Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
VALLI VUE ESTATES #2 BLK 6 LT 5
Val 11'* Vue Estates #2 Block 6 Lot 5 #015-123-13 Municipality of Anchorage Development Services Department :� ? Building Safety Division On-Site Water and Wastewater Program, 4700 Bragaw St P.O. Box 196650 Anchorage. AK 99519-6650 Page of www ct anchorage ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: suJotpocicitp PID Number: OIS' 123-1 Wastewater System: ❑ New ❑ Upgrade Aaa.ss 664Tr Dr,vt ABSORPTION FIELD Pnat N,,,W aevvo es O t>.ro nwe o swgw n«ern 0 ew O Mwa D o�ry. LEGAL DESCRIPTION Sol R«n, Iv«D.an GPo�F,' ,. equ La i S,mm.gn D.Pm b Po. DORM eom WV,* V.e+ Gwr«Asan Prem as J41 V"_ £ &1 Blo, L F, TP.n.np R" sMgn F4wx*J v W"grWs 10-9r« 1.4-911, Fr i Well: [3 New ❑ Upgrade GrIvM wglre Iw.nuteal « a es Da«c. D«rro«e vas F, F: cieocegn IPM«. he {) Fee D.an Fc—Tom wivop, «.. Pp M««W FI. FI W Piro. On. Duwa S,«q W«« L..« Ynulw cr Dau n««ta FL WA Yrq PraP s« M G..q R«prM ADor. Gloune TANK GPM Ft. F, SEPARATION DISTANCES [%Septic ❑ Holding ❑ S T E P ❑ Other To Septic Absorption Lift Holding uvic/Pnvate'pu« _ «.«.n From Tank Field Station Tank Sewer4ro t1orA 1 G+ ICW w� N A Mntui S to 1 Nemew a Ctr�w.n.,«a. Z S.n.c. Witte N LIFT STATION to 1" *lo' Gal 'PrnP wV..at 'PrnP0e*..« Rqn wn«.wm.i FPrq.�gn �`1 � J n n � Crum Wan MO. PumP Mw.l Mea« Erc,rr+� N.gclgn. P«,am.a Dy R«nM. A0 Co Wel ? 200 t BENCH MARK Loa„gn «q pan frory) Sialn6 cprftc-0 AFwewa 065elrverA lop r' `` `` Engineer's Stamp Inspections performed by: L-225 &C.1`` 0-A Dates: 1" z"° Development Services Department Approval Conditional Approval Date: j ' • • =, "i £:: Reviewed and approved by: wDate: 3 O ,Nn weal � I ' I I 1 � I I DOUBLE CLEANO"'" c` 0 �`¢ T Lot 5 Lot 4 SEPTIC TANK & AND I / 1 I 1 / I / Lot 301 I / 1 I I / INSTALLED N4 1 ad GALLON STEEL SEPTIC TANK 100+ ffEE FROM EXISTING WELL TRENCH I l / I I / r VALLIE VUE #2 BLOCK 6 �_ 1 Y 4+ FEET COVER FOUNDATION CLEANOUT CUNNECTED TU EXIST DRAINFIELD 1000 gal, septic tank 25 0 25 50 75 mo 25 150 SCALEr 1' = 50 FT. BENCH MARK BOTTOM SIDING NE CORNOR HOUSE ASSUMED ELEVATION 100 FEET 03ecn a TH. AV NUE E I I LOT 5 BLOCK 6 VALUE WE 2 I I SEPTIC SYSTEM AS -BUILT 203 W 15TH AVENUE DATE. JUNE 6, 2006 ANCH. AK. 99501 BILL RATHKE /907) 279-3916 66/1 Rn11Nn TRFr nRIVF SHEET,• 1/1 GRID: 2439 / SV060096 Municipality of Anchorage Development Services Department • Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET To: Spurkland Engineering Legal description: Valli Vue Estates #2. B6 L5 ZD The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. _ ❑ Additional soils information needed. ❑ Water monitoring results inadequate. ❑ Discrepancy in information submitted. ❑ Topographic information missing or Inadequate. ® Incomplete; missing distance to community well, surface water and curtain drain. ® Incomplete; missing installer. ® Incomplete; missing the elevation of the tank inlet and outlet inverts. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. ❑ Well log required. _ ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ❑ Other. Name of reviewer: Deb Date: 2/1 /07 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK / Municipality of Anchorage :.., ( Development Services Department \ Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 9951916650 Page of www.ci.anchorage.ak.us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW 0to00 to PID Number. OIS - 123- t Bill Ra,11,6- Rrru Wastewater System: ❑ New ❑ Upgrade .ss CM Trey, Drive, ABSORPTION FIELD :Ex •n, Pnar N,mbr a BaapNl,a O D..P TrNcn O SNNbw Trance O B.a O Mpuq O ahN LEGAL DESCRIPTION SPI RNrq Tpai D.ah eon ayna arN GPD�Fr' Fl, Back IN B�E6 0 -Mb PO. Galan parr, agnN (FNi. G," awn Wn.eln P" dal � c i * 2 L F.. Fl TN Q Rang. Swm Fill a a CninNar.W Gninm Langlh Fl. Ft. Well: n ❑New ElUpgrade G,"'"' n N✓nm a N,.s D.0 pN«Nn "Ft. 1 Fl. Fi cwm"M lPrnme A a)%;) TNN D.pu C.ea.b TNN amarpnPn wv, Pp MNN41 FI. Fl Ft' Dre.r DNeDrrW SuIO WAIN L" YriNIN DN. mwu Fl Y.P1NiP sN N ca" hoghl Ap G,N TAN K GPM Fl. FL SEPARATION DISTANCES gSeptic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption LM Holding utxx•1Pwate 'a✓'r aw✓h Fnm Tank Field Station Tank Serer Line Anclio Ga, (COD Will A&A McIIW Ste h✓naN a DanpNVnM. Z s,.l«.we. N 0. LIFT STATION La LM 410E li. N YU✓N GN Fp✓1WIgn +5 'PVnpW 1WNN 'PYmppT YvNN N�v.IN NNmN � in in c✓un aan N.o. P.PMN.A MoW EMarrM W� pMa by RNnNU BENCH MARK LIE goo V2 %i L§bM NC D..V(*n M..t4n IW FI cc ,, `` ` Engineer's Stamp Inspections performed by: a 5 . p%4AAO-n�, Dates: 1N 5 2 O(o A;�z ',�l4 .p Development Services Department ApprovalOle Conditional Approval If �_ ;9 :H 4'` °{ ; Date: . , 1 i-10 .N M11;fLAND ' ��'• CE 2225,! Reviewed and approved by: Date:ii ( `�F i fiFEJ�I�\i. IRn oru.l �. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW060096 Legal Description: VALLI VUE ESTATES #2 BLK 6 LT 5 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: BILL RATHKE Owner Address: 6641 ROUND TREE DR ANCHORAGE. AK 99516-6816 Date Issued: May 17, 2006 Expiration Date: May 17, 2007 Parcel ID: 015-123-13 Site Address: 006641 ROUND TREE DR Lot Size: 26562 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit Is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, seated, and heated to prevent freezing. 5. The following special provisions. - (EMERGENCY TANK REPLACEMENT) - SEPTIC TANK INSTALLATION MAY BE LOCATED NO LESS THAN FIVE FEET FROM ANY PROPERTY LINE OR BUILDING FOUNDATION; TEN FEET FROM ANY WATER SERVICE LINE; ONE HUNDRED FEET FROM ANY SURFACE WATER; AND ONE HUNDRED FEET FROM ANY PRIVATE WELL; AND THE SEPARATION DISTANCES REQUIRED BY 18AAC72 FROM WATER SUPPLY WELLS. Received By. I I- Date:) 06 Municipality of Anchorage Development Services Department _Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519.5650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 6/5 ./,;L3 —/3 O� I Q I t. O � s 1�u Property owner(s) &1I Pc.i1.ke Day phone 394-803 S Mailing address Zip Code Site address VA ( Rot Aa Tree Pettle- Zip Code I951(o Legal description (Sub'd., Block & Lot) Vjliq- V4 " Z Cof 5 91 ,k Legal description (Township, Range & Section) Lot Size Po 5Z P- Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank ®, Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 191 Number of Bedrooms 3 THIS APPLICATION IS AN: Initial ❑ Upgrade ❑ Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 1&0 . eb Waiver Fees: _ Date of Payment: �p//� /�� Date of Payment: Receipt Number. Receipt Number. (Rev. 11105) finJ spokNod Eimgomewoimg Environmental Consulting and Design May 3, 2006 Municipality of Anchorage Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION VALUE VUE #2 LOT 5 BLOCK 6 We are submitting an application for the replacement of the septic tank for this lot. The submittal consists of one (1) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. Sincerely, Lars Spur land 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng(.a�gci.net Lot 4 �SfP77C TANK do AND Lot 301 INSTAU NEW 00 dIAUON STffL SEPTIC 100+ FEET OM EXISTING WEU TRENCH , Lot 6 � l � VALLIE VUE g BLEICK 6 L _ , DOUBLE �1 CLEANOI"" N /-- 4 FEET COVER CONNECT TO EXIST DRAINFIELD 1000 gal, septic tank 25 0 25 50 75 107 125 150 SCALE, I' = 50 FT. FOUNDATION CLEANOUT w '.** • 19 49th E TODDEN lunncn 1 May 12, 20061 GRIDZrUKAZArfU AVEVUE F.L. 103 W 15TH. AVENI I LOT 5 BLOCK 6 VALLIE VUE 2 I I SEPTIC SYSTEM DESIGN • ANCH. AK. 99501 BILL RA RATHCA • : 1439 /om) �970—T010;6611 anuNn rarr naivr SHEET. I PERMIT # PID # VallleVue#2L5B6Ldwg I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 0* -ON-SITE SEWAGE DISPOSALS STEM AND/OR WELL INSPECTION REPORT NAME // PHONE ,❑NNEEWW. L®fUPGRADE MAILING ADDRESS _ r (G ? r LEGAL DESCRIPTION LOCATION �L- NO. OF BEDROOMS Uy DISTANCE TO: Well Absorption area Dwelling PERMIT NO. w Q Manufacturer /(d ( Material No, of compartments m� Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth Y -102 DISTANCE TO: Well Dwelling PERMIT NO. = z F Manufacturer Material Liquid capacity in gallons = DISTANCE TO: Well , ' Foundation Nearest lot lin PERMIT NO. J E z F?W No. of lines Length of each linea ,5 Total length of lines �% Trench width ��y inches Distance between lines N fT I_ p Top of tile to finish grade Material beneath the i6es Total effective absorption area 7f® w Length Width Depth PERMIT NO. QH wL Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS s SOILTESTRATING J ' INSTALLER �cj 'c G. REMARKS , / I APPROVED J� DATE LEGAL 72-013 (Rev. 3/78) i M B_8 N,I 16 _: l p F11_ I -8 V Ce DEPARTMENT HEALTH AND ENVIROPaPiENTAL :OTECTIcl I < 825 'L' STREET, ANCHORAGE, AK. 99501 1 {L(vr5. / 26•�-t3i20 )) m •' ILF o PERMIT NO. ( 802182 ) ICA ��• APPLICANT WILLIAM MEHNER SRA BOX 35M LOCATIONl�� LEGAL L5B5 VALLIVUE �nAcAen 10. LOT SIZE 20020 SQUARE FEET TYPE OF SAIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 180 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F�GlU 16=�EED, EF -r I oZ: TE=YN-dK ES I ;;ME10 FiL_L_Oiw� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- T WID < `> I N 955E E=ar -t I L3"!E5 r=lF~E FREECC!U I F:ECo --- BACKFILLING OF ANY SYSTEM WITHOUT 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 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A 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. F'aF_M I -F F-EXF' I FR a_ CaE=I--:.a M Ez.aF :3:- a ::LS;la_�No I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INdSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REt9ODELE¢7TO�NCLUDE MORE THAN 3 BEDROOMS. SIGNED WII,._IAM MEHNER . ISSUED BY-----._ _ V4. 0 GRE." rR ANCHORAGE AREA BOR'AGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 6_1)�,lVL' R cX(o_ MAILING ADDRESS -6_352,z G0jr PHONE S 3 -;� LOCATION LEGAL DESCRIPTION Z 7L S Rk '(� Y/ //,c SEPTIC TANK: DISTANCE// ,C- _ NUMBER OF FROM WELLCC'/'/M MANUFACTURER ti�� /;IfMATERIAL COMPARTMENTS INSIDE LENGTH - INSIDE WIDTH LIQUID DEPTH —LIQUID CAPACITY 10C'0 GALLONS. SEEPAGE PIT: NUMBER OF PITS 1 DIAMETER OR WIDTH,*'3, LENGTHG2, DEPTH / LINING MATERIAL ACRIB SIZE: DIAMETER DEPTH ( DISTANCE FROM: WELL6�`11H—i TOTAL EFFECTIVE ( BUILDING FOUNDATIONAL , NEAREST LOT LINE 0-+ . ABSORPTION AREA (WALL AREA) �JZ �' SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE G) E[I M CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES: NEAREST SEWER LINE REMARKS INSTALLED BY: (`Ad loEfe Ce" �7 r PIPE MATERIAL: `Z// d-0 - liOn/ /' T f_ LOT SLOPE: Gi/FS / -, REMARKS: DATE / L' Form No. EQ -031 �3 DEPTH _ SEPTIC TANK_ DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM APPROVED G.A.A.B. / c0125¢zLCCtL®n r-7es, -fag "One test is inorth a thousand oviuians" e - ®820 TUDOR ROAD. ANCHORAGE. ALASKA P9507 a T[l C✓HOHE 333-8472 Performed ForC ��e>�'As��'> enc a1eF��i�C„ Date Performed /0 Lena1 Deseriotion: Lots-Block_J Subdivision(/ /�c� �a4na ��1, ue This Form Renorts soils Lon a Percola ion Testy Depth Feet Soil( Characteristics l.) /A J(b ""l1 A y 9 -_ uas Ground Water Encountered? !r;? `rl fi L ci UA— 0 ' % fey, At what Denth?- -- — — — Reading I Uat.e I nss 'lime i Net T'irne I De ,'r,ii to H20 f Net Uron Percolation Rate Hinute Proposed installation: S2eDaue Pio [ira-in hie1 d _ Depth of Inlet Ueoth (o BoYt m Of i'it Or Trvntii CAMPENTS . NsL Perfoormr-mrR.............._..�_ed BY_.._,�G'_f _.., Data Certified BY:_C S��_s�r dl� j 4S j I � 1 uas Ground Water Encountered? !r;? `rl fi L ci UA— 0 ' % fey, At what Denth?- -- — — — Reading I Uat.e I nss 'lime i Net T'irne I De ,'r,ii to H20 f Net Uron Percolation Rate Hinute Proposed installation: S2eDaue Pio [ira-in hie1 d _ Depth of Inlet Ueoth (o BoYt m Of i'it Or Trvntii CAMPENTS . NsL Perfoormr-mrR.............._..�_ed BY_.._,�G'_f _.., Data Certified BY:_C S��_s�r dl� Alaska Walter & Wastewater Consultants, Inc.. 7320 East Chester Heights Circle — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 September 2, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: HAA for Private Septic System. Lot 5, Bk 6, Valli Vue #2 1 To whom it may concern:Q The subject lot has a 3 bedroom house on it which is served by a private well and a community well. The results of the field investigation and adequacy test are summarized as follows: A. SEPTIC TANK: The existing septic tank was installed in October of 1973 (approx. 25 years p old). According to the M.O.A records, it is 1000 gallons, has one compartment and is made of steel. Most tanks of this type typically have a structural life of approximately 20-25 years. No warrantee is made regarding the future life of the septic tank. C. SEPTIC SYSTEM ADEQUACY TEST: The drainfield consists of a log crib that was installed in 1973, and a trench that was installed in 1980. The crib has an effective depth of 6 feet. q `q On the day of our inspection (9/1/98), the crib had virtually no liquid in it. The trench has an V effective depth of 6 feet. The liquid depth in the trench could not be determined due to the fact that the sump was full of dirt. To fix this, the sump should be converted to a clean-out, and a monitoring tube driven into the drainfield. The adequacy test was performed on the crib. Over a period of almost 3 hours, 1028 gallons was introduced into the crib clean-out, which caused the level to rise to 28 inches. Approximately 16 hours later the level had dropped 16 inches, indicating that about 587 gallons had be absorbed. Based upon this data, it was determined that the absorption rate of the trench exceeds 450 gallons per day, as required for a 3 bedroom house. NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drainpipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, mist. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected. No warrantee is made regarding the future performance of this septic system If you have any quest}pns, please contact me at 337-6179. Thank you for your assistance. Sincerely, Jeffrey A./Qhrness, ITE', M.S. • Municipahty of Anchorage rr ` �a On -Site Water and Wastewater Program (907) 343-7904 5 FF E T`Y Certificate of On -Site Systems Approval Parcel I.D. 015-123-13 Expiration Date: Sep �/ w 1. GENERAL INFORMATION: Complete legal description VALLI VUE ESTATES #2, BLOCK 6, LOT 5 Location (site address) 6641 Round Tree Drive *Anchorage 99507 Current Property owner(s) William Rathke Day phone 344-8035 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNadance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. Date of Payment Date of Payment Receipt Number 09 () � � G Receipt Number COSA # O S C ,� O 1515 Waiver # 6. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness En-gineerinq Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 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 systemis on the datels 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, % T groundwater levels (that may fluctuate during the year), quality of construction (materials and ......... .. ... .... workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of ..... . . ............... .. -arn the well or septic system. GEG makes no representation whether an alternative well or septic system Y can be installed on the property in the event either of the current systems fall to perform adequately in the future. The content of this report is for the sole benefit of the that retained GEG to 7 9 5:. person/party perform the evaluation. Reliance upon the information provided in this repo rt by any other person o r party (including subsequent property purchasers) Is not authorized, nor will it confer any legal right whatsoever. 6. DSQ SIGNATURE __�L system #1 Approved for 3 System #2 Approved for Disapproved Conditional approval for #AECC884 bedrooms OF bedrooms T E 6-),- Owsl bedrooms, with the following stu atiVA-f EFk AND ATER PROG�,NM 14�?-:Zl 4_�; , ----------- el '0 C A - By: C,0� 6_,ZU& 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: VALLI VUE ESTATES #2; BLOCK 6, LOT 5 Parcel ID: 015-123-13 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 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 grou in. Date of flow to OSA St ater level at beginning of test ft. Community tY Well d`c B. TANK DATA Age of tank(s) 14 years Tank type/material EEPTI=TEE 52" Measured operating fluid level in septic tank ❑■ Standpipes/foundation cleanout per record drawing Date of pumping 10/4/18 D. ABSORPTION FIELD DATA Well production at time of test Water storage tank volu _ gallons Well disinfec r coliform test? ❑ Yes Q Nc o iform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A Which system tested (date installed) 8/680 Adequacy test date 9112120 [0-1 ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 11.7 ft (max) Fluid depth prior to test 6 in Measured depth to pipe invert from grade 5.8+ ft (min) Water added 651 gal ❑ N/A — pressurized field 28 New depth in FE Monitor tubes go to bottom of effective. If not, state 120 depth into effective Elapsed time min ❑■ Code -required soil cover over field Final fluid depth 15 in F01 System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced 2041 gallons If yes, enter date N/A Comments/Deficiencies: Pre-soaked on 9/11120 Per homeowner, perf pipe in route to the trench was placed over the top of the drainrock backfilling the crib. There is a sinlg pipe present in the area of the old crib that may be a non-fuctional MT. Per Lars Spurkland P.E., crib was crushed and abandoned in place on 5/22/06. 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' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' Q Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ 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' ❑ Yes if No *51+ ft Surface Water > 100' El Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Q Yes Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No **8'5 ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' El Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL **WR#151107 G. ENGINEER'S CERTIFICATION F �O O o � � I certify that I have determined through field inspections and review 0 �O of Municipal records that the above systems are in conformance with C� y MOA COSA guidelines in effect on this date. CE -7953 COSA Checklist yellow sheet o f e s sio�o©� #AECC884 Sonja Blewett From: rathkeww@gci.net Sent: Thursday, September 17, 2020 2:48 PM To: Sonja Blewett Subject: Re: COSA questionnaire for 6641 Round Tree Drive Attachments: COSA-questionnaire.pdf Sonja - Here is the completed questionnaire. Also, please note that the house has been unoccupied for more than 1 year (from May 30, 2019 to present). So, pumping of septic tank should not be required. Thanks for your help. Bill Rathke (631) 427-5511 122 Bay Drive East, Huntington, NY 11743. From: "Sonja Blewett" <Sonja@garnessengineering.com> To: "William Rathke" <rathkeww@gci.net> Cc: sara@sarabradbury.com Sent: Wednesday, September 9, 2020 2:45:45 PM Subject: COSA questionnaire for 6641 Round Tree Drive Hello William! Can you please fill out attached COSA questionnaire. Thank you! Sincerely. Sonja Blewett Corporate Secretary/Treasurer Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507 Phone: (907) 337-6179 Fax: (907) 338-3246 Website: www.garnessengineering.com j % X9MES GARNESS ENGINEERING GROUP, Ltd . • GE By Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 SAFETY Certificate of On-Site Systems Approval Parcel I.D. 015-123-13 Expiration Date: S - D ^ l 1. GENERAL INFORMATION: Complete legal description VALLI VUE ESTATES#2; BLOCK 6, LOT 5 Location (site address) 6641 Round Tree Drive*Anchorage 99507 Current Property owner(s) William Rathke Day phone 344-8035 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request f. . Distance: Received by: /D Date: i foi'2 COSA to be rele- dto th�?*:' �unless otherwise requested by the engineer. COSA Fee $ S Waiver Fee $ Date of Payment �'2' 1 Date of Payment Receipt Number (3-Sr-73 Receipt Number COSA# VSC___17)3 QST 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: ioI?o/!8 oo�oopO In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system F 4 /� ,,•'="::' N in accordance with the guidelines and regulations established by the Municipality of Anchorage and ��.Or• .... NN industry practices. The reported results describe the condition of the system/s on the date/s of the o' • .•• `fes . . ,�On evaluation. Separation distances were measured to readily identifiable features. Hidden defects or / V encroachments may exist that were not identified during the evaluation. The operational life of all wells * II T, , \ •.i vp and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 0 UQgroundwater levels (that may fluctuate during the year), quality of construction (materials and O VAworkmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and D....... V,are outside the control of GEG. Satisfactory test results do not guarantee future performance of the ► . A. . ness.: system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of P�nm CE 79 3 ' c 40 the well or septic system. GEG makes no representation whether an alternative well or septic system V4�s •�ce.O tfq 30 .t�' o, ' can be installed on the property in the event either of the current systems fail to perform adequately in �e ..• Fo 0 the future. The content of this report is for the sole benefit of the person/party that retained GEG to Qgdpr0fess'tono •c=7 perform the evaluation. Reliance upon the information provided in this report by any other person or ®ppp000d party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE XSystem #1 Approved for bedrooms System #2 Approved for bedrooms .. t yr f-,/v� Disapproved ,-e 7k' Conditional approval for bedrooms, with the follow/g St QJiNTE D Gw WASTEWATER f(\-(( PROGRAM r. ---,---------CopA„_( By: ,k, t.„..— Original Certificate Date: ld -11-IE 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 Y Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: VALLI VUE ESTATES #2; BLOCK 6, LOT 5 Parcel ID: 015-123-13 A. WELL DATA COMMUNITY Well typeCOMMUNITY If A, B, or C provide PWSID# 210605 Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected Total depth ft. Cased to ft. Casino •-'• (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. A - production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./L. Collected by: Arsenic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA 51" OF LIQUID IN TANK ON 10/26/18 Tank Type/Material SEPTIC/STEEL Date installed 6/6/2006 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout(Y/N) YES Depression over tank(Y/N) NO High water alarm (Y/N) N/A Date of pumping 10/4/18 Pumper ISAAC'S PUMPING SERVICE C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 6/6/50 Soil rating (g.p.d./ft2or 2/bdr 180 System type TRENCH Length 45 ft. Width 2.5 ft. Gravel below pipe 6' ft. Total depth *11.7+ ft. Eff. absorption area 540 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 8/8/17 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 1 in. Water added 673 gal. New depth 33 in. Elapsed Time: 130 min. Final fluid depth 23 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date — PER THE HOME OWNER, PERF PIPE IN ROUTE TO THE TRENCH WAS PLACED OVER THE TOP OF THE DRAINROCK BACKFILLING THE CRIB. THERE IS A SINGLE PIPE PRESENT IN THE AREA OF THE OLD CRIB THAT MAY BE A NON—FUNCTIONAL MT. PER LARS SPURKLAND P.E. CRIB WAS CRUSHED AND ABANDONED IN PLACE ON 5/22/2006. MONITORING TUBE DRY ON 10/26/18 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circui - •uirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/se• ervice line Holding tank • imal containment areas Manure/animal excrete storage areas 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 *8.5' Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+ Curtain drain None Known Wells on adjacent lots 200'+ F. COMMENTS *WR#151107 **MET CODE AT TIME OF INSTALLATION oo6oOp0O G. ENGINEER'S CERTIFICATION `_� OF...4 \l'N I certify that I have determined through field inspections and * '' 9- / • %.7*Oa review of Municipal records that the above systems are in VA V conformance with MOA COSA guidelines in effect on this .... date. DO`� ' J:ff ` Games— — Engineer's A. GARNESS Q CE-79 �p Engineer's Printed Name 9; I Oro,, • I •,ctO Date /o)?p/f 44100 jfj .3. �o sof ess�000� #AECC884 (Rev. 11105) • tE e •� � Municipality of Anchora g 1� On-Site Water and Wastewater Progr a ,off 4 =oT (907) 343-7904 �, s F E T Y tit ZQ11 3 Certificate of On-Site Systems • Parcel I.D. 015-123-13 Expir &b. Date: r !�J 1. GENERAL INFORMATION: Complete legal description VALLI VUE ESTATES#2; BLOCK 6, LOT 5 Location (site address) 6641 Round Tree Drive*Anchorage 99507 Current Property owner(s) William Rathke Day phone 344-8035 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class _Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: A/347.17 COSA to be released e en ineer,unless otherwise requested by the engineer, COSA Fee $ Waiver Fee $ Date of Payment B1a50Date of Payment Receipt Number J (DReceipt Number COSA# 0191385 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 475='''z' �(e/221/9- 4Qo�opp� In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system OF ,qL \NL in accordance with the guidelines and regulations established by the Municipality of Anchorage and ��..-•• k-v Q industry practices. The reported results describe the condition of the system/s on the date/s of the O -' ' /'•. O� evaluation. Separation distances were measured to readily identifiable features. Hidden defects or , �• O TH 70 •� ��O encroachments may exist that were not identified during the evaluation. The operational life of all wells ; -. • tr V and septic systems depend upon a variety of variables, including but not limited to, soil conditions, ( V groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system's. These conditions can vary, and ,. are outside the control of GEG. Satisfactory test results do not guarantee future performance of the d '•,J ff A. Gorne s: (/ system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of V0 • CE—795 the well or septic system. GEG makes no representation whether an alternative well or septic system Q(7.9. f 2 [ can be installed on the property in the event either of the current systems fail to perform adequately in 4p �P •' �. -I' c,..•`:=V (172 the future. The content of this report is for the sole benefit of the person/party that retained GEG to �Qq°pro ress'ioR°ate 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. #AECC884 6. DSD SIGNATURE \� System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved ;;'� Conditional approval for bedrooms, with the following stipulationsON_ sr_ -t 'Amc 4: `"/E VVA7-[� c 73 By; � r 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 \ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12 doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description. VALLI VUE ESTATES #2; BLOCK 6, LOT 5 Parcel ID: 015-123-13 A. WELL DATA COMMUNITY Well typeCOMMUNITY If A, B, or C provide PWSID# 210605 Well Log (Y/N) Date completed Sanitary seal (YIN) Wires properly protected Total depth ft. Cased to ft. Casin. • (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. ► - production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./L. Collected by: Arsenic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 6/6/2006 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 1 ! 1 I,' Pumper C. ABSORPTION FIELD DATA ',BELOW EXISTING GRADE' Date installed 6/6/80 Soil rating (g.p.d./ffo /bdr 180 System type TRENCH Length 45 ft. Width 2.5 ft. Gravel below pipe 6' ft. Total depth *11.7+ ft. Eff. absorption area 540 ft- Monitoring tube YES Depression over field NO Date of adequacy test 8/8/17 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 1 in. Water added 673 gal. New depth 33 in Elapsed Time: 130 min. Final fluid depth 23 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE If yes, give date — PER THE HOME OWNER, PERF PIPE IN ROUTE TO THE TRENCH WAS PLACED OVER THE TOP OF THE DRAINROCK BACKFILLING THE CRIB. THERE IS A SINGLE PIPE PRESENT IN THE AREA OF THE OLD CRIB THAT MAY BE A NON—FUNCTIONAL MT. PER LARS SPURKLAND P.E. CRIB WAS CRUSHED AND ABANDONED IN PLACE ON 5/22/2006. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circui suirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/se• .• ervice line Holding tank • imal containment areas Manure/animal excrete storage areas 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 *8.5' Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water_ 100'+ Driveway, parking/vehicle storage 5'4- Curtain '+Curtain drain None Known Wells on adjacent lots 200'+ F. COMMENTS *WR#151107 Qa�op4 G. ENGINEER'S CERTIFICATION .=,'='47,i •OF A• Llrs�� 4 ...yvo I certify that I have determined through field inspections and Q_ review of Municipal records that the above systems are in ' VA vA conformance with MOA COSA guidelines in effect on this bvA date. �O '•.J• fr A. arn:•s;' Engineer's Printed Name JEFFREY A. GARNESS Q 9� ' rE-795 op Op s�or •eu/Z,3 .,< �avo Date X12 3/i OODadp o��a rofsslo( 4a �d�4�oa4 #AECC884 (Rev. 11105) IV 10� Municipality of Ancho 9 On -Site Water and Wastewater Pro fa TIUL 2 3 2015 = (907)343-7904 Certificate of On -Site Systems Parcel I.D. 015-12 3-13 1. GENERAL INFORMATION Complete legal description VALLI VUE ESTATES Expiraticn Date: 6-16-17 BLOCK 6, LOT 5 Location (site address) 6641 ROUND TREE DRIVE *ANCHORAGE, AK 99507 Current Property owner(s) WILLIAM RATHKE Mailing address Real Estate Agent Day phone 344-8035 6641 ROUND TREE DRIVE *ANCHORAGE, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4 --TYPE OF WATER SUPPLY: 19 Individual Well ❑ Individual Water Storage ❑ Community Class _ Well Public Water System ❑ Day phone TYPE OF WASTEWATER DISPOSAL: Individual 19 Holding Tank ❑ Community ❑ Public Sewer WaiverNariance request for: i o `cpT � � ✓1 p Distance: D . S Received Date: 9�27V1!�- COSA to be released to the enaineer, unless otherwise requested by the engineer. COSA Fee $ �J / Date of Payment Receipt Number COSA # 015G 513'CS' Waiver Fee $ s Date of Payment 0�� Receipt Number (g Waiver # QSV /S'l (0 �,- 5. STATEMENJAFJNS ON 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 !slate) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Gayness Engineering Group, Ltd. Phone (907) 337-6179 Address 3701 E. Tudor Rd., Suite 101, Anchorage AK, 99507-3246 Engineer's Printed Name Jeffrey A. Gayness 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 systems 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 on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s, therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well orseptic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report 6. DSD SIGNATURE _AZ System #1 Approved for System #2 Approved for Disapproved Conditional approval for L0 3 bedrooms bedrooms bedrooms, with the followir Original Certificate Date: 9—,Z7-/5_ —a.7"/5 The MtlniCjip3Nfy(Q�e orage 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 engineers work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheet 9-1-12.doe Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: VALLI VUE ESTATES A. WELL DATA Well type COMMUNITY Date completed Date of test Static water level BLOCK 6. LOT 5 If A, B, or C provid Sanitary seal (YIN)— ft. Cased to ft. FROM WELL LOG ft g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./L. Arsenic'. ug./L. Date of sample: _ B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal Number of Compartments 2 Parcel ID: 015-1 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Collected by: GEG. Ltd. Date installed 6/6/2006 Cleanouts(Y/N) YES Foundation cleanout (►►►Y/) .�NYNO YES Depression over tank (Y/N) High water alarm (Y/N) N/A //// Date of pumping S��_� + / — Pumper s u w c 5 C. ABSORPTION FIELD DATA /O' *BELOW EXISTING GRADE Date installed 1566 73 Soil rating (g.p.d./ft'o /bdrm) 180 System type TRENCH Length 45 ft. Width 2.5 A. Gravel below pipe 6' ft. Total depth *11.7 ft. Eff. absorption area 540 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 6/16/15 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0 in. Water added 673 gal. Elapsed Time: 142 min. Final fluid depth 32.5 in. Absorption rate >_ For 3 bedrooms New depth 46.5in. 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE If yes, give date — PER THE HOME OWNER, PERF PIPE IN ROUTE TO THE TRENCH WAS PLACED OVER THE TOP OF THE DRAINROCK BACKFILLING THE CRIB. NO MT OR C/O PRESENT ON CRIB. PER LARS SPURKLAND P.E. CRIB WAS CRUSHED AND ABANDONED IN PLACE ON 5/22/2006 D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump ofr level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot On adjacent Absorption field on Public sewer main Sewer/septic On Public sewer manholeicleanout Holding tank Manure/animal excrete storage areas 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 DANCE FROM ABSORPTION FIELD ON LOT TO: NC V tE Property line "1146 §' Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS r -Se@ a#Ac.4tc1 W^,vty- r%ut6f G. ENGINEER'S I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date (Rev.11105) 190, n 4 3p, �0., _ O 662, w� s?s .� tion LOT 5 00000 EXISTING OF . A 4 000 �d4 w' `k Sg3 HOUSE: y 30 ova .•••...�... 9S 4 ��.,-3 ti� � ,� o�?•'x-01 RETAINING 1* 49TH •� NOTE: RETAININGN WALL(S) , 1) THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WALL G�< 18, 9' y O ..... WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. 6 Rv OQ1 *SEAN M. BOLENDER: 1P ,m� 2) CEA RIGHT OF WAY EASEMENT (BLANKET EASEMENT) EASEMENT IS 10.Op 4 ,. LS -12800 i G FOR CONSTRUCTION, OPERATION, AND MAINTENANCE OF AN ELECTRIC �� °a ���• ayoo0 TRANSMISSION AND/OR TELEPHONE DISTRIBUTION LINE OR SYSTEM. 4�Arof e3sionol v000C BOOK 76, PAGE 87. 250 H Street LEGAL DESCRIPTION: AS -BUILT Anchorage, Alaska 99501 Survey Department LOT 5, BLOCK 6, Phone 562-5291 VALLI VUE ESTATES UNIT No. 2 ff,=En�IT1C Mainline Phone 243-8985 DRAWN DATE: 07/20/2015 WORK ORDER: 15042 o/LvAL+<e4&.AB • h-9 • ^$ DRAWN BY: MJH PLAT: 77-296 CHECKED BY: SMB GRID: 2539 ORDERED BY: BILL RATHKE SCALE: 1"=40' FB/PG: 410135&36 REF: 991.06 SURVEY CERTIFICATION: LOGLANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST OTHER THAN NOTED. LEGEND: AiijAspNalt i:tf;,Si: SEPTIC STANDPIPEOO �• EXCLUSIONARY NOTE: ITIS THE OWNERS'RESPON3IBIUTYTO DETERMINE THE WATER WELL"` ® 4' EXISTENCE OF ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF-WAY Overhung TAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO FENCE —X—X— CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR od eek ESTABLISHING PROPERTY LINES, OR FOR PLOT -PLAN PURPOSES. Jeff Garness To: CrewdsonJA@ci.anchorage.ak.us; Poet, Jeff W. Subject: Valli Vue Estates #2, B6, L5 Jay and Jeff, As discussed this morning (and noted on the COSA submittal package), during the septic tank upgrade in 2006, the crib was reportedly (by the current property owner) decommissioned to some extent by filling it with drainrock. Per the property owner, the contractor installed the line from the new septic tank to the 1980 trench directly over the top of the old crib (filled with drainrock). He also stated that the portion of the line over the crib area was perforated pipe. In short, to a limited degree, the old crib is still being utilized. It appears that the old crib is not encroaching on the water service line, property line, or the community well 200 foot radius. In addition, if the location of the crib as shown on Toben Spurkland's May 12, 2006 design drawing is accurate, the crib is not encroaching on the foundation, or the new septic tank. The crib was installed in 1973 and was approved at that time in regards to separation to groundwater. Given the aforementioned facts, there appears to be no health/safety concern associated with the perforated pipe running over the top of the old crib (that is reportedly filled with drainrock). Please call or grrNil ijyou have any questions. Garness Engineering Group, Ltd 3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507 Ph: (907) 337-6179 Cell: (907) 244-9612 Fax: (907) 338-3246 Website: www.garnessengineering.com l Municipality of Anchorage gent fteparment, P.O. Box 196650.4700 Elmore Road gy Anchoraae. Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 httg:l/www.muni.org/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV161107 COSA#:OSC151378 Permit#: PID#: 015423-13 Legal Description: Valli Vue Estates #2. Block 6. Lot s Engineer: Garness Endineering Group Applicant: William Rathke Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 8.0 feet. This waiver approval applies to the existing absorption field only. Any future-upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. 0 The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. FJ Notarized letter(s) of non-objection have been received from, the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. ........... ...... ................. '............ ....................... Waiver is Granted: X Waiver is not Grante Date: !i i Approved by Name of Reviewer ...r........... r•...............-•........ a ..•........y...r.............r....... - GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS August 10, 2015 2l5 Municipality of Anchorage PO Box 196550 O -71 g� 4700 Elmore Road Anchorage, Alaska 99519-6650 D 15--123 l �j Planning and Development Services Department On -Site Water and Wastewater Program Attn: Jay Crewdson, P.E. Ref: Valli Vue Estates #2, B6, L5 — Waiver of Separation Distance from Drainfield to Property Line Mr. Crewdson, Based upon a recent asbuilt survey prepared by Sean Bolender, PLS (Lantech, Inc), the drainfield on the subj ect property appears to be within about 8.5 feet of the north property line. The drainfield on the property to the north (Valli Vue Est #2, B6, L4) is on the north end of the property, so there is no potential encroachment concerns; therefore, we are requesting that you grant a waiver allowing for the drainfield (trench) on Vallie Vue Estates 42, B6, L5 to be 8.5 feet from the north property line. If you have any questions, please call or email. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineedng.com MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services to On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 015-123-13 ti 1. GENERAL INFORMATION HAA# b�Qg9l`�) fr,4A Complete legal description Lot 5; Block 6; Valli Vue Estates #2 Location (site address or directions) 6641 Round Tree Dr. Anchoraqe, AK Propertyowner Cendant Mobility Services Day phone Mailing address C/0 Jack White Real Estate 3201 "C" St. Anchorage, AK Lending agency Day phone Mailing address Agent Clair Ramsey/ Jack White R.E. Dayphone 762-3152 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well XX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOAN21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverifythat 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 com fiance with all Municipal and State codes, ordinances, and regulations in effect on the dat'ogis inspection. Alaska Water & --- - Name of Firm Address 7320 Engineer's signature ALASKA WATER & WASTEWATER CONSULTANTS INC IS TO PAID $800.00 AT CLOSING FOR ENGINEERING SERVICES PERFORMED. 6. DHHS SIGNATURE _JZ Approved for 114RE,�5bedrooms. Disapproved. Conditional approval for Additional Comments Phone 937-6!79 _ Date OFA a`�cQ�.• •• . S 1l1 N eP f z (r A. Garr 4��5 d E-7953 ••: ����% of bedrooms, with the following stipulations: Date 9 "':Z a I 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 courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-MJPev.1/91) Back MOAM21 RECEIVED Municipality of Anchorage SEP 03 1998 DEPARTMENT OF HEALTH & HUMAN SERVICE &ICIPAurrOFANCHO Environmental Services Division 71RONWNTAI SERVICES n 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: LoT 5g $LK 6 JAt.L% Jve ES -r. *Z. Parcel I.D.: OIs -Iz� A. WELL DATA Well type YWStIL If A, B, or C, attach ADEC letter. ADEC water system number. 4 'IN Log present (Y/N) Total depth Sanitary Date completed FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well production g.p.m. 9•P•m• WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed io n/73 Tank size 1000 Number of Compartments _i Cleanouts(li( V) YES 1 Foundation cleanout &N) yfS Depression (YO �e High water alarm (Y& t4o Date of Pumping 9 1 S Pumper O.o rtcClbrJaw rvmP�r16 _ C. ABSORPTION FIELD DATA J to /q /IS — 'gwV- + L2�f3 Date installed GA jjo-T2ew-4 Soil rating (g1rd-W or 2g ) System type 2:3,-C.K%'& 2e1�CK�6 6�-CRlS IZ�.-CR�f6 Length 49 - rXenlcH Width 3on�-36"Gravel thickness below pipe 6 -CfX%& Total depth Iz - TRENc�I 5Z (A C-R�s Effective absorption area -%fo��Monitoring Tube present®/N) ES Depression over field (Ydg) t'JO Prete'% Date of adequacy test 19 Z` 9 S Results as Fa4 PASS For 3 bedrooms Fluid depth in absorption field before test (in.); d u Immediately afterl0�gal. water added (in.): Z8 u u Fluid depth 12 (ins) Minutes later: G63 Absorption yVb rate = g.p.d. Peroxide treatment (past 12 months) (Y& NoAr= ICNcwrf If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level E. SEPARATION DISTANCES *Datum Size in gallons "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: PJ0(-1L /C 0, nMvrulrif Septic/holding tank on lot zoo 11 On adjacent lots Absorption field on lot 'Zoo I On adjace Public sewer main Sewer /septic Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: r Foundation -G .� Property line i o Absorption field Water main/service lineSurface water/drainage 10clf Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 1+ Building foundation 10 1+ Surface water 100 1? Curtain drain tilC,rLr 1`00�ur! F. ENGINEER'S CERTIFICATION l certify that / in conformanl Signature I Engineer's N Date 51 Zoo 11, / Water main/service line 10 Driveway, parking/vehicle storage area 3rd Wells on adjacent lots inspections and review of Municipal ?s in effect on this date. rlmirruA I t I I HAA Fee $ '�' t7p ' 07' Date of Payment -% 1?—IW p Receipt Number 1715-3 (q7 ,J ) 72.026 (Rev. 3/96)* 1-r Waiver Fee $ Date of Payment Receipt Number le MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # G 1 S- 1 a 3- 13 1. GENERAL INFORMATION HAA# 'AQk'l(r,C`'.)(1� Complete legal description Lot 5; Block 6; Valli Vue Estates #2 address or directions) ) 6641 Round Tree Drive Anchor8pe, AK Property owner Lihvan & Jemina Kuo Day phone 346-1934 Mailing address C/O REAL ESTATE SUPPORT SVCS. 8200 Humboldt Ave. S. suite 204 inneapo is, VIN Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well xxx Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA o21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING17034 phone C� y 9 el' )ver Loop Roado, 204 Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE X Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments 0 %OTIC Date s / a e / OF R@6 cr, C. MWAM bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo 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(R" 151) Sac. MOA -21 Municipality of Anchorage I'll ECE I V E D DEPARTMENT OF HEALTH & HUMAN SERVICEg Y 29 1996 Environmental Services Division MA 825 L Street, Room 502 • Anchorage, Alaska 99501 • (NV�j V4'l horage Dept. Health & Human Services Health Authority Approval Checklist Legal Description: Lor S- (3i o c/e 6yA jai vur�4d ?- A. A. WELL DATA Cl9M MJ.o tYY iNar�2 Well type c�4-rt A Parcel I.D.: 0 1 S- - 1).3 —13 If A, B, or C, attach ADEC letter. ADEC water system number a / u CC s Log present (Y/N) Date completed Total depth Cased to Casing h ' (above ground) Sanitary seal (Y/N) W' properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g•p•m• WATER SAMPLE ULTS: Coliform Nitrate Other bacteria D e of sample: Collected by: B. SEPTIC HOLDING TANK DATA Date installed f 0 1 n / '13 Tank size /190 o Number of Compartments i Cleanouts&N) WJ Foundation cleanout (ON) 3 Depression (Y/(l "0 High water alarm (YO n' � Date of Pumpfng s/D1 g C Pumper f y0M t Sfljvo `iJ C. ABSOFIPTION FIELD DATA Date installed 10/A/73 fr� Soil rating (g.p.d./ft2or 2/bdrm %G'0 PW SystemtypeC4'0 r'c, cH Length a 3' it 4 S Width )o X- V/1' Gravel thickness below pipe `� Total depth Y",z Effective absorption area S dG '� 5 y0 fMonitoring Tube present nN) oN�y Depression over field mf_4 Date of adequacy test ��r�g b Results (Pass/Fail) PAS 5 For 3 bedrooms Fluid depth in absorption field before test (in.); y i �a Immediately after _977 gal. water added (in.): Y 11 Fluid depth z1 1 3 (ins) Minutes later: z 3 o Absorption rate = - So - g.p.d. 4 Peroxide treatment (past 12 months) (YIN) NO If yes, give date 4 CR,$ 79-S TCO — TPi £n.cH S.¢T �i¢ii YEIJ, 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles E. SEPARATION DISTANCES "Pump on" *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer ne Size in gallons "Pump off" level at* P14 — coMmv, ,T y € On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM S PPP/HOLDING TANK ON LOTTO: Foundation S f Property line -�[ v Absorption field Water main/service line I G + Surface water/drainage / °p Wells on adjacent lots a ° ° } SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /c Building foundation /O } Surface water Curtain drain " ° �- rc N o w i✓ F. ENGINEER'S CERTIFICATION Water main/service line Driveway, parking/vehicle storage area ti Wells on adjacent lots a. o a I certify that I have determined thru field inspections and review of Municipal records in conformance with MOA HAA guidelines in effect on this date. Signature -XIV - G47 1 p Engineer's Name A,3'EA r C. C6' Y*✓ $,�.. Date l.� HAA Fee $ —P'v - 1-D Date of Payment Waiver Fee $ Date of Payment Receipt Number '4�& �d / Receipt Number 72-026 (Rev. 3/96)* /p t I � ROBERT C. COWAN ,i CE -9.;01 r I are MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# 1'il�i— l��— 1�� HAA# 11 �1LI DalnIU 1. GENERAL INFORMATION N_ D_ Completelegal description Valli-Vue Estates Block 6 Lot 5 Location (site address or directions) 6641 Round Tree Drive Property owner Bonnie Mehner Day phone (907,)563-5500 Mailing address 3201 C Street, Anchorage, AK 99503 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well X Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1191) Front MOAN21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Enviro Address 206 East Engineer's signature ; 6. DHHS SIGNATURE X_ Approved for bedrooms. Disapproved. Conditional approval for Additional Comments By: kt Tnc. Phone horage, AK 99503 Date nye, lam. O. -A d/ ;1 r%1:, John earl Simpson t `. Cc -0061 bedrooms, with the following stipulations: Date 6 - (�;=C/4 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(Ray.1/91) Back MOAN21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Valli-Vue Estates # 2 Parcel I.D. Lot 5, Block 6 A. Well Data Certification on Well type Community If A, B, or C, attach ADEC letter. ADEC water system number file (qDHHS Log present (Y/N) Date completed Driller PWS # 71 n6n s Total depth Cased to Casing height Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump levelt SEPARATION DISTANCES FROM WELL TO: N/A Septic/holding tank on lot Absorption field on lot Wires properly protected (Y/N) AT INSPECTION P„ On adjacent lots On adjacent lots C,i Z ® M 6Z Z I"r1 m y Z r D g.p.m. T N o Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: NIA Coliform Nitrate Date of B. SEPTIC/HOLDING TANK DATA Date installed 12-9-78 Collected by: Tank size 1000 Gal. Other bacteria 1 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N Alarm tested (Y/N) N/ o Date of pumping MA -1 I I,; I T" 4 Pumper Polo- 20x"'1 -E R SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 200 feet + On adjacent lots N/A Foundation 5 feet To property line 15 feet +Absorption field 42 feet Water main/service line 99 feet + Surface water/drainage None Observed 72-026(3M)•Frwt CONTINUED ON BACK PAGE Z ® M co cD M Z O Nr) O M Z Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: NIA Coliform Nitrate Date of B. SEPTIC/HOLDING TANK DATA Date installed 12-9-78 Collected by: Tank size 1000 Gal. Other bacteria 1 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N Alarm tested (Y/N) N/ o Date of pumping MA -1 I I,; I T" 4 Pumper Polo- 20x"'1 -E R SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 200 feet + On adjacent lots N/A Foundation 5 feet To property line 15 feet +Absorption field 42 feet Water main/service line 99 feet + Surface water/drainage None Observed 72-026(3M)•Frwt CONTINUED ON BACK PAGE C.LIFTSTATION N/A 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 6-6-80 Soil rating (GPD/Ft2) 180 Systemtype Deep Trench Length 45 feet Width 3 feet Gravel thickness 6 feet Total depth 10 feet Total absorption area 540 sq. f eebeanout present (Y/N) Y Depression over iield(Y/N) N Date of adequacy test 5/17/94 Results (pass/fail) Pass for Water level in absorption field before test None After test _ Peroxide treatment (past 12 months) (Y/N) 114 if yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 200 feet + On adjacent lots 200 feet + Property line To building foundation 31 feet To existing or abandoned system on lot _ Bedrooms None 10 feet 12 feet + On adjacent lots 100 feet Cutbank N/A Water main/service line25 feet + Surface water None Observed Driveway, parking/vehicle storage area 11 feet Curtain drain None Observed E. ENGINEER'S CERTIFICATION f certify that I have checked, verified, or conformed to all MOA and HAA guidelines in ef/ect ops e,OQf this inspection. Y OF �q�a , �i'i1 `1 Signature /� Engineer's N rpt John Simpson, P.N.art E4s;c,ps nF7 -�� - Date i ._ I� HAA Fee $ 30O ' 6�0 / Waiver Fee $ _ Date of Payment /3�1 l Date of Payment Receipt Number h-�,5 Y rl'1ri/ / Receipt Number. 72-026 (3/93)' Back MUNICIPALITY OF ANCHORAGE 1 DEPARTMEn r OF HEALTH AND ENVIRONMENTAL Ph, fECTION DIVISION OF ENVIRONMENTAL HEALTH ��-� 1� CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL , OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date r7 � 1 1. GENERAL INFORMATION (a) Legal Description (include lot, bio k, subdivision, section, township, range) Location (address or (b) Applicant Name Telephone�Home �G—T 7rn �f�LB/u�siness<`�a� `JLI� SSSS Applicant Address 61,ell ,ell ��rt✓jJ"% ce:e "2 A-et,a P� f (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent &'11712 Address - ;Telephone (f) Mail the HAA to the following address: n . �(o $ I_L S� 2AC1 S) 2. TYPE OF RESIDENCE Single -Family GY Multi -Family ❑ Number of Bedrooms Other ,o 3. WATER SUPPLY Individual Well ElCommunity Ild Public ❑ Note: If community well system, must have written confirmation from the State Department df Environmental Conservation attesting to the legality and status. ) I ,. 4. SEWAGE DI OSAL Onsite Public ❑ Community D 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 (11/84) Page 1 of 2 5. ENGINEERING FIRM PROVIDIf. ,NSPECTIONS, TESTS, FILE SEARCH, D. 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. e Name of Firm Uf U-) Y \ r\ CL IYS. f' , Telephone J (o f (w 1 S Address 4340 &.6,bu-S, dark BIld Bldg Lf 6u ,4 1, Anchorackf k_ 495"y Date 7 P\Qrd I li8r7 �_0'. cc::,: n K:l C:333 J 6. DHEP APPROVAL �PP`` Approved for /�41/�bedrooms by Approved X Disapproved Conditional Terms of Conditional Approval CAUTION Engineer's Seal 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 72-025 (11/84) X06 Ota `ZO Jia\ MUNICIPALITY OF ANCHORAGE (MO^I OFP,\GF5 HEALTH AUTHORITY APPROVAL (HAA) � 4� �1 CHECKLIST - FEBRUARY 1984 284-4720 Legal Description: to R' <<N, blo<Ic (a A. WE(.4�fA Well Classification m(.L( If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield D f7 115 Total Depth Cased to Depth of Grouting �� a 10(00's Static Water Level Pump Set At 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 Water Sample Test Comments B. SEPTIC/HOLDING TANK DATA Sanitary Seal on Casing (Y/N) Depression Around Wellhead Lots Lots ,.,'ro Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Date Installed /a- 9- 78 Size M0a4/'on No. of Compartments Standpipes (Y/N)Air-tight Caps (Y/N) t� P5 Foundation Cleanoutnn(Y/N) Depression over Tank (Y/N) No f Date Last Pumped r7/ j pr s � Pumping/Maintenance Contract on File (Y/N) ^r A] for f Holding Tank High -Water Alarm (Y/N) N/`t A- Temporary Holding Tank Permit (Y/N) A. Separation Distances from Septic/Holding Tank: ! To Water -Supply Well trM To Building Foundation 5 To Property Line _fto r To Disposal Field 0 r 1 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments [As - b.ua r+ (0--b -60 a AacJxZd Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA (76L- Qrtq;no_( Soils Rating in Absorption Strata Type of System Design Date Installed CO " (n - 0 Length of Field ya' Width of Field � fM('LwS � Depth of Field Gravel Bed Thickness �v Square Feet of Absorption Area X, ` Standpipes Present (Y/N) Depression over Field (Y/N) 7�s p r� Date of Last Adequacy Test / / „4cY1 1) j 1 C) 7A- " f Results of Last Adequacy Test Arl quo pr 3 iia dmo m boo f e,',0 -Y, Separation Distance from Absorption Field: To Water -Supply Well +ddbi To Properly Line +� 5 To Building Foundation To Existing or Abandoned System on N Lot -A • On Adjoining Lots r� N. To Water Main/Service Line r�sl To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course nI N.A• +10o' 0"5 To Driveway, Parking Area, or Vehicle Storage Area Comments * FY^0 , 4`1 Ch oritu,,JmLl w5,�:1 bLu rYY or.o.— ice. ��amc� c.. ��c, fo Q')lons ��cl�c� ( ) no im ca�'L ft�Q �-5�d1u1'e• D. LIFT STATION Dat Installed Dimensions ----- — Size in allons Manhle/ oess (Y/N) ••Pump O�Alarm Pump Off' Level at High Wat-atm Vent (Y/N) Tested for _ Pumping Cycles_durir Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments Check Pg r4itted Bedr om Rating Against HAA Request ** I certify th a /the (Fe , verified, or conformed to all c?O nd HAA guidelines in effect on the date of this inspection. Signed L' Iq,, Date �! Comp y _ 7'i �vlaPG�. MOA No. -Sri 71--r Receipt No. �, /o- L_ � • � �� Date of Payment ¢Z17'/ Ef: ` Amount: $}�Cr `r Engineer's Seal c r; a uc Jcon•,h Page 2 of 2 N CL -52,13 �, �', \ o 72-026(11/84) ' �'�i .�«• INVOICE OOFOCS20OF92 SEWEN2 60154 RAN DRRAIN 11u.ay Cje '7uwAo ea CLEANING SERVICE Dein e4e Z)Tal c,, P.O. BOX 112688 PHONE345.2513 ANCHORAGE, ALASKA 99511-2688 L n/r 117-e4,vey- 33s L 66`11 louxv� wee L `7'Oy Job Address m Fm DATE 1 gy SALESMAN TERMS-30DAYS Fob CUSTOMERERq 77�� ROTO -ROOTER SERVICE CALL HRS. @ STEAMTHAWING HRS. @ TRIPCHARGE HRS. @ OVERTIMECHARGE HRS. @ ADDITIONAL LABOR CHARGE HRS. @ PUMPINGSERVICE 00(GAL.) HRS. J @ c/O HYDRO -JET SERVICE HRS. @ MATERIALS c PLEASE PAY FROM THIS INVOICE TOTAL I M --- -- --TOTAL FOOTAGE CLEANED OR THAWED BLADESUSED� PROBABLE CAUSE OF STOPPAGE -7�!/0-"'"'-��a'- U LINECLEANED ❑ JOB NOT GUARANTEED FOR FOLLOWING REASON WORKACCEPTEDBY %1 RI (f1'I%L" w �-gartment of Environmental Quality' Nater and Sewer Questionnaire Date Time 6 / G.7 71s - Subdivision �� /� �� ��� Block_, Lot 5 Owner's Name: Mailing Address: Questions: 1 — 5 1. How many bedrooms are now in your house? 2. How many bedrooms were in the house at the time of purchase?!� / e 3. Were the basement bedroom walls "roughed in" at the time of purchase? x es 7 4. Was the basement bathroom plumbing "roughed in" at the time of purchase? ) /-P 5 5. Did the realtor or builder inform you that you would have to enlarge the existing sewer system if you finished the basement bedroom (s)? 1m 6. If on a public water supply, do you always have an adequate supply of water? V e 7. Is the pressure always adequate? V e Y 8. Who was the builder? 9. Who was the home purchased from? 41 / o- qL OTHER COMMENTS: