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HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 6 LT 22 j MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'~ION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE~5~/~,,~,VA [ [] NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~ <Z I Manufact ~O~ ~E '~ Materia~ No. of compartments ~ ~ l Liq. capacit~ in gallons IF HOME,DE: Inside~l ngth Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. 0 ~ ~ Manufacturer Material Liquid capacity in gallons Q ~ ~ ~ Foundation I ~ I ~ {0 ~ ~ DISTANCE TO: /~5 /  Distance between lines Length of'each line Total ~qth of I~es Trench wi~ Top of tlie to finish grade Material beneath tile ~ ~eofcrib~ --~ Crlbdismeter Cribdepth ~, Total effective absorption area ~ ~ DISTANCE TO: ~ I~ Building f~ation Nearest lot line ~ DIST~: ~uilding foundation Sewer llne Septic tank Absorption area(s) PIPE MATERIALS OTHER SOIL TEST RATING ~ ~ /~ INSTALLER 72-013 (Rev. 3/78) DEPARTI'IENT OF HEALTH AND EN~IR_INMENTFIL F'ROTECTIOi',I ,_,,::..-, L STREET., ANCHORAIJE, AK .'---'~:4- 4 ? D'O PERMIT NO: ~40-?.07 UPGRADE DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE LEGAL DESCRIP LOT SIZE: VHN RELCO 501 WEST NORTHERN LIGHT BLVD. ANCHORAGE~ AK 99502 279-'?~11 .:,UB[.I~I_,ION: VFILLI ',/UE LOT: 22 BLOCK: 6 SECTION: 14 TOWNSHIP: i2N RANGE: R~W ~.O,-~-.:l~. (Sl:,L FT. OR ACRES) I CERTIFY THAT: i. I AM FAMILIAR WITH THE REquIREMENTS FOR ON-SITE SEWERS AND HELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF 'THIS PERMIT. 2. I WILL ADHERE'TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. LIFT STATION IS INSTALLED IN AN AREP COVERED BY MOA BUILDING .CODES.. (l) 8N ELE~.TRICBL PERMIT AND-INSPECTION MUST BE OBTAINED; (2) B~-BUILT~, NOT BE APPROVED HITNOLIT AN ELECTRICAL INSPECTION ~EP]RT~' ' ' AND (~...~'~ THE IF A THEN HILL ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED ~APPLICANT: ISSUED BY December 29, 1978 9780773 Andrew Chaffey Star Route A Box 34H Anchorage, Alaska 99507 Subject: Lot 22 Block 6 Valli Vue Estates Subdivision A permit issued by this depar~%ent for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the peri, it, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further q~lestions, please contaot this office at 264-4720. Sincerely, Les N. Buchholz~ Senior Environmental Specialist LNB/ljw eno: copy of permit E:,EPI:II:;?.'I"i'"II}]'q-!' OF" I*IEI=iLTH 26,4-47'28 F:'ERJ'I]:]" F,]O. ':: 70137'7']: FJF:'PL. ): Cf:[NT 1=I1"4 DRE H CHRFFE"r' L.OE:F[TZON 698t ROUND TREE LEGRL L..22 Bd; ',?RL_[.! VLIE '.F.::RR E:O::':', ]i:4H FINCH LO'F T"r'F'E OF: !Eh]IL FIBSOR-UTION S"r'E;'TEI"I IS: 'FF.'.ENCH ]i:,:!. 4 ?968 :,,::;;:?.I.~IEIE[ ::~;I;:!I...IF'II:;~:~: FEET MI::!::':,'ZMLIM NUM[3ER OF: BE[)ROOMS = SOIL RFITZNG (~!;1::! I=T',."E:R)= :35 THE LENGTH D!IqE=.'NSION IS THE L. ENGTH (IN F'EET) OF -rile TRENCH OR C,F:.'FI:(NFIEL.D. ]"HE D[i!:F'TH OF' FI 'TRE]'.,!CH CIF?. F'ZT I':'5 THE. D:['.:J;]"I=INCE BETHEEN THE '_:SUI:;i:FF:iCE OF:' THE C:if;UDL.IN[:, F:IND TI'IE E',OTTOM OF THE .F.'],':iOF:I',,,'FITICII",! '::If',! F'EET). Tt..II]:_'i..i% IS i',lO SET I.,.!:[E:,I'H FOR TRENCHE':7:;. THE GRFiVEL. [)EF"FH :IS THE fq!f'.,!IMUh'l [:,EF'TH OF' GRF:I',/EL [3E-r'HEliL'N THI:'E OUTFFIL.I_. f::'):PE FIN[:, 'TI-]E BOTTOM OF THE E',,qCRVFIT:[ON (IN FEE]'). F'EF?.PIIT F:!PF:'LICFII",FF I'-IFF:S THE RESF'ONS]BII..IT'?~ ']"O INFEIf;~:I'"I 'I'HI'_"~; DEF:'F:ff;?.TMEbFI" [:,L.IRI!qG THE :[N~5]'F!L. LI:::]TtO[",] lh!ZF'ECT):Oi",E~; OF I::11",1"/ !..4F[..L~; Fff).:rFIE:Ei',!T TO "[HI':E; F'F~:OPEI:;?.T'./ FINE) NIJME~ER OF I:~:EZI[:,ENCIE::~ 'Th!RT THE HELL HIL..L SERVE. E:FICKF:'Z LL..:[ NG OF F:tl",lh" S"?STEH H I "I'HOLIT F ! NFIL :[ NSF'ECT I OIq F:IND I:iPI::'f~:OVFIL B'T' "!'H I Z DEF:'FIR]MENT !.,.IZI..L E:E '_:;UE',JEC:T 'f'O F'REL':i;ECLIf'IOI",I. M ! N ! HL!r,1 D I S'['RNCE BE"I"HEEN A !4ELL RNE:, F:IN'-¢ ON-S ! -I"E '=?.;EiklFIGE ::LI2)IZ[ F'EET F:'OR F:I PRZ',,"f:ITE HEL.L.= OR ::i..SEI ]"O ;?.E~EI F'EFT F:r.;'.Ol',l FI F'UE:L]:C HELL [:,E:F'ENDZNG IJF'OI'.,I 'THIE T"r'I='E OF F:'UE',LZC HEL..I O I'HER REI;:!U Z REI"IEi',!TZ. i'flF:l"r~ laF'PL"r'. :!]~;F:'EC I F ]; CFIT I CIN:::; FIN[:, L]:ON:i~;'I"F~:I..IC'I" ]: ON [) I FIGI::~:I::IM'.'~i; FIRE F:I',,,'F:I Z L F!E:LE TO I I',ISUI~:E F'ROF'I:EF~: :[ F,!~;TFILI_FITI ON. :[ CEi:RT:I:F:"T' THRT ::L: I F:ff"l FI:ii'"tILZFII:,~: HI"I'H THE REQU!REi'qE:NT.'-~; FOR CJlq-.:i~;Z'flE ZEI.,!EI;?.::; I::ll'.,l[:) IAEL. L.:~; I::1:~; ZIE'f FOR-f'H E~'¢ THE t"IUNICZF'FILZ]'h" OF F'INCFICff~:RGE. 2: I I.,.IZL.L IN$'FFILL. THE 2?T'E;'T'E~]"'I IN [:iCI]:I]IRE:,I::I[',I(::E I.qITH ]"HIE COE:'E:~;. ]:: ): UN[:'ER%TFIN[) T["IF!T THE ON-'"E;ZTE :~;EP.IE:R :E;"r'STEM f'lFl"r' REgEJZRE ENLFIRGEMENT ZF' ]'HE I:;'.ES:[PENCE IS REP1CIDELEO ]'O ZNCI...UDE MORE -FHRN Z: E:E[:,ROC~h1:5. ANCHORAGE AREA BOr tlGH Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM '-EGALDESCRIPTIONL/ACC" Vt4C LZ2/ SEPTIC TANK: DISTANCE ~.OC_} FROM WELL''~ MATERIAL NUMBER Of ~ ~COMPARTMENTS INSIDE LENGTH -- INSIDE WIDTH ~ LIQUID DEPTH "---LIQUID CAPACITY{` O(~ C3 GALLONS. SEEPAGE PIT: NUMBER OF PITS [. DIAMETER OR WIDTH IZ LENGTH{~, DEPTH LIN lNG MATER IA[f~_.~ ~E: DIAMETER DEPTH DISTANCE FROM: BUILDING FOUNDATION'~O 1,"[ NEAREST LOT LINE''~ O I+ TOTAL EFFECTIVE ADDITIONAL ABSORPTION WELL~_Oc~ I .~ ABSORPTION AREA (WALL AREA)'--~'""~'-SQ. FT. WELLLj TYPE BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK SYSTEM REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED By:~ ~J~LJ REMARKS: Form No, EQ-031 ,/',0~) Greater ANCHORAGE Area BorouGH /~ /~/.///~ 355o "C"STREET ANEHORAGE, ALASKAgOS03 INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF PACILITY TO BE SERVED FINANCED THROUGH / seEPAGE P]T-- ~ DRAIN FIELD , OTHER TO be INSTALLED bY ~"~:~::~,~"~'~ NOTE: THIS P;RMIt I~ NOT VALID WITHOUT =OIL TEST DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEEPAGE PiT ~::~-') ~' , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL ,/~"'~ SEPTIC TANK SEEPAGE PIT ~ DRAIN FIELD WATER ~A[N TO SEPTIC TANK /~ / , SEEPAGE PiT /~ SEPTIC TANK, /~ seepage Pit ~ DRAIN field "One test is worth a thousand opinions" Performed For ,.~.'~ H ~'Xc~u~Eod5 6ate,.Pyer~forn},ed Legal Oescrintion. LotZ.Z-Bloct. ~ ,Subdivision This Form Renorts Soils Log ~J Percolation Test / Oenth Feet Soil Characteristics 1 lO Was~_Ground Water Encountered? /~ If Yes, At what Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop I i · , Percollation Proposed Depth of COMMENTS: lest Performed Rate Hinute Installation:F See~aoe Pit b~ Drain Field Inlet ~ ' Denth ~ Bottom Of Pit Or Trench - ~ eez ~e f ~ B.y ~ ~L Data Certified By:~~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage,343.4744 Alaska 99519-6650 CERTIFICATE OF HEALTu AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ~ ~:~. - ' 1. GENERAL INFORMATION Complete legal description Location (site address or directions) bq©l ~-- © U v~c(; ~L- Property owner Mailing address Day phone Lending agency Mailing address Agent. ~/-~¢¢L J~ ~'.~ ~-~TS~-~/. ~ ~ ~ Day phone Day phone 2-7 -2 7 / Unless otherwise requested, HAA will be held for pickup. I NUMBER OF BEDROOMS: /~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, pr(~vide written confirmation from State ADEC attest- ~ lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: v 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. 72~25 (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 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, ordiqances, and regulations in effect on the date of this inspection. NameofFirm %c~pe~,l S~u~-~,'-~.o,~E~ "~.l~_ Phone ~7~-~I~ Address AO~ ~ 1~ ~ ~d~ ~ Engineer's signature ~ % ~ Date ?/~/~ ~ DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 Fending 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. Health Authority Approval Checklist Legal Description: ~ 4- Z'2-/ ~'~v, Lfccl/,'.~ I/~-~ Parcel I.D.: A. WELL DATA Well type /5t Municipality of Anchorage 'q4~'/~0o~%~44fO~' ~ DEPARTMENT OF HEALTH & HUMAN SERVICES ? "~',~, O,~, ~ S25"L"Street, RoomS02.Anchorage. Alaska99501-~Envir°nmentalSe~icesOivisi°n [907) 34~-47~ O' ~~ IfA, B, or C, attach ADEC letter. ADEC water system number ~ l (9 bO ~ Log present (Y/N) Date completed Total depth Cased to Casing height (above ground) Sanitary seal (Y/N) Wires 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 RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: Bo Co SEPTIC/HOLDING TANK DATA Foundation cleanout (Y/N) 7 Depression (Y/N) ~[ High water alarm (Y/N) l'x-1 Dateofeumping "l-t-ql~-" Pumper A ~ ABSORPTION FIELD DATA Date installed /°173 L// Length /~. 5 I Width /~ ~ Effective absorption ama ]a~ t:/~ Date of adequacy test Fluid depth in absorption field before test (in.); '~ Fluid depth "~ q (ins.) Minutes later: Peroxide treatment (past 12 months) (Y/N) N Soil rating (g.p.d./fi2 or ft2/bdrm) ]~d2 System type ~ ~ Gravel t~c~ess below pipe ~ /Tot~ depfl~ O° t Mo~tofing Tube presentff~ ~ Depression over field ff~ ~ Results (Pass.ail) ~ For ~ bedrooms I~ediately ~er/0P~a. wa~er added (in.): ~- Abso~tion rate = ~ ~ g.p.d. Il'yes, give date Do LIFT STATION ~'~//~ Date installed Size in gallons Manhole/Access (y/N) "Pump o11" level at* "Pamp off" level at* High water alarm level at* *Datum Cycles tested SEPARATION DISTANCES DISTANCES FROM WELL ON LOT TO: lx~tt/t,/~ SEPARATION Septic/holding tank oa lot On adjacent lots Absorption field oa lot On adjacent lots Public sewer main Public sewer tnanhole/cleanont Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 'l ~, t Property line ~ / ~) I Absorption field [ .~ t Water mai,ffservice line _~ ~ / Surface water/drainage N o 14 ~- Wells on adjacent lots ~o 14 ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ ~ I Water lnain/service line Surface ~vater ~xJ o ~ e__ Ctlrtain drain Z,oI / Driveway, parking/vehicle storage area Wells on adjacent lots Ix] 0 ~4 a._._ Property line .'~ F. ENGINEER'S CERTIFICATION I certtJj2 that I have determined thru field inspections and review c in conformance with MOA It/iA guidelines in effect on this date. Date of Payment 7//~ Date of Payment Receipt Number ~/.~ f~P'~/J Receipt Number Rev. 8/95 OSS: haa.wk.doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~ZOI~,~,..Q, (b) (c) Applicant Address Bus,ness Applicant is (check one): Lending institution []; Owner/bui~t'c~'; Buyer []; Other [] (explain); (d) Lending Institution _I~:~M~,~. ~ ~.z '~.e~-.t Telephone Address ~"'~J~l~,,~# "5¢& (e) Real Estate Company and Agent ~-~O~,,~. Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family I~ Multi-Family [] Number of Bedrooms ['~ Other WATER SUPPLY [] Community'(~ Public [] Individual Well Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL [] Public~ Communi!y [] Holding Tank [] Onsite Note: If com reunite/well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ,'~' ~ 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 dis posal system is safe, functional end 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 dale o~.this~~ Address Engineer's Seal DHEP APPROVAL ~"-'~'~'"' ..-, ./~ Approved for /~-'~) ~"~ ,~'bed r oo m s by ~.____~'l'~''~ Approved ~/ DisapproveU Terms of Conditional Approval CAUTION 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) WELL DATA ~UNICIPALI'I~ OF ANCHORAGE DEPF. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) MAR2 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984264-4720 RECEIVED Legal Description: J..O'~ Well Classification 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 Cleanout/Manhole Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) 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 To Nearest Sewer Service Line on Lot ; Date Comments B.' SEPTIC/HOLDING TANK DATA Date Installed ~ size / ~-~ O No. of Compartments -'T-ruV../C) Standpipes (Y/N) "T u~o Air-tight Caps (Y/N) ~/' Foundation Cleanout (Y/N) Depression over Tank (Y/N) 1~ Date Last Pumped ~//,.~-'¢'~ ~ Pumping/Maintenance Contract on File (Y/N) I~//~- ;for ~ Holding Tank High-Water Alarm (Y/N) - f*C/~Or Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation J ~ To Disposal Field t~ ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well )' ¢~..01~ .To Building Foundation I ~ Lot NO I"~/~~' To Water Main/Service Line J~ -~ To Stream/Pood/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) J~C) ~ ~" Comments D. DFT STATION NONE Date Installed Size in Gallons "Pump On" Level at Fligh Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify t,~e checked, verifiJ~, or conformed to all M CA and HAA guidelines in effect on the date of this Signed ~ Date ~"~-~ ,~'~., J¢{~,~ inspection. Company ~ MOA No. ReceiptNo. ~77¢? ? ¢"':':'"" '' Dateof Payment ~-~'~ ~ ~''~"~ ~ " - ,,S .',v.' Amount: $ ~ ~c~ J)¢ ;~ ," 49~d-' ,~ , ', ''4'~' Engineer's Seal Page 2 of 2 CONSULTING ENGINEER SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOT 22, BNLOCK 6, VALLI VUE ESTATES LOCATION: 6901 ROUNDTREE OWNER: RONALD BROWN RESIDENCE: SINGLE FAMILY, FOUR BEDROOMS WATER SYSTEM: DATE OF PUMPING: CLASS A COMMUNITY SYSTEM FROM MUNICIPAL RECORDS: TANK: ANCHORAGE TANK, STEEL, TWO 1250 GAL. ABSORPTION SYSTEM: CONCRETE CRIB AND ABSORPTION AREA:288 SOIL RATING: 100 INSTALLATION DATE: MARCH 25, 1986 TRENCH + 125 = 413 SQ. FT. CRIB 1974. TANK AND TRENCH 1984 DATE OF TEST: MARCH 24, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK IS BURIED 7 FEET. WATER DEPTH IN TANK IS 47 INCHES.CRIB IS 8.6 FEET DEEP WITH 5.6 FEET OF LIQUID. TRENCH IS 8 FEET DEEP WITH 7 INCHES OF LIQUID. 600 GALLONS WAS ADDED TO THE SYSTEM. THE FIRST 100 GALLONS WERE ADDED THROUGH THE HOUSE CLEANOUT. WATER LEVELS IN THE TANK AND CRIB DID NOT CHANGE. THE WATER LEVEL IN THE SUMP ROSE 1 INCH. THE REMAINING 500 GALLONS WERE ADDED TO THE CRIB. THIS RESULKTED IN AN ADDITIONAL 3.5 INCH RISE IN THE SUMP. NO CHANGE IN TANK AND CRIB. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. DEPT. OF i~NVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 43l "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: 274-2533 To Whom it MaY Concern: According to records on file in this office the ~~ c~/~/ ~/~ ~~W~ter System is in compliance with the State Drinking Water Regulations MUNICIPALITY OF ANCHORAGE DMSION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEAL~{ AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1o General Information Application Date / / (a) Legal Descaziption (include lot, block, subdivision, section, township, range) Location (add,ess or directions) Applicants Add,ess ~ kD i ~z> /~.)~ ~/~ d-:/~//1 /<,/~ is (check one) Lending InStitution E~; (~rner/builder E--_:; (c) Applicant (d) Lendzng Instztutzon >-:// /1 ?~/: :7/~ /~ ¢¢ /~-E~¢*:< Telephone Address /:¢/< >: 2. ~/pe of ~esidence Single-Family Numbe= of Bedroo~s Multi-Family E~ O~e= (dearie) Water Suppl~ Note: If community well system, must have w~itten confirmation f~cm the State Depar~nt of Environmental Conservation attesting to the legality and status° Is the ~11 adequate for the number of bedrooms specified in this HAA (Y/N) S~e ~rage Disposal " Onsite ~, Public ~----[ Cor~aunity ~ Holding Tank ~--~ Is the wastewater disposal system adequate for the rzLmber of tedroons (Y/N) [Page 1 of 2] 2-15-84 5. Engineering Firm ~Providin~ ~ns_~pections, Tests, Dsta and Information I oertify that I haue ch~cked, verified, c~ conformed to all MOA HAA (klidelir~s in effect on the date of this inspection. Date "/..,/~,'d~_~ ~'/ Telephone ',~/-~; Z-~ 3-~ ) (ENGINEER 6. DH5~ A~proval Approved for Approved~._ Disapproved ~ Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Environmental P~otection dces not guarantee the continued satisfactory performance of the water supply and/o~ the wastewater disposal system° ~nis approval indicates that, as of the validation date shc~m above, based on the data and information furnished by an engineer registered in the State of Alaska, the ~rate~ supply and wastewater disposal system is safe and func- tional for the number of kedrcx~s and type of structure indicated° (D~EP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 2] 2-15-84 A® Well Classification C0~4~3 Well Log P~esent (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances f~om Well: To Septic/Holding Tank on Lot MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Date Completed Cased to To Near. st Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleancut/Manhole Water Sample Collected By Water Sample Test Results C(~L~nts F~ Sane ~1AC~+~ C, D.E.C. Approved(Y/N) ~S Yield Depth of G~outing Pump Set At Sanita-~Y Seal on Casing (Y/N) Depression A~ound Wellhead (Y/N) ; On' Adjoining Lots ; On Adjoining Lots To Nearest Pub!i~c Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 4 J~;M~ /~/-~ Size %?_~) No. of C~ga~tments 2 _ Standpipes (Y/N) y~ Air-tight Caps (Y/N) ~/~ Foundation Cleanout (Y/N)~/~5 Depression over Tank (Y/N) ~O Date Last Pumped Pumping/Maintenance Contract on File JY/N) /~/~ ; for ~/~ Holding TaPR High-Water Alarm (Y/N) /U/A Teapotally Holding Tank Permit (Y/N) Separation Distances f~om' Septic/Holding Tank: / To Water-Supply Well ~-200 / To Building Foundation II TO P~operty Line ~_~/ ~ To Disposal Field '12/ TO Weter Main/Service Line ~ / To Stream, Pond, Lake, o~ Major D~ainage Course Comments ~L~ ~ ~T[~C~?% ~ --~/3/~ ~0/~ DE~//i~ ~ O~A-~D~ __ [Page 1 of 2] 2-15-84 C. ABSORFDION FIELD DATA Soils Rating in Absorption Strata Date Installed ~F~A~2 ~u~ ~z~ Length of Field Width of Field ~.O' Eepth of Field Squ~e Feet of ~sorption ~ea ~Z5 ~8~ ~_Stan~i~s ~esent (Y~) ~p~ession ove~ Field (Y~) k~O ~te of ~st A~a~ Test Results of ~st A~a~ ~st ~ ~i~Lg~ ~ Separation Distan~ f~ ~s~rption F%eld: To Building Foundation ~ To Existing or ~ndo~d System not ~/~ ; ~ ~joining ~ts To Wate~ Main/~vi~ Line ~ ~' To ~t~(if pre~nt) ~/~ / To St~e~ond~ke/~ Sajo~ ~aina~ C~se To ~iveway, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea /~ / of System sign D. LIFT STATION /~OT .J:Jpf L I cA 6C '~- Date Installed Size in Gallons "Pump On" I~vel at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Cor~nents ** Check Permitted Bedrcom Rating Against HAA Request I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect on the date of this inspection. KB1/d5/s [Page 2 of 2] 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAL REG I ONAL OFF I CE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 PWS i.D. BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom It May Concern: Water System is in compliance with the State Drinking Water Regulations. APPLI¢ NT FILLS OUT UPPER HAt 'ONLY FF.a~perty (~wner 2~'7~_~/ ,v~ ~-~7~/_.~-/~' ~.,/7//~ ~:~ Phone Mailing Addre~ Zip Code Buyer Address Zip Code Lending Institution Phone Address ZiP Code .... . Realty Co. & A~nt ~~ ~ Phone Legal Description /~ ~ ~ ~ ~/~ ~ ~ ~ ~ Street Locati~ ~,~/ /~/)~/~ ~ i}~ ~1 F~ ~,r'~ ~ ~ Type of Resi~nce ~Single Family ~ Multiple Family No, of Bedroo~ ~ ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w~l log is required for afl wells drilled since June 1975. ~ Commungy For wells drilled prior to that date, give well depth (attach log if available), Public Ufilgy Sewer Disposal ~lndividual Year Indiv~ual Installed: /y g Public ~ility When Connecled to Public Utilily: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date ~-- ~Z~ Well to Tank ~ Septic T~k Size ALASKA I IIUII OnmEFITAL COFITBOL SI I U1CI S, II1C. ~nqineerinq 6 I~nuirenmentol Studies JANUARY 30 1984 ANDY & DA~T.RkTE CHAFF~%~ 6901 ROUNDTREE DRIVE ANCHORAGE AK 99507 SRT.T,RR -- ANDY & DART,RNE CHAb'~'~:~ BUYER - SUBDIVISION - V~T.T,R¥ VU8 ~TATES #2 BLOCK - 6 LOT - 22 AD~QUAC~ TEST FOR SEWER SYST~/~I THE TYPE OF ABSORPTION SYST~vl IS A PIT WITH AN AREA OF 288 SQFT. THE SYS~M IS CAPABLE OF ACCE~TING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 622 GALLONS. BASED UPON ~E TEST DATA THE SYSTBM IS AC~FfABLE FOR A 3 BEDROCM HOME. THE SEPTIC TANK WAS PUMPED ON 1/19/84 . SEPTIC TANK ADEQUACY THE k~ISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. 1200 LUesf 33r(l Auenue, $uif¢ [~ · t~nchoreqe, Aloske 99503 · (907) 276 1361 Subdivision Owner's Name: ~,~artment of Envirel~mental Qualit? '~ ", Nater and Sewer Questionnaire ~-~ Date~Y~/~ .z//, Time Mailing Address: Lot ~W~. 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 the basement bedroom walls "roughed in" at }he time of purchase? 4. Was t~te basement bathroom plun~'bing "roughed in" at the time of purchase? 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)? ~f/~ /~/~ 6. If on a public water supply, do you always have an adequate supply of water? 7. Is the pressure always adequate? was the builder? 9. Who was the home purchased from? OTHER COMMENTS: Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 27~-~1' Date Received ~/~ Ti~e of ]nspec~io~ Date of Inspection 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: Legal Description: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR , / . /I ~ Phone: 4. Location: ,:~..~ :._.,._ ~.A_.~..,~ \' ..(./'," ,-×..'~'~ No. of bedrooms 5. Type of facility to b~ ~nspected/~~ 6. Well Data: A. Type ~,,~:~-~-~:~/ ~~- B.~ Depth C. Construction ~~G~ D. Bacterial Analysis 7. Sewage Disposal System: A. Installed L~?~'~-.4~ ,~/ B. Installer .~?~/ ~.~2~..~ C. Septic Tank: 1. Size 7~] 2. Manufact~er ~3. D. Seepage Pit: 1. Absorption Area /2ff/gx~ 2. Material~'~ E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank , Absorption area Nearest lot line -,~ , Other contamination B. Foundation to septic tank /~7/ , Absorption area C. Absorption area to nearest lot line , Sewer Lines EQ-034 (1/74) Page 1 of two pages :~Page 2 of two pages - Request for Approval of Individual .... r & Water Facilities ~egal Description Comments Approved ~/~z~ ~w~~ Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 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 Type of Inspection: CMRO VA Property Owner: /~7~.~ Mailing Address:~-~/~ FHA CONV ~ Da~, Phone 3. Name of Buyer: Mailing AddresS: Name of Lending Institution: Mailing Address: ~). ~ Day Phone Phone 5. Name of Realtor or Agent: Mailing Address: Phone' Legal Description: Location: 7. Type of Facility 8. Water Supply Type of Supply: If Individual, to be inspected: ~J~¢*i' No. Public Utility ~ Individual number of dwellings presently served Bdrms. ~ If Individual, depth of well Sewage Disposal System Type,of System: Public Utility If Individual, date of installation Individual (on-site) EQ-037 (1/74)