HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 4 LT 15MUNICIPALITY OF ANCHORAGE
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Township, Range, Secli~
I AS-BUILT DIAGRAM (Show location o~ well, septic system, prosody lines, foundation,
TA. S V N
~ SEPTIC ~
Matedat / No. of Compa~men(s
original grade
Gravellenglh Gravelwidth ~ ~ ~~ ',
Total absorp,ion area Distance between lines ~ ~ ~ ~
WELLS ~,~ z .~ Z
~ PRIVATE ~ OTHER
Classification (A,B,C) Tot~Cased to / ~ ¢ t e [~ f ' /¢ I
REMARKS: ~ - ~T ,~ /
~ ~.~ .~ ~ Inspections Pedormed
I L ~ J~¢ t ~ cmily that Ibis inspe~ion was pedormed according Io all
Municipal and Slale guidelines in el'~~~
72-013 (3/85)
r', E P
,:1 I~ E R E F~ M I F
Eac:l"l si~>:.!l::)'L ~ c:
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IENG ]: NIZ[:i:I':< ' S DIZS I E)N, ¢4HD ANY OI.EV I AT :i: ON THEI::;,'EI'::'!:ROM MUST DIE (.~PF'r:~DVIii;D
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/ ............... ..............................................
]: s~sue;,c] B DPYI"E ~
ALASKA E I1UIROIlmeI1TAL COrlTROL $1 RUICE$, IrlC.
~nclin¢¢rinq ~- ~nuil'onmenlol $1u~i~s
SPECIFICATIONS FOR BED WASTE~vTER~R~ATMENT SYSTEM
LEGAL DESCRIPTION: LOT 15, ~L(~ ~,yALLI VUE ESTATES UNIT #2; ~
1.0 GENERAL
1.1 The Drawings, sheets 1 through 8, shall be part of
this specification.
1.2
All materials and workmanship shall meet the
requirements of the Municipality of Anchorage,
Department of Health & Human Services (DHHS), the
conditions of the permit, and all applicable rules and
regulations currently in effect.
1.3
All excavations and depths are advisory, and are
to be verified or modified in the field by the
Engineer or inspecting agency.
1.4
It is the responsibility of the property owner or
installer to adhere to approved design for the
installation, to maintain the specified separation
distances and to have the appropriate inspections,
1,5
It is the responsibility of the property owner or
installer to report to the engineer any observed
conditions which would put the system in violation
of state or Municipal regulations,
1.6
If the installation is not inspected by an AECS
engineer, AECS will not be responsible for the
installed system. An engineer at AECS should be
consulted prior to construction, to determine the
number of inspections that will be required and to
explain what these inspections will involve.
2.0 SEPTIC TANK
2.1
If there is an existing septic tank it may be used
if it meets the capacity requirement for the
residence. The structural integrity of the tank
must be verified.
2.2
The septic tank shall be a UPC-approved
two-compartment tank, constructed of 12 gauge
steel with bitumastic coating and set level on
undisturbed soil. If the tank is buried at a
depth of 4 feet or less, it must be insulated with
an overlying layer of 2 inch burial type
polystyrene rigid board insulation.
2.3
2.4
2.5
2.6
2.7
The septic tank shall be a minimum of 5 feet from
the house foundation, and a minimum of 5 feet from
the absorption area.
The septic tank and bed shall be a minimum of 100
feet from any private well or body of water, 150
feet from Class 'C' wells, and 200 feet from Class
"A" or "B" wells, unless otherwise specified.
Less than the required separation distance must
have prior approval or waiver by DHHS or Alaska
Department of Environmental Conservation (ADEC).
Piping shall be fitted with a mechanical
watertight calder coupling on the outlet and inlet
of the septic tank. Piping shall be 4 inch solid
PVC ASTM D-SOS4 or cast iron, sloped a minimum of
1/4 inch per lineal foot on the inlet side and 1/8
inch per foot on the outlet side. If the piping
is buried at a depth of 4 feet or less, it must be
insulated with an overlying layer of 2 inch burial
type polystyrene rigid board insulation.
Cleanouts shall be installed as designated and
capped with air-tight rain caps (Jim Caps or
equivalent), and extend a minimum of 1 foot above
ground level.
If a lift station is required it shall be a
combination lift station septic tank per Anchorage
Tank and Welding, Inc. design. Specifications and
design drawings are on file with the municipality
and the engineer.
3,0 SEEPAGE BED
3.1
The gravel for the bed shall be 0.5 to 2.5 inch,
screened rock with less than 3 percent passing the
No. 200 sieve. Ail substitutes must have prior
DHHS approval.
3.2
The bottom of the excavation shall be level and
raked with the backhoe blade to ensure that the
bottom has not been compacted during excavation.
3.3
Sand, for leveling, shall have a size distribution
which meets the requirements of MOA code
15.65.077.
3.4 The distribution pipe shall be perforated 4 inch
rigid PVC with a minimum crush strength of 1500
3.5
3.6
3.7
3.8
pounds and shall meet the approval of DHHS for use
as drainfield pipe. All pipes shall be laid
level, and spaced according to the drawings.
Monitor standpipes shall be placed as shown in the
drawings. They shall be 4 inch rigid PVC ASTM
D-3034, or cast iron. The section shown with
holes may be either drilled 0.5 inch holes on 6
inch centers on opposing sides of the pipe, or a
section of regular perforated sewer pipe may be
clamped to the solid section with a no--hub
coupling or solvent joint. The perforated section
of the monitor tube shall be located in gravel
only. The portion of pipe above the sewer rock
shall be solid. A rubber raincap (Jim Cap or
equivalent) shall be placed over the top of the
pipe.
Insulation is required, using burial type
polystyrene rigid board insulation. There shall
be 1 inch of insulation for every foot of soil
less than the required 4 feet of cover, but there
must be at least 24 inches of soil even though
insulation is used. The solid pipe extending from
the septic tank to the drainfield shall also have
a minimum of 4 feet of cover or an equivalent
layer of insulation combined with soil.
The side slope of the mound shall be slope 1 foot
vertical to 3 feet horizontal.
The bed shall be planted with a white clover and
red fescue mix, or with Kentucky bluegrass.
4.0 INSPECTIONS
4.1
This bed will require a minimum of three
inspections. The first inspection will be of the
open excavation, to assure that the system is
installed in the proper soil strata, correct depth
and meet minimum specified design parameters.
4.2
The second inspection will be after placement of
gravel, monitor standpipes, and distribution pipe,
to verify proper installation and position of
pipes prior to backfill.
4.3
The third inspection will be after final backfill
grading and seeding to ensure that adequate soil
cover has been provided over the bed.
4.4
4.5
The inspection of the septic tank or llft station
installation can be incorporated with any one of
the above listed inspections.
The lift station will require either an MOA
electrical inspection or certification by a
licensed electrician depending on whether the
building code applies to this part of the city.
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO f OF
CALCULATED BY ~' ~:>~-I C~ OATE
CHECKED BY DATE
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHE~'.O ~ oF
CALCULATED BY ~ ~lJ. DATE
CHECKED BY
$C^LE
DATE
Municipality of Anchorage '
DEPARTMENT OF HEALTH & HUMAN SERVICES. 825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: ~-/J'- ~/ I//z/,'// ~"~'¢ D.r/.~,r,~F-z~Township, Range, Section: '7'/~.~
SLOPE SITE PLAN
1
2
3
4
5-
WAS GROUND WATEF~
ENCOUNTERED?
S
IF YES, AT WHAT ~
DEPTH? p
E
N
Depth to Water Alter /
Manilering? ~ Date:
7-
8-
9
10
12
13
14
20
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ~-~--~ (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN ~ FT AND ~ FT
PERFORMED BY; ~4/'l~lle ,~ 4 , /~ ,el I
f' CERTIFY THAT THIS TEST WA8 PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~'~/~-/~' ~.
72-008 (Rev. 4/85)
oGREA
ANCHORAGE AREA BOR "JGH
Department of Environmental Quslity
3330 C Street
Anchorage, Alaska ggs03
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~ ~'~'~
LOCATION
MAILING ADDRESS ~;~ c~f~ .~.~' ] PHONE
LEGAL DESCRIPTION
SEPTIC TANK:
INSIDE LENGTH
MANUFACTURER ~
INSIDE WIDTH
MATERIAL
NUMBER OF
COMPARTMENTS
LIQUID DEPTH
LIQUID CAPACITY ,'~'~ GALLONS.
TILE DRAIN FIELD:~-~
DISTANCE FROM WELL FOUNDATION
NUMBER OF LINES
ABSORPTION AREA ~'~'
DEPTH: TOP OF TILE TO FINISH GRADE
NEAREST LOT LINE
TOTAL LENGTH
OF LINES
DISTANCE BETWEEN LINES TRENCH WIDTH 'F~¢IN.
SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER
TOTAL EFFECTIVE
MATERIAL BENEATH TILE IN. ABOVE TILE
IN.
WELL:
TYPE CONSTRUCTION DEPTH
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE SEWER LINE TANK SYSTEM.
CESSPOOL OTHER SOURCES
APPROVED_ DISAPPROVED REMARKS
DISTANCE FROM:
DISTANCES:
SEWER LINE DEPTH:
PIPE MATE RIAL~/~
LOT SLOPE:
REMARKS:
DATE (//~'/~('~ APPROVED
G.A.A.B.
PERMIT NO. (
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PR, BTECTION
25i~ E. TUDOR RD., 8NCHORFIGE, AK. 99507
276-2221
76785 )
APPLICANT
L. OCFITION
LEGAL
TIMBER ENTERPRISES
E~'.OWN TREE CIRCLE
L±5 B4 VFILLI 'v'UE
P 0 BOX 325±
LOT SIZE
204D8 SQUARE FEET
TYPE OF SOIL FIBSORBTION SYSTEM IS: TRENCH
MFIXIMUM NUMBER OF BEDROOMS
SOIL RFlTING (SD FTZBR)= 1i0
THE REQUIRED SIZE OF THE SOIL FIBSORF'TION SYSTEM IS:
[:,E:F'TH= ::L2 L E f-.t ~2 ]- F~ = 4;~: bi F-: R %." E L [:, E: P 'T IH := 4.
THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFtELD.
THE DEPTH OF FI TRENCH OR PIT IS THE DISTFINCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCRVRTtON (IN FEET').
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRFI',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETWEEN THE OUTFRL..L PIPE
FIND THE BOTTBM OF THE E:,,:CFIVRTION (IN FEET).
BFICKFILLING OF RN'-¢ SYSTEM WITHOUT FINAL INSPECTION AND FtPPROVFIL. BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
:1,00 FEET FOR A PRIVATE WELL OR 200 FEET FOR R PUBLIC WELL.
SF'ECIFICRTIONS FIND CONSTRUCTION DIAGF.'.FIMS FIRE A'v'AILFIBLE TO INSURE PROPER
I NSTFILLFIT I ON.
I CERTIFY THAT
±: IRM FRMILIBR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
F'ORTH B'~' THE MUNICIPBLITY OF FlNCHORFlGE.
2: I WILL INSTFILL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]:: I UNDERS"FRND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLRR. GEMENT IF THE
RESIDENCE IS REMODEL. ED TO INCLUDE MORE THAN ]: BEDROOMS.
BFFLICRNT TI ME. ER EN~CRF'R I SES
2516E. fudor Road
Anchorage, Alaska 99507 /'%'1
276-2221
S()II,S LOG I'}';H()I,A'I'I()N TEST
Pc rfo rmed fo r ..~Jmzl~e~..~,nt~rpr~_as -'
Legal l escrip'~ion- -- ~ ~ ~, '~;~-~'-~7~C~ ~d2'~ ............... ~ate Performed 9/15/76
/nls torm reports: Soils log '-'~ .... ] ........... ]Ke-~]~}{--L~F--~,-- ..........
Dep th
Feet
| - Topsoil
2 - SM (250)
3 - m~ (250)
4 ~ s~ (25o)
5 - sM
6 - SM
7 - s~ (290)
9 - ow (ZlO)
lO - aw (11o)
ll aw (11o)
12 -
13 -
14 -
Was ground water encountered? ~ .... If yes, at wha~ deiJth?
Readi ng Da te
Gross Time
Net Time. ___~_Oe_p_.t/~__to W.~t,:r Ret Ur<};,
Percola[ion rate minute. ' ............
'Proposed i ~s ta] 1 a't~;~-'- '-~-e-c,~-.ge Pi t ira in Fi eld
I)e~)th of Inlet . Dept}~--t-o'-blo'~'t-o~-~'f-')it or trenci, ...................
COHHD'iTS: ............... . ........................
Certificate of On -Site Systems Approval
Parcel I.D. 015-341-58
Legal description VALLI VUE ESTATES #2 B4 L15
Site address 6301 Brown Tree Cir Anchorage
Current property owner(s) Rebecca Hough
Expiration Date:1 ;r 20 2 y
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
r
gY Original Certificate Date
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 by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
HUMUPAUT OF ANCHORAGE
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. 015-341-58
Complete legal description VALLI VUE ESTATE #2; BLOCK 4, LOT 15
Location (site address) 6301 BROWN TREE CIRCLE *ANCHORAGE, AK
Current property owner(s) REBECCA HOUGH
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone 907-632-4803
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: D Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age — 18 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS 0 Bed ❑ Deep Trench ❑o Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited 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 $ SSV Waiver Fee $
Date of Payment/ ! a & 6 e� Date of Payment
COSA # ®5 C a3 !®`cl Waiver #
0Ott &W,
COSA Application June 2022
NMI
COSA Checklist
Legal Description: VALLI VUEW ESTATES #2; BLOCK 4, LOT 15
'J iS1.0
Parcel ID: 015-341-58
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
❑ 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 CO
Static water I at beginning of test ft.
��rrenis
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping 1 Ili Z!- 123
❑ Required maintenance completed, if AWWTS
Comments:
a
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1989!
❑� ALL standpipes present per re rd drawing
Total measured depth from gra e 4 • 5 3 ft ( )
Measured depth to pipe invert from gr de •2 ft (min)
❑ N/A — pressurized field.
0 Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
If not, state depth into effective 4.8•-5.4'
0 Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced 1985 gallons 1/19/23 date
Any rejuvenation treatment (past 12 months) NO
If yes, enter date N/A
Well production at time gpm
Water storag volume gallons
We - infected for coliform test? ❑ Yes R No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date
C. LIFT STATION
F-1 Required maintenance co
Age of lift station years
Lift station rial
Adequacy test date 1/19/23
Results Q Pass
Fluid depth prior to test 2.5 in
Water added 502 gal
New fluid depth 2.75 in
Elapsed time 1030 min
Final fluid depth 0 in
Absorption rate 450+ gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 6
Effective depth used * in
Effective depth remaining *4.8+ in
in
Comments/Deficiencies: 'PER GEG FIELD MEASURMENTS, THE BOTTOM OF THE MT IS 0.4' TO.45' BELOW THE INVERT OF THE CLEANOUTS
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' Community Sewer Manhole/Cleanout >
❑ Yes if No ft es if No ft
Neighboring Tank > 100' ❑ Yes if No ft Private Sewer c Line > 25' ❑ Yes if No ft
Absorption Field on Lot > 100' ❑ Yes if No ft Ing Tank > 100' ❑ Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' ❑Yes if No ft
Y o ft
Manure/Animal Excreta Storage > 100'
Community Sewer _ 5' F-1 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'
Q Yes
if No
ft
Surface Water > 100'
0 Yes if No ** ft
Tank to Property Line > 5'
M Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
0 Yes
if No
ft
Private Wells > 100'
M Yes if No ft
Water Main > 10'
❑■ Yes
if No *
ft
Community Wells > 200'
Q Yes if No ft
Water Service Line > 10'
❑E Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
`ASSUMED BASED UPON KEYBOX AND WATER MAIN LOCATION SHOWN ON 2005 INSPECTION REPORT BY CINDY ELLIS, PE
—ASSUMED WITH CAVEAT. THERE IS CONSIDERABLE SNOW ON THE GROUND AND WETLANDS ARE PRESENT ON THE LOT TO THE SOUTH
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.
Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-337-6179
Engineer's Printed Name Jeffrey A. Garness Date
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 system/s on the date/s of the evaluation.
Separation distances were measured to readily identifiable features. Hidden defects or encroachments may
exist that were not identified during the evaluation. The operational life of all wells and septic systems depend
upon 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 systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regardinli
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 to perform
adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG
to perform the evaluation. Reliance upon the information provided in this report by any other person or party
(including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.
COSA Checklist June 2022
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Municipality of Anchorage
Development Services DePartment
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-541-58
1. GENERAl.: INFORMATION
Expiration Date: ~ -- / ~j - ~ /"/"
Complete legaldescription VALLI VIlE ESTATES SUBDIVISION #2; LOT 15, BLOCK 4,
Location (site address or directions) 6301 BROWN TREE CIRCLE * ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
CHERYL MYERS Day phone.868-8686
6501 BROWN TREE CIRCLE · ANCHORAGE, AK 99516
Day phone
PEOOY OONZALES w/ DYNAMIC PROPERTIES Day phone
3111 "C" STREET * ANCHORAGE, AK 99503
242-3825.
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class "A" Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or pdor
to closing for the engineertng services provided.
4. 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 Health Authortty 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 ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Phone
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504-
Engineer's Printed Name 'JEFFREY A. GARNESS, P.E.
Date
537-6179
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, greundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatseever.
DSD SIGNATURE
Approved for '~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the fllowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
W~ STEWATER '
PROGRAM ."
..',,',.
s;'O.: -- ..... ·
//22) 11 } I I ) D,
(Rev. 12,'01J
Original Certificate Date:
3-1, -o3
Municipality of Anchorage
Development Services Department
Building Safety DiVision
On-Site Wafer & wastewater Program
4700 South Bmgaw SL
P.O, 6ox 196650 Anchorage, AK 99519-6650
www.d.anchomge.ak, us
(907) 343-7904
Lega! Description:
A. WELL DATA
Well type
Date completed
HEALTH AUTHORITY APPROVAL CHECKLIST
VALLI,VUE EST.,,S/D,~2i LOT 15~ BLOCK 4t ParcellD: 015-341-58
COMMUNITY WELL
IfA, B~ orC provide PWSID# 210~ __--~-'"-'-"
Sanitary sea~ll (y/N)~-------'"-~/Ires propedy protected (Y/N)
~ Cased to , ft. Casing height (above ground) in.
Date of test
Static water level
Well production
FROM WELL LOG
AT INSPECTION
WATER SAMPLE RESULTS:
Coliform colontesll00 rnl. Nitrate __ mgJl.. ' co on es/100 mi.
· . . . Collected
Oate of sample: _ by: ~
B. SEPTIC/HOLDING TANK DATA
STEEL
Tank Type/Material
Tank size ,1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping ,1 /19/200,3 Pumper
ABSORPTION FIELD DATA *TESTED 11/9/1976 TRENCH
Date installed lo~'5-s/sg Soil rating (g.p.dJ/tao~ 324
Length ,42148 ff. Width .. 4/3,3 ..... ft.
*'11.91/ 556/fl2
Total depth 6.42 f. Eft. absorption area 158a, Monitoring tube YES
Data of adequacy test 2/24/2005 Results (Pass/Fail) *PASS
Fluid depth in absorption field before test 27 in. Water added 995 gal,
Data installed 11/9/1976
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
CHUGACH PUMPING
I~eI~ELOW EXISTING I;RADL.I
System type , TRENCH/BED
Grovel below pipe ,,, 4/0.5
Depression over field NO
For 3 bedrooms
New depth **62 in.
Elapsed Time: 7/!4;~5 min. Final fluid depth 52.5/50 In. Absorption rate >= ,, 450+ g.p.d.
Any rejuvenation t~eatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
**UQUID LEVEL WAS 8 INCHES BE3.0W INVERT. SUMP EXTENDS 70 INCHES BELOW THE INVERT.
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "P~
~ ~~ Cycles tested,
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
High water alarm level at in.
Meets alarm & circuit requirements?
COMMUNITY WELL
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water. 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water service line 10'+
Curtain drain NONE KNOWN
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Building foundation, 10'+ Water main 10'+
Surface water 100"+ ,Driveway, parking/vehicle storage 10'+
Wells on adjacent lots, 200'+
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printe~ N~ne
Da,.
JEFFREY A. GARNESS
HAP, Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
March 6, 2003
Municipality of Anchorage
Department of Development Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Subject: HAA for Private Septic System. Lot 15, Block 4, Valli Vue Estate Subdivision #2.
To whom it may concern:
The subject lot has a 3 bedroom house on it which is served by a community water and private
septic system. The results of the field investigation and adequacy tests are summarized as
follows:
A. SEPTIC SYSTEM ADEQUACY TEST: The existing septic system consists of a trench
type drainfield and a bed type drainfield. The trench is 4 foot wide by 42 feet long, and has an
effective depth of 4 feet. It was installed on 11/9/1976. The bed is 33 feet wide by 48 feet long,
and has an effective depth of 0.5 feet. It was installed on 10/5-9/1989. Per the homeowner the
flow from the tank was diverted from the bed to the trench approximately 2 years ago. On
1/19/2003, a site visit was performed to pre-soak and test the bed system. Prior to starting the test
the monitoring tube was dry. A total of 1055 gallons of water were added to the monitoring tube
which caused a rise of 4.5 inches. Approximately 24 hours later the liquid level was checked in
the monitoring tube and had dropped only 1 inch. From this data it is said the bed will not absorb
the minimum 450 gallons per day. On 2/24/2003, another site visit was performed to test the
trench. Prior to starting the adequacy test, the sump had a total of 27 inches of liquid in it. A total
of 993 gallons of water was added to the sump which caused a rise of 35 inches. Upon stopping
the flow, the level dropped 9.5 inches in 7 minutes. The liquid level was then checked 1435
minutes later and the level had dropped 2.5 inches (a total of 12 inches drop). Based upon this
data, it was dete,mined that the absorption rate of the trench exceeds 450 gallons per day, as
required for a 3 bedroom house. (see attached test data)
/1
If you
have any ~lgt~t[ons, please contact us at 337-6179.
re'~~~.,·
6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
ALA$ICA WATER & WASTEWATER
CONSULTANTS, INC.
SEPTIC ADEQUACY TEST DATA
I,EGAL DESCRIPTION:
STREET ADDRESS:
CLIENT:
PIIONE NUMBER: ~6~ -E6~£
NUMBER OF BEDROOM:
SEPTIC:
FIELD MEASUREMENTS:
TOP OF MT/SUMP TO BOTTOM ......................
TOP OF MT/SUMP TO DISTRIBUTION LINE ......
STICK-UP OF MT/SUMP ................................
TOP OF MT/SUMP TO LIQUID LEVEL ..............
*SEE II.A.A. SITE VISIT CttECKLIST* DATE OF TEST:
GALLONS PER DAY NEEDED:
(MT1) / // (MT2)
(MT1) / (MT2)
(MT1) / .// (MT2)
(MT1) // (MT2)
METER NUMBER OF SEPTIC TANK MT/SUMP RISE (+) /
TIME READING GALLONS LIQUID LEVEL LIQUID LEVEL FALL(-)
5',1 '?- ~" -- ~ I~t'4-~u -
RESULTS:
7 :PASSED ABSOP E % aAL .ONSI
: FAILED - SEE ATTACHED LETTER
Comments:
MINUTES (
/-/5'0 "[ GPD)
Signature: Date:
6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504 * Ph: (907) 337-6179 * Fax: (907} 338-3246 * aww$~alaska.nct
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DEPARTMENT oF HEALTH & HUMANSERViCES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Ar~ch0rage, Alaska 99519-6650
343-4744
CERTIFICATE OF. HEALTH AUTHORITY>-
APPROVAL FOR A SINGLE FAMILY DWELLING ..
Complete legal description ~ Lot 15; Block 4; Valli ~' Estates ~2
Location (site address or directions)
6301--B~own Tree Circle
Anchorage, AK
Property owner
Mailing address
Lending agency
Michael & Sybil Smith Day phone 346-1473
6301 BrownTree Circle Anchorage, AK 99516
Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2.. NUMBER OF BEDROOMS: 3 ~''
3. TYPE OF WATER SUPPLY:
Individual Well -
well:
' , -. Community
_' . ' . Public water'.
- .NoTEi' If~community well s~/stem, provide w~itten ~confirmation fr6m State ADEC attest-
ing to the legality and status of system. .
-:,..
~vritten'confirm~tio~ from'State ADEC
f system.
(Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
e. nd typ~ o~ !-'ucb ire indicated herein. I fudher verify th~-~? !:v_~sed on the iniormation obtained from
the Murlic:, ;~:;'(y of Anchora.(!~; files ?.nd frorn I'ny investigation and inspoction, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Engineer's sign~.ture __
S & S ENGINFEEING
Eagle River~ Alaska 99577
Phone
Date /¢//'z /¢/~
(~._ Approved for [/---~/~Er~',g) bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issu(Js 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 courtesyto 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 certifics[e is issued. The Municipality of Anchorage is not
responsible for errors or omis,;ions in the professional ~ ~:dF~:',:~s work.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description: L07- J~
Health Authority Approval Checklist
MUNICIPALITY OF ANCHORAGE
IENVIRONMI:NTAL SERVICES DIVI~IOI~
EL~e,~ 5/ v'/h.,~ ~U~ CsT, ~2-- Parcel I.D.: OJ,~' -'3ql -,-C-Af~pl::) 1R '~-_qg?
A, WELL DATA
V~ell type c o,,m~,, ~, ~- y
Log present (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
RECEIVED
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMP~
Coliform
D~ol sample:
Date completed
Cased to _ __ Casing h~ve ground)
__ W~rly protected (Y/N)
FROM WELL LOG / AT INSPECTION
Nitrate
g.p.m, g.p.m,
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installedl~/~/ '7/_ Tank size I O 4) O Number of Compartments ~)- Cleanouts ~N)_
Foundation cleanout ~N) ¥~ ~ Depression (Y/~ ~/0 High water alarm (¥i~
Date of Pumping ~ /'% / q-I Pumper ~r ~/~,-,~ 5-~,,~v,c~J
C. ABSORPTION FIELD DATA
Date installed tll~l~, ~, )o/q/¢~ Soil rating (g.p.d./ff~ o~ /~'o /3~'t System type
Length ~ / ~ Width ~' / ~3 / , ~ ,
Gravel thickness below pipe ~ Total depth
Effective absorption area ~gG //~ Monitoring Tube present~/N) Ye ~ Depression over field (Y~
Date of adequacy test ~/~7/~7
) Resulte~Fai,) ~'J For ~ bedrooms
Fluid depth i~ absorption field before test (in.); ~ ~ Immediately after~O ~ gal. water added (in.):
Fluid depth ~ ~::~ ~ ~ c~
(ins) Minutes later: ~ ~ ~ Absorption rate = , ~-o ~ 'g.P.d.
Peroxide treatment (past 12 months) (Y/N) ~0~ ~o~ . . ~.
If yeb, give date'
D. LIFT STATION ~
Date installed Size in gallons ..----~~/
Manhole/Access (Y/N) "Pump on" level ~.-~ Pump off" level at* _
Cycl~
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main ,..~'"'""~ Public sewer manhole/cleanout
S~ Lift station
SEPARATION DISTANCES FROM E'I~c~HOLDING TANK ON LOT TO:
Foundation 'g' :''~ Property line D- 5~ -~ Absorption field
Water main/service line /° + Surface water/drainage /o0 -h Wells on adjacent lots
On adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line ) 0 Building foundation lo 4- Water main/service line
Surface water 1 o 0 r 4- Driveway, parking/vehicle storage area.
Curtain drain ~ o t./~L ~ ~,,¢ w ,~/ Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal reco
in conformance with MQ~ HAA gcdelines in effect on this date.
Signature ¢'~,~Z. ~,~,..-,,"~ ,'*¢
Engineer's Name //~g.~,4'r C C ~,~
are
HAA Fee $
Reoe,ptNumber
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D.
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1, GENERAL INFORMATION
Complete legal description
Lot 15: Block 4; Valli Vue/~ubdivision
Location (site address or directions) 6301 Brown Tree Circle, Anchorage, Alaska
Property owner
Mailing address
Michael and Sybii Smith Day phone 346-1473
6301 Brown Tree Circle, Anchorage, Alaska 99516
Lending agency
Mailing address.
Day phone
Agent
Address
Day phone '
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 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.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-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. 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
Address
Engineer's signature
S & S ENGINEERING
17034 Eagle River Loop Road No,
~ln River: Aias.Ea 99577
Phone
DHHs SIGNATURE
Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C, attach ADEC letter.
Legal Description: ~
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Parcel I.D.
ADEC water system number ~'1 ~-o~-
Date completed Driller
.Cased to Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of te~t
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
; On adjacent lots
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
g.p.m.
AT INSPECTION
; On adjacent lots
Public sewer manhole/cieanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Nitrate Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed [ I - ~ - '"/~
Cleanouts~-~N) ~
High water alarm (Y/N)
Tank size
Foundation cleanout~N)
Date of pumping
Compartments "~
Depression (y~O
Alarm tested (Y/N) "~
SEPARATION DIST,~,NpES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /q/~"" On adjacent lots
To property line ~l .,~ Absorption field
Surface water/drainage [ ~>t ~
72-026 (Rev. 7/91) Front
'~'~;> t '~ Foundation "7~
~-~ Water main/service line (/~:~ ~'~'
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
Manhole/Access (Y/N)
Vent (Y/N)
"Pump on" level at
"Pump off" level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed \ ¢--2"'¢~ "- ~
Length ~'1,-¢~t Width
Total absorption area \ ~¢'~/~
Depression over field (~
Results~ail)
Peroxide treatment (past 12 months) (Y¢__.~,
SEPARATION DISTANCE
Well on lot f~ /~
To building foundation
Soil rating
Gravel thickness
On adjacent lots '~
Surface water
Curtain drain _¢ ¢;~i~ '------------------~'
FROM ABSORPTION FIELD TO:
On adjacent lots ,,~-Jtr~ Property line
"'-¢~"Z~ To existing or abandoned system on lot
Cutbank id~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
System type _"~
Total depth
Cleanouts p resentdfc'C~N)
Date of adequacy test
for ~ bedrooms
If yes, give date __
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection,
Signature
$ & S ENGINEEI~ING
17034 Eagle River Loop Roa~Ne,
Escl[e River, Alaska 99577
Engineer's Name
Date
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev, 3/91) 8~ck MOA 21
DEPT. OF ENVIRONMENTAL CONSERVATION
WALTER J. HICKEL, GOVERNOR
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
(907) 349-7755
December 7, 1992
Mr. Scott Swenor
S & S Engineering
SUBJECT: VaIli-Vue Estates Subdivision
Class "A" Public Water System, PWSID 210605
Dear Mr. Swenor:
I have completeU a review of this office's files concerning the monitoring status of the
above-referenced Class "A" Public Water System and found the following:
The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on November 6, 1992. This .does meet the provisions
of 18 AAC 80.200(a), of the State Drinking Water Regulations.
The last inorganic Chemical Contaminants Sample results were submitted
to this Department on August 13, 1992. This does meet_the provisions of
18 AAC 80.200(a), of the State Drinking Water--Regulations.
The last Radioactive Contaminants Sample results were submitted to the
Department on September 9, 1992. This does meet the provisions of 18
AAC 80.200(a), State Drinking Water Regu ations.
The last Organic Chemical Contaminants/Volatile Organic Chemical were
submitted to this Department on November 12, 1991. This does meet the
provisions of 18 AAC 80.200(a), State Drinking Water Regul'ations:-~
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
Environmental Eng. Asst. II
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FoR'HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # /-~.~1 ~-~ - ~-.~'L\ \ - .~ ~-~ HAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include I?t, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner "~/(~/~.c./ //,~.3_¢_~.~.///~.~/('' Telephone: (home) ~ ~g-~Business
(c) Lending Institution~~~d/J~~Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Te'lephone
(e) Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Number of bedrooms
Single-Family F~
3. WATER SUPPLY
Individual Well Fi
Community~ Public []
Note: If community well system, must have written confirmation from the
Conservation attesting to th legality and status.
State Department of Environmental
4. SEWAGE DISPOSAL
On-s~t Pubhc [] Commumty [] Holding Tank []
-/-
Note:If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72 025 (ney. 7/8e) 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 validation date shown below, I verify that my investigation of this
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.
Nameof Firm ,~-~"('~ ~' /' ~/-'~':~(--" Telephone
Address {
Date ,~'-~'~) '~'(
Approved for '~ bedrooms bye// ..
Approved_ /~i~approved 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 aboye by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Bev. 7/85)Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
C.EO.L,S;;3.%"4",UA,Y
Legal Description: ~
A. WELL DATA
Well Classification
Well Log Present (Y/N) Date Completed ~
Total Depth Cased to D~
Static Water Level ~Pump Set At
Casir)g Height Sanitary Seal on Casing (Y/N)
Electrical W...jdag"l-n CondLY~t (Y/N) Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot-- ~ ~.O~' / ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot--,~ ~_.~d) / ; On Adjoining Lots
To Nearest Public Sewer Line
If A, B, C, D.E.C. Approvec~/N)
/
To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
; Date
B. SEPTIC/HOLDING TANK DATA
Date Instalred/(~'~ Size ./~-') No. of Compartments
StandpipeS ~N)~ Air-tight Caps ~N) Foundation Cleanout(~N)
Depression over Tank (Y/~ Date Last Pumped
pumping/Maintenance Contact on File (Y/N) ~ ;for
Holding Tank High-Wate~ AI~m (Y/N) ff~? Temporary Holding Tank Permit
SEPARATION DISTANCES FROM,:~P~IC/HOLDING TANK:
To Water-Supply Well ~' .~ ~.~ '~ To Building Foundation
To Property Li~e ,' .... ~' ~'~ ~ To Disposal Field ~ /
~ .
To Water Main/Servic.e'Line." "~z"~'~:~, /
To Stream, Pond, L~ke o~' M~jor' Drainage Course
Comments
/ed>/
72-026 (Rev. 7/88) Fron~ Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ///'~/ ~- %/
Date Installed ,/,/'- '~'"?(~ /'¢')~ ~'--'~.~',) /
Width of Field E// ) ..¢, .~/
Square Feet of Absortion Area
over Field (Y/~ID
Depression
Results of Last Adequacy Test
Type of System Des gn ~/'l~l~
Length of Field Y~--~ / /
Depth of Field ~ ~ ~. b
Gravel Bed Thickness ~ / ,
~¢¢ Statndpipes Present)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
~; emtr~ eMnOt sA E, e c t r, c a I... ~.~..(-Y7'~
/' /
To Water-Supply Well ~ ~. O 6~ /
To Building Foundation 'Z~/x ':~,~.:
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle, S/torage_.Area
Comments
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ,~> ~ O/
To Cutback (if present) /4.)//¢
Dimensions
Manl~olelA._~t(-Y'l )F~'-"~
..~urf~ Off Level at __
Vent (Y/N) __
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have c/~ecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed ~/~7.~ /
Company ,/'~'~ ~' '
Date ///-- ~ ~ ~ ~' Engineer's Seal
Receipt No,
Date of Payment
Amount: $
72-026 (Rev 7/88) Back
Receipt No,
Waiver Fee:
Date of Payment
Page 2 of 2
· . ~'. MUNICIPALITY OF ANCHORAGE ~
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744 ·
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR $ NGLE FAMILY DWELLING
1. GENERAL INFORMATION_ (Must be completed prior to submittal)
(a) Legal Des r~ion (include lot, block, subdivision, section, township, range)
Locali;~'(~dd;ess or directions)
(b) ~ropor~ ownor. ~ J-.c~ ~ ~c.A ~
(C) Lending I~itution ~
Mailing Address
Telephone: (home) ,.~'/~-?z/,p Business
(d) Real Estate Company and Agent
Address
(e)
Telephone
Mail the HAA to the following address: (or check here (:3, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family,J~ Number of bedrooms
3. WATER SUPPLY
Individual Well [] Community/~ //Public []
Note:. f community well system, must have wr tten conf rmat on from the State Department of Environmental
Conservation attesting to th legality and Status. ~ ' ' : ': ": ::' '
4. SEw^GE D, S^L
On~site,J~. /Public [] Community E] Holding Tank [] ·
Note: If community wail system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72~25 (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 validation 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,
funct dna end 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 .,/~L~'-':"J' --~-~-~_ Telephone
Address f4) /'~"y ~D ~o~ /~c~ ,x)-~2_
6. DHHS APPROVAL
Approved for <~¢~.
Approved __
D~sapproved Conditional
Termsof Conditional Approval
Date
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 DHHS do not conduct inspections
o r analyze data before a certificate is issued. The Mu nicipality 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
WELL DATA
Werl Classification
Well Log Present (Y/N)
Total Depth
Static Water Level
.~T~ ~L 0 i98~ 3;3.4L~4a, Descriptlo n
ECEIVED /
: ~ ~ If A, B, C, D.E.C. Approved ~N)
Date Completed _ / Yield
Cased to Depth~
~ump Sot ~t
Casing Height Above Ground
Electrical Wiring in Con~uif~/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of'Absorption Field on Lot
To Nearest Public Sewer Line
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
' /'; ~Oining Lots, ~
,,~ 2'z'~-"~ / ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
; Date
SEPTIC/HOLDING TANK DA/,~A/
Date Installed /¢~/7g Size /O O0 No. of Compartments
Standpipes ~N) Air-tight Caps
Depression over Tank (Y/L~
Pumpin,g,/Maintenance~,: , . Contact, on File (Y/N)
Holdin'g'~ank High~W0t~r A~arm (Y/N) .'[/J~- Temporary Holding Tank Permit (Y/N)
S EPARATIO N ~IS.T ~A NC E~',-~ ;,~ , ,' F~OM ;, SEPT C/HOLI~G ¢' TANK
TO wate~:Sb'pply We'll.;. ': } -~ 2'"~"~ To Bud ng Foundat on
To, Propef..[y L~e ," *~ ...... ~ .$O /
· ,,,,:,.. ..... ~ To Disposal Field ¢/,,
To W~ter,~aln~Serwc¢,Lme !~ .~ 7_0
To Stream Po?d .L~ke or Major Dra nage Course
Comments
Foundation Cleanout
Date Last Pumped /~/~/¢? ~,',~'.
; for
72~026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA /
Soils Rating in Absorption Strata /'/¢~?
Datelnstalled J'//f//~/,¢- . /0/,¢/~2¢ / LengthofField ~"~/.,
WdthofField ~ ~'2 ,~'~ f / ' / Depth of Field ~"
Gravel Bed Thickness
Square Feet of Absortion Area ,~,'~¢// / ~-4~'~/ Statndpipes Present~C~N)
Depression over Field (Yg~ Date of Last Adequacy Test
Results of Last Adequacy Test /~,/¢ ~/ (/"-'~'"'¢ g
SEPARATION DISTANCE FROM ABSORPTION FIELD:
Type of System Design
To Water-Supply Well
To Building Foundation ,~/)
Lot //~ ~
To Water Main/Service Line
To Property Line ..~/O /
To Existing or Abandoned System on
; On Adjoining Lots ~ Z¢' /
To Cutl~ack (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Dimensions /
Man~
..~'"'~'Pump Off'Level at
Vent/ /N)
Tested for /' Pumping Cycles during Adequacy Test,
Meets MOA
Commen~,/--/
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines
inspection.
Signed
Company
Date
MOA No.
Receipt No.
Date of Payment
Amount: $
72-026 (Rev 7/88) Back
es i~'~t ~.D {"¢~date of this
¢"~¢~ .~ineer'~ Seal
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
Tom Fink,
Mayor
unicipality of Anchorage.
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
October 27, 1989
Leroy C. Reid, PhD., P.E.
Alaska Environmental Control
Services, Inc.
PO Box 240668
Anchorage, Alaska 99524-0668
Subject:
Dear Dr.
Lot 15, Block 4 Valli Vue Estates
Correction of Legal Description
Reid: '
Subdivision #2
The legal description which was recently provided for an on-site
sewer upgrade permit, the request for a Health Authority
Approval, and the on-site sewage disposal system inspection
report (as-built drawing) was lot 15 Block 2 Valli Vue Estates
Subdivision #2. The correct legal is Lot 15 Block 4. The
following actions are required in order to properly rectify
these errors:
1. This office will issue an amended On-site Sewer Permit.
2. This office will "sign off, an amended Health Authority
Approval Certificate.
3. You must sign the amended On-site.sewer permit.
4. You must submit a corrected (signed and sealed) Health
Authority Approval request.-.' (There. will be no additional
fee for the corrected HAA).
5. You must provide the lending agency (Key Bank) with the
corrected HAA.
6. This office will make certain that none of the above actions
are erroneously related to Lot 15, Block 2 Valli Vue Estates
#2 in our files and computer system.
In order to get this matter resolved, the above corrective
actions must be initiated as soon as possible.
Sincerely,~
On-site Services
RWR/ljw:180
"Kigs Are Our Future"
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
563-6775
DATE: Sept. 21, 1989
PW$ID: 210605
Requested By: A.E.C.S.
According to the records on file in this office, the v~lli
Vue Estates S/D Water System is in complianc~ with
State of Alaska Drinking Water Regulations.
the
Sincerely,
Cindy Thomas
Environmental Engineer
~MUNICIPAL~TY OF ANC~ORAG~
DEPARTMEN~ OF HEALTH AND ENVIRONMENI~ PROTECTION
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224 or 225
Date Received: July 5, 1977
#1:
Time ___~_.'~ PDqL__
Date _~-f~_/3__~{LL~.
I, sp
#2: Time #3: Time
Date Date
Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
e
Lending Institution Request: National Bank of Alaska
Mailing Address: Post Office Box 3-3859 99509 Phone:
Property Owner:
Mailing Address:
3. Legal Description:
David Burli~am
Post Office Box 3-351 99509
Phone:
279-2506
349-1922
Lot 15 Block 4 Valli Vue Estates Subdivision
Single Family Residence: (x) Number of Bedrooms: three
Multiple Family Residence: ( ) Number of Bedrooms:
Well System:
Permit #
Construction
Individual well ( ) Community/Public System. ~
Depth of Well Well Log on File
Bacterial Analysis
( )
Sewage Disposal
Permit It
Septic Tank Size
Absorption Area
System: On-site System ~ PublJ. c Utility
Installed Installer
Manufacturer
Soils Rate Material
( )
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2~10 E=s~-T-u;~er-Read, A.,~c.h~rage~qJasEe-9.9564 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
2. Property Owner:
Mailing Address:
3. Name of Buyer:
Mailing Address:
CMRO VA
David Burlin~hsLm
FHA CONY ×X
Day Phone: 3h9-1922
Day Phone: 337-1753
4. Name of Lending Institution:
Mailing Address: ~ P~x 3-3R~.? ~neho~-se~ a&. Phone:
5. Name of Realtor or Agent:
Mailing Address:
6, Legal Description:
279-2506
Location: An ~,bm"~: A1 ~l~
7. Type of Facility to be Inspected: RF~
8. Water Supply COMMUNITY
Type of Supply: Public Utility
No. Bdrms. 3
rlndividual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System:
If Individual, date of installation
SEPTIC
Public Utility
Individual (on-site)
72-003(3/76)
Pa~ge ¢~wo
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 15 Block 4 Valli Vue Estates Subdivision
Comments:
Affadavit Attached: ( ) Letter Attached: ( )
~J ~ Date:
Disapproved:
Department Worksheet:
