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VALLI VUE ESTATES #2 BLK 4 LT 12
Valli View Estates #2 Lot 12 Block 4 #015-341-55 Municipolity of Anchoroge Page 1 of. 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchordge, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000100 PID Number: 015--541--55 c/o SALLIE NICKERSON w/ PRUDENTIAL JACK WHITE Wastewater System: [] New · Upgrode Address: 10220 LONE TREE DRIVE ABSORPTION FIELD No. of Bedroome: Ph°ne:~,907j/; 229-1148 DDeep Trench BShollow Trench DBed DMound DOther LEGAL DESCRIPTION 1.2 o.D/s.. ~. 6.0 12 4 VALLI VUE #2 2.9 - ,:3.0 FL 3,02 FL - - - 0 - 0.2 FL 44 I WELL: [] New r-1Upgrade~,.,.,~~''~ G~v". w~h: 5 FL Number of line':1 IDi~tance bet'een "ne~:_ FL j~FL FL 379 s(~. FL D 3034/ F-810 FL A+ HOME SERVICES 6/26/00 - 6/27/00 SEPARATION DISTANCES []s.pt~o [] Holding ~.E.P. Well 200'+ 200'+ -- -- 25'+ Su~oce ~00'+ 100'+ - - - LIFT S Water Lot Drain NONE KNOWN I I , Remorks: BENCH MARK GARAGE FLOOR CONCRETE SLAB. 100.00 inspections performed by:. AWWC, INC- Dates: 1 st 6/26/2000 2nd 6/27/2000 ~"~"-"l "~ ~''"~''"i 3rd 6/29/2000 t~ :.~ e~ :r~,~ A. Garness,," ... Department of Health and Human Services approval ~[~'~'o,."'. ............ "~s,~,:~ Reviewed and approved by: /)- ~'~., ~. .f~/// ~"/. ~"~u-c.~, Date:'7-/o-oo PERMIT NUMBER: AS BUILT DJ~J~.WING PARCEL ID NUMBER: SWO00100 ' 015-341-55 ~ xx~ ~ '~ ~DBL2 t ~; ~~ - ~.01 (AV~.) MT2 67.1 - 81.8 - DATE: ~%, l DmWN7/7/2000By: ~d . ~.. '.. . ........ ~ ......................... CONSULTANTS, INC. ...... ' S~LE: Z PREPPED FOR: PHONE NUMBER: PAgE NUMBER: ' ,~ / /~ ~ '~ SALLIE NIOKERSON (907) ~2,-,~48 ~ 0,2 ~;~'~Jr~:~,;:?"~.~ VALLI VUE ESTATES ¢2; LOT 12, BLOCK 4 ~&~%¢'' ......... ~s~ AS-BUILT OF SEPTIC SYSTE~ UPORADE '~%~ MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 PO. Box 196650, Anchorage, AK 99519-0050 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT [~-j~'F0-~''~7' . upgr..e Date Issued: May 12, 2000 Expiration Date: May 12, 2001 Permit Number: SW000'I00 Legal Description: VALLI VUE ESTATES #2 BLK 4 LT 12 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Sallie Nickerson Owner Address: 10220 Lone Tree Dr. Anchorage, AK 99516-0000 Parcel iD: 015-341-55 Site Address: 010220 LONE TREE DR Lot Size: 20913 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Date: ALASIG t WATER & WASTEWATER May 22, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Revision to Sewer Upgrade Permit# SW000100 for Lot 12, Block 4, Valli Vue Estates Subdivision #2 To whom it may concern: Per the homeowner request, a second test hole was excavated on the property to see if a gravity flow system could be used. Attached is a soil log labeled test hole #2, a revised site plan and a revised design. We request the sewer upgrade permit number SW000100 be revised to include the new design criteria. DRAINFIELD DESIGN: a. Percolation Rate: <1 minute/inch b. Allowable Application Rate: 1.2 gallon/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 375 ft2 f. Total Depth: 6 feet (maximum) g. Effective Depth: 3 feet h. Width: 5 feet i. Length: 44 feet j. Reduction Factor: 0.58 k. Effective absorption area = 379 ft2 I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you ~ve any questions, please contact us at 337-6179. Thank you for your assistance Pre~ 6901 Debarr PPod Suite 2B ~ Anchorage, AK ~ 99504 ~ (907)337-6179 N Fax (907)338-3246 NOTE: A(L PROPERTIES SHOWN~ARE / '~ ~'~ ~,. SERVED BY A COMMUNITY WATER / \\ %\\ ~ LOT 13, BLOCK ~ LOT 12. BLOCK ~ ~ VALLI rUE EST ~2 [~~~~ ' / PROPOSED sePtIC UPG~DE /// % / ,'~/ '~ VALU VUE EST. ~ '~~ LOT 18, BLOCK 4; / ~' %x, x, / / CATE: REVISED 5/22/2000 . .. , ...... , CONSULTANTS, lNG.* .............. , ~ SCA~: ~ ,"=,oo' , ~AL DESCRIPTION: '4~ LOT 12, BLOCK 4, VALLI VUE ESTATES SUBDIVISION ~2 SITE P~N FOR DESIGN Of SEPTIC SYSTEM UPGRADE ~ DEPRESSIONS O~R ~ELOS. K~ BOX / / DATE: REVISED ......... CONSULTANTS, INC..~ ~ 1" SALLIE NICKERSON (907) 229-1148 2 OF 2 )~¢ ~ejrfre~ A. ~o~es~.' "~ ~o~ ~2, ~OCK ~: w~u rUE ~S~T~S SU~9~WS~O, ~ DESIGN OF SEPTIC SYSTE~ UPGRADE ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DFBARR ROAD, SUITE 2B * ~CHORAGE, AK. 9950~' ~::~-~.. PHONE (907) 337-8179 * FAX (907) 338-3246 ~./~. ~.' , ..,~..~ ISOIL LOG - PERCOLATION TESTI ~.f~ ...... ,f,~..[.. .... LEGAL DESCRIPTION: VALLI VUE ~2; LOT 12, BLOCK 4 PERFORMED FOR: SALLIE NICKERSON ~Z".I .. [j _...."_~,~ o=~.,c~I TESTHOLE ~2I DEPTH ~ (feeO GP ~ ML GM CL ~ SP CH S SC DEPTH TO DATE 3ROUNDWATER SEEP ~ 10.5' 5/17/00 : 10.5' 5/1 11.5' 5/24/00 10 11 SM/GM DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIHE (HINUTES) READING (INCHES) ~ 2 ~/~ 7/00 __. 16 17 ~O0 -- -- 19 PERCOLATION RATE <1 (HIN./INCH) PERC. HOLE DIA. 6 (INCHES) PERFORMED BY A~SKA WATER & WASTEWATER. I, JEFFR~ A. GARNESS, CERTI~ THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: 5/2~/2000 DEPTH TO DATE SROUNDWATER SEEP @ 10.5' 5/17/00 10.5' 5/19/00 11.5' 5/24/00 ALASIC WATER & WASTEWATER May 9, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Upgrade Design for Lot 12, Block 4, Yalli Vne Subdivision #2 To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The existing drainfield is in a state of failure and in need of an upgrade. One test hole was excavated on the property. The proposed septic system will be designed within the 30 foot radius of this test hole. We are proposing that a 1250 gallon S.T.E.P. tank and a five foot wide drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. The soils below the organic layers are a GM/GW material fi'om 1 foot to a depth of 8.5 feet. The soil then transitions to a SM/ML material to a depth of 12 feet (bottom of test hole). No groundwater was encountered during the excavation of the test holes but there was heavy seepage at 8.5 feet. A percolation test was performed between the depths of 4.5 feet to 5.0 feet which had a percolation rate of <1 minute/inch. It is our opinion that the insitu sandy soils should act as a sand filter and that an application rate of 1.2 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.2 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 375 ft2 f. Total Depth: 4.5 feet (max.) g. Effective Depth: 2 feet h. Width: 5 feet i. Reduction Factor: 0.70 i. Minimum Length: 54 feet long j Effective absorption area = 386 ft2 6901 Debarr Road, Suite 2B - Anchorage, AK 99504 - Ph: (907)337-6179 - Fax: (907)338-3246 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY.' As can be seen on the attached topography site plan, the area of the proposed septic upgrade is generally flat. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179, or 244-9612. Thank you for your assistance. ~erel~ ~ NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, one soil log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B - Anchorage, AK 99504 - Ph: (907)337-6179 - Fax: (907)338-3246 NOTE: AI~L PR~)PERTIES SHOWN~ARI // ".~'-... SERVED BY A COMMUNITY WATER / ~\'~ SY~EM~ ~ ~xAND BY PRIVATE SEPTICS. ~ ~X~ ~~ ~ LOT 12. BLOCK 3; ~ -- PROPOSED SEP~C ~ ~/ '~ ~ LOT 17, BLOCK 4; / ~ ~'~~2 / ~1~ ~Z/ PAGE NUMBER: D~WN BY: A~IA WATER & WASTEWATER K.D.W. ,~ ............. ....... CONSULTANTS, INC,' ~" ~ ....... SALLIE NECKERSON (907) 229-1148 1 OF 2 ~ LOT 12, BLOCK 4, VALLI VUE ESTATES SUBDIVISION ~2 SITE P~N FOR DESIGN OF SEPTIC SYSTEM UPGRADE ~ LOT LINE EAST OF THE PR~pTosED THE ~ /X~ [ DRAINFIELD FLAGGED BY ,~-~E-~EfEREO ~ '~/-'.,,,, ,~ LAND SURVEYOR PRIOR TO CONSTRUCTION. ~ %' ",.,. / / / W~TH DUAL OUTLETS ~y~/'",~',~ ~ ',, ';" THETo BEDISTRIBUTIONI-1/4 INcHLINEscHIS l / / .,~'~:,: ~ )~ 40 PVC WITH 1/4- INCH '~. ,,, .' DIAMETER HOLES SPACED / / "'-. 2"'--. %-% % % / E×,~N,~ PLO,,,' / -.><..% -%,`%. %-.% / / . WA'ER. ~LNE_.~., '% % ~ / N~ ~OX / / S/lO/2OOO 6901 DEB~RROAD.$UITEZB "~CHOP.~GE./~J~ 9950~* PHONE (907)557-6179' F~(907)558-$z~.GCONSULTANTS' 1NC,*~--~ '- ............. ,. ?~,- ~ 1 ' : 50' .R~.~.O ~OR: PUONE NUMBER: PAge ~UMBER: ~:' ' SALLIE NICKERSON (907) 229-1 148 2 OF 2 ~CAL DESCRIPTION: LOT 12, BLOCK 4; VALLI rUE ESTATES SUBDIVISION ~2 DESIGN OF SEPTIC SYSTEM UPGRADE ALASKA WATER & WASTEWATER CONSULTANTS, INC. ~"~-~'~'~'OF l'~ 6901 DEBARR(907)ROAD, SUITE 29 * ANCHORAGE, AK, 99504 DATE PERFORMED: 4'/2812000 lO/~.~,.'~...I ~.-7953 ..'"~,~d~ DEPTH~[~: ORGAN[CS TEST HOLE '3. :D'. "c:~ ..... SITE PL ~ GW GC OL SH OH 7 DEPTH TO DATE ~ROUNBWATER 9.5' 5/9/2000 , 10~~. SM/ML 11 DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (HINUTES) READING (INCHES) 12 512/2000 15 ~ 7 __ _~s°~ 18 19 PERCOLATION RATE <1 (NIN./INCH) PERC. HOLE BIA. 6 (INCHES) 20 TEST RUN BETWEEN 4.5 FT. AND 5.0 FT. CONHENTS: PERFORMED BY A~SKA WATER ~ WASTEWATER. I, JEFFR~ A. GARNESS, CERTI~ THAT THIS WAS PER~M~ IN ACCORDANCE WITH ALL STATE ANB MUNICIPAL GUfDELINES IN EFFECT ON BATE: ,~ //¢/0~ DEPTH TO DATE 3ROUNDWATER SEEP @ 8.5' 4/28/00 9.1' 8/2/2000 9.2' 5/5/2000 9.5' 5/9/2000 Municipality of Anchorage Page t of ~.----- 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: ~----~[,~i¢'~)~'-[~/¢ PID Number: ¢L~¢~1~¢ Na~: ~1~ ~. ~ ~t~' Wastewater System: U New .~pgrade Address: I~ ~ ~ ~ ~ ABSORPTION FIELD Phone: ~eep Trench ~ Shallow Trench U Bed U Mound ~ Other LEGAL DESCRIPTION soi,*....: I '%GPD/Sq. Ft. Total Depth from original grad~ Lot: (~ Block: ~ Subdivision: Depth to pipe bottom from odginal ~d¢: Gravel depth beneath pipe Township: I Range:io : ~,,, added aboveorfgina, grad~, Ft. Gravel lan,th: WELL: U New ~ Upgrade Gravel width: ~(Ft. Number of lines:[ ~Oisl~ ¢ - Ft. I lweenlbes: Classification (Private. A.B.C): / Total Depth: Cased TO: Total absorption area: Pipe material; ~ O Driller: Date Drilled: Static Water Leveh Instafler:Ft. ~¢~ ~.{~ ~Dateinstalled~/' [O Yield: ~ Pump Set at: ~ Casing .eigM Above Ground: ~ ¢~. ~t.TANK SEPARATION DISTANCES ~¢i~ ~ ~ Holding U S.T.E.P. TO Septic Absorption Lift Ho]ding )ublic/Private Manufacturer: Capacity in gallons: From Tank Field Stal~on Tank Sewer Lines ~~ ~ w., ~ ~,¢ ~ ~,~ ~,e~~ .u~.ro~Co~,~r,~.,.: S.~¢~oe t~'¢ im'~ ¢ ~ -- LIFT STATION Water LineL°t ~, ~ ~ ~ ~ Size in gallons:~ Manufacturer: Foundation [~/ ~/ ~ ~ ~ CurtainDrain ~¢¢~ ~, ~ -- PumpMa~del IE,ectrioa,,nspectionsperformedby: Remarks: BENCH MARK ~on and Description~O~ ~ ~ ¢¢ ~¢~ ~ ~¢~ ~ J Assumed Elevation: ENGINEER'S SEAL Inspections performed by: E~= ~-=r,A:~ ~=~ dazes: ~sz ~, ~. Department of He~ and Hum~ Services apprgvaU ~¢~"., ~ ~' ~'~'~ Reviewed and approved by:~ ~¢ f ~¢ Date: ~//6/~ ¢ "*:-' "*"'"",'~ ,,- '""¢" 72-013 (Rev. 9/91) MOA 25 Permit I)1o SW950216 Page 2 of 2 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 Legal Description.'VALLI VUE SUBDIVISION #2, BLOCK 4, LOT 12 PID No.:~1534155 CO1 C02 NEW 1000 GAL ~9' SEPTIC ' TANK FINAL GRADE N.T.S. / / / t ~20' DRAINAGE ',! UTIL. & DRAINAGE ESMT: ~'~. APPROX. WATER LINE 3 HOUSE MT C04 ~ __ /99.9'+ 93,9'/ DRIVE Eco C04 C, ~88.3' : · 94.3' NO WATER FOUND COg I 1.2;5 I 33.5 I co3 [ 1822 [ 3~.8 I C04 130 26.3 MT 1185 I 23.0 I x D.V. 115;5 I 31.5 I t000 G~ SEPTIC TANK TRENCH I SUCH THAT BE USED ~N THE ,' ENGINEER'S SEAL · 72 013 A (Rev. 9/91) MOA 25 PAGE 1 OF 1 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:SW930216 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SCHAPIRA MITCHEL J & OWNER ADDRESS:10220 LONE TREE DR ANCHORAGE, AK 99516 DATE ISSUED: 7/13/93 EXPIRATION DATE: 7/13/94 PARCEL ID:01534155 LEGAL DESCRIPTION: VALLI VUE ESTATES #2 BLK 4 L T 12 LOT SIZE: 20913 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / HOLDING 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 343-4329 OR 343-4681 AFTER BUSINESS HOURS 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. SPECIAL PROVISIONS: RECEIVED BY: ~u~/. ISSUED BY: ~~~~ / DATE: DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. July 6, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM OES[GN ~unicipality of Anchorage )EPARTMENT OF HEALTH AND HUMAN SERVICES 125 L Street ~nchorage, AK 99519-6650 rEFERENCE: Valli Vue Subdivision %2, Block 4, Lot 12 ~e request you expedite the issuance of a permit to upgrade khe septic system serving the three bedroom house on the =eferenced property. Dwner reports existing septic system is in a state of failure ·nd is backing into the garage. Due to these unsanitary ~onditions, we would appreciate you expediting a permit to lpgrade the existing septic system. test hole was excavated and a percolation test performed. ~he approximate location of the test hole is located on the ~ttached site plan. The monitoring tube within the test hole ~as been checked and found to be dry. ~e do not anticipate any adverse effects on neighboring )roperties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. t A. Shafer, P.E. ~S/LSU/lsu 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 I LEGAL VAT][~[ VUE SUBDIVISION L. S. ULSHER [CKD. R.A.S. LOT 12 DATE 7/5/93 : SHT. I OF 1 DESIGN CRITERIA: 5 BDRM = 450 GPD SOILS = 1.2 GPD/SQ. FT. 450/1.2 = 375 SQ. FT. REQ'D DE,EP TRENCH: 9.5 DEEP ~-'"~'- ~ 5.5' EFFECTIVE,':.-,---~,,x: 34' LONG ~ PROPERTY SERVED BY A COMMUNITY WATER SYSTEM. NO WELLS WITHIN 200' OF SEPTIC SYSTEM. 10' UTIL. & DRAINAGE ESMT: DRAINAGE 3 HOUSE APPROX. WATER MNE LOC vo~ ~ DRIVE FCO .No. ~457.E '?'~'o \ CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. \ 1000 GA~ SEPTIC TANK PUI~P, AND REMOVE 1000 ~AL TANK) ;T TRENCH/TO BE SUCH THAT BE US/ED IN THE / / TRENCH / / / SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS-BUILT SURVEY DRAWN BY: FRED WALATKA &: ASSOCIATES IT IS THE RESPONSIBILTIY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. STRUCTURES, EASEMENTS, OR ENCROACHMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUI~AN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2. 3 4 5 6 7 8- 9 10 11 12 13 14- 15- 16 17 18 19. 20- DATE PERF Range, Section: SLOPE WAS GROUND WATERItJ/~lO ENCOUNTERED? IF YES, AT WHAT '~' O DEPTH? __ . p E SiTE PLAN Reading Date Gross Net JDepth to Net Time Time ~' Water Drop ~ ~H0 ~ ~ I" PERCOLATION RATE ~ (minutes/inch} PERC HOLE DIAMETER , TEST RUN eETWEEN '~ FT AND (~,~- FT 17034 Eagle Riv~ L~ R~ 0 ~r 72-008 (Rev. 4/85) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: VALLI VUE SUBDIVISION %2, BLOCK 4, LOT 12 GENERAL: 1. e The scope of this project includes the installation of a 1000 gallon septic tank and a leachfield trench to serve the three bedroom residence located on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and removed. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTA?J,RTION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. e The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Se Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two Valli Vue Subdivision ~2, July 6, 1993 Block 4, Lot 12 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leaohfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6e Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DI~AINFIELD INSTALLATION= Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched ruffed- up) before gravel (sewer rock) placement. 2e Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. e A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. e Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. De Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Valli Vue Subdivision %2, July 6, 1993 Block 4, Lot 12 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank constructed by a manufacturer. proposed for installation must be Municipally approved septic tank The following septic system Anchorage: pipe materials are approved for use in installations in the Municipality of Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the %200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. Page Four Valli Vue Subdivision %2, July 6, 1993 Block 4, Lot 12 INSPECTIONS= Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. GREA ER ANCHORAGE AREA BOR ,CGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS '~(~ ""~3-~'i PHONE '-~- /<:~.~-'2..- SEPTIC TANK: INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY/~'~ GALLONS, NUMBER OF LINES DISTANCE BETWEEN LINES TOTAL LENGTH NEAREST LOT LINE .OF LINES TRENCH WIDTH ('/'PIN. TOTAL EFFECTIVE ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE IN. WELL: TYPE BUILDING FOUNDATION__ CESSPOOL APPROVED CONSTRUCTION DEPTH NEAREST NEAREST SEPTIC SEEPAGE LOT LINE SEWER LINE TANK SYSTEM· OTHER SOURCES DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: DIAGRAM OF SYSTEM iNSTALLED By:L--~)~~ SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: DATE/((<¢ht~ APPROVED G.A.A.B. PERHIT NO. E-"iLJt'-.~ :[ L: ][. cRL_ ][ T"T" L--iF- Flll~'-.I,::l- ~'~F;-:Ftt,7_-iiE: DEPRRTHENT OF HERLTH RND ENVZRONMENTFIL PROTECTZON 25J. 6 E. TUDOR RD.., RNCHORRGE, FIK. 5~507 276-222t ( 7678]: ) RPPLICRNT LOCRT I ON LEGRL T I f IBEF-. ENTERF F-. I_,E_, LONE TREE DR 1_t.2 B4 VFIL. LI ',/UE LOT SIZE 3:4 '~ - ':L 922 ;-]O9::LZ: SL.]UFIRE FEET 'T'¢F'E OF =,.Jlt. HBz, JF;BTIJN S'¢STEH IS: TRENCH MR:=.::IMUH N_i'tBER OF BEDR]OMS = =,LIL RRTING ,'S..3 FT.'E.F .... THE RE6!UIRED SIZE OF THE c~OIL FIBS~F.'PTION =t_. rEt't I=,. _~.,=:~ _~F-.~-~ . EL. [:.EF"T'H== THE LENGTH DIMENSION IS THE LENGTH (IN FEE]') OF THE TRENCH OR DRRINFIEL. D, THE DEPTH OF R TRENCH OR PIT IS TFIE DISTRNCE BETWEEN TFIE SURFRCE OF THE GROUND RND THE BOTTOM OF THE E,',.(CR'v'RTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN ]'HE OUTFRL. L PIPE FIND THE BOTTOM OF ]'HE EXCFIVFITION (IN FEET:). E, ML.k.F IL. LING OF Ri'.,l'¢ _'r_,TEi'l .NITNBUT FINRL IN--,FEL. TIuN RN[:' IflFFF:J',HL E,T THIS DEPRRTMENT WILL BE SUBJECT TO PF.'i'3;Ei_TION. NINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL S~STEM IS ±00 FEET FOR R PRIVRTE WELL OR 200 FEET FOR R PUBLIC WELL. SPECIFICRTIONS RND CONSTRUCTION DIRGRRHS RRE RVRILRBLE TO INSURE PROPER INS'TRLLRTION. I CERTIF'¢ THRT l: IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SE]" FORTH B~' THE MUNICIPRLIT'¢ OF RNCHORRGE. 2: i WILL INSTRLL THE '_:;'¢STEM IN RCCORDRNCE WITH THE CODES. 3:: I UNDERSTRND THRT THE ON-SITE SEWER S'T'STEM i','lR'¢ REQUIRE EI'.4LRRGEHENT IF' THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN --'.': BEDROOMS. ........... RFFLIF:FtNT'"~" ~'~"-'~'~ -~'~ ~~TTME, ER EI'~'ERPR ISES -' B' .... 2516 E. Anchorage, Alaska 99507 276-2221 S()II,S 1,0(i - I'I.:I~,()KATiON TEST Pcrf0rmud for Timber Enterprises _-. :~nte Pcrfor This form reports: Soils log X Percolatim~ tes~ Dep th Feet 1 Topsoil 2 - GW (8~) 3 _ sw (8~) ~ ~ ~w (89) 5 - ow (8~) 6 - ow (8~) 7 - ow (8~) 8 - sw lo - sw (12~) Il sw (125) 12 - sw 13 - 14 - ~'iat Was ground watcr encountered? No If yes, at wimt depth? Rcadin9 Date Gross Time , Net Time _.~_~e..p_~?~__~o W, ater Net Urop ................ f .............. ~-I .............................. Perco]aLion rate ,,nnu~e. - .......... 'Proposed ins[allaZ~]?"~ge Pit Drain Field I)u,)Lh of [nleL . Dept[J~%[]J~Co~-b-f-'Ht or trench COHHE1tTS: CERTIFICATE FOR A Municipality-of Anchorage . Develo pment Ses iCDeivSis,oD. e Pa rtm e nt ' Building y ''' · ' ~../ On-Site Water & Wastewater Program f / ,/ 4700 Bragaw Street ~ P O Box 196650 ~ ./'~ ,'¢~' ,//q ~//- ' Ancho;age, AK 99519-6650 /'""'/?, www.muni.org/onsite "~/,/--~'~ ' (907) 343-7904 [ .,/ OF ON-SITE SYSTEHS APPROVAL SINGL '"rFAHILY DWELLING Parcel I.D. 015-341-55 1. GENERAL INFORMATION COSA# ~)~:2C~IO I I Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address VALLI VUE ESTATES #2; BLOCK 4, LOT .,~ 10220 LONE TREE DRIVE * ANCHORAGE, AK * 99516 lAN WILLIAMS & ANN PALEY Day phone 10220 LONE TREE DRIVE * ANCHORAGE, AK * 99516 Day phone 345-8406 KATHERINE DONOHUE W/ PRUDENTIAL Dayphone 275-7716 5801 CENTERPOINT DRIVE, #200 * ANCHORAGE, AK * 99505 Unlesso~erwise ~queste~ COSAwillbeheldbyDSD ~rpickup. 2. NUMBER OF BEDROOMS: 3. 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] ~ Individual On-site [] Individual Water Storage [] ! Individual Holding tank [] Community Class A Well []. Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska.. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for proPerties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of'issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsi'ble for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of t~ffe validation date shown below; ! verity that my investigation, based on procedures outlined in the Certificate of Qn-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 5701 E.. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 557-6179 Date .Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG; LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal fight whatsoever. DSD SIGNATURE ~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ~ : WATER AND "-,.- : WASTEWATER ', PROGRAM ...' ... ... Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nkra~e Advisory (Rev. 11/05) ~,, se, ~I~ ~dv l~o,'-y Maintenance Agreements Supplemental Engineer's Report' Other Original Certificate Date:... 7 ''" Municipality of Anchorage Development Se ices Department Building Safety Division ~ " ' On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Legal Description: VALLI VUE ESTATES #2; BLOCK 4, LOT 12 A. WELL DATA CHECKLIST Parcel ID: Well type COMMUNITY If A, B, or C provide PWSID# 210605 Well Log (Y/N) Date corn pleted Sanitary .seal (Y/N) Wires properly protecte~)._J Total depth ft. Cased to ft. Casing he__round) in. FROM WELL LOG AT I.~CTION Date of test ft~~ Static water level .ft. ~-.Well production ,.--'"'/g.p.m. g.p.m. WATER SAMPLE RES .'[~'/ Coliform ,..--'"'~colonies/100 mi. Nitrate mg./L. Other bacteria colonies/100 mi. ~ ug./L. Date of sam pie: Collected by: SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date installed 8/9/1993 Cleanouts (Y/N) YES High water alarm (Y/N) N/A ABSORPTION FIELD .DATA Date installed 6/26-27/2000 Length 44 ff. Date of pumpi%~ I'BELOW EXISTING GRADEI Soil rating ~or ft2/bdrm) 1.2 Width 5 ft. Total depth *6.3-6.7 ft. Eft. absorption area 579 ft2 Monitoring tube YES Date of adequacy test 6/17/2010 Results (Pass/Fail) PASS Fluid depth in absorption field before test 4 in. Water added 470 gal. Elapsed Time: 120 min. Final fluid depth 5 in. Any rejuvenation treatment (past 12 mo.) (YiN & type) NONE Pump System type TRENCH Gravel below pipe 3.02 ft. Depression over field NO For 5 bedrooms New depth 8 in. Absorption rate >= 450+ g.p.d. KNOWN If yes, give date - D. LIFT STATION Date installed "Pump on" level at Size in gallons Manhole/Access ~ ~ in. "Pump off" leve~.~ High water alarm level at in. Cycles tested. Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lEt station on lot On adjacent lots · Absorption fu~ld on lot On adjacent lots ~'~" Public sewer main .....~eanout Sewer/s~ .------'"'""'~ Holding tank ~inment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property.line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water. 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation. 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ Water main 10'+ Driveway, parking/vehicle storage 10'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with .MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date -7/'~//0 COSA Fee S ~ ~ 0 Date of Payment '7 ,//O ReCeipt Number 0(~ ~ ! ~ (Rev; 11/05) Waiver Fee $ Date of Payment Receipt Number LOT II / / / / / / / % /~ / / 3~MTIC ~ .%,~/s (~) Anchor~ Rec~di~ Di~rict~ Alask~ ~.~t..~ .~d LOT ~ ~RTIFICATiON LEGEND h~, ~ ~t ~ ~b IIt~t~ ~ ~e wttNfl h ~- 0 Ir~ p~ ~ ro~r recovered. w~b~Mrl~-~~Je~twop~ty ~ ~J ~ 2X2 hub &teok ~r~ ~ ~ ~ ~j~ ~ ~ ~ ~ m tb ~1~ · 5]8" x ~" rebar set this su~ey ~tlm ~ ~f ~ me ao ~d~aXs, ~11t~ I~, ~ ~ ~*lble - ~ ' Fence Li~e (Ap~ox. L~ation) ScOle Ref. 30' ?.558 F'~' N°"/O-047 Prepared by: (907)P79.6PO0 t~. t.. BUTTON t~e~i~er~d Lond Surveyor 519 W, £i~hth Ave. Anchoro~ A4~o 99~01 Property of; .ZA/V W/£L/AA~$ AA/NE PALEY Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 015-541-55 1. GENERAL INFORMATION ~G¢.¢~c~.5 Completelegaldescription VALLI VUE~,S./D ~2: LOT 12. BLOCK 4 Location (site address or directions) 10220 LONE TREE DRIVE. ANCHORAGE AK. 99516 Property owner Mailing address Lending agency Mailing address C/O SALLIE NICKERSON w/ PRUDENTIAL JACK WHITE Day phone (907~ 229-1148 Day phone Agent SALLIE NICKERSON w? PRUDENTIAL JACK WHITE Dayphone (907) 229-1148 Address ,~201 "C" STREET SUITE 200 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well xxx Public water NOTE: If community well system, provide wd~ten confirmation from State ADEC arrest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide wdtten confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91 ) Front MOA #21 Computer Version Note: Alaska. Water. and Wastewater Consultants, Inc,. shall be paid $3970.00 at, or prior to, ctos/ng for the engineering services providea. 5. STATEMENT OF INSPECTION BY ENGINEER As cart[fled 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 vedfy 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 ~)¢t'd State codes, ordinances, and regulations in effect on the date of this inspection. . _ ~ ! Address 69~/J 7. ~/_, ~/ri ?//aCn,~ Engineer's S,gnature ,~'~"/~ ...__~' D~Jon system in accordance with ADEC and MOA~DH~ Guidelines & Regulations. The reporfed results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance ~z C ~,.,F... ~.~,/. .~ of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not prot4de any warranty for future estimate of how long the ~¢0~:'"/¢ © /H 7~/~/ '" ".'t~?t!~'r~- v~ system will continue to meet the operational requirements of the ADEC or MOA DHHS. ~./,~ .-:'...7. The content of this report is for the sole benefit of the owner listed abovs. Any ~,~' ' " i ~ -~ '~/.~/'~." reliance upon or use of this report by any other person or par~y is not authorized, ~2~- .,~..,~ .~. /~.~. , ._ .~ ...... ~. . . . ,~., nor will it confer any legal right whatsoever. ~.~ './.Je~re~/~'/~. O~q~..' Approved for .-~ bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments Date ~-o o The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their 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. 72-025 (Rev. 1/91) Back MOA ¢Y21 Computer Version RECEIVED Municipality of Anchorage JUL DEPARTMENT Of HEALTH & HUMAN SERVICES 07 £000 ~ · ' n MUNIC~P^i. iT¥ OF Environmental Services Divlslo ,,, ^NCHO~ 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) ;~f4qT.~L SErViCES D~j~-'r~ Health Authority Approval Checklist Legal Description: VALLI VUE S/D #2; LOT 12, BLOCK 4 Parcel I.D.: 015-341-55 A. WELL DATA Well Type CLASS "A" Log present (Y/N) Total depth Cased to Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform IfA, B, or C, attach ADEC letter. ADEC water system number 210605 Date completed ~ ,~e ground) FROM WELL LOG Nitrate Wires properly protected (Y/N). AT INSPECTION g.p.m. ~ g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed 8/9/93 Tank size Foundation cleanout (Y/N) YES Collected by: 1000 Number of Compartments Depression (Y/N) NO Date of Pumping 5/29/2000 Pumper NORTHLAND PUMPERS C, ABSORPTION FIELD DATA Date installed 6/26/00-6/27/00 Soil rating (g.p.d./ft2 orfi2/bdrm) Length 44' Width 5' 2 Cleanouts (Y/N) · YES High water alarm (Y/N) N,/A I, BELOW FINAL ORADESI 1.2 .System type TRENCH Gravel thickness below pipe 3.02' Total depth *6.4' Effective absorption area 379 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N). NO Date of adequacy test NEW Results (Pass/Fail) For .~B~edrooms Fluid depth in absorption field before test (in.); ~al. water added (in.): __ 72-026 (Rev. 3/98)* Computer Verslon D. LIFT STATION ~~' Date installed ~-- --- Manhole/Access (Y/N) ~' level at* "Pump off"level at*_ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WELL Septic/holding tank on lot Absorption field on lot Public sewer main On adjacent lots .~blic sewer manhole/cleanout Liffstation 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 5'+ Wells on adjacent lots_ 200'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain 10'+ Building foundation 100'+ NONE KNOWN F. ENGINEER'S CERTIF/J( I certify that I~ de~e~ of Municipal ~ecc s/hq with Signature ",_/ ~tt/l Engineor's!aT~ ~ ~j Date ?/-; ~o :ATIO, J~I, P e/ ow 10'+ Driveway, parking/vehicle storage area_ 10'+ Wells on adjacent lots 200'+ )ld inspections and review ~,stems are in conformance this date. JEFFREY A. GARNESS Water main/service line 10'+__ .... HAA Fee $ '~P-~ Date of Payment Receipt Number 72-026 (Rev. 3/98)* Computer Version Waiver Fee $ Date of Payment. Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Env ronmenta Services. On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 12; Block 4; Valli Vue Estates #2 Location (site address or directions) 10220 Lone Tree Property owner Mailing address Lending agency Mailing address Agent Address Mitch Schapira 10220 Lone Tree Drive Day phone 258-0070 346-3198 Anchorage, AK 99516 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well X×X 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: XXX 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 INSPI=CTION 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 inves_ti._gation 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 ~ ~?/ff¢ '- ~-~F ,'? Engineer's signature DHHS S/IGNATURE Approved for _.~ 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 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 omissions in the professional engineer's work. 72-025(Roy. I/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Desoription: /~/~ Z~Z// ///-~-////') /~'/~-4'~? '~ ~ _ Parcel I.D. A. Well Data Well type Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 Absorption field on lot ./ / Public sewer main // Sewer servic~__ WATE/~MPLE RESULTS: Co/~rm . Nitrate /Date of sample: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to ~ght ____ .Wires properly .~pt~d (Y/N) FROM WELL LOG INSPECTI N //' g.p.m, g.p.m. ~rrl ~_~ ~0 ~ ri3 ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Other bacteria Collected by: B. SEPTIC/h~;.~;-:~ TANK DATA Date installed ~d:~/4~ ./~2 Tank size //000 ~ Compartments / Cleanout~N) __ __. /F°undati°n cleanou¢) __ __ Depression/~ High water alarm (WN) /~ Alarm tested (Y/N) ~ Date of pumping ~ Pumper ~/~ / SEPARATION DISTANCES FROM SEPTIC~TANK TO: Well(s) on lot On adjacent lots / To property line ./(~) Absorption field ~"~/ Sudace water/drainage ~ ~ 0 Foundation Jo / Water main/service line /'/O ~ CONTINUED ON BACK PAGE ' 72-026 (3/93)* Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ,.-~- Cycles tested Meets MOA electrical codes SEPA~ROM LIFT STATION TO: WJett"bn lot On adjacent lots Manufacturer Manhol~ Surface water D. ABSORPTION FIELD DATA Date installed r-~/,/~/~.-~ Soil rating (GPD/F,2) ~, ? .System type 77~/'2 ~_~/¢' Length ~4/Z- / Widt~ ~-,,.~' 7~/ Gravelthickness ,~"~-~ O¢''''- Totaldepth /.-/,--.3~' / Total absorption area .-~ ~7~ Cleanout present(~) Depression over field (Y/~ Date of adequacy test ./0/z~''-.//¢~ Results (pass/fail) ,/'~/,/W for ,~//.Fg Bedrooms Water level in absorption field before test ~ / ~ Peroxide treatment (pest 12 months) (Y/N) ,XJ /,r~ / After test If yes, give date '~/,/~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /d/,/~ _On adjacent lots / t To building foundation ~. O --/-" To existing or abandoned system on lot On adjacent lots Z O ~-- Cutbank /.JO ,/'J ~' Water main/service line Surface water /[24P/..J ~ Driveway, parking/vehicle storage area Curtain drain /t/'CgAJ-¢' ~J O 54J E. ENGINEER'S CERTIFICATION I ced/f/that I have checked, verified, or conformed to all MOA and HAA Engineers Name ~GtN~P-~N6 Date ~/~o ~'.,'~k~ 995~7 & ////~ ~ ..... / / ' HAAFee$ /~) ' ¢/~ Date of Payment ~ ~/i ~ c~'~ Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back , DATE~, ~-..~- ~RECEIVED .~, INSPECTION APPOINTMENTS TIME TIME TIME .~ %~- ~ ~0 INSPEC~]CIPALI~Y ....... ~,~..;~ ~ Lo~EcTtON MUNICIPALITY OF ANCHORAGE 825 L Street - Anchorage, Alaska 99501 ) ENVI RON~ENTAL SANITATION DIVISION RECEIVED Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES 5. LEG L DESCRIPTION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four ~' SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~. Three [] Six [] Other~ 7, WATER SUPPLY [] INDIVIDUAL* COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** /¢77 E~ PUBLIC UTI LITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM [~INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or []Holding -rank Size: ?~(r~)O If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4, DISTANCES WELLTO: Absorption Area to nearest Lot Line PERMIT NUMBER DATEINSTALLED INSTALLER SOl LS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line 5. COMMENTS ~//APPROV ED FOR ,~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED BY ~ I~ DATE 72-O10 (Rev, 6/79) 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION March 3, 1980 Krogseng Real Estate 6025 Winding Way Anchorage, Alaska 99502 Subject: Lot 12 Block~v~l~i rue Estates Subdivision #2 Robert/Jen~ 2al 1_~~ Approval for the individual sewer and water facilities can not be granted until the following item has been completed: (1) The septic tank pumped with a receipt submitted to this office. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: National Bank of Alaska Mortgage Loan Department Pouch 7-025 99510 / ?..~ MUNICIPALITY OF ANCHORAGF~-N DEPARTME ~ OF HEALTH AND ENVIRONMEN~L 825 L Street, Anchorage, Alaska / ~. 279-~511, exto 224 or 225 V ~TM Date Received: #1: Time /i~ ~/~ #2: Time #3: Date L~7- U7 ~5 Date Insp I/l*bt~ Insp PROTECTION 99501 May 27, 1977 Time Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER WATER FACILITIES Lending Institution Request: Alaska National Bank of the North Mailing Address: Pouch 7-010 99510 Phone: 278-4581/273 Property Owner: David Burlingham Mailing Address: Phone: 3. Legal Description: Lot 12 Block 4 Valli Vue Estates 4: Single Family Residence: (x) Number of Bedrooms: ? Multiple Family Residence: ( ) Number of Bedrooms: Well System: Permit # Construction Individual well ( ) Communi~y/Public System (x) Depth of Well Well Log on File Bacterial Analysis ( ) Sewage Disposal System: On-site Permit # Inst~lled Septic Tank Size 6. System (xk Public Utility ( ) /~_//~A Installer~ ~?~3 ~ ~c~ Manufacturer Absorption Area ~A3~_~ Soils Rate /~ Material Distances: Well to Septic Tank ~)~-t_~to Absorption Area 7. to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Two . ,~ ' Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 12 Block 4 Valli Vue Estates Subdivision Affadavit Attached: ( ) Letter Attached: ( ) Department Worksheet: 3330 GREATER ANCHORAGE ARE/, BOROUGH Department of Environmental Quality "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type of Inspection: ' CNRO VA FHA CONV Property Owner: Dav±cl ~urlingham Mailing Address: Name of BUyer: tqailing Address: Day Phone 19ot~.z~c Hall & Jenna O~nwell Hall 3000 W. 34th #8 Day P h on e Her-277-0996 4. Name of Lending Institution: Alaska National ~ of the Noz~c!~ Mai 1 ing Address: Pouch 7-010, Anch. Ak 99510 Phone 278-4581 ext. 273 5. Name of' Realtor or Agent: Area Realtors-Jeanette Carlander Nailing Address: 3300 "C" Street, Anch. Ak Phone 278-2525 6. Legal Description: Lot 12, Blk. 4, Valli Vue Estates Location: 220 Lone Tree Drive, Anch. Ak Type of Facility to Hater Supply Type of Supply: If Indiv.idual, If Individual, be inspected: Public Utility number of dwellings depth of well Sewage Disposal'System Type.of S~stem: Public Utility If Individual, date of installation No. Bdrms. C~JNIS"Z X presently served SEPTIC ~ (on-site)