HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 1 LT 51Valli Vue Estates
#2
Lot 51
Block I
#015-123-06
GRE -,. ?ER ANCHORAGE AREA BOk-,. UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE //') ~ ~ NUMBER OF
FROM WELLL~.I:)~-4A-fl/A/~"MANUFACTURER MATERIAL . COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY
TILE DRAIN FIELD:
DISTANCE FROM WELL~OUNDATION /0
NUMBER OF LINES I DISTANCE BETWEEN LINES
ABSORPTION AREA g ~-- SQ. FT. LENGTH OF EACH LINE '~)'
DEPTH: TOPOFTILETOF.N.S. GRADE ' DEPTHOEE.LTER
MATERIAL BENEATH TILE . ABOVE TILE
-[ OF LINES ~-~O(~
NEAREST LOT LINE ~' TOTAL LENGTH ~
/I////~/' TRENCH W ID TH,~ ,~ IN. TOTAL EFFECTIVE
IN.
WELL:
BUILDING
FOUNDATION
CESSPOOL
APPROVED
.CONSTRUCTION
NEAREST NEAREST
LOT LINE , SEWER LINE__
OTHER SOURCES
DISAPPROVED REMARKS
DEPTH _
SEPTIC SEEPAGE
TANK ~ SYSTEM
DISTANCE FROM:
DISTANCES:
INSTALLED
/~///
SEWER LINE DEPTH: --
PIPE MATERIAL: ~¢~
LOT SLOPE:
REMARKS:
Form EQ-032
HF F I_ t: . .. ',1 I
L 7 ': I::1"1' ]' "bi
L.EGRL
THE R'.Ei:I]:!I_.I ]: I-~:E[::, :, .I. ,~..E OF 't"HE 'L: 13 ] I.. I:IE:'_-7';Of~PT ]~ Of",1 _, r .., f L.i'l :
'T'IdiE L. tEIgEiTH t], I MIS?-,I:.'.51 CIN 1[ S 'THIE LENGTH ':.' I i',l FEET :) Ol:' THE TRENCI-4 OR [>[~-'.1::11 i',lF' I ELI::,.
T'HE B, EF'TI.'~ OF FI TF'.EI'qC:H OR F'I-f' :[S THE; [:,ISTI::IbtCE BE'f'I,.IEEN THE SL.II:,?.FFIC:E OF THE
I:~if-::'OIJl'.,ll:::, FIN[;, THE; E',EFI"TOH OF- THE [.Z',=.:,CFt'v'FIT ]7 EIN ,:: I bi FEET
'THEFdE :IS NO SET !.,.IZ[J:,TI.I FOi';?. TF...'E:NC:HE'S.
'THEi: GF:R'v'IEL DEF"TH Z~-.: T'HE t','ili'-,I:[HLIH [;,EF'TH OF GP.F¢,,,'EL E[ETI.,.hE-.".EN THE OUTFFILI_. F'ZPE
Fff',ID THE E:OTTEIH OF 'fT'IIE I_-::::-::C:I::I',/FIT :[ ON ,:i IN
HIH]:hlLJH D):S-I'f:¥,If_-:IE E:IE'FI.qEE~N fl WELL. FIN[:) F:~N"r' OI",I-SI'TE SIEb.lfaGE [)ZSF'F)'_:~;RL S"r':STEH
::1.OO FE:ET F'(]R f:! F'I:,i:]:',,,'f:I-I"E WELL. OF: ;;::00 FEET FOF,' fl PL.JBLZC b.IEL_L..
~;I:'EC: :[ F' Z CRT ]70PqS FIf.,IIT:, COI'.,]:.:.i;TF,4'.UCT I Ol'.,I E:, ]: IaG,L;~:FIPIS FII:,?.E fl',,"fl :[ L..flBL. E TEl Z bISL.II~'.E F'RC]F'IEI'4:
N.ST FH_.!...RT ]: ON.
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i C:ER'I" ]: F"r' THF:I"I'
:I..: ]; FIH F:F:IHit...IFIR WITH THE RED:;{U]:F~rEHEI',ITS FOR OI'4-SI:T'E SEb.IERS FII",i[) b. IEI....L..S FI:E; SET
I:::ORTH E:'T' 'I"HE Pil..II'-,I:[C]:F'FII..]:"I""¢ OF FII'.,IE:HORf:H]~iIE.
;Z: ]; W:[L.I... INSTFILJ.. 'THE..~.;"/STEM !N FIE:CEIR:DFINE:E WI:TH THE E:ODE'_'5.
::.i:: Z UI'.,IDERS-FfaNC, THFIT I'iE: ON-_S]:TE SEWER S'.r's"r'EH f'lF:l'-r' I:,::EQUIF.:[E E]qL.FIF:'.LTiEJ"IEI'.,FF IF 'T'HE
F?.E~i;I[)IEI",ICE IS qCL.LIDE I"IOI:--::E 'THF:IN 3: _F.:EDr.;?.OOHS,,
:iii; ]: GI',I[.:]::,: ~%
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/
GRE,~,-FER ANCHORAG[ AREA BOROUGH
DEPARTMENT OF ENVTRONMFtlTA[ OUALITY
3330 "C" Street
ANCHORAGE, ALASKA 99503
Case #
Performed For
Legal Description: Lot ~ Block
This Form RePorts Soils Log
Soil Tes( Must Be Logged To 4'
Depth
Feet Soil Characteristics
2~
3~
4~
6--
8~
9~
lO~
~2~
13~
.I f
Ground Water Encountered?
Yes, At What Depth?
Dated Performed U[.~[W?
Subdivision VA~-~ Vl~c~
Percolation Test
Below Proposed Seepage System
J I
Reading Date
Pef'colaLion Rate -.~
Gross Time Net Time Depth to
Proposed Installation: Seepage Pit Drain
Depth of Inlet Z/ Depth to Bottom ~-f~Pit Or
Test Performed BY ~l/~Zz_,qc'~¢ E~/~¢,_Z;
Field
Trenc[--/~/
Ps~) I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On.~te Services Section
P.O. Box lg6650 Anc~rage, Nas~ 9951g-6650
(907) 34.3-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
015-125-06
GENERAL INFORMATION ~5¢_¢L~8~
Complete legal description VALLI VUE~SUBDIVISION ,~2: LOT 51. BLOCK 1
Location (site address or directions) ~83o ROUND TREE DRIVE
Pmpertyowner ROSS FOSBERG
Mailing address 8221 MENTRA. ANCHORAGE. AK 99518
Lending agency
Mailing address
Day phone~
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
'3. TYPE OF WATER SUPPLY:
Individual well
Community well xx
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTE-WATER DISPOSAL:
individual on-site xx
Holding Tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
lng to the legalfty and status of system.
72472,5 (Rev. t/91) Front MOA #21 Computer Vemion
Note: Alaska Water and Waste. water Consultants, Inc. shall be paid $700.00 at,
or prior to, closing for the engineering servfces provfded.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my
inves'dgation of this Health Authority Approval application shmNs 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 heroin. I further vedfy that based on the infomlafion obtained from the Municipality of
Anchorage files and from my investigation and i~spection, the on-site water supply and/or wastewater
disposal system is in compliance with all Munic~l~l and State codes, ordinances, and regulations in effect
on the date of this inspectien;~,, ~ :t//
NameofFirm ALASKAWATER&'WAS'FEWATERCONSULTANTS, INC. Phone (907)337-6179
~ I /
Address 6901 DEBARR ROAD,/S/UI~"E 2~ A~CHORAGE, ALASKA 99504 ,
system in accordance w~ ADEC and ~OA~DI-ll~.S Guidelines & Regulations. The repert~cl resutte described the
performance of the system under the d~nditions encountered at the time of the test, and separation distances
measured to readily identifiable features. The operational life of ail wells and septic systems depend
~n the /~cai s~~~s c~nd~t~~n~ gr~und water ~evais that may ~uctuate during th~ year~ and the water
the evaiuator of the system. Satisfactory test results do not guarantee futura per/'ormance
AWWC, lnc. can thorafore not pravlde any warran~y for future estimate of how teng the ~.~.... ~ (~ kl~ ~ ...'.~v~)
The content of this raport is for the sole benetit of the owner #st~d anove. ,,~ny ~ ~/ ~
reliance upon or use of this raport by any other person or party is not authorized, ~ ~ ,~...~ .. ~. ..... · .~....
nor will it confer any legal dght whatsesver.
7953 '
6. DHHS SIGNATURE
f/' 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 Healtfl Authority
Approval Ceraficates based only upon the representaitons given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska, The DHHS does this as a courtesy to purchasem of
homes and their lending institutions in order to satisfy certain federal and state raquirements. Employess of
DHHS do not conduct inspections or analyze data before a certificate is issued, The Municipality of
Anchorage is not responsible for ermm or emissions in the professional engineer's wod(.
72-025 (Rev. 1/gl) Back MOA ~21 C~mputar Vemion
RECEIVED
Municipality of Anchorage MAY 2:~ 2000
DEPARTMENT OF HEALTH & HUMAN ~E~ ^NC~O~
Environmental Services Division ,VIROi'~ENTAL SERVICES DIVISIC
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744
Health Authority Approval Checklist
Legal Description: VALLI VUE S/D #2; LOT 51, BLOCK 1 Parcel I.D.:
015-125-06
A. WELL DATA
Well Type CLASS "A"
Log present (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number 210605
Date completed
Total depth Cased to
Casing height (above ground)
Sanitary seal (Y/N)
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
WATER SAMPLE RESULTS:
Coliform Nitrate
g.p.m.
AT INSPECTION
~cteda
g.p.m.
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 7/6/77 Tank size 1000 ' Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (y/N) YES Depression (Y/N) NO High water alarm (Y/N) N/A
Date of Pumping 5/17/00
C, ABSORPTION FIELD DATA
Date installed 7/6/77
Length 38' Width
YES
Pumper A + HOME SERVICES
MT ONLY EXTENDS 27.5"
BELOW DRA NP PE NVERT.
Soil rating (g.p.d./f12 or ft2/bdrm) 125 System type TRENCH
.3' Gravel thickness below pipe 5' Total depth 10%/-
Effective absorption area 375 SQ. FT. Monitoring Tube present (Y/N) YES Depression overfield (Y/N)
Date of adequacy test 5/17/00 Results (Pass/Fail) PASS For 3
Fluid depth in absorption field before test (in.); DRY immediately after 2012 gal. water added (in.):
Fluid depth DRY (ins) Minutes later: 60 Absorption rate = 450+
NO
Bedrooms
4,5
Peroxide treatment (past 12 months) (Y/N)
72~026 (Rev. 3/96)* Computer Vemlon
NONE KNOWN If yes, give date
D. LIFT STATION ~~/
Date installed ~~
Manhole/Access (Y/N) _ ~on" level at* "Pump off" level at*
High wat~ *Datum __
~sted
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main ~
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+
Water main/service line 10'+ Surface water/drainage 100'+
Absorption field __
Wells on adjacent lots
5'+
200'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
10'+
Building foundation
100'+
NONE KNOWN
10'+ Water main/service line_
Driveway, parking/vehicle storage area __
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review
of Municipal records that the above systems are in conformance
with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name
JEFFREY A. GARNESS
Date
10'+
Wells on adjacent lots 200'+
.......
~/...?' '...
.....................
~....~ .................... ...~
~0~. "'.. C~-7~53 ..." ~
.... ..........
~ cress[
HAA Fee $ ~ ~ ~)
Date of Payment ~'~/~'~ J ~
Receipt Number '~;' '7 -~' { ~ ~--5'-/~
72-026 (Rev, 3/96)* Compuler Version
Waiver Fee $.
Date of Payment
Receipt Number
Fost.lt' Fax Note 7671
Phone ff ~
· ~ ~ de~tml~ the ex~{~'nee ~t stay ~ae-
LOT SURVEY CERTIFICATION 6).,o,' cop