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HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 5 LT 10Onsite File Valli Vue Estates #2 Block 5 Lot 10 #015-123-47 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211272 PID Number: 015-123-47 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New FT1 Upgrade Name William & Diane Finnegan ABSORPTION FIELD El Deep Trench El Wide Trench ❑Bed El Mound Site Address 6651 Crooked Tree Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 480-401-6501 5 Existing GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Valli Vue Estates #2 5 10 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Fie%)ld/� Tank Line Ft2 Ft. Well N/A N/A N/A N/A >25' TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer 1500 Gal. Surface Water ( > 100' NSA N/A N/A Material Plastic Number of compartments 2 Lot Line >5' N/A N/A j N/A NA Foundation *71 N/A N/A j N/A LIFT STATION urer Capacity Gal. Remarks *See tank profile drawing Tank only permit. Tank is insulated. Alarm location installed by PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer � JR s Septic Drainfield Existing CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection I5, 7/30/21 Location and description dates: 2 o Bottom of siding 3rtl 4u, ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date .k BenjarrrtSchiller Septic stem Approved(� Date 8 X2021 ����sl • . '���w��� Oa/2/zi92 , , • Note: this approval does not include well permit requirements. (Kev U5/01/18) Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A LENGINEER1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP211272 PID # 015-123-47 VALLI VUE ESTATES SUB #2, BLOCK 5 LOT 10 A B MH 25.2 SV 22.5 2CO 22.0 A B 10.2 13.8 15.2 FEET 0 50 100 2CO 5-BDRM HOME August 2, 2021 DRIVE FOR LOT 9 10' x 60' DRIVEWAY EASEMENT BK 280 PG 698 C ROO K E D T R E E S T R E E T 5' T&E EASEMENT BK 215 PG 433 10' UTILITY EASEMENT 1500-GAL SEPTIC TANK w/ 20" MANWAY SV MH EXISTING FIELD TO REMAIN IN SERVICE PLAN AS-BUILT PROFILE AS-BUILT (NO SCALE) 95.4 89.8 96.0 99.5FCOMH SV1500 GAL SEPTIC TANK 95.7 2CO95.25 Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A LENGINEERAugust 2, 2021 PERMIT # OSP211272 PID # 015-123-47 VALLI VUE ESTATES SUB #2, BLOCK 5 LOT 10 2" INSULATION Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A LENGINEERPERMIT # OSP211272 PID # 015-123-47 VALLI VUE ESTATES SUB #2, BLOCK 5 LOT 10 August 2, 20211"=3' FOUNDATION TO TANK SLOPE PROFILE 7.0' 3.5' 100.0 (BENCHMARK) 95.7 I N F L U E N C E L I N E 1 1 630 FEET 89.8 COMMON DRNEWA YEASEMENT EXTEY RECORDED AT 2003-022662-0 (EXTENDS EA SEMEN T A DDL TIONA L 30 A TOTAL LENGTH OF -90') COMMON DRIVEWAY EASEMENT RECORDED AT BOOK 280, PAGE 698 WATER SERVICE V, (LOT 10 ) N 89 56'40" W 6069 of At,� , 49 TH �C r SHANE A. HOLT e LS-6914%SJG %,�\,°fessionsl �Qo SURVEYNOTES. THIS SUBOL VISION HA NUMEROUS MINOR ERRORS THROUGHOUT THEREFORE, THE DISTANCE TIES TO THELOTLINE5ARESHOWN TO THE CLOSE5TFOOT THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OFRECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTE, FENCELINES THAT MAYAPPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS-BUILTSURVEY 1" =40' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 10, BLOCKS, VALLL VUE NO 2 SUB ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 3RD DAY OF AUGUST , 2021 HOLTLAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 15130, FB 214-67,215-31 3455513 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 On -Site Wastewater Disposal System Permit Permit Number: OSP211272 Work Type: SepticTank Upgrade Tax Code Number: 01512347000 Site Legal Address: VALLI VUE ESTATES #2 BLK 5 LT 10 G:2539 Site Mailing Address: 6651 CROOKED TREE DR, Anchorage Owner: FINNEGAN WILLIAM & DIANE Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: ri�cnt �, G Jt. Department 7/13/2021 7/13/2022 45040 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Veronica Pope GE 2021.07.13 Received By: 18:42:36 -00800' Date: Issued By:i/(' '�' 1�� � �Zc� f Date. % 3Idoa 5 UNICPALITY OF ANCHORAGE Community Development Department `' Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel ►.D. 015-123-47 Property owner(s) William & Diane Finnegan Day phone 480-401-6501 Mailinq address 800 E Dimond Blvd Ste 193-476, Anchorage, AK 99515 Site address 6651 Crooked Tree Drive Legal description (Sub'd., Block & Lot) Valli VUe Est Sub #2, Block 5 Lot 10 Legal description (Township, Range & Section) Lot Size 45,040 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank 7X Upgrade ❑X El (D) Holding Tank ElRenewal ElDuplex 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) Permit/Rush Fees:? Z� Date of Payment: '7hila 0 Receipt Number: 08 G3 1 5 6 Permit No. 65P2-1 12.77_. Permit App_'.:- : - Waiver Fees: Date of Payment: Receipt Number: Waiver No. July 7, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 7/7/21 Subject: Valli Vue Est #2 B5 L10 - 6651 Round Tree Dr Septic tank design Dear On-Site Services Engineer: The owners of the above lot are intending to sell their home and the existing septic tank is well beyond its 30-year life expectancy. Therefore, we are submitting this permit application for its replacement. The subdivision is serviced by a community well that serves this lot as well as the surrounding properties and is greater than 200’ away from the property lines of this property. No septic system on this lot or adjacent lots will have any effect on the proposed septic tank location. The tank will be at least 10’ away from the foundation and 5’ away from the existing septic trench. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211272, Rebecca Carroll, 07/13/21 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' 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 5 LOT 10 FEET 0 50 100 2CO NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM NO EXISTING WELLS - PROPERTIES ARE ON A COMMUNITY WELL SYSTEM 5-BDRM HOME July 7, 2021 DRIVE FOR LOT 9 10' x 60' DRIVEWAY EASEMENT BK 280 PG 698 CROO K E D TR E E S TR E E T 5' T&E EASEMENT BK 215 PG 433 10' UTILITY EASEMENT 1500-GAL SEPTIC TANK w/ 20" MANWAY MAINTAIN MIN 10' FROM FOUNDATION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211272, Rebecca Carroll, 07/13/21 NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-472.0 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION oTc t AuNt eC~r E~O :~,~;~ ~./~¢~ .1,~ ILq, capacty nga ohs j ~-~)~ IF HOMEMADE: DISTANCE TO: Well DISTANCE TO: No. of lines Top of tile to finish grade /__ Length Type of crib DISTANCE TQ: DISTANCE TO: Well IAbsorption al~.~ / Inside length Dwelling Total lengtt~o~ I) nas Material beneath tile Depth Crib depth Building foundation Dwelling.~ Material Nearest lot line ( Trench w~.~t h~ Mches NO. OF BEDROOMS PERMITNO..~(~ ~'~J No, of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between Total effective absorption area PERMIT NO. Total effective absorption area Nearest lot Kine Depth Driller Distance to tot line Building foundation Sewer line Septic tank OTHER PIPE MATER]ALS SOl L TEST RA'TING INSTAI~LER REMARKS DATE LEGAL 7 ? O~-~--S I TE PERMIT NO. ( 8002~1 ) APPLICANT JIM JOHNSON LOCATION L. RDoKED TREE LEGAL LiO 8.5 VALLI VLIE DEPARTMENT OF,~BLTH 8ND ENVIRONMENTAL PR~ECTION _,FREET~ ~NCHORBGE, ~K. 995~ R SUITE }ge fiNCH,d~ ~ 1016 WE_T 6TH LOT SIZE 5t480 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEbl IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 5 SOIL RATING THE REQUIRED SIZE OF THE SOIL RBSORPTIOM SYSTEM IS: C, EPTH= :L2 LEblL]TH= 40 ~3Ri:iVEL DEPTH= 8 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFACE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFBLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F-:E(~iJ I E:ED SEF"T I C: 'TI:INK $ I ZE= 1500 I]FILLOI'-,IS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPEL:TION_, OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NLMBER OF RE_.IDENIjES THAT THE WELL WILL SERVE. TWO < 2 > I ~4SPEC:T IONS ARE REQU I RED BACKFILLING OF ANY SYSTEM WITHOLIT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS ±00 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVATE WELL TO B PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION, PERMIT EXPIRES DEC:EMBER ~1.- I 988 I CERTIFY THAT I: IRM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS 8S SET FORTH BY THE MUNICIPALITY OF ANCHORAGE 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 5 BEDROOMS. S I GNED: ........................................ R, PF'L I CAMT JIE JOHNSON .... V4. 0 {J~ ~' IHE HL~IC1F~JT~ OF [~] SOILS LOG PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch ~650. Anchorage, Alaska 9950~ ')76-222~ SOILS LOG -- PERCOLATION TEST Custom Structures - Floyd Bridge DATE PERFORMED: PERCOLATION TEST ASI NO. 00980 6/20/80 LEGAL De~SCRIPTION: Lot 10 ~ Block S~' VallJ Vue-Estates Unit No.2 2 8 m 10- 11- 12 14 15 16 17 18 19 20 COMMENTS SLOPE SITE PLAN Silty Sandy Gravel u/oen. Cobble Silty. Sand w'Some Grave] ocn, Cobbie c . - - G~oss ~ Net Depth tol '- ' ~'iNet "~. · . RQadmg Da~ . - Time --~--- ' Time -. ;; Water ;' Drop - · -~- 6/20~80 ~0:t2 ..... 0 ..... 9.25 .... 0 .2 ' ' '10:22'' 10 min. 0.76' ~_$1' ~ _... )'~10~2 .: 10 . 1,0~' ·0.27' 4 10:42 ' 10 1.71' . n,lR' 5 ~ ~. "~0:4~ ~ 0 0.30' 0 ~ 6 - 10:5~ 10 min. 0.~7' 0.37' 7 ' '- '11:0~' 10 min. 0.89' 0.22" 8 ' - 11:1~ 10 1.09' 0.?~' ~¢ , --_: ~'-:.,11:2~ - 10 1.23' 0,14' Gravelly.Sao ~/oen. Cobble Sl~ ~ois~ ..... Stephen D, 5hrader PERCOLATION.RATE -;~ miri,/ir)Ch {minutes/inch) TEST RUN BETWEEN .* 7.0 FT~AND c/.D F'IF PEREORMEDBY~ S. Shrader CERTIFIED8Y: S. Shrader DATE:~,20/80 .... Alaska Soils Investigati6ns .... ,, · 624 W. International Airpor~ Road ~72-oo8 (7/76)'.-f . ~-- ' ' ' ' ' ' · -:"' ' " Anchorage, Alaska MUNICIPALITY OFANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-123-47 Expiration Date: l 3 a0 3 1. GENERAL INFORMATION Complete legal description Valli Vue Estates Sub #2 Block 5 Lot 10 Location (Site address) 6651 Crooked Tree Dr, Anchorage, AK 99507 Current property owner(s) Diane & William Finnegan Day phone (480)401-6501 Mailing address 800 E Dimond Blvd Ste 193-476, Anchorage, AK 99515 Real estate agent 2. TYPE OF DWELLING: ❑■ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment �;AAI Date of Payment Receipt Number. Q� SZ7D Receipt Number COSA # 0 S C 2-11 `15 9 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 Benjamin Schiller Date 8/2/2021 6. DSD SIGNATURE .. , ..... System #1 Approved for 5 bedrooms �� Jgen)arirtchiller System #2 Approved for bedrooms �<`��`.• CE 12592 •4��s�`® s8/2/21 pp ��kk�, ROFESWO Disapproved Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 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 Sub #2, Block 5 Lot 10 Parcel ID: 015-123-47 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system WELL DATA ❑ Wel filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Class A Community Well B. TANK DATA Age of tank(s) <1 years Tank type/material Septic/Plastic Measured operating fluid level in septic tank N/A © Standpipes/foundation cleanout per record drawing Date of pumping Tank installed on 7/30/21 D. ABSORPTION FIELD DATA Deep Trench Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) ug/L ❑ Arsenic less than MRL (ND) Collected by"� Date of Sample .�Require ON ❑intenance completed Age of lift station ears Lift station material Comments: Which system tested (date installed) 7/9/80 Adequacy test date 7/13/21 W ALL standpipes present per record drawing Results 2 Pass For 5 bedrooms Total measured depth from grade 11 -0 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade *n/a ft (min) Water added 947 gal ❑ N/A — pressurized field New depth 2.5 in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective WCode-required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate '750 gpd (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: 'Trench was installed before MOA code required cleanouts. COSA Checklist yellow sheet E. SEPARATION DISTANCES From PTivate Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station t > 100' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' ft if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No t Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft o ' Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' Community Wells > 200' Q Yes if No _ Water Service Line > 10' Animal Containme 0' ❑ Yes if No ❑ Yes if No ft _ Manure/Animal Excreta Storage > Community Sewer Main > 75' ❑ Yes if No ft 0 Yes i From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 7 ft Surface Water > 100' ft ft ft ft ft ❑ Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5'✓❑ ✓❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No _ Water Main > 10'✓❑ ❑ Yes if No ft Community Wells > 200' Q Yes if No _ Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' 0 Yes if No Surface Water > 100' 71 Yes if No ft F. ENGINEER'S COMMENTS * Tank is outside of the soil bearing prism of the foundation. G. ENGINEER'S CERTIFICATION i certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet OF TH Benjarr"nchiller l CE 12592 � 8/2/21 PROFESSt4Nt'� ft ft ft ft Parcel I.D. # 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description L~ J~ /0 ~ ~ Location (site address or directions) ~ -~/ Property owner Mailing address Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~' ~ 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 tat~k Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 Js 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 ,.¢ O ~' ~/¢c.~4_~./~ Phone Address ~..0 ~ I,~-~ /~.~-~-~'/ _,,-~ Engineer's signature ~ ~~ / DHHS SIGNATURE /~.' Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date ~./~M,.& 'Z~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 {Rev. 1/91) Back MOA ~1 Legal Description: A. WELL DATA Municipality of Anchorage ~, Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Log present(Y/N) Date completed Driller Total depth __Cased to Casing height. Sanita~ seal(Y/N) Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot g.p.m. AT INSPECTION ; On adjacent lots m g.p.m, r-l-'l Absorption field on lot ; On adjacent lots Public sewer main Sewer service line Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~7/7/~t2 Cleanouts (Y/N) (~)~ High water alarm (Y/N) ............ .... Tank size /2~/--'t¢-2 Compartments Foundation cleanout (Y/N) / Depression (Y/N) Alarm tested (Y/N) [~//,'~ C. LIFT STATION Date installed Size in gallons ' Manufacturer 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 7 ~ 7'--~'"O ' Length &'//'~ Width ~ Total absorption area ~ ~ ~-- Depression over field (Y/N) ~ Results (pass/fail) ~ Peroxide treatment (past 12 months) (Y/N) Soil rating /,~,~ System type Gravel thickness ~ Total depth /'~ (~/~'~) Cleanoutspresent(Y/N) N ~ Date of adequacy test ~ ~ for ~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~//A On adjacent lots .~' ~g.~.c7 Property line To building foundation ¢'~ .'~-'~ T~,xisting or abandoned system on lot On adjacent lots Cutbank FA Water main/service line Surface water hi//'% Driveway, parking/vehicle storage area Curtain drain E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect/on_:the date~o¢.. . this. inspection. Engineer's Name /T~p~ld. ~)~¥~,.~.~-ut./ ~-~- Date HAA Fee $ /70'4:¢ ' Date of Payment ,,~ '~ ¢~'~ ~-- Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev, 3/91) Back MOA 21 203 WEBT 15¥H, A~ENUE ~UITE 20& (907) 279-~916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: Let 10, Block 5 Valli Vue LOCATION: 6651 Crooked Tree OWNER: Paulene Eickbush RESIDENCE: Sin§le F'am:i. ly,~ ~: Bedrooms WELL: CemmLnity Water System F'WSID 210605 SEPTIC SYSTEM: FROM MUNICIPAL. RECORDS: 5 Bedroom System TANK: Greer Steel 1500 Gal. Twe Cemparts. ABSORPTION SYSTEM: Trench ABSORPTION AREA: 625 Sq. Ft. SOIL RATING: 125 INSTALLATION DATE: 7-7-80 DATE OF LAST PUMPING: Ancb. Cess Pool tl-21-91 DATE OF TEST: February "- J 999 TEST PROCEDURE: System was inspected and measured. Tank was ~ound witb 3 Yeet o~ cover and with a liquid level e'~ 48 inches. No trench clean out Trench sump was 11 ~eet deep with 24 inches of water. 6(])0 gallons o~ clean water- was added to the trench while the water levels im the tank and the sump were mon:Ltored. Tbe water level in the tank did not change~ while the level in the sump rose 11 inc:hes. The mext day the water' level in the monitor tube was checked. The water level bad dropped to the pretest level ~ ~ indicating that more than 600 gallons e'F water bad beem absor'bed. TEST RESULT: Depar tmc.~nt o~ This system meets the code requ:i, rements ef i':he Heal th and ,~oc.i ,al Serviees the Municipality o.F Ancherage. NOTE The operational life o~ ali. septic systems depends on the local soil conditions.$ groundwater levels that may fluctuate tiLer'lng the year~ and the water usage o~ the ~amily being served by the system. These conditions are outside the control o~ tbe evaluator o~ tb:i.s septic system. We can ther'e~ore not give any estimate of how long tills system will ~unction saris.Factory ~or- DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR (907) 349-7755 February 6, 1992 FOR: Tobben Spurkland PWSID Cf 210605 My review of the records on file in this office reveals that the Valli Vue Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer BR/cf DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME -- TIME DATE DATE i DATE INSPECTOR INSPEC; ,O~ ~ INSPECTO~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH &  825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION ) ENVIRONMENTAL SANITATION DIVISION OCT 2 9 1980 Telephone 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND 1. PBOPERTY OWNER PHONE g. G-oi-Jr 0,SbCg ;?'l-iq/~ PROPERTY RESIDE[~T (If different from a~ave~ I PHONE 2, BUYER RHONE MAI LING AD DR ESS LENDING INSTITUTION PHONE 4. REALTOR/AGENT PHONE MAILING ADgRESS STREET LOCATIO~ 6. TYPE OF RESIDENCE [~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One (~ Four [] Two E] Five [] Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* ,.~.COMMUNITY PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) ,/?~I~') YEAR ON-sITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~}INDIVlDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verifi~d INSTALLER []Septic Tank or []Holding Tank Size:. /-~ ~) 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 I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [~//APPROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate} [] DISAPPROVED DATE BY 72-010 (Rev, 6/79)