The URL can be used to link to this page

Home My WebLink AboutVALLI VUE ESTATES #2 BLK 6 LT 19 MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL. PROTECTION ENV]RONMENI'AL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE -- [] NEW 13Al~P.¥t. i~YG~ '3~/¥- ~7~7 ~UPGRADE MAILING ADDRESS LEGAL DESCRIPTION DISTANCE TO: I Weg *Z I Abs°roti°>a;a Dwelling PERMIT NO. ~ ~ Liq. capacity in gallons IF HOME.DE: ~nslde length Width Liquid depth 6 ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity Jn gallons Q Well Foundation Nearest lot llne PERMIT NO. Length of eac lin~ of lines Trench width Distance between lines ~ ~~ Top of tile to finish grade ~ / Material beneath tile Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter ~ Crib depth Total effective a~sorption area ~ Weg Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PiPE MATERIALS N APPROVED DATE LEGAL 72 013 (Rev. 3/78) PERMIT NO. F4W]~t I CIPFtLIT~' OF R~ICH~RFtGE DEPARTMENT ~'X~HEALTH 8ND ENVIRONMENTAL ~ 'OTECTION 825 'L STREET, ANCHORAGE, AK, 99b~l 264-4720 ~D~--SITE SE~4ER PERMIT ( 820807 ) RPPLICANT LOCATION LEGAL DRRRYL BYBE Lt9 B6 VRLLI VUE 685± ROUND TREE CR 99507 544-8?2? LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RRTING (SQ FT/BR)= i90 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: CCEF'TH= L~- LENGTt-~= 48 GRRkCEL [-~EPTH= 6 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). REC. SEPT I C TRI'~I--': S I ZE= -~000 GRLLF_jI'-IS PERMIT RPPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALL. BTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T~[~ (2) I NSPE£:TI[~S 8RE RE~]LIIRE[-) 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 PRIVRTE WELL OR t50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNIT~ SEWER LINE IS ?5 FEET. OTHER REQUIREMENTS MRY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE RVRILABLE TO INSURE PROPER INSTALLATION. F'ERr4 I T E~CP I RES [.-~E~]Er4BE~: _?--l.., 1982 I CERTIFY THAT i: IRM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTBLL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. '."4. O MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 82E L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCR,ET'O": V /i SLOPE WAS GROUND)jNATER ENCOUNTEREb? IF YES, AT WHAT DEPTH? SITE PLAN 14 15 16 17 18 19. 20- COMMENTS PERFORMEO.V= Gross Net Depth to Net Reading Date Time Time Water Drop ~ Ilo '7 /o o .'fy O, ~ PERCOLATION RATE TEST RUN BETWEEN }~"- (minutes/inch) ~'>~.FTAND 7-o ET 72-008 (6/79) GRE:'~'~R ANCHORAGE AREA BO?~'"~H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: FROM WELL J¥"Jr/-~/'' MANUFACTURER - COmPARTmENTS. '-~ INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH .LIQUID CAPACITY /('-~;) ~) GALLONS. SEEPAGE PIT: / NUMBER OF PITS DIAMETER LINING MATERIAL ' SIZE: BUILDING FOUNDATION__ OR WIDTH DIAMETER NEAREST LOT LINE __ LENGTH DEPTH DEPTH ~'- DISTANCE FROM, TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) S~. FT. ADDITIONAL ABSORPTION WELL: TYPE (~ONSTRUCTION BUILDING NEAREST FOUNDATION __ LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK SYSTEM REMARKS DISTANCES: PIPE MATERIAL: LOT SLOPE: Form No. EQ*031 DIAGRAM Of SYSTEM ~5 ,,.~_~:,,",-./-",x GRIEATe:R ANCHORAGE: ARE:A BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCNORAGE~ ALASKA 99503 TELEPHONE 27,~-4561 PERMIT NO. MAILINg ADDRESS , PHONE INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT ~ , DRAIN FIELD COMPLETION DATE ANTI I /[ / FINAL INSPECTION: 24 HOUR NOT~CE REQUIRED. BACKFILLING OF ANY SYSTEM W~THOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SIZE TYPE FOUNDATION TO SEPTIC TANK~ fOUNDATION TO SeEPAGe PIT ~,~<~ , DRAIN FIELD SEPTIC TANK ,~/ SEePAGe PIT. ,~..31 DRAIN FIELD DRAIN FIELD WATER MAIN TO SEPTIC TANK /~ / SEEPAGE PIT DRAIN f}ELD --~ .. ALSO CONSIDE~ AREA WELLS. I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-G8 AND THAT THE A~OVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. 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 Location (site address or directions) ~ ¢~ / /~0~J '~-'~¢~ C1'r-4/¢ ProPer.tyow~er "~¢xf'C/¢/ ~,?~- Day phone ~¢-~0 Mailing address, , ~/ ~nJ ~e~ C~'~; ~. 9~/~ Lending ageh'~ :c, Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE oF WASTEWATER DISPOSAL: Individual on-site Holding tank Commu.nity on-site Public sewer NOTE: X If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA~21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system 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 /.¢0.~ ~'¢, ,-~5,~'¢~'Vc-- Engineer's s ig n at u r~'~':~{~ [, ~f'~,¢,,¢*~-~ Phone Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments ' ' By: 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. 724)25 (Rev. 1/91} Back MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: B/k. 4¢ It V I/' ~/u/E-5'/~Parce, I.D. A. WELL DATA Well type COYhllttanlY)/ Log present (Y/N) /1////~ Total depth A/'/~r Sanitary seal (Y/N) /t///~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed /V//~ Driller Casedto /1//,.~ Casing height Wires properly protected (Y/N) /I///~ FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main g.p.m. ; On adjacent lots Public sewer service line ; On adjacent lots Cublic sewer manhole/cleanout ,-- Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: -- B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts~(Y/N) Y Foundation cleanout (Y/N) Y High wate:r aiarm,,(¥/N)ii',., Date of Pumpirt~;.;, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Compartments ~' Depression (Y/N) ~ Alarm tested (Y/N) /?///~ Well(s) on lot /V'//~ ',' On adjacent lots To property line ~ I Absorption field /~) Surface water/drainage /1/'//z~ / Foundation Water main/service line /~//~- 72-0?6 (Rev. 3/91)Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed ,/~/////~' Size in gallons Manufacturer Manhole/Access (Y/N) Vent (Y/N) -- "Pump on" level at -- "Pump off" level at -- High water alarm level Cycles tested Meets MOA electrical codes (Y/N) -- SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ~- On adjacent lots Surface water -- D. ABSORPTION FIELD DATA Date installed ¢ Length ~// / Width '~ Total absorption area ~¢~ Depression over field (Y/N) Results (pass/fail) ~/~r~ -~ Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Soil rating //¢'¢ /~'/~'.Df6,~t System type ?' Gravel thickness ~7~ ¢/ Cleanouts present (Y/N) Date of adequacy test for ~ If yes, give date ,,/t,//~ Total depth ¥ bedrooms Well on lot To building foundation On adjacent lots /V///~' Surface water Curtain drain /'~//,~ On adjacent lots A///,'z~ Propertyline /~' To existing or abandoned system on lot Cutbank ~Water main/service line /~//,~ Driveway, parking/vehicle storage area -'~ / E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA Signature ¢~- ~'~/¢" Engineer's Name Date ~/~ HAA Fee $ '/ 7 Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/gl) Back MOA 21 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received 3.-.-..~-7-~ Time of Inspection Date of Inspection 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES ~ FOR ~ ,.6- ~ ~' ~'7 d Phone: 2.-"7 ~- ~ ~'0~, 3. Legal Description: 4. Location: 5. Type of facility to be inspected ~~No. of bedrooms 6. Well Data.[~~/~~ A. Type C, Construction B. Depth D. Bacterial Analysis 7. Sewage Disposal System: A. Installed /.~z~'~ B. Installer C. Septic Tank: 1. Size /,.<-o-a~/ 2. Manufacturer D. Seepage Pit: 1. Absorption A 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines __, Nearest lot line , Other contamination B. Foundation to septic tank C. Absorption area tO nearest lot line , Absorption area EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re~st for Approval of Individual ' l'er & Water Facilities L~gW1 Description Comments Approved J2~/~[kbs approved Date o ~. 6~ ~t~.~- <~ ~ , , Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) 3330 'GREATER ANCHORAGE AREA BOROUGH· Department of Environmental Quality 'C" St., Anchorage, Alaska 99503 274-4561 .REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES · l. Type of 2, Property Owner: Mailing Address: 3. Name of Buyer: Nailing Address: Inspection: CMRO VA I~en Jackson ,W~sill~ AK Thomas R. Thien 6831 Round Tree Drive FHA CONV ..Day Phone Day Phone 4. Name of Lending Institution: National Bs~k of Alaska Mailing Address: Box 3-38~9 99~01 Phone 279-2~06 5. Name of Realtor or Agent: Gene's Re~l_ty-Irene Dwye~ (for b~ver) Town & Country-Bill Leike~ ~fo~ seller) Mailing Address: Phone 6. Legal Descriotion: Estates Lot 19, Block 6, Valli Vue/Subdivision Unit t 0 c a t i o n: 6831 Round Tree Drive :. 7. .~ype of Facility 8. Water Supply to be inspect'ed: Single Family No. Bdrms. 3 Type of S~pp y. -Public Utility Oomm~u~ityindividual If Individual, number of dwellings presently .served If Individua'l, depth of well Se'wage Disposal' System · Type ,of ys~em. Public Utility If individual, date of installation Please ~e%urn ~o: Lesm_u Denn National Bsm_k of Alaska ~ox 3-3859 An~ho:es, ge, Alaska 9~01 individual 'on-site ~"-'~artment of Enviro~mental Quality"'~ ;ater and Sewer Questionnaire Subdivision Owner's Name: Questions: 1. How many bedrooms are now in your house? ~ 2. How many bedrooms were in the house at the time of purchase? ~ 3. Were {he basement bedroom walls "roughed in" at the time of purchase?~_ 4. Was the basement bathroom plumbing "roughed in" at the time of purchase? I~b~ 5. Did the realtor or builder inform you that you would have to enlarg~enthe existing sewer system if you finished the basement bedroom (s)? '~ I,Z) 6. If on a public water supply, do you always have an adequate supply of water? ;/'~ .i~) 7. Is the pressure always adequate? 8. Who was the builder? K ~ OTHER COMMENTS: