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Home My WebLink AboutVALLI VUE ESTATES #2 BLK 6 LT 24 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 Report Permit Number: .~vv' ~¢'0 ~ J) 7 PID Number: Name: ~Om ~eln~ Po~ Wastewater SYstem: D New ffi Upgrade Addre,,: ~0 ~ ~r~ C;;~/~ ABSORPTION FIELD I NO. of Bedrooms: Phone: ~-~00 ~ DDeepTredch D Shallow Trench ~Bed DMound DOth~r LEGAL DESCRIPTION ~: Total Depth from origina~ ~ GPD/Sq, Ft, Block;/ Subdiv~ion: Depth to pipe b0tt~nal grade: Gravel~ d~ipe Lot: Gravel width: WELL: D New D Upgrade Driller: Date Drilled: StaticWater Level: Installer: ~H ~ ON ~ Date installed: Yield:GPM IPump Set at; Ft. ICasing Height AbOveGr°und:Ft. TANK SEPARATION DISTANCES s septic D Holding D S.T.E.P. To Septic Absorption Lift H~lding Public/PrivateManufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~¢~ Material:V Number of Compadments: Sudace w~t~ >~ LIFT STATION ~.~. Lot Size in gallons: I Manufamuror: Line Foundation ~ "Pump °n" level at: ["Pump °ff"level ~t: I High w~ter alarm at: Cu~ain Pump Make & Model ~ Electrical Inspections pedormed by: Drain I BENCH MARK Remarks: ~ ~n~ ~ ~.~/~ c,~ Location and Description: Assumed Elevation: ENGINEER'S SEAL Inspections performed by: f/~h~ff Ttc~ ~ve Dates: ls; 2nd Department of Health~ Human~ ices approval 72-013 (Rev. 9/91} MOA 25 PERMIT NO: SW960297 PID NO: 01512328 NEW 1250 GAL. SEPTIC TANK DOUBLE CLEANOUT EXISTING ,' '.,TRENCH ~,' PLAN VIEW SCALE: 1" = 30'- 0" .- LOT 24 .-" BLOCK SWING TIES FROM: COR."A" COR."B" TO: S.T.C.O. "C" 10.5' 22.5. S.T.C.O. "D" 19' 23' DBL. C.O. "E" 21' 23.7' PAGE 2 OF 2 92.2' ~FINISH GRADE (4'+ SOIL COVER) NEW 1250 GALLON SEPTIC TANK CROSS-SECTION NOT TO SCALE _INV. - 92.0' LOT 24, BLK. 6 VALLI VUE EST #2 SEPTIC TANK REPLACEMENT AS-BUILT INSPECTION REPORT FLATrOP TECHNICAL SERVICES 14530 ECHO STREET ANCHORAGE, ALASKA 99516 SCALE: AS NOTED DRAWN BY TFM SEPTEMBER, 1996 PAGE 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:SW960297 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:EDRINGTON TOM OWNER ADDRESS:6850 ROUND TREE CIR ANCHORAGE, AK 99516 DATE ISSUED: 9/12/96 EXPIRATION DATE: PARCEL ID:01512328 LEGAL DESCRIPTION: VALLI VUE ESTATES #2 BLK 6 LT 24 LOT SIZE: 21093 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: SEPTIC TANK 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. 1 OF 9/12/97 SPECIAL PROVISIONS: DATE: CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 September 9, 1996 ANCHORAGE, ALASKA 99516 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to request issuance of an upgrade permit to allow replacement of the 1250 gallon septic tank serving the existing 4 bedroom residence on Lot 24, Blk. 6, Valli Vue Estates, Unit//2, located at 6850 Crooked Tree Drive. A site plan is enclosed for your review. An expedited permit issuance is requested because the existing tank is 20 years old and may collapse in the near future. The lots in this subdivision are served by a Class "A" community water system, and no wells are located within 200 feet of the proposed construction. The topography of the lot in the area of the proposed tmdc replacement is generally level. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent prope~lies, nor will it have any significant impact on reserved space- surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. BLOCK 6 ,, ',.. VALVE SEPTIC SYSTEM LOT 72 BLOCK 1 LOT 73 ~ SEPTIC "- V SYSTEM o LOT 24, BLK. 6, VALLI VUE EST #2 SEPTIC TANK REPLACEMENT SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 SEPTEMBER, 1996 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. Flattop Techn~al Serv~es 14530 Echo Street, Anchorage, AK99516 Phone (907) 345-1355 Lot 24, BIk. 6, Valli Vue Estates, Unit #2 6850 Crooked Tree Drive Septic tank replacement Specifications 1.0 General: 1.1 The scope of the project consists of removal of a 20 year old 1250 gallon septic tank and installation of a new 1250 gallon septic tank in the same location. 1.2 Construction shall be as depicted on the approved site plan. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The new 1250 gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 2.3 The old septic tank shall be properly abandoned or disposed of in accordance with M.O.A. specs. 3.0 Inspection: 3.1 One engineering inspection will be requh'ed during the course of the project after the tank is set level and the piping connected, but prior to backfill. 3.2 The installer shall coordinate the timing of the inspection with the engineer sufficiently far in advance to ensure the availability of the engineer. GRB..ER ANCHORAGE AREA BOR DePartment of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS /t~ ~,,,~? ,~,,.~,~-~,/ ,~,/F~f/~ PHONE LEGAL DESCRIPTION ,,g~' 7-,~.'.~/ ~/~'~ ~:~' [,~l// ~ SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER ~. INSIDE WIDTH. LIQUID DEPTH NUMBER OF ..~ COMPARTMENTS L I QU ID CAPACITY/~'~.~'O GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL~'~ NUMBER OF LINES / ABSORPTION AREA ~') ! TOTAL LENGTH FOUNDATION /~) "/- NEAREST LOT LINE /g~ ~/ OF LINES DISTANCE BETWEEN LINES DEPTH: TOP OF TILE TO FINISH GRADE SQ. FT. /1~//~I TRENCH WIDTH'~-~IN. TOTAL EFFECTIVE LENGTH OF EACH LINE ~.~ ) DEPTH OF FILTER ~' MATERIAL BENEATH TILE ~ ~¢. ABOVE TILE ~ IN. WELL: TYPE __ BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST LOT LINE __ SEWER LINE OTHER SOURCES ' DISAPPROVED R EMA R E4.S _ DEPTH SEPTIC SEEPAGE TANK__ SYSTEM DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: ~ REMARKS: Form LQ-032 DIAGRAM OF SYSTEM G.A.A.B. ~ PERblI T NO. · IFFLI _.HI',I I' ] Ii]E,E.,L. ~,j':~l] ERPF...!z,E_-, P. ' ' -:'='~' :" -- : " ' - '--' :' [:'R LOCFITION RLIUI'4L. IREL [CP.. ~¢ L. RUUI-..EB TREE LEGKIL L24 SE, ',,,'FILL. I VUE ESTFITES LOT SIZE Z.:4 S~-:J_5~22 2:L08}]: SQLIRRE FEET T'¢PE OF SOIl... RBSORE:TION S'.r'STEH IS: TRENCH I"IFI',,,~IHLJH NUMBER OF BEDROOHS = 4 SOIl_ RRTING (S6] FT,.-'BR)= ::LSEI THE RE~]~UIRED SIZE ClF THE SOIl.. RBSORF'TtON S'¢STEM IS: £:. E'F'-'I"H ~== ~ L_ Ell'-4 C~ 5f-F~t~'= ~i""'"=~.H--" -- '-.-" ~.[_.--' E::" ES; F" ]'-~'4== ~ ~ THE LENGTH DZMENSZON ZS THE LENGTH ,::ZN FEET) OF THE TRENCH OF;'. DRFIZNF~ELD, THE DEPTH OK R TR. ENCH OR F'ZT ZS THE I}ZSTRNCE BETNEEN THE SURFRCE OF THE GROUND FIND THE BOTTOM OF THE EXCRVRTZON (~N F'EET). THERE ZS NO SET WZDTFI FOR TRENCHES. THE GRRVEL DEP'FH IS THE MINIHUH [:,EPTH OF GRRVEL. E:ETI,.IEEN TNE OI...ITFRLL. PIPE RND TNE BOTTOM OF THE ENCRVRTION (IN FEET). BFICKFILLING OF' RN"r' S'¢S]'EM WITHOIJT FINRL INSPECTION FIN(:' FIF'PRO',,,'RL BY 'f'HI'.S" DEPRRTI"IENT WILL BE SUB.:rECT TO PROSEC:UTIOI'-.L MINIMUM DISTFINCE BIETI.,.!EEN ICJ WELL RND FIN'¢ ON-SITE SEWRGE DISPOSRL S"r'S'I"EM IS ::LE~(~ FEET FOR FI PRIVRTE WELL OF;'. ;-]EJEl FEE'/ FOR. FI F'IJBLIC WELL. SPECtF'ICRTIONS RND CONSTRUCTION DIRGRRNS RRE FR,'RILRBLE 'TO INSURE F'ROF'ER I NSTRLLFIT I ON. I CERTIFY THRT :L: I RI"I FRHILtFIR WITH THE RE~;!UIREi"IENTS FOR ON-SITE SENER.'.S RND P.IEI.._LS FIS SET FO,';,'TH 8N' THE MUNICIF'FILIT'¢ OF RNCHORRGE. 2: t I.,.IILL INSTRL. L THE S'¢STEH IN RCCORDRNCE WtTN THE (;ODES. :.L'-':: I LII'.,IDERSTFIi'.,ID THRT ]'HE ON-SITE SE!.¢ER S'¢STEH I"lR"r' REQUIRE ENLRRGEMEI",IT IF' 'THE RESI[:'ENCE IS RENODELED TO INCLIJE:,E MORE THFIN 4 BE[:'ROOHS. S I GNED: Lot 2.4 Round Tree Drive Test Hole locations are approximate and have not been located by survey methods. T.H. 1 10/~/76 ORGAMIC ~,L~TERIA L SILT w/SOME SAND Redd~ 0 1.0' 2.0' GRAVELLY SAND w/TRACE SILT (SP) Occasional Cobbles, Brown No Water Table 16' T.D. This log represents subsurface soil soil conditions within Valley View Estates subdivisionr Block 6, Lot 24 Anchorage, Alaska ~M GOAISUL.TAt',3TS, ~.l~C, Timber Enterprises 65631O October 7, 1976 R & M No. 656310 Dave Burlingham c/o Timber Enterprises PO Box 3351 Anchorage, Alaska 99501 Test Hole and Soil Log Report for Sanitary System Valley View Estates Subdivision Lot 45, Block 1, and Lot 24, Block 6, Anchorage, Alaska Dear Mr. Burlingham: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This in- vestigation was performed in accordance with your request of October 6, 1976 and those procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland of the Muncipality of Anchorage Department of Environmental Quality. mwo tqst holes w~re dug within the subject site area for the purpose of defining general subsurface soil conditions for the proposed sanitary systems. Excavation was accomplished with a tractor-mounted backhoe and both test holes were extended to a total depth of 16 feet below ground surface. The final logs prepared for the test holes has been included in Drawing A-01. Groundwater was not encountered in either test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R &~ CONSULTANTS~, INC. James W. Rooney Vice President ~R/ddp xc: Municipality of Anchorage Corn plete legal description 'rL Lot' 24; Block 6; Valli Vue Estates #2 Location (site address or directions) 6850 Crooked Tree Drive Property owner ngaddress ~R~n ~-~,,~]~,~ m~'~ ' Len~'iflg agency Mailing address "' Address Tom & Janet Edrinqton Day phone Day phone Day phone 346-2600 257-0116 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: If community well syste~, 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. 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 Murdcipal and State codes, ordinances, and regulations in effect on the date of this inspection. Alaska Wa/g~' & Phone Name of Firm /wa~t~)~v/~ ~//s~ae~'"'~'te~///''', Address / z/~/~,/R ,~, :iB ,~ .~/~,/~ __ ^y^~..-~-~.~ ^~-~-~, Date Enginee¢s signature "--7~f v~ ........ =,~,~..~, /~';" Alaska Water& " . Wastewater ConsultanM, ~ ii: 'Shall be PAID ~__._~¢¢ of ~r to, closing for the DHH8 81GNATURE ~ Approved for ~0 U~ bedrooms. Disapproved. Conditional approval for bedrooms, with th-e 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 DH HS does this as a courtesy to purchasers of homes ar~;d their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not c(~nduct 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. RECEIVED Municipality of Anchorage MAY 07 7999 DEPARTMENT OF HEALTH & HUMAN SEP~-~I~LIT¥ OF Environmental Services Division ENVJRON/v~NTAL SERVICES 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription: ~ gE ~ ~1~ ParcelI.D.: A. WELL DATA We~.pe C~O~4,'~ ~,?~ If~,~B, or C, attach ADEC letter. ADEC water system number Log pr~ Date completed ~ Total depth "-.., Cased to __ Casing height (ab.~3ve'-ground) Sanitary seal (Y/N) ~ Wires pr~cted (Y/N) Zw"Z, w, ' Well production Coliform ~ Nitrate D~t~mple: ' B. SEPTIC/HOLDING TANK DATA Dateinstailed .])~/ ~ Tanksize FoundatiOn cleanout (~N)..., y Date of Pumping . Collected by: g.p.m, g.p.m. Number of Compartments__~ Cleanouts ~N)~--~ High water alarm (y/N) Depression pumper C. ABSORPTION FIELD DATA Date installed ///7(~, Soil rating (g,~or ft~/bdrm) Length ~.~ ~, / Width ~ Gravel thickness below pipe Effective absorption area ~'~) Momtoring Tube present ~N) 5~-P Depression over field (Y~).__ Date of adequacy test ~!,',q~-~: ~/~Results~/Fail) /~,-~ For Fluid depth in absorption field before test (in.)t ~l ': Immediately after-'Jr~/~ gal. water added (in.): Fluiddepth ~ (ins)Minutes later: /J(~(~ Absorption rate =' ~()~ ''~ g.p.d. Peroxide treatment (past 12 months) (Y/~ /~D.,'/-C~/7~d~.JT~ If yes, give date System type Total depth bedrooms D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level E, SEPARATION DISTANCES Size irLgallonS~' level at*. "Pump off" level at* SE-'PA-RAT~ON DISTANCES FROM WELL ON LOT TO: Septic/hold~ Absorption field on lot *Datum Public sewer main Sewer._~.~tie-sei~T~e line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 7, 5 ' ~ Propertyiine ~ ~ Absorption field Water main/service dna . Surface water/drainage 7 On adjacent lots ,~- ,~~blic Sewer manhole/cl~aano-'~ut------. Wells on adjacent lots 7 ~-O 43 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I0 ! Building foundation ~ ~) -+ Water main/service line Su~ace water ~ / ~ ~riveway, parking/vehicle storage area Cu~ain drain ~d~ ~O~m Wells on adjacent lots ~ ENGINEER'S CERTIFICATION ~ ~¢~ ~ [o¢~ ~ 5~5~ ~ 7~ I ae~i~ that I h~w d~t~rmine~u field in~pea#on~ and review of Munioipal re~ord~ in conforman~t~O~l,~ in effect on this date. Sign.tare Engineer's Na~/~(/~_~ ~' Date HAA Fee $ '!,/ Date of Payment Receipt Number ~ ~ ~- Z' '~ /',-~/~ ~]/--~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 I.D. # ol~' 1. GENERAL INFORMATION Complete legat description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# t--~-. '~,';[ '.~'~'~ \ Location (site address or directions) Property owner Mailing address Day phone ~4~- ¢0/o ~-~' Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4- ~' 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 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 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. Phone Date DHHS SIGNATURE .~' Approved for bedrooms. Disapproved. Conditional approval for 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 purohasers 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. Legal Description: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ' D. E'/~! 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (9(l~a) ~;qz~;'44V JUN 20 1996 Health Authority Approval Checklist Municipality of Anchorage Dept. Health & Human Servicea -~- ~ Parcel I.D.: O I~ -/~ - g~ A. WELL DATA Well type 0_~c~ ~ t,4. I(~, B, or C, attach ADEC letter. ADEC water system number X/A b~.~ ~J~--- :t3 ~: ~ Cased~:te c°mpleted Casing height (above grotm~~'~'~ Sani~tary seal (Y/N)~ Wires properly p~ _ ~~ ~ ~NSPECTION Static water level Well production / g.p.m. ~ g.p.m. WAq~R S~ l~le: Nitrate Collected by: B. SEPTIC/HOLDING TANK DATA Date installed I I/'l ~ Foundation cleanout (Y/ND , ~ D~te~6f Pffmping~£ C. ABSORPTION ICLELD DATA Date installed t/ Length ~,_~ / Width Other bacteria Tank size 1 Z2~O Number of Compartments ~-, Clem~outs (Y/N) Depression (Y/N) N0 . High water alarm (Y/N) Pumper a:>t..~ t-lc- ~ o ~.-~l~ ff, Soil rating (~ or fl%~) l~O System ~e ~ J Gravel t~ckness below pipe TotM dcp~ ~' *~ Effective absorption area ~> .~ O Monitoring Tube present(Y/I0, y Depression over field (Y/N) AJO Date ofadequacy test 6/t'Z/9~ Results(Pass/Fail) P~fi; For 4' bedrooms Fluid depth in absorption field before test (in.); ~ ~ ~/1~ Immediately after 100 g4g~. water added (in.): Fluiddepth4~S~r (ins.) Minutes later: 12. gO Absorpfionrate = '~(o0~ g.p.d. Peroxide treatment (past 12 months) (Y/N) /~}O~'-JD~td If yes, give date Date hlstallcd ~ Size iii gallons Mailhole/Access (Y:) __~ulp off level at* E. SEPARATION DISTANCES S'gP~RATION DISTANCES FROM WELL ON LOT TO: Septic/~ ; On adjacent lots Absorption field on lot -~'~'~_ ;0~ ~ ~_.......---.-~-~ ~ Public sewer maia /- Public sewer ii1~11!~ ~ine Lift station SEPARA~ON DISTANCES FROM SE~IC/HOLDING TANK ON LOT TO: Building foundation ~, ~ t~ Property line ~O/~ Abso~tion field ~ Water main/se~ice line~ Surface wateffdrainage > I oO* Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foandation Z ~ t ~ Water main/service line ~ ,.2~..~ou...~ O Surface water '~' I o o ' Driveway, parkiag/vehicle storage area ~ O t..~ Curtain drain I,~-o,o'Oco~xJ Wells on adjacent lots .~ Z-OO! Property line . ENG~EER S CERTIFICATION ~ · ~ /~ / certq) that / hav~e,~J~ed thr~fiJld inspections and review :Municipal records ~thO~ba~s~Ws i, conformance ~th ~14/~[,~ ~[~li~*' in effect on this date, ~gnature ~////~1 [/~ ~ ....................................................................................................... ~ HAAFee $ ~ ' ~ Waiver Fees Receipt Number / y~ C/- ~TDq ) Receipt Number ,/ Rev. 8/95 OSS: haa.wk.doc 06/13/96 THU 13:53 FAX 907 662 5485 VISTA REAL ESTATE '~ ~ / .. ~.. P~T, A~E NOT SHOWN H~REON, 06113198 THU 13;§8 FAX 907 562 548,5 VISTA.REAL ESTATE ~';" EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORD[:D PLAT, ARE NOT SHOWN H~REON, ,./4. 1981 REC'D BY r~:~c~. KEEP THIS SLIP SL320 FOR REFERENCe: MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or di~s~ c~f Aj~t (b) Property owner /¢/i0/7c~¢,1 ?(n,.~/c~_,~ Telephone: (home) .Business 3' ¥¥-4:~'-~/ MailingAddress/ ~/~ J~(/.,y ~'~n/-¢/'~ ~?~00 ~/~r~':¢ll I~¢(.~, /~/~c4 (c) Lending Institution /'4, ,~. Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone ~,~ ~- 0.5"0/ (e) Mail the HAA to the following address: (or check here ~1, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3. WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev 7/88) 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 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 /~/'~/--/o~ 7-~ch,~ic~f -qe,'~';¢-~-z Telephone ~ ~5-- I~ Address 1~,5-~O ~c~o ~/,~ ~d ~O~¢~/ ~ ~/~ 6. DHHS APPROVAL Approved for_ ~ bedrooms by Approved ~,,~.~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DH HS) issues Health Authority Approval cerificated 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 o'f 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. ~-02~ (,o, ?/.~ ~.~ Page 2 of 2 Well Classification ~z~ ~, l/ 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 Eine To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Co~,, o~ p~C MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) __ Yield 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 ; Date B. SEPTIC/HOLDING TANK DATA Date Installed I1{:~' 7,~/ size ~5'~ Standpipes (Y/N) Y' ~.~} Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) No. of Compartments ~' Foundation Cleanout (Y/N) DateLastPumped ~l [[~(~ b~, ..,/~__..c~,~¢,/' ; for N,/-. Temporary Holding Tank Permit (Y/N) /v.~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line ~ ~o ' To Water Main/Service Line ~ '~ b- ' To Stream, Pond. Lake or Major Drainage Course ~> ¢0~' ' Comments To Building Foundation To Disposal Field IO' 72-026 (Rev. 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed It / ,.7 / 7~ Width of Field ?~ 'f 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 Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: "Fo Water-Supply Well 'Fo Building Foundation Lot t~,//-. -Fo Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course 'Fo Driveway, Parking Area, or Vehicle Storage Area {t / tY ~'oo ' To Property Line c, o, To Existing or Abandoned System on ; On Adjoining Lots ~ '~- zS" To Cutback (if present) /V,/',-. ~ foo Comments D. I. IFT 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 ~t'i~l~$ in effect on inspection. Signed cr~.~ ~ ~ ~'~ Company ~l~F~ ~;c~/ ~e~td~ ~'~'" Date ~o ¢ /~, /¢¢~ ~~~,,.~,,~ ............ MOA NO. ~9 - ~g~? __ ~ ..~ %~H~ooo~e / Receipt No Date of Payment //- / ~ ~ Waiver Fee: $ Amount: $ / ~ ~- ~ ~ Date of Payment 72 026 (Rev. 7/88) 8ack Page 2 of 2 the date of this Engineer's Seal ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 563-6775 DATE: 11/1/89 PWSID: 210605 Requested By: Flattop Technical Services According to the records on file in this office, the Valli Vue S/D water System is in compliance with State of Alaska Drinking Water Regulations. the Sincerely, Cindy ThOmas Environmental Engineer Ff0NICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HE~TH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~-~%~ ]~b4~O~L'~ Telephoue - Home Business Applicants Address (c) Applicant is (check one) Lending Institution ~ ; ~er/builder ~ ; Buyer ~ ; Other ~ (explain); ' ' Address (e) Real Estate Co. & Agent __~. ~,~-~4IT~'-/ Address --~lO~_ ~_e ~TI~..~__.~T"i- Telephone _ ~_/~ ~ (f) Mail the HAA to the following address: 2. Type of Residence Singl~-Family~ Multi-Family~--~ Other (describe) Number of Bedrooms____~ 3. Water Suj~.ly.- Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4o Sewage Disposa~ Onsite~ Public~ Community~--~ Helding Tank~ Note: If community well system, must have written confirmatiou from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. ~ineerin~ Firm Providing Inspections,. ~ests~ 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 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 regula- tions in effect on the date of this inspection. Name of Firm Telephone Address ~0~ ~ /5/~ Date ~c~ ~_ /~ ~?~," 0 ~! ,Z~,/~ \ ~. ~ ENGI~ER SEAL) ~-~ .' ~e'~H ~;-~l ' ~ ~ // I ~ ~ ~ 2225~E ~:~ DHE~ Approval ~'~ ~/ ' ~ "- ',~E,[,.~zt ' '~ Approved f bedrooms BF~¢~¢ /~---~'~at~, xc~ j,'~; / Approved ~ Disapproved ~ Condition~ ~ Terms of Conditional Approval · CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAG1L~PH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. TH]Z DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ?~CHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] ao Well Classification Well Log P~esent (Y/N) Total Depth ~/'~ Cased to Static Water Level Casing Height Above Ground Elect~icai Wiring in Conduit (Y/N) Separation Distances f~on Well: To Septic/Holding Tank on Lot TO Nearest Edge of Absoz~ption Field on Lot To Nearest Public Sewer Line C leanout/Manhole Water Sample Collected By Water Sample Test Results ~UNI~I~AU~y OJ~ ,'%NCHO~AG~ ~NVIRONM~NYAL Legal Description: ~0~ ~& _ If A, B, ~ C, D.E.C. ~p~o~d(Y~) ~te ~le~d ~/~ Yield W~ W/~ ~p~ of ~outing ~ ~t At Sanit~ ~al on ~sing (Y/N) ~ ~essi~ ~nd ~l~ead (Y~) -- ; On Adjoining Lots ~ ; On Adjoining Lots ----- To Nearest Public Sewer To Nearest Sever Service Line on Lot ~ ; Date ' ' B. SEPTIC/T~mmm~%~ TANK DATA Date Installed II IT& Size !,250 Standpipes (Y/N) ~" (ON~) Air-tight Caps (Y/N) Y Depression over Tank (Y/N) I%/ Date Last Pumped No. of Cct,~a~tments T %X/O Foundation Cleanout (Y/N) Y Pumping/Maintenance Contract on File (Y/N) ~//~, ; for ~//A Holding Tank High-Water Alarm (Y/N) h//~% Tempora~'":; Holding Tank Pe~tit (Y/N) tq//A Separation Distances ~cm Septic/Holding Tank: To Water-Supply Well J~o To P~operty Line ~ To Water Main/Service Line course N oN TO ~ilding Foundation ~ To Disposal Field ~O TO Stream, Pond, Lake, c~ Major D~_ainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIEIJ) DATA Soils Rating in Absorption Strata Date Installed Rio 1/ Width of Field. ~" Square Feet of A~sorpt~on ~A~ea Depression over Field (Y/N) Results of Last Adequacy Test Separation Distanae from Absorption Field: Date of Last Adequacy Test Type of System Design -~F:~(,%-I Length of Field ~ Depth of Field /5 Gravel Bed Thickness ~ Standpipes P~esent (Y/N) ~ tf; ','. s,-/ To ~ater-Supply Well To Building Foundation Lot ~ Q9 ~ ~ To Water Main/Service Line To Stream/Pon~/Lake/c~ Ma]o~ D~a~nage Course To D~iveway~. ~_~.k.~.ng A~.~e,9,.~o~ Vehicle Storage A~ea Ccnnmnts ALL ~$u~ ~4 ~UT ~:~-o ~ To P~operty Line ~ 0 TO Existing or Abandoned System on ; On Adjoining Lots ! D ~ ~ ~O+ To Cutbank(if present) D. LIFT STATION No'~ Date Installed Sime in Gallons "Pump On!' ~e~ve,1 at.....~,~ High Water Alarm I~ve. 1 at ,. Tested for ' Electrical Codes(Y/N) Counts Dir~ensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request I aertify that I have checked, verified, c~ conformed to all MOA HAA ~.~d~l~[~ in effect the date of this inspection.~ on Slgned' Date ' ' NGIN . KB1/d5/s [Page 2 of 2] 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCE~T~AL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (007) Address: 274-2533 To Whom It May Concern:. According to r~cords, on file in this office the ~'~¢~-~-~- ~ ~ ~ ~t~¢]'Water System is in complian~w-T~-~-~t~-~-~nking Water Regulations. -. Sincerely, ,~ ' ' - ~ulqlCIPALI'TY OF . DEPT, OF t¢~AL~[H & NIUNIC PAL TY OF ANCHORAGE pI;,OTEC~ION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~Y RoNMENTAL 825 L Street- Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-.720 RF. CEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER I~c~y ¢'¢~ L~ · PHONE MAI LiNG ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER 3. LENDING INSTITUTION PHONE 4AILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION .407- J g TREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One ~' Four [~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY [] INDIVI DUAL* * ATTACH WELL LOG. A well Icg is 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** **If individual/on-site, give installation date /~ "/~ '~ If system is over two (2) years old an adequacy test is required [] PUBLIC UTI LITY by this Department. NOTE: THE INSPECTION FEE I~UST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~010(3/78) THIS SIDE FOR OFFICIAL USE ONL', DATE RECEIVED iNSPECTION APPOINTMENTS ;'rIME TIME TIME : DATE DATE DATE I INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENOF. NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDI'VIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED ~3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Ileal ~ Connection Verified INSTALLER []SopticTankor []HoldingTank L ITT'L~- ~)i¢¢f¢-~4-- Size: / 3-$''~ If Tank is homemade SOILS RATING give dimensions: / ~ TYPE OF TA~I( MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS [~'1..~ APPROVED FOR ~ BEDROOMS I~1 CONDITIONAL APPROVAL (letter must accompany certificate) __[]DISAPPROVED /'""~) DATE BY ( T~_(~ k~~ LEGAL DESCRIPTION 72-010 (Rev, 3/78) August 2~ 1979 Mary/Richard Boorman Star Route A Box 36A Anchorage~ Alaska 99507 Subject~ Lot 24 B_ock 6 Valli Vae Estates Subdivision Approval for your individual sewer and water facilities can not be granted until the following items have been completed: (1) The septic tank pu~ped with a receipt submitted to this offlce. If there are uny further questions, please contact this office at 264~4720. Sincerely, Robert Co Pratt, f{.$o Associate Specialist P~CP/lJw First National Bank of Anchorage Attention: Trish Maltick Post office B~x 720 99510