::t -:IR ANCHORAGE: AREA BOF UGH DEPARTMENT OF ENVIRONMENTAL QUALITY/ 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT LEGAL DESCRIPTION SOIL TEST RESiJLTS SEEPAGE PIT DRAIN FIELD NOTE~ THIS PERMIT I$ NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED J~/~///~/~;/~* i ~'~/~ 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· DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS / FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE P~ WALL . SEPTIC TANK TO NEAREST LOT L~NE. ., SEEPAGE PIT . WELL TO SEPTIC TANK WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, , SEEPAGE PIT TO RIVER, LAKE, STREAM. · SEEPAGE PIT · ALSO CONSIDER AREA WELLS. · SEEPAGE PIT , DRAIN F~ELD 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 SEEPAOE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. four (4) beclrocxms. Z understand an upgrade w~uld/be nece~,ary~/sh~{ld more b~droc~s be added. GREATER ANCtlORAGL ARLA UORL)U, uepartment of [nvironmenLal Quality 3330 "C" Street Anchorage, Alaska 99503 SOILS I,OG - PEROI,ATION TEST Performed f o ri_/_-~_~ ¢_ _F _ .~.m_ ~e_F~m ,_rz.~ ~ .L_ Legal Description:_~? 4 ,3-'~,F.~.~_ This form reports: Soils log Dep th Feet 1 2- 3- 4- 5- 6- 7- 8- 9- 10- 11 - ;]ate Performed Percolation test 12- 13- Was Il: yes. at what depth? Reading DaLe Gross Tim Net Time ~tDepth to Water Net Urop Percolation rate minute, -Proposed installation: ~eepage Pit Drain Field Depth of Inlet COMMENTS: (6/74) MUNICIPALITY OF ANCHORAGE o Development Services Departments Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-341-47 Legal description Valli Vue Estates #2 Block 4 lot 4 Site address 10100 Lone Tree Dr Anchorage, Ak Current property owner(s) Schalmann Expiration Date: 10-4-2023 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By. c_ Original Certificate Date: D�� ZZ This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided y an independent professional engineer. I he Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA ApprovaLJune 2022 MUNICIPALITY OF ANCHORAGE r� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-341-47 Complete legal description Valli Vue Estates #2, Block 4 Lot 4 Location (Site address) 10100 Lone Tree Drive, Anchora e, AK 99507 Current property owner(s) Eric Dreibelbeis & Candice Schlafmann Day phone (515) 577-2989 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑■ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑E Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 3 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed X Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: xpedited review requested-❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 6 56 Waiver Fee $ Date of Payment 10Laa 1 �2 a COSA # O S C 2 `21543 Date of Payment Waiver # COSA Application_June 2022 Legal Description: COSA Checklist Valli Vue Estates #2, Block 4 Lot 4 Parcel ID: 015-341-47 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA is filed with Onsite (or attached) Date drilled Notal depth Cased to ft \ ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Well production at time of test gpm ft Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative to mg/L ❑ Nitrate less than MRL (ND) Arsenic L ❑ Arsenic less than MRL (ND) Collected by Static water level at beginning of test ft. Date Comments Property is served by a COMMUNITY WELL B. TANK DATA Measured operating fluid level in septic tank 30" Date of pumping 10/3/22 Isaacs Pumping ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 09/1975 ❑■ ALL standpipes present per record drawing Total measured depth from grade 13.6 ft (max) Measured depth to pipe invert from grade 6.0 ft (min) ❑ N/A - pressurized field. F-1 in A C. LIFT STATION L]-Reired maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 10/4/22 Results ❑■ Pass Fluid depth prior to test 26 in Water added 600 gal New fluid depth 26 in 60 er recor rawings, field is Insulated. Elapsed time min ❑ Monitor tubes go to bottom of effective. Final fluid depth 26 in If not, state depth into effective 7.6 Absorption rate ' 600 gpd ❑Presoaked required if EIELD_STAT_U.S—P_O.S_T_REC.OVERY (Required if house vacant or field not used for more 96 than 30 days prior to date of test) Effective depth (per record drawings) in Gallons introduced N/A gallons N/A date Effective depth used 26 in Any rejuvenation treatment (past 12 months) N/A Effective depth remaining 70 in If yes, enter date Comments/Deficienci COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Fn -]Yes if No Community Sewer Manhole/Cleanout > 100' ❑■ Yes if No ft ❑■ Yes if No ft Neighboring Tank > 100' ❑i Yes if No ft Private Sewer/Septic Line > 25' ❑E Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' ❑■ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Fol Yes if No ft ❑■ Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑� Yes if No ft ❑■ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Fn -]Yes if No ft Surface Water > 100'■❑ Yes if No ft Tank to Property Line > 5' ❑i Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' n Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' ❑■ Yes if No ft Community Wells > 200'■❑ Yes if No ft Water Service Line > 10' 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Naive of Firm Forge Engineering Phone (907) 522-7773 Engineer's Printed Name Benjamin Sc�iiller, P.E. Date 10/6/22 COSA Checklist—June 2022 or A/ k�, *:49TH •*r Benlaffb/Schiller f cis l CE 12592 ,�c`�� it A , PROFESS10Nt�?� MUNICIPALITY OF ANC - .� ='�; tip 1 Development Services Department " �.�� a FSB 2 220 Py e: 907-343-7904 On-Site Water & Wastewater Section -x: 907-343-7997 �6 Cu Certificate of On-Site Systems ^ '. • • a Parcel I.D. 015-341-47 Expiration Date: I - 29 - 9 1. GENERAL INFORMATION Complete legal description Valli Vue Estate #2 B4 L4 Location (site address) 10100 Lone Tree Dr. Current property owner(s) Brenda & Blase Burkhart Day phone (907) 240-1638 Mailing address 10100 Lone Tree Dr. Anchorage, AK 99507 Real estate agent Day phone 2. TYPE OF DWELLING: H Single Family (w/wo ADU) n Duplex ] Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well 0 Community ❑ Public Water System ❑ Public Sewer LJ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer.unless otherwise requested by the engineer. COSA Fee $ C). 00 Waiver Fee $ Date of Payment 0 2. 2S J Date of Payment Receipt Number 01 2'°0 Receipt Number COSA# r7SC CI 11053 Waiver# 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 Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 2/15/19 �•��w....,III ,r 6. DSD SIGNATURE �� ♦ • 49th,, •.:...,0 System#1 Approved for bedrooms ICHAEL E. AN �M�1.1,314.114::System #2 Approved for bedroomsi '.•• 2/15/19 ,.•'� '.•Disapproved ♦+ 4111../3:1-0 • ��;; �::•� Conditional approval for bedrooms, with the following stipulations: 0N_s, WA r Vvgs ER AND r. PROGRAT ER 4 I � p By: �--- Original Certificate Date: —`t'r-1 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 COSA Checklist blue sheet COSA Checklist Legal Description: Valli Vue Estates#2 Block 4 Lot 4 Parcel ID: 015-341-47 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled Water storage tank volume gallons Total depth ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height(above ground) in. Collected by Date of flow test for COSA Date of Sample Static water level at beginning of test ft. Comments COMMUNITY WELL B. TANK DATA C. LIFT STATION Age of tank(s) 0 years ❑ Required maintenance completed Tank type/material Age of lift station years Measured operating fluid level in septic tank New Lift station material ❑■ Standpipes/foundation cleanout per record drawing Comments: Date of pumping New D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) °911975 Adequacy test date 11'2918 El ALL standpipes present per record drawing Results E Pass For 4 bedrooms Total measured depth from grade 12 ft(max) Fluid depth prior to test 28 in Measured depth to pipe invert from grade 5.7 ft(min) Water added 876 gal ❑ N/A—pressurized field New depth 31 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective 6.3 ft ❑■ Code-required soil cover over field Final fluid depth 28 in Absorption rate >600 gpd ❑ System presoaked No (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' ID Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line>25' 0 Yes if No ft Absorption Field on Lot> 100' 0✓ Yes if No ft Holding Tank > 100' 0✓ Yes if No ft Neighboring Absorption Fields> 100' Animal Containment> 50' ❑✓ Yes if No ft 0D Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main> 75' 0✓ Yes if No ft —0✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' Q✓ Yes if No ft Surface Water> 100' ElYes if No ft Property Line > 5' ✓0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells> 100' ✓� Yes if No ft Water Main > 10' ElYes if No ft Community Wells>200' Q Yes if No ft Water Service Line> 10' ❑l 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' El Yes if No ft Wells on Adjacent Lots: Water Main > 10' El Yes if No ft Private Wells> 100' 0✓ Yes if No ft Water Service Line > 10' El Yes if No ft Community Wells>200' 0 Yes if No ft Surface Water> 100' El Yes if No ft F. ENGINEER'S COMMENTS `.,+osIMII\11%it 1 G. ENGINEER'S CERTIFICATION ��P� ..OF••.;g4-� ��♦ I certify that I have determined through field inspections and review �•' I,-��•s � ice •' ...1"0 • .1 of Municipal records that the above systems are in conformance with i\ • MOA COSA guidelines in effect on this date. .� r. dg th , • O MICHAEL E. ANDERSON a 1.e. N O. CE-4381 ,•'•�� • 4. 0 fie, .•••, 2/15/19 ,••'• di COSA Checklist yellow sheet v.,(�0 ••••.........+•'•..41 •4i,1SA\Simi f' k,,,„4sa' ,_ _4 _ is7.3y i,,g 4 cl : • IV i1� 0 Z8� N isGQ t4 k ‘ 1 ; 1 ,, ,, jo0 7! k\ \Q ...... '1 9 A Jot t� t 1 ,,,, yoq- - ,,,. W ;101' .• '7/4 ------------- - ° ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: / ��$‘ FOLLOWING DESCRIBED PROPERTY: ........ �� QF A/ �� 740a/ W,-- 10,Zrz/&,'7,e/4Z Gol'. '/ DATE- r . '5 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS ,,'%<---#41 -�••. -�.;'�: '•�_'�: INDICATED. IT IS THE RESPONSIBILITY OF THE Art- . . .9 T H OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: r• if` EASEMENTS, COVENANTS., OR RESTRICTIONS z--•��' # - �' WHICH DO NOT APPEAR ON THE RECORDED SUBOI- -----u- • Duane Merl, word :_i� : VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: i .. LS'599 • '4 ANY DATA HEREON BE USED FOR CONSTRUCTION _ 4y-1, •Z/.l /9`'J'' OF FENCE LINES, OR FOR ESTABLISHING BOUND- ;+�4C; W ARY LINES. DRAWN: ' ' ~ _ : - ~' : .MUNICIPALITYOFANCHORAGE . ' , ' -' ~' .'~'~.' .DEPARTMENT.OF HEALTH & HUMAN SERV CES ' : '; :i:' .... '\~-~!~'] Division'0f Environmental SerVices - '. "~"':- -'"~-' :,~~; . -'"' ~ ': on~si:teservices Section" · ' ! '~ ;~" "~' PiO B0~(196650 Anch0ragb, Aiaskh~ 995:19-6650 - "- CERTIFICATE OF HEALTH AUTHORITY . '"~ ~:.' ~. APPROVAE;FOR'A SINGLE FAMILYDwELL'ING = L~0~ati~ (site;,~dress or directionS) 10].O~) 5one "2tee D~ive Day phone 346-3184 4300 "B" Street Suite 206 Anchorage, AK addr~§~ A~.ent A~dress ' Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDRooMs. 4 ~' T;PE OF WATER SUPPLY:' Individual well Community'well xxx Day phone Day.phone Public water NOTE: If community well sYS. tem, provide written confirmation from State ADEC attest- ' ing to the legality and status of system. . . ' 4. TYPE OF WASTEWATER DISPOSAL: ' - Individual on-site ~ - Public,~ew~ -/':' .' NOTE: . !fcOmm,Unity'~a~ ~ ~ attesti[3g !~th'e` 72-O25(Rev, 1/91) Front MOA~'21 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. Ifu rther 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 corn pliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S &S ENGINEERING Phone ("'~ ~ ' ;~ ¢/ ~ ~ 17034 Eagle River Loop Road No. 204 Address ~..I~ I~lver..Alaska 9.957,7 Sm DHHS SIGNATURE X Approved for Disapproved. Conditional approval for bedrooms, bedrooms= with the following stipulations: Additional Comments Date 7-/;- 2'7 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 engih~er 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. Employe~s of DHHS do not conduct inspections or analyze data before a certificate is issued: The Muni~:ipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, MUNICIPALITY OF ANCHORAGE Municipality of Anchorage JUN 2 0 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Se~ices Division 825 L Street, Room 502. Anchorage, Alaska 99501. (907) 3~lnr~'' ,..V~, Health Authority Approval Checklist Legal Description:/-03- ~ /~oc~ 5~ V,~u~-/ V~,~ ~s~, Parcel I.D.: O ~' ~' - 3 ?/ ~'-/7 A. WELL DATA Welltype ~-~,~s-~ /') IfA, B, orC, attach ADEC letter. ADEC water system number ~t.,lO ~o$- Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SA~S: ~ple: _ B. S~P~I~HOLDING TANK DATA Date installed ~ / '7~'- Date completed Cased to __ Casin~above ground) ~,,...~S pmpedy protected (Y/N) FROM WELL LO~.~ AT INSPECTION Nitrate Other bacteria Tank size I ~ ~- o Collected by: Number of Compartments I C eanouts ~/N). Depression (Y/~ ~,o High water alarm (Y/~ /', 0 Pumper Foundation cleano~ut {~/N) Date o~f,P'~mpir~g ,:./'. C, ABSoRpTIoN FIELD DATA ~5"- Date installed ...... ¥ I / Length ~ ~¢ Effective absorption area]_~.~'~(~'~nitoring Tube present ~/N) ¥~ Depression over field (Y/{~ /~ 0 Date of adequacy te~t' '~'//<~/~ '7 Results (Pass/Fail) /O~ £.~ For Z~ bedrooms Fluid depth in absorption field before test (in.); Fluid depth ;~ ~ (ins) Minutes later: ) ~' &-- Absorption rate = ~, O o "~ .g.p.d. Peroxide treatment (past 12 months) (Y/N) "' ~"~ K 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "P[[~'PumPoff'' level at* High water alarm level ~ _ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot ~/ On adjacent lots . Public sewe~~ / 4 Public sewer manhole/cleanout Sewer/septic se~ice line ~ / A Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~ Property line / o Y- Absorption field ~,o Water main/service line lo v-- Surface water/drainage ! Do ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain lO ~ BuildJng foundation I 0 Water main/service line ? o o ~L Driveway, parking/vehicle storage area r,' ~ ,-' !~ /~ ~'~) ~,v ~' Wells on adjacent lots ~ o o -4 F, ENGINEER'S CERTIFICATION ¢',','.',' ~ ¢ I certify that I have determined thru field inspections and review of Municipal record,~ s are SignatureinC°nf°rmancewithMOAHAAguide/inesineffect°nthisdate'¢~/ ~ ~'r'&~''~-~ ~i Cth ~O"/~'~"??'¢~J~ HAAFee $~¢ "~ Waiver FeeS ..... ' Date of Payment ~/7.-E2/~ Date of Payment Receipt Number '~F/ ~' :~ ~ L ~ ~ ~- Receipt Number 72-026 (Rev. 3/96)* GENERAL INFORMATION MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFrCATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL oF ON-S~TE SEWER AND WATER FAC.,TY 264-4720 Application Date ~-~/e7 Legal Descri. ption.(include lot, block, subdivision, section, township, range) Location (address or directions) ,/Z~.~ ~ (b) Applicant .ame~-- ~/'/~ ~;,~Ph0ne: Home ~/~ Business Applicant Address ~ ~ (c) Applicant is (check one): Lending Institution ~; oWner/~uilde~; Buyer ~; Other ~ (explain); (d) Lending Institution . Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address:.., TYPE OF RESIDENCE Single- Family'S" Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well [] Community/~' Public Note: If community Well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite/~ Public [] Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) '~JOM s,JeeU!~u~ leUO{SgejoJd JO ~uo~loeasu~ lonpuoo ~ou op d3Ha ,o ~ee~old~3 'sluemeJ~nbeJ ~1~1~ pub IBJeP~J U eJJgO ~JSJlB~ oJ JepJo UJ ~uolJnlllSUl leUO!SSaJoJd luepuedepu} ue ~q eAoqe g qdeJSeJed u{ UeAl6 suomlelUeseJdeJ eH1 uodn ~lelOS peseq SeleOijipeo leAoJddV ~luoqlnv qlleeH senssl (d~FIQ) uolloelOJd le~Ue~UO~lAu~ DUe qlleeH NOIJ. N¥O leUOBipuoo le@9 s,Jaou!Bu~] uo loeJ¢e uf suo!JelnSeJ pu~ 'segueu!pJo 'sepoo ejelS pub ledlo]un~ lie Jo/pue ~jddns Jel~M el!e-uo eqj 'uofloadsu! pue uo!~eS!~8eAu! ~ ~oJl pu~ pau!~lqo uo!lem~olul eql uo paseq J~ql ~lpeA Ja~Mn~ I 'u!aJeq peleo!pul eJn~onJls lo edXl pue smooJpeq to Jeq~nu eql JoJ alenbape pub leuo!loun~ 'e~ee s! melsXs legode!p Jel~MelSeM Jo/puB ~lddne qlleeH s!ql jo uo!leSl~seaul X~ leqi XHJeA I 'MOleq UMOHS e~ep UOl~eP!leA cHI ~o se pue oleJe~ pex!~Je lees X~ Xq pelj!Heo sV NOI/VlNIJOJNI ON¥ V.I. Va 'HOI:IV.:IS ':l"]ld 'SIS=II 'SNOI.LD~dSNI ~)NIQIAOIJd ~IHI;:I !DNIEI=I::INIDN:~ 'g MUNICIPALITY OF ANCHORAGE (M HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: WELL DATA Wel, Classification C~¢¢-~'~ Well Log Present (Y/N) Total Depth Cased to If~A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Depth of Grouting 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 F~ To Nearest Public Sewer Line Pump Set At . ~,~1~, p'~e~,(~'r1~und Wellhead (Y/N) ]; On Adjoining Lots On Adjoining Lots Cleanout/Manhole Water Sample Water Sam~est Results Comments To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA To Property Line To Water Main/Service Line Course Comments Date Installed standpipes (Y/N)~ ' t~ Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well '~ '~?'~¢>~ / / Size Air-tight Caps (Y/N) No. of Compartments ~ ~ Foundation Cleanout (Y/N) Date Last Pumped ~H ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~:~--~ Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~:~,x~O / To Building Foundation '~' / Lot /~¢¢~'b ~.~ To Water Main/Service Line '~/0 / TO Stream/Pond/Lake/or Major Drainage Course Type of System Design Length of Field ~'~ / Depth of Field /~' / Gravel Bed Thickness ~' Standpipes Present (Y/N) Date of Last Adequacy Test '7/~O~'/Op 7 / To Property Line To Existing or Al:~andoned System on ;On Adjoining Lots ,/~Z'~g'z~ To Cutbank (if present) /("/~. · .~ / To Driveway, Parking Area. or Vehicle St(2rage Area 2 L/~'"(~ · / Date Installed ~ Dimensions Size in Gallons ~ ~~Y/~) "~ump On" kevol at ' ~ ~ "~ump Off" kevel at High Water Alarm Level at ~ Vent (Y/N) Tested for // Pumping Cycles during Adequacy Test. Meets MOA I certify t h/at )/~¢v.e. chJKl'kCd,/ ~ /'// verified, or conformed to all ~OA ~nd HAA guidelines in effect on the date of this inspection. Amount: $ _ Page 2 of 2 72-026 (11/84) l/X)' o o MUNICIPALllY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION RECI!IVE[) Engineer's Seal DEPT. OF ENViRONMeNTaL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 I ~TEVE COWPER, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the \ / ..... ~' < Water System is in compliance with the State Drinking Water Regulations Sincerely, SEPTIC ADEQUACY TEST RESULTS Owner: _~/~-/Q Date of Inspection: RESULTS: WATER SYSTEM: Legal Description: ~// Address: o SEWER SYSTEM: The above test information has been verified and systems functioned as described. We do not provide any guarantee on the long term performance of the system due to operations and conditions beyond our control. If the system is used as intended, the results will remain similar. Certif~ MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or (~irections) /DIDO Lo N ET'/3 E E (b) Applicant Name .~._ .~"t / ET F; ~v'~_l~ EI~Te ephone: Home ~*~/~'~'.,""~'~'~' ! C// Business Applicant Address (c) Applicant is (check one): Lending Institution ~; Owner/~r~; Buyer ~; Other ~ (explain); (d) Lending Institutioh ~) I~ ~., Telephone Address (e) Real Estate Company and Agent Address Telephone (t) Mail the HAA to the following address: HOL. TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well [] Community/~ 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 corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (1~/84) 5. 'ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is sate, 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 tiles 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 thi~tion. ~ ~~O~ ~ Name of Firm"-'-~O''~t Telephone ~""~ q"' ~'/'~ Address ~ ~ ~ Date /~t~ (_ ~ I, f ~ ~ D.EPAPP.OV . Approved for ~¢~/?~' bedrooms~/v~ ~'~--~_E~ate Approved ~ Disapprd~'ed Conditional. Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 WELL DATA MUNICIPALITY OF ANCHORAGE {MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR ] 264-4720 Legal Description: L..O'~' Well Classification ~.,~,,A~'.~.~, ~ I~ A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~, To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by 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 To Nearest Sewer Service Line on Lot ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~, To Property Line To Water Main/Service Line Course Size I,,,~O No. of Compartments Air-tight Caps (Y/N) ~ ' Foundation Cleanout (Y/N) Date Last Pumped [~1/'/,,~ , ;for Temporary Holding Tank Permit (Y/N) J~ -- To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026(11/84) C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~:' ~ Date Installed ~/IZ/15' Width of Field '~.0" Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot N ~(~---. To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Comments D. U.T STATIC. t"/O N E Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or. Aonformed to all MO/~ and HAA guidelines in effect on the date of this inspection. Company MOA No Date of Payment ~AFG _ ~JQ INSPECTION APPOINTMENTS /~ DATE RECEIVED MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAG~ )~/t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~EPT' OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL Fi~OTECTIOH ENVmON ENTALSAN TAT O. DWm O. MAY A !981 Telephone 264-4720 o. DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing. ~. P,OPERTV OWNER PHONE ~a~s E. and Sandra R. Ceseran~ 344-2464 MAILING ADDRESS SEA Box 28D ~Anchorage, Ak. 99507 PROPERTY RESIDENT (If different from above) PHONE Sa~ 2. BUYER PHONE Thomas and Penny Vasf]ef~ MAILING ADDRESS [ Carol Douthit~ C-23 Her~taqe Homs~ 207 E. No. Liqhts~ Anchorage, Ak. 99503 3. LENDING INSTITUTION ~ PHONE Ho~ Federal SavJnqs and Loan Assn., - Donna Na~]~ 274-]45] MAILING ADDRESS 535 "D"~ Ancho~aqe~ Ak. 9950] 4. REALTOR/AGENT PHONE Betty Ha]s~y - Admiral Rea]t,y, ~ :~ 279-8586 MAILING ADDRESS 930 ~. F~fth~ Anchorage= Ak. 99503 5. LEGAL DESCRIPTION Lqt 4, Blk. 4, Valli Vue Estates #2 ~TREET LOCATION lOlO0 Lone Tree Dr. 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 [~ INDIVIDUAL/ON-SITE** ~ C~,'~ ~"' YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY I, 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 UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER E~]Septic Tank or []Holding Tank Size: /~D If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line ] Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [] CONDITIONAL APPBOVAL 11otter must accompany certificate} [] DISAPPROVED DATE B~ 72-O10 (Rev. 6/79) 2(.'~. 15th AVE "C" SUITE 203 A,~CHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOT 4, BLOCK 4, VALLI VUE LOCATION: 10100 LONETREE OWNER: KAREN VASILEFF RESIDENCE: SINGLE FAMILY, FOUR BEDROOMS WATER SYSTEM: CLASS A COMMUNITY WATER SYSTEM SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: SUNSET PLASTIC 1250 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 288 SQ. FT. SOIL RATING: 85 INSTALLATION DATE: SEPT. 1975 DATE OF PUMPING: APRIL 11, 1986 ANCHORAGE CESSPOOL PUMPING DATE OF TEST: APRIL 11, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUNF BURRIED FIVE FEET. LIQUID DEPTH WAS 53 INCHES. CLEANOUT TO TRENCH WAS SIX FEET DEEP, TRENCH SUMP WAS 12 FEET DEEP WITH FIVE FEET OF LIQUID. 340 GALLONS OF CLEAN WATER wAs ADDED TO THE TRENCH AT A CONSTANT RATE OF 9 GALLONS PER MINUTE. THIS CAUSED THE WATERLEVEL IN THE SUMP TO RISE 3/4 OF AN INCH. 15 MINUTES AFTER ~ ~i.L THE ADDITION OF THE WATER THE WATER LEVEL WAS .... BACK TO TE~' ,R~ESULT.~ THIS SYSTEM ~TS ~_~RMRNTK QF " THE"huNICIP-AnITY QF ~A:N_C~HORAGE.% The operational life of all septzc systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue'to rdeet the operational requi- rements of the Municipality and State. MATERIALS l~TIh~o ' QUALITY cohr[ROL SC)iLS ENGINEERING 2_204 Clevelond Ave. F:O. Box 10-1126 Anchoroge,AK. 99511 2_77-O231 710 Third Ave P.O. Box 2540 Fairbonks, AK. 99707 452-1Z 67 ' 456-5155 I C SYSTEM ADEQUACY REPORT JOB NO. 1555 DATE OF REPORT 5/20/81 DATE OF TEST 5/22/81 LEGAL DESCRIPTION LOT 4 ., BLOCK 4 , 7 1'1~,~-, SUBDIVISION OR_ SECTION , T__N, R_ W, S.M. , ALASKA PERFORMED FOR: Ceserani SRA Box 280 Anchorage, PHONE NO. REQUESTED BY: Betty Has]ey _ Admir~.l Real'Ir PHONE NO. TYPE OF SYSTEM ' [] NUMBER OF BEDROOMS 4 SEPTIC TANK WAS PUMPED D YES ~ NO ABSORPTION RATE: AVERAGE 24 HOURS 600 SURGE RATEi 480 GALLONS IN 48 [] SEPTIC TANK - SIZE · El CRIB OR SEEPAGE PIT LEACH FIELD 1500 GALLONS GALLONS. MINOTES. NOTES ~ OBSERVATIONS Day 1 Init: Rd. 84 3/4" After 480 g~_l~ - 84" Day 2 Day ~ Init. Rd. - 85 ~ ...... Einal_P~d~ ~84--3~4---- AfLer 480_ - 8~. ~6_00 - ~4~ TEST PERFORMED BY.' L.[v[- REPORT PREPARED BY: ___L.~[. ___ APPROVED BY:_ KRB _ . -- ANCHORAGE, ALASKA 99501 (907) 264-4/1 '1 GEORGE M. StJI LIVAN, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROYECTION May 19, 1981 James E./Sandra R. Ceserani Star Route A Box 28D Anchorage, Alaska 99507 Subject: Lot 4 Block 4 Valli Vue Estates Subdivision #2 Approval for the individual cannot be granted until the completed: sewer and water facilities following items have been (1) The septic hank pumped with a receipt submJ_tted Lo this office. (2) An adequacy test needs to be performed on the existing leaching area. This test will determine if the existing system is adequate according to National Standard. A listing of prJ_vate firms performing the test is enclosed. This report needs to be submitted to this office for our review. If there are any further questions, please call this office at 264-4720. Sincerely,' Robert C. Pratt~ R.S. Associate Specialist RCP/ljw CC: Home Federal Savings and Loan % Donna Nail 535 D Street 99501 Betty Halsey % Admiral Realty 930 West 5th Avenue 99501 f~MUNICIPALITY OF ANCHORAGEs, DEPARTMEi ~OF HEALTH AND ENVIRONMEN~ ] PROTECTION 825 L Street, Anchorage, AlasKa 99501 279-2511, ext. 224 or 225 Date Received: July 5, 1977 #1: Time ~;~___~//k__ #2: Time #3: Time Date U-U-~.~L~ Date Date Insp .~i ~.~h~. Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: National Bank of Alaska Mailing Address: 2o Property Owner: David L. Burlinqham Mailing Address: Post Office Box 3-3859 99509 Phone: Post Office Box 3-351 99509 279-2506 Phone: 349-1922 Legal Description: Lot 4 Block 4 Valli Vue Estates Subdivision Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: four Number of Bedrooms: Well System: Permit # Construction Individual Well ( ) Con~uuity/Public System (x~ Depth of Well Well Log on File Bacterial Analysis 6. Sewage Disposal System: On-site System (xJ Public Utility ( ) Permit # ~ Installed _~f'~_ Instal!er/~~.__ Septic Tank Size Manufacturer Absorption Area ~.~,/~,,/~-~, ~ _ Soils Rate /~-/ 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest'Lot Line ~ · Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal DescrJ. ption: Lot 4 Block 4 Valli Vue Estates Subdivision Co~d. nent s: Affadavit Attached: ( ) Approved:~ Disapproved: Letter Attached: ) Da~e: Department Worksheet: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO~.~_C3'ION 2r~ast ~ud~r Roa~, ~nc~6-2221 INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner: Mailing Address: CMRO__VA Timber Enterprises. Inc. ~PO BOx '~-q~;1 An~ho~'~.. Ak. FHA CONV /~/ David L. Burli~ham Day Phone: ~49-.1.922 3. Name of Buyer: Irving J. Bl~m~re_ Mailing Address: ~/n .~ts~ 0fl 3001 C St. Anchorage, Ak. 4. Name of Lending Institution: ~t.~l ~nk nf ~l ~w~ Mailing Address: ~ ~ ~-~R59 ~nw"g". ~ Phone: 5. Name of Realtor or Agent: ~r~a R~,t tnr~ Day Phone: Mailing Address: Legal Description: Location: Anchor~ge~ A]n~ka 7. Type of Facility to be Inspected: RFR 8. Water Supply C 0~{LTNITY Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System SEPTIC Type of System: Public Utility. If Individual, date of installation No. Bdrms, 4 ,Individual .Individual (on-site]. 72 003(3/76)