HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 6 LT 18 Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: -.~1 (~'~"~ PID Number: c:>~
Nam ~//~ 't~.Upg rede
i,~q~t,.i/,~,.,~ Wastewater System: D New
A~ ~~ ~ ~. ~ ABSORPTION FIELD
Phone: ~~ INo. o~rooms: ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other
LEGAL DESCRIPTION so~'"~'"~: ~GPD/Sq. Ft. T°talDepthfr°~°rigJnalgrade:/
Lot~ ~ ~B~°ck: ~ ~Sub~iv'sion:~ Depth t0 pipe botlom from origina~: Ft, Gravel depth beneath pipe
Township: J Range: ~ Section: Fill added above original grade:~ /Ft, Gravel length: ~
WELL: ~New ~Upgrade Graw~ ~ F,. ~m~s: ~istance~e~een,,n~s~.
Classification (Private, ~,B.C)~ Total Depth: Cased To: Total absorption rea: Pipe material:
Driller: D ateDrilled: Static Water Level:Ft. ~ ~~ D ate'n stalled:
SEPARATION DISTANCES ~s~pti~ ~ Holding ~ S.T.E.P.
To Sept,c Absorption Lift Ho,ding ,ublic/Pdvate Ma ufacturer:
From Tank Fie~d Station Tank Sewer Lines
We,, / N.m .ro,
Surface
Water ~ ~ / / / LIFT STATION
Lot ~ Size in ~
Line ~ ~ ~ ~ ~ ~
Remarks: BENCH MARK
Location and Description:
Inspections performed by: s s s EN~INE,m.. Dates: 1st ~
Eagle River, Alaska 995~ - r~ ~
Department of Health and Human Services approval
Reviewed and approved by:/~'~ ~'~ Date: ~/ ~?OFESS~
72-(113 (1/91) MOA 25
Page ~ of ~,
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Repor!
Legal Description:
_..
N
72-013 A (2/91) MOA 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910228
DESIGN ENGINEER:S ~ S ENGINEERS
OWNER NAME:WALTER WLLIAM A &
OWNER ADDRESS:6821 ROUND TREE DR
ANCHORAGE AK 99516
DATE ISSUED: 8/05/91
EXPIRATION DATE: 8/05/92
PARCEL ID:01531145
LEGAL DESCRIPTION: VALLI VUE ESTATES #2 BLK 6 ~
~18
LOT SIZE: 21984 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 2
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ENGINEER MUST NOTIFY DHHS AT LEATS TWPO HOURS PRIOR TO EACH
INSPECTION. THE EXISTING FIBER-GLASS TANK MUST BE
INSPECTED FOR INTEGRITY. REPLACEMENT WITH A 1,250 GALLON
TANK MAY BE REQUIRED. DURING CONSTRUCTION, ENGINEER MUST
FIELD VERIFY THAT THE EXISTING TRENCH IS NOT SURCHARGED
AND THAT THERE REMAINS USABLE SIDEWALL AREA. PROPOSED
TRENCH UPGRADE MAY REQUIRE ENLARGING IF EXISTING TRENCH DOES
NOT HAVE SUFFIC~/f USABLE~LL AR~. ~
SSUED BY: DATE:
1991
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(g07) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
Munidipa~y of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, A~x~ska 99519-6650
REFERENCE: Lot 18; Block 6; Valli Vue Subdivision #2;
PER~IT REQUEST NARRATIVE
Request you issu~ a p~rmit ~hat w~ll a~ow the upgrading of an existing
on-sd~e wastewat~r d~posal system on the referenced property. The
~xisting system has failed an adequacy test.
The on~sit~ wastewater disposa~ system on t~ property has had a
~ory of f~ sinc~ ~ w~ o~gi~y i~d in 1974. Th~
s~p~c tank w~ r~plac~d in 1977; ~ s~pag~ p~ w~ upgraded w~ a
~ench conn~d to t~ ~b in 1980; and now th~ absorp~on ~
req~r~ an ad~o~ ~nch. It ~ o~ opi~on th~ p~ of th~
probl~ ~ a r~ of so~ b~ng ~sified w~h a b~ p~col~on
r~ t~n a~y ex~. It appea~ th~ th~ upgrad~ of t~ syst~
in 1980 ~z~d a v~u~ so~ r~po~ th~ w~ p~fo~d in 1974 when
th~ o~gi~ ~b w~ i~d.
Th~ area is served by a Public Wa~r System (Community) and the
upgrading of th~s system does not appear to have any appreciable
adverse ~ffeet on the surrounding properties.
If you require additional information, please contact u~.
Sine~rely,
ROGER 3. sHAFER, P.E.
RJS/gm
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~.~/_~,/~ ~4~ ~///~/~/_.~'7'~
LEGAL OESOR'PT'ON: /--18 LJa [I, /ue
2
3
4
5
6
7
11
13-
14---
15-
16
17-
18-
19-
20-
DATE PERFORMED
Township, Range, Section:
SLOPE
ENCOUNTERED?
SITE PLAN
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth to Waler After
MonitorinD? ~ !
Gross Net Depth to Net
Reading Date Time Time Water Drop
/
TEST RUN t3ETWEEN ~
(minutes/inch) PERC HOLE DIAMETER
FT AND ~ FT
COMMENTS
S & S ENGINEERING
PERFORMED I~9~e River, Alaska 995~7 ' I ~ A ~ ~//[,'~CERT FY THAT TH S TEST WAS PERFORMED iN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON'THIS DATE. DATE: !
72-008 (Rev. 4/85)
'/~ MUNICIPALITY OF ANCHORAGE
~,~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
· 826 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~Q Top of tile to finish grade r ~ , Materialbeneath tile /~ ¢ inches Tota effec~s~tionarea
OTHER
INSTALLER ~0~0~
//
72-013 (Rev. 3/78)
PERMIT NO.
,DEF'RRTMENT L,, HEALTH AND EN¥IRONMENTAL I-'FiTE-~TICN
825 '"L' STREET.. ANCHORAGE, AK. La950t
264-4728
C, F4--S I TE ~EI4EF~ LJPC~]~E:,E F'EF:F1 I T
810008 )
APPLICANT
LOCATION
LEGAL
STEVEN JOHNSON SRR BOX 31-J 99507
ROUND TREE DRIVE - 6821
L ~8 B 6 VRLLI VUE ESTATES LOT SIZE
X44-4~81
20000 SQUARE FEET
TMPE OF SOIL. ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4
SOIL RATING (SQ FT?BR)= 200
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
g. EPTH= J-]: LEF~]"TH= 2:-z] ~3 F: R"..-' E L C. EPT~4=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETHEEN THE SURFACE OF THE
GROUND AND I'AE BOTTOM OF THE EXCAVATION (IN FEET).
TAERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTA OF GRAVEL 8ETHEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE E>(CAVRTION (IN FEET).
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTM AND THE
NUMBER OF RESIDENCES THAT THE HELL HILL SERVE.
....... T~4C~ (2) ! F&SPEE:TI E~S F~F]E F:Eg!LJ I F:EL}
BACKFILLING OF ANY SMSTEM WITHOUT FINAL INSPECTION AND APPROVAL BM THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A HELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVRTE NELL OR %50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TMPE OF PUBLIC HELL
MINIMUM DISTANCE FROM R PRIVBTE HELL TO R PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITM SEHER LINE IS 75 FEET.
OTHER REQUIREMENTS MAM RPPLM. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'EF-:Fll ]t; ]- E:"-:.'P ][ RE'_--] [:,E,]EFIBEF-: 2;1., 1981
I CERTIFM THAT
:1.: I AM FAMILIAR HITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH B"r' THE MUNICIPRLIT't' OF ANCHORAGE.
2: I HILL INSTALL THE S"r'STEM IN ACCORDANCE WITH THE CODES.
2-'.: I UNDERSTAND THFIT THE ON-SITE SEWER SMSTEM MAM REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED: ...........................................
APPLICANT STEVEN JOHNSON
V4. 0
· '-~/'.-.../,~(/,-~,, [:,EF'RRTMENT ,~:",HEFILTH RND EN'¢IROI"]i"IENTRL ' 'pTE']:TIO.~4%,
, _^.~.'~"~'",i~¢' ~,.d_¢'~.~' 825 "L :STREET., RNCHORRGE., PK..9D5.~.~
PERMIT NO. ; ,~SOu._ ~
- , r'- -" z<44-4~:E'.1
HPFLI~HNT STEVEN JOHNSON SRR BU,,~ 2:.1-J
LUL. HTIJN RZ_ND TREE DRIVE.-
' -,=; .'2 288¢8 SQUFIRE FEET
LEGRL LOT '18 BLK 6 VRLLI VUE EST. LOT
TYPE ~-IF .=,uIL RBSORPTION :,Y_,TEi] TRENCH
MRXIMUM NUME, ER OF BEDROOMS = '4 =,OIL RRTINO (.~.,.]
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
C. EF'TH=' d_~-- LE~4ISTH= =RR~EL [)EPTH= 9
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF ~ TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES,
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFBLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
PERMIT RPPLICRNT WRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
..... ~.i RE -¢-.'LI I RE[:"
Tl..-ICI '-. Z :) I I'-.~SF'E"]:T I l_~l'-~__ R ~--':. E
BRCKFILLING OF RNY --,?--,TEM WITHOUT FINRL INz. FEL, TI_N RND RPF'ROVRL 8'T' THIS
DEPRRTMENT WILL BE _,UE, JEL. T TO PROSECLITION.
MINIMUM DISTBNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
'100 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC NELL.
MINIMUM DISTRNCE FROM R PRIVRTE NELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS PRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
PERf"I ir T E:=~P I RES DEE:Et--1BER
I CERTIF'T' THRT ·
2L: IRM FRMILIRR WITH THE REQUIREMENTS FOF.: ON-SITE SEWERS RND WELLS RS SET'
FORTH BY THE MUNICIPRLITY OF RNuHuRHaE
2: I NILL IN_,THLL THE ...,'r:,TEM IN RPCRF.:[:.RNRE ~-4ITH THE L.O[.,E-%
c sI,¢ .-' - RE _ . ,'
~: I LINDERST~N~:, THRT ,-, .~,., E SEWERTHE =,-/=,TEM MRY ¢;IIIRE ENLRR.~EMENT IF THE
RESIDENCE~:,EL/~D_ T~IRf'~ 4 BE[:,R. OOMS.
_ _. ,._ .... ............... .....
I S':';UED __[:,RTE ',,,' 4. 0
\aO .
/ '- ~ ..~!~ .-
/.
,.~NICIPALITY OF ANCHORAGE
Heal and Environmental Protec~ Fourth825 LFl°°rstreetWest
~chorage, Alaska 99501
264-4720
.......... ~N-5~-~CTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION --
SEPTIC TANK:
~)' ~ _ .~. NUMBER OF ,~
DIST
ANCE
FRON1 WELL~/~ ---
iNSI[JE LENGTN ~_ INSIDE WIDI'H~ LIQUID DEPTH LIQUID CAPACITY/~'~G~LLON5.
TILE DRAIN FIELD:
TOTAL LENGTH
DiSi/~,NCE FRON,I WELl ....... FOUNDATION_ NEAREST LOT LINE_ OF ~.INE
# of Lines ...... DISTANCE BETWEEN LINES ....... TRENCH WIDTH____ IN. TOTAL EFFECTIVE
LENGTH OF EACH LINE
DEPTH OF FILTER
MATERIAL BENEATH TILE _ IN. ABOVE TILE
_IN.
SEEPAGE PIT:
Log Crib __Rings__
b~UlLDir,.,G FCUNDA~IOr,! ___
DI,AM ETER OR WIDTH LENGTH___, DEPTI4
Crib Size: DIAMETER .... DEPflI___ OISTANCE FROM: WELL
TOT/~L EFFECTIVE
NEAREST LOT LINE ___ ABSORPTION AREA (WALL AREA)
_SQ. FT.
lass:(~w-~. Depth:
ell Distance To: Lot Line
ldg: Sewer Line:
ipe Materials:
of Bedrooms:
nstaller:
emarks:
/ ' ', , / I I
IF -L J _4 N
OC:FIT :!1
El]iFIL
R Ct Lti'.,t t]:q 'tq'. E E CZRCLE
L ::LB B E; '¢I::ILL. t ',?I..IE
'd'a:4 'Ji;f_.:!_FII~'E F'EET
!ICl;:':; I h'l U I"1 ' '
¢,tLll _1: .... OF E:EE:,RCICIi"I:~; = 4
THE RIF:3.;:&.I/:Ftb_-i} :5:I:,7. E~,~?~.~THE 'SOZI.. RE:SORf:'TIEIN S"/S"FEH IE;:
Ti'iE DEP]'H OF: R TRENCH Ot:R I:Z'T :iS THE: DZSTFINCE BETWEEN THE E;I. JRFRCE OF THE
GRCiL~N[:, FINi) THE BOTTOH OF THE EXCRVFITZON (ZN FEET).
T'i. iERE ZS NO SET [,.IZE:,]"FI FOR TRENCHES.
'll'lk{ GiRI::I',,,'EL DEPTH ]:S THE I'"tINIMLtM DEPTH OE GRRVEL 13ETWEEN THE OU'T'F'FtLI...
F:ti"4E:, TFiE BOT TOM OF THE E/:-::C:Ft'¢FIT ): FiN ':: Z N F:EET )./-
R i-:h::~C:KFIGE F'L.FtNF PJFI'T' BE ZNSTRLL. EB, R"i' THE PERHITTEE¢S OPTZON SUBJECT 1"O THE
F'OL[.Cd4 Z NG cr)i'.4D~ T ~ ONS:
% EITHER FI (]_1:t55 i OR tZ NSF FIF'PROVE[:, F'LRNT blR'¢ BE IN~;TRLX...EE).
fl CONTiNLIOUI~; HRINTENRNCE F:IGE'.EEHEN'F IS REQU]:RE[:,. IF' R HF~iN"FEN!:~NCE
I:::iGREEMENT' IS NOT KEPT CI. JRF~:ENT './OU f'iR'¢ DE RE6~UIRED TO ENLF~RGE ]'HE
F~SSORPT:[ON E;'.¢S]'EM flND,./OR "r'OU Mf4'T' DE 5UBJEC]- TO PRO'.SECU]'ION.
F:F:ICKFtLLZI",tG OE Fll'4"r~ ........ ]LI I .W]T'HOLIT F:[i'-4FIL It",iE;F'ECT:[ON i::lJ"4[:~ HFI: [4 _~I-IL
[)Ei::I:II:R"FHENT I.'.IILI,. E',E ':: E 'i'ET:T ]'- FI..U_b.L. LI .[-I,
i'i); N ]: HLIH D I ::.i;TRi'-,iCE BETWEEN FI kiELL FIN[) RN'.¢ ON-dF :[ TE '.~;ENFtGE E:,:[ E;POE;FIL. 5'.r':5'TEH :f: 5
::UZ~6 F'EE'T FiZ;i¢;~: l':l PR~',,,'FFI"E WELL OR 2l~)8 FEE'i" FOR R PUBLZC HELL.
O'fHER i';i:EE!I.J]:REi'iENT% HFI'¢ RPPL'¢. SPECIFICR"I"ZON9 RND CONSTRUCTION DIFIGRRM:E; FIRE
FY,/F~:[I,..Ri3L. tL TO !N~;URE PRCII::'ER
X CEF.'.TZF".? THF:IT
i.: 1: FIM FFtMtL. ZFIE: kl:i:T'i-i THE: REg!UL[F.:EMEiqTS FOR ON-E;ITE ::.;EPJEF.'E; FIND I.,IEL. L:E; FIE;
FCIiRTH B'T' q-I-.Ii"!: t"ItJNIC~:PFtLZT"r' OF FINCHOF?.FIGE.
;::: :i: W]ZL.I... iNSTFILL. 'T'i-'iI:'_-: SYSTEM ti"4 RCCORDRNCE Wi'TH THE CODES.
ii:: I LIF,IDERSTFIN[) ']"HRT THE ON-E;Z'f'E SEHEI'R S'.¢STEH HF'I"¢ RE(;!UI!:;;'.E ENI.J:iRGEHENT Ii--' THE
F;~tES:[E)ENCE ZS I-?EI"tODEL.[-]} TO iNCLUi:)E HORE TFiRN 4 BEC, RE~Oi'iS.
tqE'F'L. :~ ClgN-f' R ,'2: ~i i'.,,G-
.................................... : ..............
:i: '...l[._-t:- ........ :,4-: ....................... '"s. _
ANCHORAGE AREA BORr" GH
Department ~3~n;irs~rner~;ntal (~uality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~n/3~g_ E~.~-,~f~l~E.$ MAILING ADDRESS PHONE
LOCATION ,~z~/O ~' ~:::>~-~/2g' LEGAL DESCRIPTION .~7~ /~./ ,~-~J- /~
SEPTIC TANK:
DISTANCE
FROM WELl ~g,~m, MANUFACTURER ~'--'~-~- MATERIAL
INSIDE LENGTH __ INSIDE WIDTH LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY / ~-¢ GALLONS,
SEEPAGE PIt:
NUMBER OF PItS / DIAMETER
LINING M AT E R I A ~"~- ~,',/~
~'C RI B SIZE:
OR WIDTH ~-2.-~
DIAMETER
BUILDING FOUNDATION ~/t~
NEAREST LOT LINE
ADDITIONAL ABSORPTION
LENGTH ~/ DEPTH /~/
DEPTH ~1 DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~ SQ. FT.
WELL:
TYPE ~n/~/. ~/~__ CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION __ LOT LINE SEWER LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK SYSTEM
DISTANCES:
INSTALLED BY: ~
PiPE MATERIAL: ~4.-¢~'~ --Z",~O,~--/
LOT SLOPE:
REMARKS:
Form No. EQ-031
DIAGRAM OF SYSTEM
dot"
G.A.A.B.
GREATER ANCHORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
/ 0-'0 0
PERMIT NO..
MAILING ADDRESS PHONE
F'NANCED THROUGH TO "E INSTALLED BY
OTHER.
NOTE*' THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE ~/ C''-] ~] t'~ TYPE ~ __~/~ SEEPAGE AREA SIZE ~( I~ ¢ TYPE?~/~/~r~
MINIMUM DISTANCES, REQUIREMENTS
FOUNDAT]ON TO SEPTIC TANK ~'~-~
FOUNDATION TO SEEPAGE Pit C*~ ~¢~l (
SEPTIC TANK TO SEEPAGE PiT WALL
TO NEAREST LOT LINE.
Well TO sePtiC TaNK ~(~(~
DRAIN PIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEEPAGE PIT ~
ALSO CONSrDER AREA WELLS.
SEEPAGE PIT
DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
BOROUGH REGULATIONS GARDING
~NSTALLATION.
DIAGRAM OF SYSTEM
Z Z Z Z Z i~ ii~iiZ Z Z Z Z-
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
,:,A', ~4~- 7¢APPL,,::,,,.,T'~ ,,,ONAT,.',',E
GREA1ER AHCHORAGC AREA BOROUGtt
DEPARTMEHT OF ENV!RONMFNTAL OUALITY
3330 "C" Street
ANcHORAgE ALASKA 99503
Performed For__pc c B
Legal Description: Lot I~ Bl'~c~ ~
Th~s Form Reports Soils Log~_
Soil Test Must Be Logged Fo ~' Below
Depth
Feet Soil Characteristics
lO-
ll-
12--~-
13--
14--_ -
Was Ground Water Encountered?_~J(~_.
If Yes, At What Depth?
Case #
Dated Performed
Percolation Test
Proposed Seepage System
Reading
Date
-
Gross Time
Net Time
L
Depth to H20
'Net Drop1
Percolation 'Rate ._Minl.l~e
Proposed Installation: Seepage Pit
Depth of Inlet Depth
COMMENTS:
Drain Field
Bottom of-Pit or Trench
- Dare:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel hD. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Lot 181 Block 6;
V,aIli Vu¢~ Subdivision #2
Location (site address or directions) 6821 Round Tree Cirdle
Property owner
Mailing address
Lending agency
Mailing address.
W~??i~m £ Fuo?y~ W~Y~o~ Day phone
68¢I Round Tr¢~. Circle. Anchorage, Ak. 99516
Day phone
546-2204
Agent Janet Walker_'SLEEPER. REALTY
Address 800 East Dimond Sure 3-300
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well
Community well XX
Public water
Day phone
344-2501
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
XX
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage flies 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 17034 Eagle Ri~er Loop Road No.
Eagle River, Alaska
EngineeCs signature
DHHS SIGNATURE
./~ Approved for ~--F7~/~-
Disapproved,
__ Conditional approval for
Phone
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By: ~ ~,~7- Date ~'~/FJ~/'
/
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.
72q)25 (Rev, 1/91) Back MOA
Legal Description:
A. WELL DATA
Well type ~
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
~. t~:> ~-~/~' ~:~ Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
Log present(Y/N)
Date completed Driller
Total depth
.Cased to Casing height
Sanita~ seal(Y/N)
Wires properly protected (Y/N)
Date of test
Static waier level
Well flow
Pump level
FROM WELL LOG
g.p.m.
AT INSPECTION
N~IJNIcIPALiTY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
RECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot '~-¢~c~,I Jr
Absorption field on lot '~¢~4::)1 '~
; On adjacent lots
; On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Public sewer service line
Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate · Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed \C::>'~'[ ~'~'~ Tank size \"~-~:::> Compartments /~ /
Cleanouts~TN) y Foundation cleanou~-(A~N) "~ Depression (Y~
High water alarm (Y/N) ------ ~ Alarm':tested (y/N) ' -' ~
Date of pumping (.z~'~ ! '~-~l J J~(l~l~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot J~ C)~I~ On adjacent lots '~/i~1'~1~ Foundation
To property line / ~.~I'"qL' Absorption field ~'1..~ Water main/service line
Surface water/drainage
72-026 (Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
Manhole/Access (Y/N)
Vent (Y/N)
"Pump on" level at
"Pump off" level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
Date installed f¢¢o~. ,[~,-'=:~ I
Length ~.)l,..~ Wide
Total absorption area ~..-E~
Depression over field (Y~
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/~
Soil rating
Gravel thickness
Cleanouts present~¢7~)
Date of adequacy test
for ~
System type
Total depth
V
bedrooms
..~'4~ If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /',/~ JI¢, On adjacent lots ~:~¢/r~ Property line
To building foundation '¢2C~l To existing or abandoned system on lot
On adjacent lots__ "22c:~ f 'F Cutbank I'..~ C~ 1~ _'~ Water main/service line
Surface water \
Curtain drain .t,.~r~
E. ENGINEER'S CER'rlFICATION
Driveway, parking/vehicle storage area
I certify that I have checked, verified, or conformed to all MOA and HAA
date of this inspection.
$ & S ENGINEERING
Signature 17034 Earlle Ri~er Loop Road
Eagle River, Alaska 99577
Engineer's Name
Date f~'~ \'~ ~::~ \
HAA Fee $ / 7¢
Date of Payment
72-026 (Rov. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
July 19, 1991
WALTER J. HICKEL, 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
· , DANTE RECEIVED
' " INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE )ATE
INSPECTOR INSPECTOR I INSPECTO~,~,
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE(EI~)NMENTAL PROTECTION
825 L Street - Anchorage, Alaska 09501
i ENVIRONMENTAL SANITATION DIVISION SEP 1
1980
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIE
!DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
Steven J. Johnson
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
Gary A. Gordon
MAILING ADDRESS
3, LENDING INSTITUTION PHONE
First National Bank of Anchorage % Ruby Caswell 265-3466
MAI LING ADOR ESS
Post Office Box 720 99510
4. REALTOR/AGENT PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
Lot 18 Block 6 Valli Vue Esta%es Subdivision ~2
STREET LOCATION
6821 Roundtree Circle
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [~ Four
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
[] I NDIVI DUAL* * ATTACH WELL LOG. A well Icg (s required for all wells drilled
~ COMMUNITY since June 1975. For wells drilled prior to that date, give well
~ PUBLIC UTI LITY depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** 1976 .YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
E~]Septic Tank or [] Holding Tank
Size: ,/~'~'7~', If Tank is homemade
give d i ~f~e3~lo n s:
NUMBEROFBEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DA'rE DRILLED
LOG RECEIVED
PERMIT NUMEER
DATEINSTALLED
INSTALLER
SOILS RATING
[] OTHER
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL ( [ (~{',~ ~.
Septic/Holding Tank Lot Line
Absorption Area Sewer Line
4. DISTANCES
WELLTO:
Absorption Area to nearest Lot Line
5. COMMENTS
[~-~APPROVED FOR ~ BEDROOMS
'~ CONDITIONAL APPROVAL ~t ac~/n~(letter must acc any certifica
[] DISAPPROVED j~fO//'
72 010 (Rev. 6/79)
I....,NICh'ALITY OF A,~I~.,;I 3~,AGE
DEPARTMENT OF HEALTH AND E£,,IVH;O,,'gMENTAL PROTECI'ION
279-2511, ext. 22,~, 225
RE~gESI FOR APPROVAL OI~
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of inspection: VA FHA
2. Property Owner: Steven J. Johnson
Mailing Address: Day Phone:
3. Name of Buyer: Gary A. Gordon
Mailing Address: Day Phone:
4. Name of Lending Institution: The First National Bank of Anchorage
Mailing Address: p' O. Bo× 720, Anchorag_e, 99510 Phone:
5. Name of Realtor or Agent: N/A
Mailing Address: Phone:
6. Legal Description: L 18, B 6, Valli Vue Estates #2
CONV
265-3466
X
Location: 6821 Roundtree Circle
7. Type of Facility to be Inspected:
8. Water Supply
Type Of Supply:
single family
No. Bdrms.__ 4~_
Public Utility
Individual
If Individual, number of dwellings presently served
If Individual, depth of weir
Sewage. Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual (on-site). X
Laura:
Mr. Johnson had the system pumped the first part of July. I have requested
a receipt from Isaacs Vacuum Cesspool & Septic Tank Cleaning which I will
forward to you when I receive it. If you need anything else please call.
72-OO3{3/76)
ALASKA
el]UlROrlmelqTAL COrlTROL SeRUICI~S, Ir'lC.
~ntlineerin§ ~ ~nuironmental ~tudies
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTEI &
ENVIRONMENTAL PROTECTION
SEP 2 6 1980
RECEIVED
1220 [JJgsl 25t}~ Auenu¢ · Ancher~q¢, ^l~sk 99503 · (907) 276-1361
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
[)EPARTMFNf OF HFAI TH AN[) ENVIRONMENTAL PROTECTION
September 16, 1980
Johnson/Gordon Propertyi
Ruby Caswell
% First National Bank of Anchorage
Post Office Box 720
~]chorage, Alaska 99510
Subject: Lo~ 18 Block 6 Valli Vue Estates Subdivision #2
Approval for the individual
cannot be granted until the
completed:
(2)
sewer and water facilities
following items have been
The septic tank pumped with a receipt submitted to
to this department.
An adequacy test be performed on the existing leaching
area.~ This test will determine if the system is
adequate according to National Standards. A listing
of private firms performing the test is enclosed. This
report needs to be submitted to this department for
our review.
If there are any further questions,
department at 264-4720.
please call this
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw