HomeMy WebLinkAboutVALLI VUE ESTATES #1 BLK 1 LT 22
Municipality of Anchorage Page i 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:. ~k~J c~ ~ O0 ~ (~ PID Number:
Name: ~O,~.l ~,~ ~ ~ ~b~ Wastewater System: D New '~Upgrade
Address: ~,~ ~ ~- do~ ~ ABSORPTION FIELD
I
Phone: ~4~k__ ~1 ~j No.~edrooms: DDeepTrer~ShaliowTrenoh BBed ~Mound ~Other
LEGAL DESCRIPTION (.~ ,~(~,~o';, Soil Rating: ~. Ft. Total Depthfromoriginalgrade:
Lot: Block: Subdiv~ion:( ~ ' Depth to pipe bottom from original grade~ Gravel depth beneath pipe
~ DNew D Upgrade Gravel width: Ft. Number of line.Distance be~een lines:Ft.
Classification(Pr'~ TotalDepth: Ft. CasedTo: Ft. Total absorption area: SO. Ft, Pipemateriah
Driller: ~ ~ StaticWaterLevel:Ft. Installer: Oateinstalled:
I I ' ' '~ TANK
Yield: Pump Set at: Casing He~g~ e Ground.,
GPM Ft.
SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P.
TO Septic Absorption Lift Hoi~ing Public/Private Manufacturer:~_ ,,/ Capacity in gallons:
From Tank Fiel~ Station Tank Sewer Linss ~0~'
0
Material: NumbeE Compa~ments:
Sudace
w~ IOO~ i0o~,¢'~~ LIFT STATION
Line
Foundation ~(. ~ "Pump on" level at: I "Pump O"'1 'eve' ~t: ~h~
Remarks: BENCH MARK
ocation and Description:.~p
A~umed Elevation:
Inspootionspedormedby: ~C, I~C~ Dates:lst
Depadment of Health and Human Seduces approval
Reviewed and approved by: ~~. ~ Date:~-/o
72-013 (Rev. 9/91) MOA 25
$1 22,3 22.0
$2 29.0 27,0
D! 30,4 28.2
02 31,0 28,9
A B
S1 22,3 22.0
S2 29.0 27.0
D! 30.4 28.2
02 31,0 28,9
AI.AS~ WA~R A~ WAS~WA~R CONS~TA~S, INC.
8901 DE~R ROm SU~ 28, ~CHOmOE, AK 9950&
PHONE (007) 3~7-617g/F~: (907) ~38-3246
VALLI VUE ~1, LOT 22, BLOCK 1
~E OF
AS-BUILT OF SEPTIC SYSTEM
PREPPED FOR= PHONE NUMBER:
DON AND
A.C.G. 1 = 40' 2 OF 2
PERMIT NUMBER: AS BUILT DI~WING PARCEL ID NUMBER:
SW990089 ' 015-$11-2:5
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J I SUUP
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A B I I
S~ ~ 22.5 22.0 I
I I EXISTING DRAINF~ELD
S2 29.0 27.0 [ I (P~S~oN~ 5/15/98) '
/
(~P
D1 30.4 28.2 J~
D2 31.0 28.9 J ~ ]
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A~S~ WATER AND WASTEWATER CONS~TANTS, INC.
8901 BEBARR ROAD SUrE 2B, ANOHORAOE, AK 9950~
PREPAREO FOR: PHONE NUMBER: ~0~ · ~-7953,,.,.,'.
ME'NIB ROLLER 344-6181/522-5638
DATE:5/18/99 DroWN BY: SCALE: J PAGE:
A.C,G. 1 = 40' 2 OF 2
A B
S1 22.3 22,0
S2 29.0 27.0
D1 .50.4 28.2
D2 31.0 28.9
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: May 10, 1999
Expiration Date: May 09, 2000
Permit Number: SW990089
Legal Description: VALLI VUE ESTATES #1 BLK 1 LT 22
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: Kathy Bouschor
Owner Address: 6826 Double Tree Ct.
Anchorage, AK 99516-6842
Parcel ID: 015-311-23
Site Address: 006826 DOUBLE TREE CT
Lot Size: 23518 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank [] 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 subsudace 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:
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99504
Phoue (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
May6,1999
Municipality of Anchorage
Department of Health and Hunmn Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic Tank Upgrade for Lot 22, Block 1, Valli Vue Estates Subdivision Itl
To whom it may concern:
The existing 3 bedroom house is served by a community water system and a private septic system
that consists of a 1000 gallon septic tank and a trench type drainfield. The septic tank has
collapsed and needs to be upgraded as soon as possible due to the health hazard.
We propose to excavate, pump, crush, and abandon the existing septic tank by burying on-site;
and replace it with a new 1000 gallon septic tank in the same area of the old tank. Double
cleanouts are to be installed after the new tank. We request that you issue a expedited permit due
to the health hazard.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If
assistance.
uestions, please contact us at 337-6179.
Thank you for your
~ ...... - ........ DOUBLE TREE COUR~ x ', I
O' MALLEY ROAD
NOTE: ALL PROPERTIES IN VALLI VUE EST. ~1 ARE SERVED
BY A COMMUNi~ WATER SYSTEM AND PRIVATE SEPTICS.
THERE ARE NO WELLS WITHIN 200 FE~ OF THE ~ISTING
SEPTIC SYSTEM.
~S~ WA~ A~ WASTEWA~R CONS~T~fi, ~C. :.:~'~' ~ j~x. ~
SITE PLAN FOR SEPTI6 TANK UPORADE ~¢~A':~:'"4
A.
3REPARED FOE: PHONE NUMBER: ~ , ~
.za.,~ ROLLER ~"-~ .l/SaZ-~aza ~}~'.~._ ~ ~-~"~ ..'",~
~o~ ~ ~%:%.. .......... 2¢~~
J.L.M. 1 = 100' 1 OF 2 a~erofa~=i°%~~
10'
........ ~ · INSTALL DBL CO-~
II ~t .... ~~. 3 BED~u
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t ~ (PASSgD~ ~~EPT[CADEQUA~T TE~) EP ~ TANK (COL~PSED)
~ ~ (APPROX. LOCATION) AND REP~CE WITH
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O'MALLEY ROAD
~S~ ~A~R A~ ~AS~A~ CONS~TA~S, ~C.
LEGAL
VALLIE VUE ESTATES SUBDIVISION ~1; LOT 22, BLOCK 1,
DESIGN FOR SEPTIC TANK UPGSADE
DON AND ME~NIE ROLLER
544-6181/522-3658
J.L.M. 1 = 30' 2 OF 2
oGRE/
iR ANCHORAGE AREA BOR
Department of Environmental Quality
3330 C Street
AnchorBge, AIsska ggs03
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE ~ J.~~
FROMWELL~L.~ MANUFACTURER
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPAC I TYZ<~_ GA LLON S.
TILE DRAIN FIELD: ~',, '
DISTANCE FRO~ WELL[~''~OUNDATION
NUMBER OF LINES / DISTANCE BETWEEN LINES
ABSORPTION AREA ~/~--~ SQ. FT. LENGTH OF EACH LINE
DEPTII: TOP OF TILE TO FINISH GRADE
WELL' ~.~ ' '~- · ~,
BUILDING NEAREST NEAREST
FOUNDATION .... LOT LINE
NEAREST LOT LINE ~¢/1~' TOTAL LENGTH
OF LINES
TRENCH WIDTH ~/
IN. TOTAL EFFECTIVE
~'~.~. --
MATERIAL BENEATH TILL ~ IN. ABOVE TILE
.DEPTH
SEPTIC SEEPAGE
, SEWER LINE TANK , SYSTEM
DISTANCE FROM:
CESSPOOL
OTHER SOURCES
APPROVED_. DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY: ~'~¢~.4~
sEwER LINE DEPTH:
LOT SLOPE:
REMA R KS:J~, -'<~~J¢
Form EQ-032
GREATER ANCHORAGE AREA BOROUGH /)h~)]~
DEPARTMENT OF ENVIRONMENTAL QUALITY -(~//c:: PE MIT NO.
3330 "C"STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456!
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
//,
INSTALLATION OF: SEPTIC TANK ~ ~EEPAG~ PIT
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
TO BE INSTALLED BY
DRAIN FIELD
OTHER
NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION bY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION,
MINIMUM DISTANCES, REOUIREMENTS
/
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT ~/ ., DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE Pit ~ ~ , DRAIN FIELD
TO NEARE T L T INE.
DRAIN FIELD
· SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
, SEEPAGE PIT
TO RIVER, LAKE. STREAM.
SEEPAGE PIT
/"/~O 'f, DRAIN
CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INtO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH Airtight REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGU ATIONS REGARDING INSTALLATION.
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER A NO~ GE AREA BOROUGH
DATE APPLICANT'S SIGNATURE
ORDINANCE NO, 28-68 AND THAT THE ABOVE
GF I'ER ANCHORAGE AREA DOF,.OUGH
Department of Environmental Quality
3330 "C" Street
Anchorage~ Alaska 99503
P. erforrc, ed for ...j~.~ , Date performed
/nls Torm lepor'cs. 3oils log ~. . Percolation test
Feet
7 - /..:~,.~' :5:"-'~"L': ~,.'
.. ,,: ..........
Was ground water encountered?
__~.X~) .... If yes, at what depth?
Reading
Date Gross lime Net Time Depth to H20 Net Drop
Pro}(se¢~ i~mtal!ai:ion,, c
.... oafi,. Pit Drain Field
l)~pt~; o'F Inlet ............................. hep ,h to 12otto;} of pit or
CO,,~E
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. # 015-311-23',
FIAA #
1. GENERAL INFORt~IATION
Complete legal description
22; B].ock 1; Valli Vue Estates #1
Location (site address ord,,~-~,*~..t k.n..)'" o
Property owner
Mailing address
Kathy_ Bouschor
6826 Double Tree Court
Anchoraqez AK 99516
6826 Double Tree Court
Day phone
Anchorage,
564-7941
AK 99516
Lending agency
Mailing address
Day phone
Agent
Address
[Day phone
2. NU~BER OF BBDROOEf~$:
3. TYPE OF WA'Ii'El? SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well
Community well
Public water
If community well system, provide written corffirmation from State ADEC attest-
lng to the legality and status of system.
4. TVPE OF WA$¥EWA'I'E~] DISPOSAL:
NOTE:
Individual on-site XXX
Holding tank ~'2~¢
Community on-site
Public sewer
If community was~ewater system, provide written confirmation from State AD£i'C
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA#21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division I:EB 5 1999,
825 L Street, Room 502 · Anchorage, Alaska 99501 ·
"Oept. Fleal[h & Human bervices
Health Authority Approval Checklist
LegalDescription: LO-/ 2¢'~ ig~-~ll~l/f'~rLL-'~ ///~/2ParcelI,D.:
A, WELL DAT~
Well type ( ~J//W/~/~/Ty
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
/'J//~- Cased to
Date completed
If A, B, or C, attach ADEC letter. ADEC water system number
Casin~ height (above ground)
Wires properly protected (Y/N)
FROM wELL LOG AT INSPECTION
Date of test /~J/'~
Static water level
Well production .~J//~ g.p.m. ./~//~
g,p.m.
WATER SAMPLE RESULTS:.
Coliform / J///~
Date of sample:
B, SEPTIC/HOLDING TANK DATA
Date installed ~/l~l~ Tanksize
t~oundation cleanout {~N)
Date of Pumping
C. ABSORPTION FIELD DATA
Date installed (~/I.~
Length ~S' Width
Effective absorption area
Date of adequacy test
Nitrate
~//~ Other bacteria
Collected by:
Depression (Y/~)
Pumper
Number of Compartments [ Cleanouts
High water alarm (Y/~
I-------3
Soil rating (g p d/ft~ or ff~/bd~.~
/ ~'~0 System type /~
Gravel thickness below pipe ~ ~. Totaldepth ~,S' ~ ~/¢
Monitoring Tube pmsent~) ~ Depms~mn owr field ~
Result8 (Pass/Fail) ~RS~ For ~ .bedrooms
Fluid depth in absorption field before test (in,); ~/ Immediatelyafter~g gal. wateradded (in.): ~,[/'
Fluid depth ~p.~x (ins) Minutes later: I.~[ Absorption rate = /-/~0 4 .g.p.d.
Peroxide treatment (past12 months) (Yd) fyes, givedate
72-026 (Rev. 3/96)*
ALASKA WATER & WASTEWATER ~ u~..~z.~a,~
SEPTIC ADEQUACY TEST DATA
,~,,-q'~ ~ ~a':....:',~.~.?....,
LEGAL DESCRIPTION: L.o'~ 3,~- ~ ~CC-// t,//~,c-Z, ~/~,t,~
~0~',. ~-~ ..." ,~
STreET *0O~ESS=. "~:~.;~ ..........
CLIENT:,
NUMBER OF BEDROOMS
TEST DATE START ~/l~ TEST DATE END ~{1~/~
SEPTIC TANK SIZE: /0~6 ~ LI~ STATION YES / ~
BATE OF PUMPING: Jl-2~-~ PUMPER:.
' ~VER
s~sJ~ T~.~,
~ DEEP TRENCH g BED , ---
~ CONVENTIONAL ~.~"
~ DEAINFIELD ~ PRESSURIZED
J~CONVENTmNAL g MOUNDED
~ PRESSURIZED
~ MOUNDED ~ OTHER:
IF YES, WHERE? ~= ~, ~-"
ARE ON THE INSPECTION REPORT? ~/ N~
~F .o, W.~CH O.E/S~
METER GALLONS SEPTIC TANK aO~ITORI~G TUBE ~MONITORING TUBE
TIME READING ADDED LIQUID LEVEL LIQUID LEVEL gOUlD LEVEL
RESULTS: ~SSED: ~ ~ ~ FAILED:
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEAL%~q
(a)
(b)
(c)
(d)
(e
L~gal Description (include lot, blo~k, sub_division, .-~ct3.on, township., rDnge)
..... ~ ~-~ ~) . .~
Applicant_is (ched< o~)~nding Institution
~ndi~ I~stit~tio~ ~ ~ ~.~
,,~<~ ;,;~17-'~-- - ~
Address
Telepho~
2o T_~y~o_ of Pssidenm
Single-Family
N~anber of Bedroc~
3. ~te_~__ Suppl~!
iviSua. mn
Multi-Family
O~e~ (~s~'i~)
Ccrm~nity [~j Pubiic F~_~[
Note: If cx2n~unity wall system, must have w~itten confiz,~mntion f~2on ['.he State
~p~t~nt of ~viro~ntal Conservation attesting to t~ legality m~d status.
Is Mle v.~ll adequate fo~ the numar of l~c~s s~cified in this }~ (Y~) p///'
4. ~g~q~sposa 1
Onsite ~ ~blic~ ~ ~i~nity ~ Holding 'I'a~ ~
Is the wastewater, dis~sal system adequate for the nt~r of ~dro~ (Y/N) ~;
y~ ,~,:~.'.c~t',,?:.~ *,~ ,~,~,~.~-,,~'+ /,.,-~.~+,~ ~f~;(,'.~'~/ ~ ~'-'~-?.
[Pag~ 1 of 2]
2-3.5--84
5. E_ngineerin~q Firm Pr. ovi__d~in_~ns~?tions, %%sts, ~ta and Information
I ~tify ~at I have ~cked, ~rified, o~ ~nfo~d to all MDA ~ ~i~li~s in
effe~ on the date~of this ins~ction.
Sig~ ~.k. r~
(ENGINEER SEAL)
6, DHEP A~oval
Approved for ~-~.: [~.drocg~s
Appr oved~ Disap~oved ~-~:
Terms of Conditional Approval
The Municipality of ;u~cho~age Eepa~tn~nt of Health and Enviror~ental P~.otection dces
not guarantee the continued satisfactory perfo~anc9 of the water supply and/or the
wastewate~ disposal system. This approval indicates that, as of the validation date
sh~n above, based on the data and information furnished by ar~ engir~er registered in
the State of klaska, the wate~ supply and wastewater disposal system is safe and func--
tional for t2~e nun~)e~ of bedrc~m~ and type. of stmucttree indicated.
(E~EP SEAL)
7. Mail the ~ to the following add~ess:
KB2/dS/s
[Page 2 of 21
2-15--84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
A. WELL DATA
Well Log P~esent (Y/N)
Total D~pth J///~ Cased to
Static Water Level ~/
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances f~om Well:
To Septic/Holding Tank on Lot
Date Completed
/
Pump Set At
; Oa Adjoining Lots
; On AdjoiningLots ~00'
To Nearest Public Sewer
To Nearest Edge of Absorption Field on Lot ~DO' ~
To Nearest PublicSew~ Line ~/,,//'~
Cleanout/Manhole /~/%~ To Nearest Sewe~ Service Line on Lot
Wate~ Sample Collected By /U//~ ; Date
Wate~ Sample Test Results ~///~
B. SEPTIC/HOLDING TANK DATA
Date Installed ~ -/~- 7~'* Size /43~O ~?4 No. of Ccr~pa~tn~nts /
Standpipes (Y/N) I/~ ai~-tight Caps (Y/N)%/~j Foundation Cleanout (Y/N) /~f'..__~
Depression over Tank (Y/N)/~9 Date Last Pumped {~{'-/~o~
Pumping/Maintenance Contract on File (Y/N),{~/~ ; fo~ ~J///~
Holding Tank High-Water Alarm (Y/N) ~;/~ Temporary Holding Tank Permit (Y/N),{7/~
Separation Distances f~om Septic/Holding Tank:
To Water-Supply Well
To P~operty Line z/~5''
To Water Main/Service Line ~'~
co se
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, c~ Major D~ainage
Commsnts
[Page 1 of 2] 2-15-84
RILL SHEFFIELD, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
SOUTHCENTRAL REGIONAL OFFICE
437 "E" STREET, SUITE 200
ANCHORAGE, ALASKA 99501
DATE:
Telephone: (907)
Address:
274-2533
To ~¢aom It May Concern:
According to records on file in this office the ~/J '--'~)~C
Water System is in compliance with the State Drinking
Water Regulations.
Sincerely,