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HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 6 LT 17 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: OSP241286 Work Type: SepticTank Upgrade Tax Code Number: 01531146000 Site Legal Address: VALLI VUE ESTATES #2 BLK 6 LT 17 G:2539 Site Mailing Address: 6811 ROUND TREE DR, Anchorage Owner: COLOMBIE MICHAEL A & JODY J Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 9/18/2024 9/18/2025 23900 ❑ 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 eceav .d=By: el Issued By: Lz 4�� Date: Date: 4 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-311-46 Property owner(s) Mike Columbie Day phone 907-529-0506 Mailing address 6811 Round Tree Drive, Anchorage, AK 99507 Site address 6811 Round Tree Drive, Anchorage, AK 99507 Legal description (Sub'd., Block & Lot) Valli Vue Estates #2, Block 6 Lot 17 Legal description (Township, Range & Section) Lot Size 23,900 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo AD U) Septic Tank RX Upgrade RXDuplex (D) ❑ Holding Tank ❑ Renewal ❑ 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. f` !i (Signature of property owner or authorized agent) Permit/Rush Fees: ,P 2.2 Date of Payment:3,, G Receipt Number: I Permit No. 6).5 P 2 LA 12'2;6 Permit App_-'- .,:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. September 18, 2024 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Valli Vue Estates #2, Block 6 Lot 17 – Round Tree Drive Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the septic location. Since this lot and all surrounding lots are on a community water system, no conflicts exist between this proposed system and any other septic system, whether on this lot or adjacent lots. We are replacing the septic tank with the same size designed for 4 bedrooms. The new septic tank will be a minimum of 200’ from the community well, and 100’ from any surface water. 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 OSP241286, Deb Wockenfuss, 09/18/24 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=30' DECOMMISSION EXISTING SEPTIC TANK PER UPC CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE WV - WATER VALVE LEGEND VALLI VUE ESTATES #2, BLOCK 6 LOT 17 FEET 0 30 60 NOTE: THIS LOT AND ALL SURROUNDING LOTS ARE ON A COMMUNITY WATER SYSTEM. R O U N D T R E E D R I VE 4-BDRM HOME SEPTIC PLAN 9/17/24 10' UTILITY EASEMENT WV APPROX. LOCATION OF 3 EX TRENCHES TO REMAIN IN SERVICE NEW 1250 SEPTIC TANK 2CO APPROX. LOCATION OF WATER LINE MAINTAIN ≥5' FROM EX. FIELDSMAINTAIN ≥10' FROM HOUSE FOUNDATION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241286, Deb Wockenfuss, 09/18/24 VALLI V U E E S T A T E S SUBD I V I S I O N N O . 2 BLOC K 6 ROU N D T R E E D R I V E Taylor L. Dosch No. 189892 R E GIS TEREDPROFESSIO N A L L A N D S URVEYOR DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~i ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE [~ NEW Steiner Hansen 243-5710 [~ UPGRADE MAILING ADDRESS 4707 Melvin Drive LEGAL DESCRIPTION · Lot 17, Block 6 Valli Vue Estates #2 LOCATION NO. OF BEDROOMS Roundtree Drive~' IWel, I AbsorlStion area Dwelling PERMIT NO. DISTANCE TO: 800330 F- Z Manufacturer Material No. of compartments ~ ~ Anchorage Tank Steel 2 kiq.l~O~0ca acity in gallons IF HOMEMADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO, O Z ,~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO. ~.m~ No. of~nes Length2o~achline Total lengthoflines69, Trenchwidth36 inches Distance between lines 6' ~:.. Top of tile to finish grade Material beneath tile Total effective absorption area m 4' Average 60 inches 759 sq. ft, Length Width Depth PERMIT NO. ~ F- Type of crib Crib diameter Crib depth Total effective absorption area tu Well Building foundation Nearest lot line o} DISTANCE TO: _~ Class Depth Driller Distance to lot line PERMIT NO, m Building foundation Sewer line Septic tank i Absorption area(s) ~ DISTANCE TO: Round Tree Drive OTHER ~.~ 4" C.I. to t~ench, A" Perf. PVC Seepage I~ /,,/ ,.;~ ¢~ 22' ; ~,,t23 INSTALLER Clabo Construction Company REMARKS ~l~C All drain rock covered with MIRIFI 140 ~'~x prior to backfill. / 4754 72-013 (Rev. 3/78) PERMIT NO. NUN Z C Z PR[_ I T"..,r" r'jF R~]14E~RR~3E DEPRRTHENT ?'~ HERLTH RND ENVIRONHENTRL ¢~'~OTECTION 825 "L STREET~ RNCFIORRGE, BK. 92~._Ji 264-4720 8~Z~0~S0 ) RF'PL I CRNT LOCRTION LEGRL STEINER HRNSEN 4707 MGLVIN R',,"E LOT t7 BU4 6 VRLLI VUE EST¢ LOT .=,I-."E TYPE OF SOIL RBSORPTION S~STEM IS: TRENCH 24~-5710 2~D00 SQURRE FEET MR~4IMUM NUMBER OF BEDROOMS = 4 SOIL RRTING (S~..-.! FT,-'BR)= 85 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: E~EF'TF~= ~ LE~qGTF]= ¢J.S: 6 F~: II:'l '..," E L E)EF'TFI= 2. 5 THE LENGTM DIMENSION IS TFIE LENGTFI ,,'IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTFINCE BETWEEN THE SURFRCE OF THE GROUND FiND THE BOTTOM OF THE E,~:CR',,,'RTION ,.'.IN FEET). THERE IS NO SET NIDTN FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRR',,,'EL BETWEEN THE OUTFFILL PIPE RND THE BOTTOM OF THE E",,4CRVRTION (IN FEET). RF£~]U 'r r~..' E B, SEF'T I £: TRi'4K $ '~ ZE= -1~ 25¢~ ¢_~F~LLE, f45 PERMIT RPPLICBNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE NELL WILL SERVE. .............. T~.4C, ,:' 2 ) I F,~SPEE:T I O~'-.]S FIRE REQIIJ I F.:ED BRCKFILLING OF RNV SYSTEM WITHOUT FINRL INSPECTION RND BPPRO","RL BY THIS DEPRRTMENT WILL BE SUB..TECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL FIND FINY ON-SITE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR R PRI'¢RTE WELL OR 2L50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPOM THE T'¢PE OF PUBLIC NELL MINII"IUM DISTRNCE FROM R PRIVRTE WELL TO R PRIYRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REC.:!UIREMENTS MRY F~PPLY. SPECIFICBTIONS RND CONSTRUCTION DIRGRRMS FIRE F;'¢RILFIBLE TO INSURE PROPER INSTFILLRTION. I CERTIFY THFI'T ±: I BM FBMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF FINCHORRGE. 2: I WILL INSTFILL THE S'¢STEM IN RCCORDRNCE WITH THE CODES. "::: I U[~DERSTRND TI.IRT THE ON-~-;ITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. " S I GNED: ........................................ ~IPF'L II~_,TE I NEF~. I-IH[L EN V4. 0 IF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-050, Anchorage, Alaska 99502 276-222~ SOILS LOG -- PERCOLATION TEST ~ SOILS LOG [] PERCOLATION TEST PERFORMED FOR: Steiner Hansen Lot 17, Block 6, Valli Vbe. LEGAL DESCRIPTION: DATE PERFORMED: Estates ~2, Anchorage, Alaska 7-22-80 5 6 7- 8- 9- 10- 11 13 14- 15 16 17 18 19 20 COMMENTS ORGANIC OVE P~ URDEN SIL~Z SAND WITH SOME GRAVEL SM G SANDY GRAVEL - GP to GW G Slight Water Seepage SANDY SILT - ML SANDY GRAVEL - GW SLOPE SITE PLAN ; , , cst / G End of Hole G Indicates Grab Sample WAS GROUND WATER No ENCOUNTERED~ IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT PERFORMED BY: 72 OO8 (7/76) -'C,;/ CERT' ,ED BY: It is the responsibi!'ity of the owner or builder, prior to construction, tolverify She proposed bui!ding grade relative tb ~iiiished gr]de and utility connections and to deter- mine the existence of any easemellis, cove- nants, or restrictions which do not appear on the recorded subdivision plat. GRID. wo. No 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. # ~3~-~ -~.t~-~-[~z~ HAA# ~ ~Q~"~'LI 1, GENERAL INFORMATION Comp etelegaldescription Location (site address or directions) ~'E~ II = Property owner /"/~N¢"~£~n,~r-~ ~-~..r~,, Dayphone Mailingaddress ~'~11 Ro~<,,~' ~r~¢ 0~ ~c4o~, ~ Lending agency ~ la~ ~5~ C~;F ~o~ Day phone 7~- Mailing address ~OOO CF~i/ ~o~ ~.~ ~.~ ~ Agent N. A, Day phone Address c~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~/ TYPE OF WATER SUPPLY: individual well ~ NOTE: Community well Public water If community well system, provide written confirmation from'State AD, EC attest; . lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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. NameofFirm ~'1o/-/o~) ~'ec)~c~/ -~r~;cc_r Phone Address 1¥5'3'~ ~CAo ~'/~. /L)~c/)~f'~c/~', ~ v- Engineer's signature ~',~--J--~-;~'~- ~. ~ Date 'e. · 6. DHHS SIGNATURE Approved for bedrooms. /_~_~nditional approval for 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 DH HS does this as a courtesy to 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 engineeffs work. 72-02~(Rev, 1/91) Back MOA~Y21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1'7/o~ A. Well Data Well type C. I~-~' '~4~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number. Date completed Driller Cased to Casing height Wires properly protected (WN) FROM WELL LOG AT INSPECTION .g.p.m. Nitrate Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~'//7 / ~'~ Cleanouts (Y/N) T ~ 0 ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Tank size I '~ ~'o e'~,l Foundation cleanout (Y/N) Y' High water alarm (Y/N) h~, ,4, Alarm tested (Y/N) Date of pumping 7 / ~'/9,.c' Pumper I~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ On adjacent lots '-' To property line ~' 5' ' Absorption field Sudace water/drainage Other bacteria g.p.m. Compartments '~ Depression (Y/N) Foundation Water main/service line 72-026 (3/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION IV. Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Dateinstalled 0 It'7 I &O Soilrating(GPD/FF) ~5~ ~ Leah 6~ Wi~h 3 ' Gravel thickness d~" Totalabso~tion area ~ Cleanout present (Y/N) Y Date of adequacy te~ 7 /u/~,~ Results (pas~fail) I¢~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) System type Total depth Depression over field (Y/N) for /'/ Bedrooms After test O" /~'~'~ o£ Ifyes, g~vedate /V ,4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots_ Surlace water '> Curtain drain On adjacent lots ,~. "8 oa ' Property line /O ' To existing or abandoned system on lot ¢/./4. Cutbank N. ~. Water main/service line '~ to' Driveway. parking/vehicle storage area ¢ y.¢/-¢ ,,, ,p~,,-,~/~//y E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signature .'.'.'.'~...~-¢4..~ ~.. ~ ' ~' Engineer's Name '7-/,~_c,c/~,¢-¢ F. r-loc.-<, o .. ,~d' Date .7'c<17 Il, Iq~C ci:-3~,89 HM FeeS '~00 "'~ Date of Payment _ ~,,'~'~'///,~,~ ~ Reoeipt Number___/'~(¢¢'/7/ ~ .1 72-026 (~93)* Back Waiver Fee $ Date of Payment Receipt Number 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.# 1. GENERAL INFORMATION Complete legal description HAA# Lot 17; Block 6; V~ Vae Estates #2 Location (site add'tess or directions) 6811 Round Tree Drive Property owner Mailing address Lending agency Mailing address.. RE/MAX INTERNATIONAL RELOCATION COMPA~ay phone. Englewood, Colorado Day phone. Agent Kat~ Ch~nbers RE/MAX PROPERTIES Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well XX Public water NOTE: Day phone 27&-2761 If c~mmunity well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~025 (Rev. 1/91) Froot 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 ~ny investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING 7034 Eagle River Loop Roa~ Eaqle River~ Alaska 995?7 DHHS SIGNATURE Approved ,or Disapproved. ConditiOnal approval for Phone bedrooms. bedrooms, with the following stipulations: Additional Comments 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. Em ployees 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 engineeCs work, Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L~'T. [~". J_'~L~ C A. WELL DATA Well type ~~/ If~B, or C, attach ADEC letter. Log present (Y/N) Date completed ADEC water system number Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK,'/~.I_A~T~ Date installed Cleanouts ~N) High water alarm (Y/N) Date of pumping Tank size [ ~)~.~O ~-'(AL. Compartments _~ Foundation cleanout CN) ,J/~FS> Depression (Y,~ /~.3~ Alarm tested (Y/N) ~ I-,8-~% Pumper ~+ ~ S~0,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line ~(~)l 4. Surface water/drainage On adjacent lots Absorption field ~,Oo ¢ Foundation ,/O ¢ Water main/service line 72-026 (Rev. 7/91)Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FR. CM~LIFT STATION TO: Well on lot ~ On adjacent lots D. ABSORPTION FIELD DATA Date installed Length ~_~c~ i Width Total absorption area -~ff Depression over field (YI~ Results (~/fail) ~'~% ~--oi'~. Peroxide treatment (past 12 months) (Y~) Manufacturer ~ Manhole/~ "Pump off" level at ~ Cycles tested Surface water Soil rating Gravel thickness ~:~#~F.u.x~ ~F~. Total depth Cleanouts present ON) Y~'~ Date of adequacy test for System type bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~.~ (~ ¢'~ ¢-¢ To building foundation ~'~'-~ ~ On adjacent lots '~© · '¢ Surface water ICC' ~' Curtain drain ~-~ /~¢~E. On adjacent lots (:'~ ~"~ '~ Property line Cutbank To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area /0 '¢' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ~. of this inspection. S & S ENGINEERING Signature t 7034 Eagle River Loop Roa~ Eagle River, Alaska 99577 Engineer's Name __ Date \ -- HAA Fee $ / 70 Date of Payment /~ /0 - '~ ,'~-~ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 (907) 349-7755 Januaw 16,1992 FOR: S & S Engineering PWSID#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, Keven K. Kleweno Environmental Engineer kKK/cf  MUNICIPALITY OF ANCHORAGE ~ Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # (-') ~Z'~ - ~ \ ~ - L'~ [,'~ HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 17: Block 6: Valli Vue Estates Subdivision #2 (b) (c) Location (address Oi' di~'ections) 6811 Round Tr~.¢.~ Anchora?., AZa~.a Property owner 'K~.n Hu~¢~ Mailing Address..' Lending Institution' Mailing Address Telephone: (home) .~4~-18¢0 Business Telephone (d) Real Estate Company and Agent HOMEQUITY/N~ke Lewis Address 400 EaSt Las Colinas Bo~evard, Su~t& 300, Irving, Texas 75039 Telephone (214) 506-8884 Mailthe HAA tothefollowing address:(orcheck here ~,ifholdforpick up.) Listcontaetperson and day phone numberbelow: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, S~te 204 Eagle River, Alaska 99577 (e) 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well ~ Community I~ Public [] Note: If community well system, must have written confirmation from the state Department of Environmental Conservation attesting to ~hlegality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community weJl system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 ~ ~.o ~ ebBd leAoJddv IBuoIIIpuoo JO SLUJe/ ~.~=u~ --,- ,- sseJppv 'ON peo~ euoqdele± w~!4 ~,o ewBN 'uouoadsu! siql bo elep eql uo ioejja u! suo!~eln6eA pub 'seouBu!pJo 'sapoo pub IBdio!un~ lib q~!M eoUB!ldWoo u! s! LUe~S~S IBsods!p JeIBMelSBM Jo/pue ,qddns ~e3eM el!s-uo eq~ 'uo!1oedsu! pub uo!IB6!lse^u! /~LU LUOJJ pUB SeW aeBJoqouv JO X~!lBd!o!un!4t eq~ uJoJj peu!B~qo uo!lBuJJolu! eq~ uo pesBq leq~ X]pe^ Jeq3Jnj I 'u!eJeq pel~oipu! eJn~onJ3s ~o ed,~l pub suJooJpeq Jo Jeqwnu eql Jo1 e~BnbepB puc IBUO!1ounJ 'eJBs s! waisXs IBsods!p ~m, BMelSBM do/puB /,Iddns Je~BM e~!s-uo eq~ ~Bq~ SMOqS IB^oJddv X~poqlnv q~lBeH s! q~ ~o UO!IB6RSeAU!/~LU ~Bql ~J!JeA I 'MOleq UMOqS elBp UO!IBp!IBA eql Jo sB pue ole~eq pexwB IBes/~uJ/,q pewiJeo sV NOI.L¥1NI~O-INI aNl¢ ~/.LYa 'HOI=I~:I$ :1'I1-1 'S.L$:IJ. '$NOIJ. O:IdSNI 9NlalAOIdd ,~ Orr J~,~ ~. A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) ~ Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Lo'/~ I '"~... _/~l~c.[(" (o .; '" iq" If A, B, C, D.E.C. Approved (Y/N) ~ Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Date Completed Yield .Depth of Grouting' Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~-~-_4', '/-~¢',C ~ ~ d ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~ -,2~-~Size i.b_ 5-Df~-/ No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~/~ Foundation Cleanout (Y/N) Date Last Pumped ! D- II- ~ ~/~ ;for ~/~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ..2 To Property Line To Water Main/Service Line / tO To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field 72-026(Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'~ - ¢_ ~ Width of Field -~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~2 ~ O ~ Statndpipes Present (Y/N) /~ Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well .2-eX:> / -- ' To Property Line / To Building Foundation ,;'5- Lot A)/¢~ ; On Adjoining Lots 9© To Water Main/Service Line / 0 ¢' To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course / Oo ' ~' To Driveway, Parking Area, or Vehicle Storage Area ~ o To Existing or Abandoned System on Comments D, LIFT STATION Date Installed % Size in Gallons ~'~ "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) ~ Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed $ & $ ENGINEERING 17034 Ea01e River Loop Road No. 204 Company 1.'.¢c Ri'¢.~r. A!~~'a 99577 MOA No. ~j, ',~'~-OO..? ~ /L~' ¢'~/' Receipt NO. Y~/~" d¢'*'~ Waiver Fee: $ Receipt No. Date of Payment _ Amount: $ 72 026 (Rev. 7/88) Back Date of Payment Page 2 of 2 L, DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 July 19, 1991 WALTER J. HIOKEL, GOVERNOR 563-6775 FOR: S & S Engineering PWSID 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 provisions of 18 AAC 80.060 State of Alaska Drinking Water Regulations. Keven K. Kleweno Lead Engineer 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 December 11, 1989 STEVE COWPER, GOVERNOR 563 -6775 S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 ATTENTION: RODNEY PWSID: #210605 According to the records on file in this office, the Valli Vue Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VERA E. CRAIG ~ . Environmental Fiet~ Officer VEC:bas ~ ::,. ApPLI( ;T FILLS OUT UPPER HA~ "ONLY Property Owner ~ (~ ~.J ~-~L~ ~ ~ ~'~ t~ ~ ~ -~ -7 Phone Address Zip ~de Lendinglnsfitut[on ~ ~A~I~4U ~ 0~ ~ ~O~ ~ Phone Address (r, ~.c~ ~Z0 ~t,/c,~r~O00. Z4d ZipCode ~0 Realty Co. & A~nt ~ Phone Address Zip Code Legal Descript~n L~ {~ G ~O~ ~ ~'~CJ ~ V~ ~ ~T4 ~ ~ ~ ~ Type of Resi~nce Single Family Multiple Family No. of Bedroo~ -~ O Other Water Supply O Individu~l A~ACH W~LL LOG. A w~l log is required for all wells dallied since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). O PublIc Utility Sewer Disposal I~ ~ I ~ ~. When Connected to Public Utility: Public Utility ~ Holding Tank j NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Da Inspector Inspmtor Inspmtor Inspmtor Field Notes: MUNICJPALI~ OF ANCHORAGE ENVIROi~M~';, A. , ,O, ~CTION OCi' 2 5 1982 (~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAP~OVED ( ) CONDITIONAL APPROVAL* Soils Rating Date ~wer Installed Well To ~sorption Area Well Log Received ~" ~.~ ~ Well to Tank Septic T~k Size ~ .~ 72-023 (3182)