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VALLI VUE ESTATES #2 BLK 3 LT 30
Valli Vue Estates #2 Lot 30 Block 3 #015-341-38 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP251055 PID Number: 015-341-38 Dwelling: W Single Family (SF) F1 with ADU 1771 Duplex (D) r-1 Two Single Family Project: 1771 New FE -1 Upgrade Name DOUGLAS & JULIE WHITTAKER ORPTION F RPTION FIELD r�E] D Trench El D Trench F-1 Wide Trench E] Bed ound Site Address 6324 RED TREE CIRCLE, ANCHORAGE, AK Other ZPZ Phone Number of Bedrooms Soil Rating depth fr original grade ]Ft. 907-602-9660 4 ITotal LEGAL DESCRIPTION Depth to pipe invert le Gravel depth beneath pipe !>< , Ft. Subdivision Block Lot VALLI VUE ESTATES #2 3 30 Fill added above original gr G Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dise between lines NlFt. SEPARATION DISTANCES To Septic Absorption LiftStation Holding Sewer Total orption area Number of trenches Dist. -between —Nijc7hes From Tank Field Tank Line Ft' Well PUBLIC EXIST. - - 25+ TANK 9 Septic [I S.T.E.P. [E0:1 Holding El Other Manufacturer GREEK TANK Capacity 1500 Gal. Surface Water 100'+ EXIST. - - Material Number of compartments Lot Line 5+ EXIST. - - NA PLASTIC (DEEP BURIAL) 2 Foundation *8'+ EXIST. - - ATION Manufacturer Capacity Remarks *SEE DETAIL DRAWING, PAGE 3 OF 3. Gal. NOTE: TANK LARGER THAN NEEDED Alarm location Elec r I tailed by Installer PIPE MATERIAL House to tank D3034d Tankto D3034 rainfield ARM SEPTIC SERVICES Drainfield EXIST. CO/MT D3034 Inspector GARNESS ENGINEERING GROUP, LTD. BENCH MARK (Assumed elevation) 100.00 ft Inspdatesn ectiois, 5/19/2025 Location and description : 2 �d aro 4th BOTTOM OF WINDOW SILL TRIM NEAR FCO ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date N P0 4 ......... . ....... .......... ...... .......... Septic Syste e Hess; Approved Date CE 79 3 04. 1- ,N e: this approval does not include well permit requirements. 4�111 Pr e s"\ 4=7 #AECC884 tmev uoiuzi-i 7 10PARCEL ID NUMBER:OSP2555 RECORD DRAWING 015-341-38 ( EXISTING DRAINFIELD. \ LOCATION SHOWN PER \ PROFESSIONAL LOCATES —� `L APPROX. LOCATION OF NEIGHBORING SEPTIC SYSTEK RED TREE CIRCLE INSTALLED DOUBLE CLEANOUTS (DBL1 & DBL2 r: e; EXISTING 4 -BEDROOM HOUSE e EXISTING WATER LINE. LOCATION SHOWN PER .` PROFESSIONAL LOCATES VALLIE WE ESTATES #2; \ BLK 3, LOT 29 N -NEW 1500 -GALLON GREER PLASTIC SEPTIC TANK WITH �\ MANHOLES ON EACH gyp, SCALE: END OF TANK. G 30' cp A A B C \ FCO 16.0 10.1 34.8 MH1 23.4 13.5 34.9 MH2 27.4 13.5 32.3 DBL1 29.5 15.2 32.3 DBL2 29.8 16.0 33.0 C01 46.6 31.4 38.1 MT1 43.8 29.4 38.7 CO2 13.1 24.4 48.7 MT2 16.7 22.9 46.4 VALUE VUE ESTATES #2; BLK 3, LOT 31 NOTE: THE TOP OF DRAINROCK NOTE: PIPE LOCATIONS ARE NOTE: PER THE CONTRACTOR, i IN THE TRENCH WAS SHOWN PER GEG SHOTS THE OLD TANK WAS EXCAVATED, EXPOSED NEAR THE NEW TAKEN WITH LEICA DISTO PUMPED, REMOVED, AND SEPTIC TANK. CONFIRMED THAT S910 LASER DISTANCE DISPOSED OFFSITE. THERE IS 5.5' SEPARATION METER. SWING -TIES TO _ HOUSE CORNERS WERE ' GENERATED IN AUTOCAD. --------_-_--._.__-_—�- --- 10'UTILITYEASEMENT /. ENGINEERING - SALES CONSULTING 3701 E. TUDOR ROAD, SURE 101 -ANCHORAGE, ALASKA -PHONE (907) 337.8179 - WEBSITE: www.gamessenginsering.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DOUGLAS WHITTAKER 907-602-9660 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: VALLI VUE ESTATES #2; BLOCK 3, LOT 30 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC TANK UPGRADE 5/30/2025 OF a W# v C 71? LICENSE 1441 ESS *"' #AECC884 ��,�,• N NUMBER: PARCEL ID NUMBER: RECORD DRAWING 015-341-38 TOP OF MANHOLE FINAL GRADE TOP OF MANHOLE (MH1)=97.18 =96.86-96.95 F (MH2)=97.12 TOP OF TANK @ INLET = 94.48— INVERT OF BUNG (ii) INLET = 93.89 NEW 1500 -GALLON GREER PLASTIC SEPTIC TANK a �9S \�c�F \�9 l� /BOTTOM OF FOOTER = 93.07 NFA \0 vo O,e DETAIL DRAWING FOR TANK TO FOUNDATION ENGINEERING � SALES - CONSULTING , 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, ALASKA' PHONE (907) 337-8179' WEBSITE: www.gamessenginsenng.eom PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DOUGLAS WHITTAKER 907-602-9660 3 OF 3 PROJECTILEGAL DESCRIPTION: DRAWN BY: VALLI VUE ESTATES #2; BLOCK 3, LOT 30 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC TANK UPGRADE 5/30/2025 TOP OF TANK OUTLET = 94.48 +!-2° OF INSULATION PER CONTRACTOR VERT OF BUNG (81 OUTLET - 93.58 NEW 1500 -GALLON \ GREER PLASTIC SEPTIC TANK — BOTTOM OF EXCAVATION OF TANK = 88.08 .�S:wx�sl CE-79Q� •' •OFESS\�����• LICENSE 11Illis #AECC884 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251055 Work Type: SepticTank Upgrade Tax Code Number: 01534138000 Site Legal Address: VALLI VUE ESTATES #2 BLK 3 LT 30 G:2538 Site Mailing Address: 6324 RED TREE CIR, Anchorage Owner: WHITTAKER DOUGLAS P & JULIE A Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: S' Departulent 3/18/2025 3/18/2026 20469 ❑ 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 edge of the field to confirm tank to field separation. 2. Possible outcomes of this tank install; encroachment easement for field, new cleanout and monitor tube, field to lot line waiver. Received By: S -S C- F G) 1 Issued By: L Date: Date: �„�,1 � t `--c> 4 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-341-38 Property owner(s) DOUGLAS WHITTAKER Mailing address 6324 RED TREE, ANCHORAGE, AK Site address 6324 RED TREE, ANCHORAGE, AK Phone: 907-343-7904 Fax: 907-343-7997 Day phone 907-602-9660 Legal description (Sub'd., Block & Lot) VALLI VUE ESTATES #2; BLOCK 3, LOT 30 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field F� Initial ❑Single Family (SF) rX-1 (w/wo ADU) Septic Tank ❑ Upgrade 0 Duplex (D) D Holding Tank EJ Renewal M Multiple Dwellings D Privy D (SF and/or D) Private Well M Water Storage D THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance:' I 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: ?, I ✓- Waiver Fees: 3 / 1,3 Date of Payment: Z Date of Payment: I I Receipt Number: Permit No. Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FornnsTerynit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251055, Curtis Townsend, 03/18/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251055, Curtis Townsend, 03/18/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251055, Curtis Townsend, 03/18/25 V I � t` t r• LU 0 L. u LAJ LL fJ�e• f i 1 5 I= Y v.� �' f • t �� .t'•e • eZ Y •. UJ fA PA -' VA LL- N cr) z .x .... v • '- F� O A=7 t C] 0 0 • ca 0 �=swam > � L D 0 0 � 00 Y i J y) ...�. 0 0 W aftwo cy) (1) 14- 0 .j CL L. v •.•. y I►p...0 ip -r- Q O 0 4 4 O ?� LA C •♦.= o ,coo Ea C C O > O C Q • V! .� .0 +� O V i a > t � *' .ti 0 t7 CL 0 f►1 O CL °�'OO V0z E a- U o �tr 1J v,v C �.. O �♦.. O �. C C -0 O IL -� �+ ♦' o O O -C 0 E � v z ,.. O y Q o c ,..• 0 ..._ m��� a or CL •. LAJ c T ° -0 �-v O C-vU '0 e W C a CL v 0 �► �Q� O V O� C �D � 0 C ft „O V � y t3 C O O > v` t 3c J y�.? T ' �..•h .cQ.htowe 0 -C c .0 CL o ;� V 0 �- "� '� v C3 �.• Q ..,. „ •--• to y v -i .0 CL V C O cL O 0 .�., C 0 ID 4w OC t7 O > y H L 3+ .0 x..r V) C 0. 0000 .0 0 -.�0_•.... E O O RED TREE CIRCLE 3.2 x 7.3' 0 SEPTIC PIP 4.0' SALCONY—�J WOODEN FENCE—..,,�\r,\//' WOOD H WIRE FENCE, .d, Lot 31 -- \ JI z^/ N Lot 34 Lot 35 \ \ i ASPHALT PAEMENT EXHIBIT A TO EASEMENT n GD '\ Op CIA \N \ 10' UTILITY T LITY & '.0. CANT--, - \ TDRAINAGE EASEMENTS 5 _y RESIr;EN<,E 4� \ Lot 29 evlY.-1 WALKO':t .1 6AScmEN? E5� 3,4' z 12,5• S7ORACE \ -- �) \\ DECKS \ (-J 1.4' CANT Lot 30 20,469 s.f. r is / 0 / 0' UTILITY EASEMENTS 4� �1 kid N 86'59'47"W 175.00' Lot 14 \ Lot 13\\ NOTES: THIS PROPERTY IS SERVED BY A COMMUNITY WATER SYSTEM, THE DRIVEWAY TO LOT 29 ENCROACHES AS SHOWN. PLOT PLAN ___ AS BUILT _X_ SCALE _ 1__= 30 GRID _ SW2538__ Pro ect No. ___ J24-1361 P.O. Box 210O05 Lang & Associates, inc. Anchorage, Alaska 99521-0005 (907) 522-6476 Professional Land Surveyors jonathan*langsurvey.com F Bopp P� 0 A �p ken®longsurvey.com d .•,-� • • • • •'; .. I hereby certify that I have surveyed the following described property: LOT 30, BLOCK 3, VALLI VUE ESTATES UNIT No. 2 (Plot 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 _ Day of 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, State of Alaska AECC963 LO LOLO CD � T � I � lt7 CD a C-41 C:) ~ , MUNICIPALITY OF ANCHORAGE ....~ · DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ,r ENVIRONiVIEN"i'AL ENGINEERING DIVISION 825 L Street- Anchorage. Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MUN ICIPA~I~i~ ANCHORA~E[~[NEW - ' ................ ~OTECTiv,4 LEGAL DESCRIPTION 2/~N 2 '] lUS~ I ~Well ~. bsorption area Dwelling PERMIT NO~ kJq. capacit Jn gallons inside length Width Liquid depth ~ II, Foundation i Nearest lot line PERMIT NO,~ "o. oflines , Length o~¢h line Total I':~tZ' lines_ Tren~ ~th . inches Distance between lines Total effective absor tion area ~ Topoftiletofinish~a~e¢~j~j~_~ ~g ~1 Material beneath tile ~J*O inches ¢~ Z ~ '~: Length ~ Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot llne PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(si 72-013~ PERMIT NO. RPF'L i CRNT LOCRT I BN LEGRL DEPRRTMENT ~ HERLTH RND EN',,,'IRONMENTRL ,~OTEC:TION _.TREET, RNTHnRRGE. BK. J:2 264-47RC~ 0~-~. Z T~ ~...-]~ F'~F.~ Z T 71 ¢1'-,o '- RNDERSON BRZS BO,. 694 E. RE[:, TREE CIRE:LE LOT g8 BLK Z~ ',/RLLI VUE SIJB LOT SIZE ~.~L, ,_,~.1 '-]ITJl IRRE FEET TYF'E OF :,;_ilL HE,_,uRFTIuN SYSTEM '-' TRENC:H · . ". ' ..,. =, L ~.:R~INI..~ ,::SQ FT,."BR)= M~'3XIMI_IM NI_IME, ER OF BEDROOMS = '> '- THE REQLtIRED _I,:.E OF THE _,uIL RES]RPTION SYSTEM I_. :2;---"5 C, EPTH=: 12 L_E~-~GTH= -~-2 n_SRR"./E [_ [:,EPTH= .-~t. 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT tS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND 8ND THE BOTTOM OF THE EXCBVRTION (IN FEET). TNERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). F'ERMIT HPPLI_.BNT HRS THE RE~FuN~IBILITT TB INFORM THIS DEPRRTMENT [,IIRING THE INc, TMLLRFION IN_FECTIuN_ OF RNY HELL_, BDJBCENT TO THIS FECPERT'¢ FIN[:, THE NUMBER OF RESIDENCES TI-IRT THE WELL WILL SERVE. ~ __ ~¢- '- ' -' - ' ''',,'~ BY ERRP'FTI LING OF BNY _T--TEM WITHOLIT FINRL IN--FEL. TION RND HFPEL,HL THI_, DEPRRTMENT WILL E,E --,UE, JEL. T TO PR_-¥SEE_TIZN MINIMUM DISTRNCE BETWEEN R NELL RND RNY ON-SITE SENRGE DISPOSRL SYSTEM IS 100 FEET FOR R PRIVRTE WELL OR !50 TO 288 FEET FROM A PUBLIC NELL· DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVR'FE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. · - "--- t '-=~- ~ ::L PEF-:[-'I I T E::--'F' I RE.--. DEL--:-E~-IBE[-i.: r-', ' ,,R', -.EETIFT THRT ~ ~ ,= ,--~- I RM FRMILIRR NITH THE ..E..]LIREME~;~FS ~FL4R flN-'-~TE _,EWER_-, RND WELLS H--, SET I FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I I,.IILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ]:: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3: BEDROOMS. _., I ~NE[ __ ]_ .............. BPPL I CFtNT RN[:,ERSON BROS. ISSUED B'~~~ ~--~ ...... E:'FI ' E - -r-~ --~- -~-~- ~- - - i Il i SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825'L. Street, Anch¢irage, Alaska 99501 264-4720 -SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR= 'EGAL DESCR,PT ON: 1- , 6- 10- 11- -~12 - · 13- 14- 15- 16- 17 18- 19- SLOPE NO. 1732-E June 22, 1968 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Readir~j Date Gross Net · Depth to Net Time Time ' Water Drop I COMMENTS /'~ /~)0 7' ~5~ PERCOLATION RATE TEST RUN BETWEE~N ET AND (minutes/inch) FT 72*-008 (6/79) :1 ~MUNICIPALITY O F~,...-,..'~HO RAG E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION CITIZEN COMPLAINT [] JUNK CAR [] NUISANCE ~,~WAG E []AIR [] WATER [] NOISE [] HOUSING ~ PUB FAC LOCATION OF PROBLEM DETAILS OF COMPLAINT VIOLATOR'S NAME (If known) ADDRESS PHONE o79-o96o 70-006 (Rev. 1/78) DO NOT TAKE ANONYMOUS COMPLAINTS c>, IG9. ~.63 , d~,-.i'4 ?m I n~reby certify that I have su~teyed the following described property, Lot .~[,..Block. '-P MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251267 Parcel ID 015 -341-38 Expiration Date: 5/19/2026 Legal description VALLI VUE ESTATES #2 BLK 3 LT 30 Site address 6324 RED TREE CIR Current property owner(s) WHITTAKER DOUGLAS P X The On-site system(s) is/are approved for 4 bedrooms 0 Conditional approval for bedrooms, with the following stipulations: Comments or conditions: Original Certificate Date: 7/10/2025 This ificate of On Systems Approval (COSA) is intended to demonstrate the subject sy m(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, evelopment Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-341-38 Complete legal description Valli Vue Estates #2 L30 133 Location (site address) 6324 Red Tree *Anchorage AK Current property owner(s) Douglas Whittaker 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 907-602-9660 3. TYPE OF WATER SUPPLY: El Private Well serving #_ dwelling units 171 Other Non-public well as regulated by MOA M Water Storage X Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: RN Private Septic [] Private Septic serving 2 dwelling units 171 Holding Tank R Community Septic or Public Sewer 5. SEPTIC TANK: Fj Steel 01 Plastic ❑ Concrete R Fiberglass Age NEW _ See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: [:1 AWWTS F1 Bed RN Deep Trench El Wide Trench 171 Seepage Pit Waiver request for: Distance: Expedited review requested: 1771 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 $ M Waiver Fee $ Date of Payment 717M Date of Payment COSA# ()sC X2 7 Waiver # COSA APPJ1ca0on_Apr2025.doc COSA Checklist Legal Description: Valli Vue Estates #2 L30 B3 Parcel ID: 015-341-38 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 LL DATA ❑ Well log I Date drilled COMMUNITY WATER with Onsite (or attached) Well production at time of depth ft Water storage Cased to ft \ ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) Date of flow test for CO Well >merame gallons for coliform test? ❑ Yes © No TJ Coliform bacteria is Negative itrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L E]Arsenic less than MRL (ND) Collected by Static water at beginning of test ft. Date B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA T STATION ❑ Require tenance compl Age of lift station rs Lift station m Which system tested (date installed) Aug 1981 Adequacy test date 2/26/25 ❑■ ALL standpipes present per record drawing Results Q Pass Total measured depth from grade t4.3 ft (max) Lttr2t Fluid depth prior to test 0 in Measured depth to pipe invert from grade a•(v ft(min)/Cbl Water added *957 gal ` ❑ N/A — pressurized field. New fluid depth 10.5 in ❑ Per record drawings, field is insulated. Elapsed time 120 min ❑ Monitor tubes go to bottom of effective. Final fluid depth 0 in If not, state depth into effective 27"(MT1) Absolp4en-rate 600 gpd_„, ❑ 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/A If yes, enter date STATUS — POST RECOVERY Effective depth (per record drawings) 60 in Effective depth used >0 in 33 Effective depth remaining min P7" Comments/Deficiencies: Used MT1 for adequacy test. MT2 was installed later and reportedly only driven to refusal about 36 in below invert *Introduction of the first 224 gallons of water caused 10" rise in MT1. See Attached Easement COSA Checklist June 2022 E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100' -❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Disposal Field on Lot > 100' ❑ Yes if No Neighboring Disposal Fields > 100' [:]]Yes cif " o ft Sewer Line/Main > 100' if No ft Sewer Manhole lCanout > 100' ft ❑ Yes =tic if No ft ,5eService/Septic Line > 260 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 N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10' ❑ Yes if No 8'25 ft Surface Water > 100' ❑✓ Yes if No Field to Foundation > 10' ❑✓ Yes Tank to Property Line > 5' ❑✓ Yes Field to Property Line > 10' ❑✓ Yes Water Main/Service Line > 10' ❑✓ Yes F. ENGINEER'S COMMENTS if No ft Wells on Adjacent Lots: if No ft Wells > 100' ❑✓ Yes if No _ if No *0 ft Community Wells > 200' ❑✓ Yes if No _ if No ft If tank or field is under driveway comment below ft ft ft ft 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 Garness Engineering Group, LTD. (GEG) Engineer's Printed Name Jeffrey A. Gayness, P.E. In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist—May2025.docx Phone 907-337-6179 Date o�F �F.. :. 4�T .... O f _y .R.. a r QSS..... 0� CE -79P3 3��5.•c�oG LICENSEE F�ofFs510n0�0 #AECC884 0 Ar -:"'s Municipality ®® \ l nt S �� ) � n tm •nt P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Developmentices Divisi On-Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW Waiver#: OSV251026 COSA#:OSC251267 Permit#: PID#: 015-341-38 Legal Description: Valli Vue Estates #2 Block 3 Lot 30 Engineer: Garness Engineering Group Your request for a waiver of the required 10 feet horizontal separation from the disposal field to the property line has been approved. The approved separation distance is 0.0 feet. This waiver approval applies to the existing disposal field only. 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 Date: f , ?�_ Approved by: �rrrrrrrrrrrr■ rrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■ •rrrrrrrrrrrrrrrrrrr a rrrrrrr■ **** VARIAN C E/WA`IVE R REVIEW **** 0 July 9, 2025 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: Waiver Modification — From 3 -Foot to 0 -Foot Setback Property: Valli Vue Estates #2, Lot 30, Block 3 To whom it may concern, A lot line waiver was verbally granted in 1981 allowing for a 3 -foot setback. We recently determined that the drainfield encroaches onto the neighboring lot (133, L31). In short, the separation distance between the drainfield and the lot line is zero feet. The separation distance between the subject drainfield (5' effective) and the drainfield on B3 L31(7' effective) is approximately 15 feet; therefore, separation is adequate. At this time, we are requesting that the existing waiver be formally amended to zero feet. We are not aware of any adverse consequences associated with granting this updated waiver. If you have any questions, please contact us at (907) 337-6179. Thank you for your assistance. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com A 2025-010855-0 S Recording District 301 Anchorage K A 04/29/2025 12:58 PM Page 1 of 5 LC After recording in the Anchorage Recording District Return to: Douglas P. Whittaker 6324 Red Tree Circle Anchorage, Alaska 99507 EASEMENT [Septic Drain Field] THIS EASEMENT is made effective as of this Zf day of April, 2025, by and between: Alexander S. Bogart and Tania D. Bogart, husband and wife, whose address is 6314 Red Tree Circle, Anchorage, Alaska 99507, hereinafter referred to as "Grantors;" and Douglas P. Whittaker, an unmarried man, whose address is 6324 Red Tree Circle, Anchorage, Alaska 99507, hereinafter referred to as "Grantee." The Grantors for and in consideration of the payment of Ten Dollars ($10.00) and other good and sufficient consideration, receipt of which is acknowledged, hereby GRANT, BARGAIN, SELL, and CONVEY, unto Grantee, and to the heirs, successors, and assigns of Grantee an Easement in and to certain real property (the "Servient Tenement") which is more particularly described as follows: Lot 31, Block 3, VALLI VUE ESTATES UNIT NO. 2, according to the official plat thereof, filed under Plat No. 77-296, in the records of the Anchorage Recording District, Third Judicial District, State of Alaska. The Easement granted in this instrument is for the benefit of and appurtenant to the following described parcel of real property (the "Dominant Tenement"), or any portion of such property (including any portions arrived at through further subdivision thereof): Lot 30, Block 3, VALLI VUE ESTATES UNIT NO. 2, according to the official plat thereof, filed under Plat No, 77-296, in the records of the Anchorage Recording District, Third Judicial District, State of Alaska. Portions of the septic drain field and related supporting structures [e.g. pipes, gavel filled beds, etc.] used by the Dominant Tenement appear to be located within the Servient Tenement. The Easement granted in this instrument is for the purposes of allowing those portions of the existing septic drain field and related supporting structures used by the Dominant Tenement, as are located within the Servient Tenement, to remain and be used within the Servient Tenement. More specifically, but without limitation, the Easement granted in this instrument includes the right to continue to use and maintain that portion of the Servient Tenement encompassed by this Easement for a septic drain field and related supporting structures as long as the septic drain field remains operational. This Easement does not provide the Dominant Tenement any right to locate a new septic drain field or related supporting structures within the Servient Tenement. The Easement granted in this instrument encompasses only that portion of the Servient Tenement within which the Dominant Tenement's existing septic drain field and related supporting structures are currently located. The portion of the Dominant Tenement's existing septic drain field piping within the Servient Tenement appears to be located within of a strip of real property measuring approximately two feet in width by ten feet in length (2' x 10) along the common property line between the Servient and Dominant Tenements, as approximately depicted in Exhibit "A" and Exhibit "B" appended hereto. This Easement shall terminate if a new septic drain field is developed for use by the Dominant Tenement. Otherwise, the Easement created herein is perpetual and runs with the land. The Easement granted herein is not exclusive. Other individuals and entities may have or be granted rights in that portion of the Servient Tenement covered by this Easement, provided those rights are not inconsistent with the purposes of this Easement. GRANTORS: Alexander t. Bog Tania D. Bo rt STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) THIS IS TO CERTIFY that on this day of April 2025, before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared Alexander S. Bogart and Tania D. Bogart, to me known and known to me to be the individuals named in and who executed the within and foregoing Easement; and they acknowledged to me that they executed said instrument freely and voluntarily, with full knowledge of its contents, for the uses and purposes therein set forth. F r„ hand and official seal the day and year in this certificate first above written NOTARY PUBLIC Charles D. Kasmar / STATE OF ALASJ�A ✓�� MyCOmMissionExpires May2$,2025 Notary Public in and for Alaska My Commission expires:.��y,Z��.Z�.2._ ,Ij!j!ij Page 2 of 5 301-2025-010851%:,—o : ougl P. Whittaker STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) THIS IS TO CERTIFY that on this day of April 2025, before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared Douglas P. Whittaker, to me known and known to me to be the individuals named in and who executed the within and foregoing Easement; and they acknowledged to me that they executed said instrument freely and voluntarily, with full knowledge of its contents, for the uses and purposes therein set forth. WITNESS my hand and official seal the day and year in this certificate first above written. ENOTARY PUBLIC Charles D. Kasmar Notary Public in and for Alaska STATE OFALASKA My Commission expires: My Commission Expires May 26, 2025 Page 3 of 5 301-2025-010855-0 z UJ 0 3: 0 V) Ix 0 I z Uri « R x 6 r : +F # y 2 l F ' " 1F t s MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alaska 99519~6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~/,_c~'..~)~// - ~.¢,~' HAA # ~'+l~( i,'( r ,~ '[ GENERAL INFORMATION Complete legal description Location (site address or directions) ~¢' -~ '~,¢' /~-~" /"~- Property owner ~'~o!~. ~ {/',~,.,-~ ~,_._.,--~ ti, / ,'¢.._ ~¢'; .. ~¢r%_,.T&~-- / %~ . L.-~-~*-¢7c-~% Day phone ~ ~-' Mailing address ~.~ ~ , F'~e~:~ !~.L~ ~ Lending agency Mailin_g address Agent ,')q ~L ~/J Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O25 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of tile validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ('--' ,~ ~ s ~'~'u ¢-- ~ ~ ,-~3 ~ '~ ~ I ¢, ~-~-,v'5 Phone Address c/Gal Engineer's signature /'/~' /~ 4/~¢~,,~-._. Date DHHS SIGNATURE Approved for L1L Disapproved. Conditional approval for bedrooms. 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES APR 17 20 Environmental Services Division MUNICIPALLY' OF ANCI~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)~1~. S~RWCFS Health Authority Approval Checklist LegalDescription: (~o ['~ t-Jh~l ~ L~'<~'~ ParcelI.D.: A. WELL DATA Well type A IfA, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Date completed 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 o[ sample: Collected by: B. SEPTiC/HOLDING TANK DATA Date installed ~u/~ ~ ~ Tank size Foundation cleanout (y/N) ~ Date of Pumping IZ.~O~ Number of Compartments ~' cleanouts(Y/N)__ Depression (Y/N) /'J High water alarm (Y/N) Pumper ~ + l~rO~'t~- $~R,u'[C~;5! C. ABSORPTION FIELD DATA Date installed ,~o~ ~ O~'~ Length '-~ ~ ~ Width ~ Gravel thickness below pipe Effective absorption area ~O 5; F Monitoring Tube present (y/N) ~ Date of adequacy test ~. - I ~ - ~3 O Results (Pass/Fail) [~'¢~--5~ Soil rating (~ or ff~/bdrm) ~,~' System type ~. I Total depth I . Depression over field (y/N) For :FOol7-. .bedrooms Fluid depth in absorption field before test (in.); Fluid depth O (ins) Minutes later:. 7 Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Immediately after&'OOgaL water added (in.): Absorption rate = ~ Goo q.p.d. If yes, give date D. LIFT STATION /,JET' 0~-~ Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ,~J O Septic/holding tank on lot _ On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Liffstation SEPARATION DISTANCES FROM SEPTIC/I*I(Yc~.NG TANK ON LOTTO: Foundation + 5 Property line ~' ~' t Absorption field ~ 5' Water main/service line + t 0 .Sudace water/drainage + ~ o 0 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line, + 3 Building foundation + f o Water main/service line Surface water +lDo ' Driveway, parking/vehicle storage area +*~ ~ Curtain drain 1' 1 eow Wells on adjacent lots -{-, 'Zc, o F. ENGINEER'S CERTIFICATION I certify that I have determined in conformance with MOA HAA guidelines in effect on this date. Signature ~/J~/~'~' ~"~"' Engineer's Name g, H, UOI C3 o~ ~ ~ o~ S T, ~ ~ ar~ Date "{" ~ (' ' o 0 HAAFee $ ~'~ Date of payment ~/) '-~/"~ Receipt Number ~z)--(~?~_ L/ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* . MUNiClPALiTYOFANCHORAGE ,... !'::: j~'~-:.- :. :'.'_ ._ :. ~. DEPARTMENT OF HEALTH & HUMAN SERVICES_. '~ '- - Division of Environmental Services !-,~ -, ' ,: On-Site Services Section . ~ -.~: .... ..: .? ...... P.O. Box 196650 Anchorage, Alaska 99519-6650 ..... 343-4744 .. '~' CERTIFICATE OF HEALTH AUTHORITY ~' ' - "' -' APPROVAL FORA SINGLE FAMILY DWELLING ,," - ._-, ' 1.' GENERALINFORM;ATION ' 4 Location (site address or directions) ' .'. 'Prop~rtyOWner" '~-~l('c~/~ ~---- ~ Z-~-~. /V~, ~:~'¢~-~Day phone Lending agency' Ma'!-Iing'~ddress. YAgent ' : ~'' '-- · Day phone Day phc .":., Unless otherWise requested, HAA wdl be held for pmkuD, . ' ~.: · 2: '~'uM'BER OFBEDRooMs ( ~bU~ -.' ': . :: ~ ~ .. :. 3. TYPE OF WATER SUPPLY: Individual well .---"'.' :' ' ' comm~nity~ll .... ' ......"' : Pu-Iic--ate-b w r NOTE: If community well system, provide written ~)nfi~mation from State AbEc'attest- ~ :;' Z:',.. · - . ing to the legality and status of system. -' : ,. -,, o, w%%,0.,,;,:o,,,: /-. .. .. ' ~::~':~.2: :., ' .... .'." ' : · -' ' - · ~'~ . ',~t::,,'X¢' Pubho sewer ,. -:...,.- ...... -,, :::,,.-~:: *¢; --~*/'7: ,-.~4,¢~, t,. . ~ , ~: :-<~.?.. ,.., .. . :. :).. . .. --'- - NOTE: If C~mmuni~ wasteWater system, provide writer confirmation fro~.S{ate ADEC a~esting to the legali~ a~d status of system. . -'.:-:,.: 72*025{Rev. 1/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wasmwater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations iri effect on the date of this inspection. Name of Firm Co/.JS'~/ ~'.,~J~/'~..5', Phone c~/'/~ -CoO O ~gineeCs signature DHHS' sIGNATURE -T%~ r ' ~".':' A~r0~ed f~r bedrooms ...... ,~. . . ... · -:-.~Disapprove ' ' ' ' -'.... ' .'. ':' Conditional approval for bedrooms, with the following stipulations: Additional Comments ,,The MuniCipality o~,,~;nc'horage Department of Health and Human Services (DHHS) ~ssues Health Authority "~.~'-' ..... 'i/"ert fic~t~ I~'ased on ~t Upon the representations gi¥~rl in Paragraph 5 above 15~ an independent ..._c.~,;.,~,~;... ~.,..~,,4~ r,=nistered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes ~'r~s~?,,~, ~ .(: \-~,, ,~. .... ~ - . . ..... ~ ~n orderto sabs certain federal and state requirements Emp oyees OT ummS do not ~h'd their lending ihstitutions ' ' fY ' · 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 ~ork ~'~ :, · .' Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: s/q) Tt'Z-t'ot A. Well Data Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number ~' ! o ~, o 5' Well type Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) FROM WELL LOG g.p.m. Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 4- ~. oo Absorption field on lot 'f- ~ oo ' Public sewer main + 'g.o~ ' Sewer service line -+ ~.oo ' Wires properly protected (Y/N) AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank . 7_0o WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ,/4 o ~ ! ff X' I Cleanouts (Y/N) ~/ High water alarm (Y/N) Date of pumping Tank size ! 'z.-5 o ,~ Compartments Foundation cleanout (Y/N) F Depression (Y/N) , Alarm tested (Y/N) ~ '~ Pumper /~ '/''/¢o~¢ ~ ~'/~'/¢-E.¢ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /,////4- To property line '/- 5- ' Surface water/drainage On adjacent lots Absorption field /~'//,4- (/-/Loo) Foundation ~ ~ 4- 5- ' Water main/service line 72-026 (3/93)* Fronl CONTINUED ON BACK PAGE C. LIFT STATION '~' /..2o 7- ~' .5 ~"~, Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Z', ~..~? d/¢¢/: z Date installed ~ ~ ~f f?~/' Soil rating (GPD/Ft2) (~' ~/~/~ System type /'~¢-~c-/U Length . ~ ~"' Width ~ ~'" Gravel thickness ,~ ' Total depth _ /'~ ~ Total absorption area C~ ~/'C~ Cleanout present (Y/N) Y Depression over field (Y/N) /v'/ Date of adequacy test ~ "~'~- ¢~ Results(pass/fail) Water level in absorption field before test O Peroxide treatment (past 12 months) (Y/N) /~'0 ,/~/'-/'-55 for .~-~2 C-'/E., Bedrooms After test z/' ~' If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ,,t,//'~ To building foundation 7~/(2 ' On adjacent lots /' Z o ' Surface water 'c/DO ' Curtain drain ¢' / ¢~ ' On adjacent lots ~ ~2o Property line To existing or abandoned system on lot Cutbank ,z/~¢ ' Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all M, OA and HAA guidelines Signature HAAFee$ ~'~,~ Date of Payment "~/.=¢/,. Receipt Number ¢~d~ Waiver Fee $ Date of Payment Receipt Number 72-026(3/93)" Back MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH B/qD ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATS 1o General Information Application Date (a) Legal 5ascription (include lot? block, subdivision, section, township, range) Location (address or_direct~ons) ~ _ (b) Applicants Name 8¢ra/J ~, ~F'OZZ)~ Telephone - HomeS¢~-/~/FBustness (c) Applicant is (check one) Lending Institution ~ ; ~er/b~lder ~ ; (e) Real Estate Co. & Agen~ ~ ~/~ Address ° Telephone (f) Mail the HAA to the following address: ~esidence Single-Family~--~ Number of Bedrooms Multi-Family Other (describe) Note: If community well sys~em, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewag~ Di~ Onsite~ 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° [Page 1 of 2] E~ineerln~, Firm Providing Inspections,_ Test~t~le 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 %zastewater 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 w~ter 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 L)~°~9S~¥0~'~/~ ~5 /~- ~-~ ~}6~ Telephone ~q~'ZO~ Date DREP A~ Approved for ~]ZZ~ bedrooms Approved~ Disapproved Terms of Cdnditioual Approval (ENGINEER SEAL) By Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE UEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER ILEGISTERED IN THE STATE OF ALASKA° THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND T~IR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE~ MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED° TttE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS 0R OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK° (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOAi~ HEALTH AUTHORITY APPROVAL (HAAi CHECKLIST - FEBRUARY 1984 Well Classification ~ 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 To Nearest Edge of Absc~mption Field on Lot To Nearest Public Sewer Line Cleancut/Manhole Water Sample Collected By Water Sample Test Results MUNICIPALITY OF ANCHOP. AGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION If A, B, c~ C, D.E.C. Approved(Y/N) Date Completed Cased to Pump Set At Depth of Q~outing Yield~ Sanitary Seal on Casing (Y/N) Dep~essionA~oundWellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed t~U6? /?~J Size I 'L~O ~ No. of Ca,ua~tm~nts Standpipes (Y/N) y Air-tight Caps (Y/N) y Foundation Cleanout (Y/N) X Depression over Tank (Y/N) AJ Date Last Pumped "~c~ ~ /~ ~-~ Pumping/Maintenance Contract on File (Y/N) ~ ; for Holding Tank High-Water Alarm (Y/N) /t//~- Temgorany Holding Tank Permit (Y/N) Separation Distances f~om Septic/Holding Tank: To Water-Supply Well To P~aperty Line +~l To Water Main/Service Line Course '~/~ To Building Foundation To Disposal Field Counts To Stream, Pond, Lake, c~ Majo~ D~ainage Receipt ~ Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed Width of Field Square Feet of Absorption Area Type of System Design 'l Length of Field 3 ~ i Depth of Field ; Gravel Bed Thickness 3- ~ Standpipes Present (Y/N) Depression over Field (Y/N) ~3 Date of Last Adequacy Test Results of Last Adequacy Test /%~~J+~'~O~ ~ ~/~' Separation Distance frc~ Absorption Field: To Water-Supply Well d-2~9o To Property Line 'k3 To Building Foundation ~ /o ' To Existing Or Abandoned System cn Lot ~2/~ ; On Adjoining Lots + ~d To Water Main/Service Line ~ ~ ~ To Cutbank(if present) /J/~ To Stream/Pond/Lake/c~ Major D~ainage Course + To D~iveway, Parking Area, c~ Vehicle Storage A~ea Comients Date Installed Size in Gallons "Pump On" Level 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 during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA l%~quest I certify that I have checked, verified, or eonfur,~d to all MOA HAA Guidelines in effect on the date of this inspection. Signed KB1/d5/s [Page 2 of 2] 2-15-84 APPLICf" IT FILLS OUT UPPER HAL "ONLY td~opertyO~;ner ~.~cp /~,~t/Z~o- ~-~i /~-~ ~../~ j/~ ~ ~ Phone ~ailino~ddre~ ~'~ ~O ~ ~C~O A ~O~-7 ~ ~ ZipCode Buyer ~ ~ ~ ~ ~ ~ [~F~O ~ ~ Address Zip Code Lending Institution ~ ~ /~1 ~ ~ ~ 0 ~ ~ ~ ~ ~ ~ Phone Address Zip Code RealtyCo.&A~nt ~A~ ~/c ~ /~ /~/~ ~ ~C~ Phone Address ~ ~ '~O~ ~O~ ~/~O~ A~ ZipCode ~'~ Street Locati~ ~'~ f~ ~ ~ ~ [V e ~ ~ Type of Res[~nce ~ Single Family ~ Multiple Family NO. of Bedroo~ ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ~ Individual Year Indiv~ual installed: ~ ff~ ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector MUNICI 'ALr[Y O~ AN(JH(JF. ALCE ( PROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72-023(3/82)