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Home My WebLink AboutVALLI VUE ESTATES #2 BLK 6 LT 25 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221178 PID Number: 015-123-27 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name VERAL & JUDITH STOCKTON ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 6840 CROOKED TREE DRIVE, ANCHOREGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot VALLI VUE ESTATES #2 6 25 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FtZ Ft. Well 200'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ __ NA Foundation 10'+ ILIFT STATION Manufacturer Capacity Gal. Remarks Tank insulated. 3BR HOUSE — 1500 GAL S.T. installed for current functionality & future flexibility. Alarm location Electrical installed by Installer NORTHERN EXCAVATION PIPE MATERIAL House to tank 3034 d ainfie d 3034 Drainfield CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection 1" 2/15/23Location dates: Z d 2/16/2023 and description 3rd 4th BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL 2401`�,, -qb OF X11 Conditional Approval: Date ..... Q� Vo e(b IF .. 49- ....�.. �� • • Septic System Curtis Huffman Approved - �� 'Fc •, CE 128991 Date Z 2.a WZz }��J'��.•2/24/2023. �� k,F�pROFESSI�HP -� � Note: this approval does not include well permit requirements. � kRev 05102n6) 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com February 24, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: VALLI VUE EST. #2 B6, L25 – EXISTING FIELD TO FOUNDATION WAIVER Due to limited site constraints, the existing aged steel tank was removed, properly decommissioned and a new 1500-gallon HDPE tank installed in the same location. Per the septic tank upgrade permit the existing field was located to verify 5’ separation to the newly installed septic tank and a field cleanout was installed to the start of the trench. It was discovered at excavation that it appears this existing septic field is within 10’ of the existing foundation and has been for the past 30 years without any known issues or adverse impacts. Granting of this waiver is justified because there have been no known or observed adverse impacts for 30 years of any effluent interaction to the foundation. The MOA has approved the existing inspection report and subsequent COSAs of this property. This appears to be the closest portion of the 5’-wide trench to the foundation slab. The slab foundation is the garage with no living area impacts. The field invert is approximately 4’ below the bottom of this foundation garage area. The area has good compactable soils and no known groundwater issues. There has been no known settling or point load issues and the porosity of the soils indicate minimal if any lateral migration. We believe that separation is adequate to prevent any potential damage to the building or drain field per record documents and visual observations. We are unaware of any adverse impacts this waiver would have to the existing drain field or foundation. Given this justification, we respectfully request a 3’ existing field to foundation waiver be granted at this time. Granting of this waiver will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. licn Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Division On-Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV231007 COSA#:OSC231044 PID#: 015-123-27 Legal Description: Valli Vue Estates #2 Block 6 Lot 25 Engineer: Curtis Huffman Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the foundation has been approved. The approved separation distance is 3.0 feet. This waiver approval applies to the proposed absorption field. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: Z Z 2OZ Approved by: Name of Reviewer **** VARIANCE/WAIVER REVIEW **** PID:015-123-27 PERMIT:OSP221178 FIRST WATER CONSULTING VALLI VUE ESTATES #2 BLK 6 LT 25 // \ / / / Lot 23 10' UTILITY EASEMENTS NOTES 1) DUE TO SNOW & ICE COVER, SOME SURFACE LEVEL FEATURES ARE APPROXIMATE. 2) THE LOT IS SERVED BY A COMMUNITY WATER SYSTEM. PLOT PLAN AS BUILT _X SCALE GRID —40-_ GRID _ SW 2539Project No. -----L3=25.0/L1---- 11500 & Associates, n C (907) Daryl Avenue, Anchorage, Alaska ="`-3049 (907) 522-6476 Phone kenOlongsurvey.com �� Professional Land Surveyors jonothanOlangsurvey.com ?�OFAt,9`ll trovisOlangsurvey.com e'�, • •' • •, �, I hereby certify that I have surveyed the following described property: LOT 25, BLOCK 6, VALLI VUE ESTATES — UNIT No. 2 (PLAT No. 77-296) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the "✓`'""�'' �c.V1,0''"I'll �__ Day of 1_.___at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 48TH *I y , KENNETH G. LANG ,N 5,402 �Q� �� %l " ,1 9FDP' • .. (.'. • SSSAW !OFESSIONN� P State of Alaska AECC963 MUNICIPALITY OF ANCHORAGE nr On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 r� http://www.muni.org/onsite V u Depai-tment On -Site Wastewater Disposal System Permit Permit Number: OSP221178 Effective Date: 2/2/2023 Work Type: SepticTank Upgrade Expiration Date: 2/2/2024 Tax Code Number: 01512327000 Site Legal Address: VALLI VUE ESTATES #2 BLK 6 LT 25 G:2539 Site Mailing Address: 6840 CROOKED TREE DR, Anchorage Owner: STOCKTON VERAL E & JUDITH T Lot Size in Sq Ft: 20532 Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. Locate the beginning of the field prior to installation to confirm that the 5' separation between the tank and field will be met. Install a cleanout so the field can be located in the future. 2. The water service line is to be located and shown on the record drawing. i -ReGefved=EPj,: _ .1 5su e Issued By: Date: Date: Z Z 2y MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-123-27 Property owner(s) VERAL & JUDITH STOCKTON Day phone Mailing address 6831 ORCHID DRIVE, SALCHA, AK 99714 Site address 6840 CROOKED TREE DRIVE, ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) VALLI VUE ESTATES #2, B6 L25 Legal description 20 (Township, Range & Section) . __ .. Lot Size 532Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo AD U) Septic Tank 0 Upgrade 0 (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 4225 Waiver Fees: Date of Payment: �0Z3/a4,� ), Date of Payment: Receipt Number: 36ZQ 7 Receipt Number: Permit No. 17S Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com June 10, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: VALLI VUE ESTATES #2 B6, L25 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by public water / Class A well. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221178, Deb Wockenfuss, 06/28/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221178, Deb Wockenfuss, 06/28/22 ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ( ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ~NEW LEGAL DESCRIPTION LOCATION C~O KC& '~r~ NO' Of BEDROOMS l Well ~ Absor~t~n area Dwelling ~~ ~n' ~ DISTANCE TO: ~0~ ~D ~ (~ Manufacturer ~ Mat0rial~ [ No. of comoartments ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O z ~ Manufacturer Material Liquid capacity in gallons PER T NO O Well Foundation Nearest lot line~ ~ OTHfi8 pvc v 'H~ 0 · MUNICIPALITY OF ANCHORAGE ~ ~ ~, Department,~ Health and Environmenta]~lrotection .? ? 825 ~ Street, ~nchorage~ AK. J35UI .' ~1~ ~ 264-4720 ~ ?,'~O~S~ * * * HANDNRITTEN PERMIT * * * ~:~l~-~:-~...~ Permit # ~ ON-SITE 'SEWER PERMIT .t Location: Phone Number: ~,7~--':~'~ ~ ~TYpe of Soil ~sorption System ~ Trench: ~ Drainfield. Seepage BeC~ Holding Tank: M~imumX N~ber of Bedrooms.-- ~ Soil Rating(sq.ft/br) /~D The Required Size of the Soil ~sorption System Is:" ~EPTH t~ LENGTH ~ :~ GRAVEL DEPTH ~ W~DTH The length dimension is the length(in feet) of the trench or drainfield. The ~epth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in fee~). 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). · * REQUIRED SEPTIC(HOLDING) TANK SIZE= /~ GALLONS Pe~it applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this p~operty and the nu~er of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED ~ ~ ~ Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distan'ce between a well and any on-site sewage disposal system is 100 feet~ for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minim~ distance from a private well to a private sewer line is 25 feet and to a co,unity sewer line is 75 feet. Well logs are required an~ must be returned to this d~partmen.t within 30 days of the well completion. Other requirements may apply. .Specifications and construction diagrams are available to insure proper installation. · * * PERMIT EXPIRES DECEMBER 31, 1 9 g 3 * * * I certify that: (1) I ~ f~iliar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that~ bedrooms. SigneR: . ~__ Issued , App,'cant Date: SWP/024(1/81) 'tmzt ~ - ,, ~ ~ ON-SITE $~WER PERMIT ~- ~ -~' ~al De,trip%ion: i~l Size: ~pe of Soil ~sorp~ion System I~~~--~ ~'~neh; _~ Dratnfield~ ~ Beepage Bedj - ~ Holding Tank: ~ - · he ~e~tred Size of the Soil ~,sozption System ihe lengkh dxmens, on i~ the length(~n feet) of the ~rench or dra.znf~eld, The ~pth of a trench or pit is the distallce between the surface of the ground and ~he bottom of the excavatlon(i~~ ~ feet). There is no ~et width for trenches, fSe gravel depth is the minim~ depth of 9ravel between the outfall pipe and ,~h8 ~ttom of the ~xoavation{in feet.). ~ ~ REQUIRED SEPTIC(HOLDINg), , ~ANK SIZE = ..... . GALLONSt ~ ~ ~mi% applicant ha~ khe responsxbllity %o info~ this dep=rtmen du~:ing the zltallation i~speotions of ar{y we]ls adjacent to this pro~z'ty an~ the ~es~dences that th~ well will serve, ~ ~ * T~O(2) INSPECTIONS ARE REQUIRED * ~ ~ Lkfztlzng of any myst. em without, final inspection and approval by this deparkmer i'1 ~ subject to i~o~ Bi,tahOe between a well and any on-site sewage disposal system is !00 8 p~vat.~ well or 150 %o 200 feet f~om a public well dep~hdinq upon the type '.pubt~,c well, Minimum dimtance from a private well to a privake s~wer line i~5 feet and to 8 gommunity ~ewer line is 75 feet. well logs are r~quired I must be r~turnt~ to this deEattm~nk within 30 days of tbs well completion ' ~er requiremer~t~ ~zy apply. Speoifioat$ons and constroction dxagram~, are ~t!able tO insure proper in~tallatioo. ~ ~ { P~RMll' EXPIRtS DECE~ER 51~ 1 9 8 3 * ~ ~ [ certify that: (1) ~ ~ f~iliay with the requirements for on-site s~wers add wells as Set forth by th~ M~-~icipality of ~{oho~age. (2) I will install the system in aecordano~ with c~es, (3) X under~kand thak the on-s~te sewer system may require er~largemenl if · ' ~ t hat/.~ bed room~4, S~gne' ' ~: l~sued by ~ Date: ......... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG ~' [] PERCOLATION TEST ': ' 3- 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE ENCO NTE"E ? O E IF YES, AT WHAT ~ DEPTH? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN COMMENTS PERFORMED BY: -~'~'~ ~(,~-'~ CERTIFIED BY: (minutes/inch) FT AND __ FT 72-008 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 015-123-27 Certificate of On -Site Systems Approval 2 - Expiration Date: 2 11 Legal description VALLI VUE ESTATES #2 BLK 6 LT 25 Site address 6840 Crooked Tree Dr Anchorage Current property owner(s) Veral and Judith Stockton X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: M Original Certificate Date: 2/27/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approva"une 2022 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-123-27 Complete legal description VALLI VUE ESTATES #2 BLOCK 6, LOT 25 Location (site address) 6840 CROOKED TREE DRIVE, ANCHORAGE, AK 99507 Current property owner(s) VERAL & JUDITH STOCKTON 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ® Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 0 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit 3, Waiver request for: EXISTING FIELD TO FOUNDATION Distance:._ Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ V1@ Date of Payment a Y/ 01)e COSA# OSC/ (Irl 6--7q �z35— Waiver Fee $ 7S� Date of Payment Waiver # Vea COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: VALLI VUE ESTATES #2 BLOCK 6, LOT 25 Parcel ID: 015-123-27 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC &/OR CLASS “A” WATER Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NA – NEW TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/18/1983 ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 5.5 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective 3.5’ OF 5’ED Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 5/4/2022 Results Pass Fluid depth prior to test 1 in Water added 750 gal New fluid depth 5 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 60 in Effective depth used 18 in (MISSING ED) Effective depth remaining 42 in Comments/Deficiencies: Measurements taken show approximately 3.5’ of the 5’ ED MOA inspection report (IR). Field appears to be working at and below the bottom of the existing MT/Sump, which was missing approximately 18”. Field pipe was jetted and cleaned in 2/2023. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No *3’+ ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *Waiver submitted with this COSA application – 3’ separation to existing foundation to field. G. CERTIFICATION & 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, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 2/24/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 2/24/23 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 lot, block, subdivision, section, township, range) Lot 25; Block 6; Valli Vu~ Estates ~2 Location (address or directions) 6840 Crooked Tree DrZve (b) Property owner Mailing Address (c) Lending Institution Mailing Address A1 Be~tgstrom Telephone: (home) 346-3801 Business 562-6186 6840 Crooked Tree Drive, Anchora.~e, Ak. Telephone Jack White Company ATTN: Dale Murphy (d) RealEstate Company and Agent Address 5201 C Street Telephone 563-5500 Suite 100 Anchoraqe, Alaska 99503 · (e) Mail the HAA to the following address: (or check here I~'¢ if hold for pick up.) List contact person and day phone number below: $ & S ENGINEERING 1703-* Eagle R~ver Lo~I~ Road No. ~ Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family E~x' Number of bedrooms $ .... 3. WATER SUPPLY Individual Well [] Community ~ Public [] Note: If community weld 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 legality 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 ~ ~ S ENGINEERING 17034 Eagle River Loop Road No, 204 Address Eagle ~,[yer, Alaska 99577 Date Telephone 6, DHHS APPROVAL Approved for_~--~ bedrooms by Approved ~.~ _._ Disapproved Terms of Conditional Approval Conditional ~ ' ............... IF TI ,f;T,all[flgF--- I1 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph $ above by an independent .p_rofessional 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 om issions in the professional engineer's work. A. WELL DATA Well ClassificatiOn MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Des~/ription: If A, B, C, D.E.C. Approved (~N) ~ Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Fieldon Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~"f(:~" ~"~ Size Standpipes ~'N) y Depression over Tank (Y~' TO Water-Supply Well To Property Line To Water Main/Service Line [, ~ No. of Compartments ' ~- Air-tight Caps~:~'q) 7 Foundation Cleanout(~N) r~ ..Date Last Pumped /C~ - ) ,~,-- '~::~' '~//~- ;for Pumping/Maintenance Contact on File (Y/Ni~/~ Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Building Foundation To Disposal Field ~ ~ To Stream, Pond, Lake or Major Drainage Course \ ~ Comments A 72-026(Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA . / Soils Rating in Absorption Strata Date Installed Width of Field ~'~ Type of System Design "~'T'~,~(-~F4 Length of Field ~ Depth of Field "~ /~, I ,,~/~, Square Feet of Absortion Area Depression over Field (Y~ Results of Last Adequacy Test Gravel Bed Thickness ~ ¢ /--'~6~-~~' Statndpipes Present'CP/N) r.--[ Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well '"-Z-~~t-~ To Building Foundatio~ Lot To Water Main/Service Line To Property Line '~---'='1 f To Existing or Abandoned System on ; On Adjoining Lots %f.,4- To Cutback (if present) ~....~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. ~,~T STATION Size in Gallo n~'---~ ~ "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) ng Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. Signed Company Date MOA NO. S & S ENGINEERING 17034 Eagle River Loop Eoad No. 204 Date of Payment '~--~:::~/-~' ~'~ Amount: $ ,,/'~,. P~-'~. Receipt No Waiver Fee: $ Date of Payment 72-O26 (Rev. 7/88) Back Page 2 of 2