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Home My WebLink AboutVALLI VUE ESTATES #2 BLK 3 LT 44 Municipality of Anchorage Page j 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 Name: '--I'~' ~ ~ ~1,~.~ Wastewater System: D New [ .~Upgrade Address: l o~ ~ 'T~.~ ? ABSORPTION FIELD Phone: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other ~>V~' ~Oq~ ~ No. of Bedrooms: LEGAL DESCRIPTION So,.a..~: Total Depth from original grade: GPD/Sq. Subdivision: Depth to pipe bottom from odginal grade: Gravel depth beneath pipe Township: J Range; Section: .~ Fill added above original grade: Gravel length; Gravel depth: Number of lines: ~D~stancebetwee~lines: WELL: New Upgrade Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. SC. Ft. Driller: Date Drilled: Static Water Level:Ft. Installer~. ~.~ Date installed: Yield:GPM ] Pump Set at: Ft. ICasing Height Ab°ye Gr°und:Ft. TANK SEPARATION DISTANCES ~s~pti~ ~ Ho~.g ~ S.T.E.P. TO Septic Absorption Lift Holding Public/Priwte Manufacturer: Capacity in gallons: From Tank Field Station Tan~ Sewer Lines A~ C ~ ~i~ [~ Well .~/~ Material: ~ ~ Number of Co~rtments: Sudace w~t~ NJ~ LIFT STATION Line ~ ~0 I Gu~ain ~/~ ~ump Mak* &Mod01 I Boctrical Inspoctions por~ormed Drain Remarks: BENCH MARK Location and Description: IAssumed Elevation: Inspections performed by: ~' ~ Dates: 1st R/¢ ~ /q I Department of Health~ s approval Reviewed and approved by: _ . ate:. . 72-013 (1/91) MOA 25 Permit No. Page ./x~ of ~ 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 72-013 A (2/91) 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:SW910285 DESIGN ENSINEER:TOBBEN SPURKLAND, OWNER NAME:TENNISON GARY J & OWNER ADDRESS:10501 LONE TREE DR ANCHORAGE, AK 99516 DATE ISSUED: 9/12/91 P.E. EXPIRATION DATE: 9/12/92 PARCEL ID:01532219 LEGAL DESCRIPTION: VALLI VUE ESTATES #2 B 3 L 44 SEC 14, T12N, R3W, SM LOT SIZE: 20134 (SQ. FT.) NUMBER OF BEDROOMS: ~ 3 THIS PERMIT: 3 ~ THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ISSUED BY: DATE: DATE: Th:~ o!alis given lo ~i~! i~-iocating -.¢ ...... ~- ohb, and the c. ompany ~.~/,,?~ /(r.:/..~ ;fimkland hereby certify that ! have su~,eyed the Yollowing~ A:~charage. Recording: Precinct, Alaska, and that ;he improvemen~ situated thereon are within the pro~e."ty lines and do not overlap or encroach on the pror, crty lying ndjacc, nt thereto, that no improvcmen~ on. prop- crly lying adjacent t~ereto encroach on thc premlyeg ir, qxcstion ~d ~hnt there are no ~m,dwa)'s, tram;miss:on lines or other x'i*ible easements on said propc~y exrept as ir, dicMed hereon. Dated at Anchor*ge, Alaska /9~ ~>. of ~/~ ' '""' ' FRED WA~%~ & A~S~S EngJnc'~-s and Surveyor~ GREA. -~, ANCHORAGE AREA O' Depsrtment of Environmental Quslity 3330 C Street Anchorege, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME O"('OJ'a~j"J~ MAILING ADDRESS /0(' ~, "~}L, ~q.~¥~Z,t.u~- ~O~PHONE :Z-?~r~---f'~/(-/ LOCATION LEGALDESCRIPTJON c"¢(/,~ U.~' B/k 3 (~¢- ~ SEPTIC TANK: DISTANCE FROM WELL ~2~01¢/~ MANUFACTURER ~*L4t4;~e ~¢' MATERIAL INSIDE LENGTH ~ INSIDE WIDTH_ a--- LIQUID DEPTH NUMBER OF _COMPARTMENTS LIQUID CAPACITY lOgO GALLONS. DISTANCE FROM WELL ~-.(¢0~-~ FOUNDATION TOTAL LENGTH .NEAREST LOT LINE£2"'z-/ OF LINES (0~ NUMBER OF LINES J DISTANCE BETWEEN LINES '~' TRENCH WIDTH ~ IN. TOTAL EFFECTIVE ABSORPTION AREA ~ ~f¢ ~-~ SQ. FT. LENGTH OF EACH LINE ~:)ql DEPTH OF FILTER I DEPTH: TOP OF TILE TO FINISH GRADE.~I--~'I MATERIAL BENEATH TILE__~ JJ~. ABOVE TILE ~/ IN. WELL: TYPE ~6)fi4(44 ~ ~t f'~l' ~ CONSTRUCTION DEPTH_ DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION _, LOT LINE SEWER LINE TANK , SYSTEM 2~0~'-- CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: 0 Jr.__ DIAGRAM OF SYSTEM INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: REMARKS: Form EQ-032 G.A.A.B. \~ GREATEr ANCHORAGE Area BOROUGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE FINANCED THROUgh SOIL TeST RESULTS (''~ COMPLETION DATE ANTIC[RATED SEEPAGE PiT , DRAIN FIELD ~ OTHER TO BE INSTALLED BY 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. SEPTIC TANK SIZE ~/'~ '~ ') TYPE . J~ SEEPAGE AREA SIZE YP '~'~' DIAGRAM OF SYSTEM WELL TO SEPTIC TANK ~,OCJ~ ' , SEEPAGE PIT ~--~ SEPTIC TANK, (0 ,.)r , SEEPAGE PIT ~/O0 (- DRAIN FIELD CERTIFY THAT ] AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORD ANCE NO. 28-68 AND THAT THE ABOVE "One te~ is worth a ~housand opinions" Glacier Excavating Date Performed Description: Lot 44 Block 3 ~orm Renort$ Soils Loq YES Performed For Legal This 5/21/75 __Subdivision Valley View Subd. Percolation Test De~th Feet Soil Characteristics 2 3-- 4 5-- 6-- 7 ~--. 10-- Overburden (ML) Sandy Gravel GW-GP Gravelly Silty Sand SM-250 (occasional cobbles) /~.._ Was ~roun~ Mater ~nc~u~tered? NO I~ Yes, At what Depth? I I ,1~. ~...~-~_! ': ; I .I I Readinq Date Gross Time Net Time Depth to H20 Net Drop! I Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field De~th of Inlet Depth To Bottom Of Pit Or Trench Cn~ENTS: 250 Square feet drainaqe area. require~ per bedrnnm No bedrock or ground water encountered Test Performed By K~,;;~ ~-~f~-F'- /James D. Mack Data Certified B~:CONSTRUCTION TEST LAB Date:~ 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 44; Block 3; Valli Vue Estates Subdivision #2 Location (site address or directions) 10501 Lone Tree Drive, Anchorage, Alaska Property owner Mailing address Gary. TennJson Day phone 10501 Lone Tree Drive, Anchorage, Alaska Lending agency GMAC Mailing address ATmF~mTON: Agent Mary Minder/2001 REAL~Z Day phone Day phone 276-2001 Address 2600 Denali, Anchoraqe, Alaska 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: NOTE: Individual well xx× Community well Public water If community well system, provid~ written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX NOTE: 99503 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. 72-025(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 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 $ & $ ~NGINEERING Phone 170;¢4 E~,gle River Loop Road ~Jo. 2~0~ Address Eaqle River, Alaska 9'9577 Engineer's signature Date ~'~_z~_,rI "5 DHHS SIGNATURE 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 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. 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 GENERAL INFORMATION Complete legal description Lot 44; Block 3; Valli Vue'~f ~ Location (site address or directions) 10501 Lone Tree Drive Anchorage, AK Property owner Ji~.gx~ & Doreen Ha~on Mailing address 10501 Lone Tree DrZve Lending agency Mailing address ' Day phone_ 346-~17 Anchorag~z AK 99516 Day phone Agent Address Dave Werth/ Remax Properties 2600 Cordova Street Suite 100 Day phone Anchora~:~ AK Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well XXX Public water 276-2761 99503 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XXX TYPE OF WASTEWATER DISPOSAL: 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. NOTE: 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 omsite 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. S & S ENGINEERING Name of Firm ___--17034Eagle-River-I~eepRoad Ne,~04 Phone Eagle River, Alaska 99577 Add tess Engineer's signature DHHS SIGNATURE /"'~ Approved for Z~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~./¢¢ .~f'-, 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: Lo 7 q~ Health Authority Approval Checklist ~-~c~ ] ¥'%~'/ Vc'4?~/z) ParcelI.D.: A. WELL DATA Well type ~2-,~-'X 5 Log present (y/N) Total depth Sanitary seal (Y, qq) Date of test Static water level Well production WATER SAMPLE~TS: Coliform // Nitrate D~of sample: ff A, B, or C, attach ADEC letter. ADEC water system number ~t l O 6 O S- Date completed Cased to Casing heighJc,0tb'6ve ground) .... Wir, e~perly protected (Y/N) FROM WELL LOG~ AT INSPECTION AT INSPECTION g.p.m. Collected by: Other bacteria B. S~-~-~OLDING TANK DATA Date installed ~} /Tcy'/qj Tank size .l a- Foundad0nclean0utC~N) ¥~5 Depression(YO v/=,/~ High water alarm Orfl~ Number of Compartments 2 Cleanouts {~/N) Yt$ ~0 Soilrating (g.p.d./ft2or-~ o~ ,,cO Systemtype -rte~.c~ Gravel thickness below pipe q Total depth Ot,°rt/o.~ ,~-'=',,OE tg~-~-~,o~ = I0/ ~l ~t C. ABSORPTION FIELD DATA Date installed ~' / ~ '[. '~ 5" Length (~ q I ~ Width Effective absorotion area I ~ ~ z .e Monitoring Tube present'N) ¥~-f Depression over field (Y/I~ ~O Date of adequacy test q/a-o / q ~ Results O'S/Fail) ,/°d- $ J' For q bedrooms Fluid depth in absorption field before test (in.); c/ ~ Immediately after6Og gal. wateradded (in.): I0 ~t}' . Fluid depthlo $ ~ .(ins.) Minutes later: ~ ~o Absorpfionrate = ~ (~ ~ g.p.d. Peroxide treatment (past 12 months) (Y/N) Iv ~ '~- K,,.'o,~w If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons ~ '~vel at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding lank on lot Absorption field on lot Public sewer main ~ Public sewer mmfiaole/cleanout S~ Li~ station SEPARATION DISTANCES FRO~OLDING TANK ON LOT TO: / /4- Building foundation ~ 4- Property line ~. 5:- Absorption field Water main/service line t o 4- Surface wateffdrainage /oo Wells on adjacent lots ~ % On adjac~la--t~ CO,,~ 0 , ~j'acent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation / O / 4- Property Line ! o '_,c Water main/service line /0 Surface water / o 0 / -/-- Driveway, parking/vehicle storage area Curtain drain/,,o-,~ /c,,~o ~., ,,v Wells on adjacent lots ~X 0 0 F. ENGINEER'S CERTIFICATION m conformance wtth N[Odl fZJ~l_~uided~nes in effect on this date Fee $ ~ W~ver Fee $ Date of Pa~ent -- ~ ~;~-- ~ Date of Payment Receipt N~lb~r '7 ¢ 75 Receipt Number os : Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo/' ~-4 /~& :~ A. WELL DATA Well type ~O/~/,~u~/'F,~ I(~B, or C, attach ADEC letter. Log present (Y/N) Date completed Total depth Cased to Sanitary seal (Y/N) Parcel I.D. ADEC water system number Driller Casing height Wires properly protected (Y/N) ~lOGO~ FROM WELL LOG ; On adjacent lots Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/~,~.'~g tank on lot ~ ~ ~¢ Absorption field on lot ~.oo C./- Public sewer main Sewer service line WATER SAMPLE RESULTS: /.-'~-C g.p.m. AT INSPECTION ; On adjacent lots · Public sewer manhole/cleanout Petroleum tank Coliform Nitrate Other bacteria Date of sample: B. SEPTIC~ANK DATA Date installed ~/~'~'/~J Cleanouts(~N) High water alarm (Y~[~ Date of pumping Collected by: Tank size / ~.~-O Foundation cleanout(~) ~ Compartments Depression ( Y/~)~ Alarm tested (Y~ Pumper /1./. /~0/~¢ SEPARATION DISTANCES FROM SEPTIC/~ TANK TO: Well(s)onlot..k.)O'¢~- fc, c-o~CEXJ7~ Onadjacentlots /fJo.4/~'/~?'¢~-J~f'/('C-Foundation ~7 / To property line ~-~'[ ~/ Absorption field %/¢ ~..' .Watermain/serviceline ~f~- Surface water/drainage /,-'o,o'&T /¢/zeO-E/J~'- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION D a'""'~Ateq~' t a i I e d Size in ga~ Vent (Y/N) Manufacturer Manhole/Access (Y/N)~ High water alarm level Meets MOA electrical codes (Y/ SEPARATIO~SDfSlCANCE FROM LIFT STATION TO: ~ On adjacent lots D, ABSORPTION FIELD DATA Date installed o¢/[(/¢/''¢~ Soil rating Cycles tested Surfac~ ~--~.~?D ~/~c'-/~/~oo.,,4 System type T,~E/UCI~I Length &q/ /,~// Width Total absorption area Depression over field (Y/(~ Results ~fail) Peroxide treatment (past 12 months) (Y/N) '-~' ~ / Gravel thickness ~ ' ¢'~' Totaldepth /Z,'-- /~' Cleanouts present {~N) ~'~-~ Date of adequacy test ~//¢//¢3' for .-~ bedrooms ,/E~t~oca,~) If yes, give date /tJ/~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adiacent lots ./~'(/~- Well on lot To building foundation On adjacent lots Property line E. ENGINEER'S CERTIFICATION To existing or abandoned system on lot Cutbank /,/o..~" f.t~.fe-~u~' Water main/service line Surface water /Co.-cE, /¢¢-~-£~,,-7/7- Driveway, parking/vehicle storage area ~o Curtain drain ~o,.¢E /.'F,~,~.//.z ¢2~.?"-Io...J z)¢= L_~.,~.F~-z.-D ~,,.3 I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date S 8, S ENGINEERING 17034 Eagle River Loop Rowel NO, ~04 HAA Fee $ Date of Payn,ent Receipt Number Waiver Fee: $ Date of Payment Receipt Number tOT ~ DEPT. OF ENVIRONMENTAL CONSERVATION- ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD,, SUITE $-470 ANCHORAGE, ALASKA 99515 (907) $49-7755 February 26, t998 Scott S & S Engineering SUBJECT: VaB-Vue Subdivision Class "A" Public Water System, PWSiD 210605 Dear Scott: I. have completed .a review of this office's files ooncernlng the monitoring status of the above-referenced Class "A" Publ'ic W~tei' System end found the following: 1. Tho last satisfactory Total Coliform Bacteria Sample results was submitted to this Dapartr~ent on February 4, 1993. This does meet the provisions of 18 AAO 80.200(a), of the State Drinking Water Regulations, The lest inorganic Chemical Contami~ants Sample results were submitted' to this Dep~ftmer~t on August 13, 1992. This does meet the provisions of 18 AAC 80.200(~), of the State Drinking Water Regulat!ons. The last Radioactive Contaminants Sample results were submitted to the Department on December 2, 1992. This does meet the provisions of 18 AAC 80,200(a), 8tats Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to thi~ Department on November 12, 1991. Based on analysis of the pravious'VOC s~mple~ results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking W~ter Regulations. Issuance of this letter does not imply that the abOve.referer~ced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above 'nformat~on, please do ~ot hesitate to contact this office at 349-7755, · Sincerely, Michael Lu EnVironmental Eng. Asst, II 1. Type of Inspection: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROvI~I~R~JTY OF ANCHORAGE 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221DEPT. OF HEALTH & ENVIP, ONMENTAL pp, OTECTION REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 0iST 3 0 lg78 o..o v^ Property Owner: Mailing Address: E~UITABLE RELOCATION SERVICE % Jack White Company 99503 3201 C Street, Anchoraqet AK Day Phone: 277-1553 3. Name of Buyer: Not yet sold Mailing Address: Day Phone: 4. Name of Lending Institution: Not yet sold Mailing Address: Phone: 5. Name of Realtor or Agent: Elliot Lawson... % Jack White Company Mailing Address:32Ol c Streetf Anch. AK 99503 Phone:. 277-1553 Legal Description: Lot 44, Block 3, Vallivue Estates #2 (10501 Lone Tree Dr., Anchorage) Location: New Seward Hwy to O'Malley... qo up O'Malley to Main Tree Dr. (left turn) take 1st left off Main Tree on Lone Tree .... go to 10501 address. House is on right side of road when going down Lone Tree. 7. Type of Facility to be Inspected: Sinqle-£amily Residence No. Bdrms. 3 8. Water Supply Type of Supply: Public Utility ,individual COMMUNITY If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) xxxxx if Individual, date of installation about 1975 72-OO3{3/76) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH 84 ENVIRONMENTAL PROTECTIOMUNICIPALITY OF ANCHORAGE 525 L Street - Anchorage, Alaska 99501 , DEPT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAl_ ENGINEERING DIVISION Telephone 264-4720 OCT 3 0 1978 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW"I~~~_ DIRF,CTIONS: Complete all parts on page 1. Incomplete requssts will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNF. R PHONE ._ Equitable Relocation Service 277-1554 MAILING ADDRESS % Jack White Company PROPERTY RESIDENT (If different from above) PRONE 2. BUYER PHONE Unknown - not sold yet MAI I_1N G ADDR ESS 3. LENDING INSTITUTION PHONE ;MAILING ADDRESS 4. REAL'J'OR/AGENT Elliot Lawson % Jack White Company MAll_lNG ADDRESS 3201 C Street 99503 5. LEGAL DESCRIPTION Lot 44 Block 3 Valli Vue Estates Subdivision ~2 STREET LOCATION 10501 Lone Tree Drive G. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled :~ COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach Io9 if available.) 8. SSWAGE DISPOSAL SYSTEM dx iNDiViDUAL/ON.SiTE~* [] PUBLIC UTILITY **if individual/on-site, give installation date. If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACN REQUE. ST BEFORE PROCESSING CAN BE INITIATED. 72~3t 0(3/78) ~ -I-HIS SIDE FOR OFFICIAL USE ONL'~ ................ DATE RECEIVED INSPECTION APPOINTMENTS I 'l YPE OF RESIDENCE NUMBER OP BEDFIOOMS , : :5INGLE FAMILY [] ONE E~) THREE ~ FIVE EL] OTHER , .} MLJLTIPLE FAMILY [~ TWO [] FOUR E'] SIX PERMIT NUMBER 2, Wf~] ER SUPPLY ~ INDIVIDUAL DEPTH OF WELL ~ COMMUNITY -~/~HI L.I_ED ' I PDBLIC UTILITY Connection Verified ......... LOG RECEIVED PERMIT NUMBER "Si"WAGE DISPOSAL SYSTEM ~~NOI~qDUAL/ON-SITE '~ Jl~..IC ~JTI LI'FY ,'lic:c I'allk ol [i]] Holdhlg Tank ?:, ....... if '['ank is homemade ~ Al.. ABSORPTION AREA DIS I'/\NCES · WELL 'FO: SOILS RA'I1NG MANUFA' JRER MATERIAL Septic/ltolding -Funk Absorption Area 5 ROMMENTS [~1~ APP FiOV E D FOR ( ]'J CONDITIONAL APPROVAL (letter must accompany certificate) [.] DISAPPI~OVED i, ?, OlO ire,.,. 3~78) Valli Vu Estates Block 3 Lo1' 44 #015-322-19 Municipality of Anchorage Development Services Department Building Safety Division On-Site 'Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-66~0 www.ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ~ i,,' - 3 22. -IT 1. GENERAL INFORMATION Complete legal description L~/- Location (site address or directions) Current Property owner(s) Expiration Date: Lending agency ~ne~fz~ /"~-)'~'~,~'~ Dayphone '?o"Z.-~-~¢O Mailing address ~JZO( Real Estate Agent I~..,,~ Mailing Address qT_¥t Un/ess otherwiae requested, HAA wi// be he/d by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual ,O,n-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Se~/ices Department (DSD) Issues Cer[ificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by -"n indapendent professional civi! engineer registered in the State of Alaska. Certificates of Health Authority Apprcval are required for the transfer of flee (except between spouses) for properties served by a single-fgmily on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners CertJficams of He-=lth Authori~ Approval are valid for 90 days from the date of issue fcr properties served by a private cr C!ass C well and may be reissued with new water sample results. (Certificates may be reissued for a pedcd cf 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 responsible for errors cr omis-4qns in th.e professional eng!neer's work. 4. 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 en procedures outlined in the Health Authority 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 cf 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(sro) in compliance with all applicable Municipal and State ccdes, ordinances. and regulations in effect at the time of installation. Name of Firm ~1,~ Jl~.? 'T'~'c/~m,'ol £~,.v,P../ Phone Engineer's Pdnted Name '~'-/~o~'~ .F', e-~o,-c Date DSD SIGNATURE Approved far · Disapproved. bedrooms. Conditional approval for .... .. . ......,. .... bedrooms, with the follo~ng stipula?ons:: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ¢ - ~ - ~ ..~ MuniciPality of AnchOrage. Development Services Department Bulldlng Safety DIvision ' On-Site Water & Wastewater Program 4700 ~3uth Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-70O4 HEALTH AUTHORITY APPROVAL CHECKLIST Wires propedy protected ~/N) Total depth ff. Cased to _. FROM WELL LOG Date of test Casing height (above ground) AT INSPECTION in. Static wa~er level ff. Well production g.p.m. ' ff. g.p.m. WATER S/~MPLE RESULTS: · Coliform colonlas/100 mi. Nitrate mg./I. Amenic: · mg./l. Date of sample: B. SEPTIC/HOM31NG TANK DATA Tank Type/Material ~S~,~/';,~ Tanksize IZ~'~ gal. Number of Co. lp<ub,~enL~ Foundation cleanout (Y/N) ~' Date of pumping Other bacteria Collected by: Date installed '~ Cleanoute (Y/N) Depression over tank (Y/N) .k/ High water alarm (y/N) Pumper /e/~. /-Jo~,~ ~. coionies/100 mi. C. ABSORPTION FIELD DATA Date installed ~/11/?.? Soil rating (g.p.d./ft2 or ~/bdrm) '2.T~';~,.,~ System type Lengt~ ~'~ ff. Width -~ f. Gmv. el below pipe ~ ~' fL ToteldepU11.~. ,C ff. Eft. absorption ama 12't~.ft2 Monitedng tube 7" Depression overfield Da~ of adequacy test ~/1~"/0 2.. Results (Pass/Fall) I~'~.~d' For '~ bedrooms Elapsed Time: ?. $,~ min. Final fluid depth ~?/~ in. ~'re/' Abeorptlon rate >= Any rejuvenation treatment(past 12 mo.) (y/N &type) New depth I V'& in. Ax:,P O~'o~:~ g.p.d. If yes, give date A/. ,a, D. UFTSTATION ~J, '~. Date installed 'Pump on' level at in. Size in gallons 'Pump off' level et in. Datum Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO:. h/. A. Se~c tan~ilt station on lot on adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manbelgc~eanout Se~er/septic sewlee line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 7' ProPerty line ~'~,-' Absorption field Water main ~ t ~' Water sowtce line ~, Io' Surface water Wells on adjacent lots '~ · &~, ' SEPARATION DISTANCE FROM ABSORPTION REID ON LOT TO: Property line ~ O' Water Service line ~. t¢~ ' Cuflain drain /u'¢~,~, F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspec~on$ and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effecf on this date. Engineer's Printed Name Date ' '7/ Manhole/Access (Y/N) High water alarm level at Meets alamt & cimuit requirements? HAA Fee $ Date of Payment . Receipt Number (Rev. 12/01) Budding foundation '~ I¢~ ' Water main '~, /o ' Surface Water '~ t¢~o' 'Ddveway. paddnghtehldee~=rage Wells on adjacent lots '~> z,=o ' Waiver Fee $ Date of Payment Receipt Number in* Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 'un,~,.w.¢i.an c h orage.ak.u$ (907) 343-7904 SEPTIC SYSTEM ADVISORY FOR HEALTH AUTHORITY APPROVAL #HA020346 Legal Description: Valli Vue Estates Unit #2 Block 3 Lot 44 PID # 015-322-19 Prior to a recent adequacy test on the septic system for this property, 120 inches of standing water was observed in the absorption field. The total effective depth of the system is 131 inches. This indicates that approximately 90 % of the absorption area in inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Health Authority Approval. If there are any further questions regarding this advisory, please call the On-Site Water and Wastewater Program at 343-7904. CIVIL & ENVIRONMENTAL ENGE'qEERP4G" ENERGY CONSERVA'I'ION & ANALYSIS TIIEODORE F. MOORE, P.E. 14530 ECHO ST. PiI: (907) 345-1355 ANCHORAGE, ALAS KA 99516 July 18, 2002 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The fo!lowing information is submitted to describe the procedures used in the adequacy test I conducted July 16, 2002 on the septic system serving the 4-bedroom residence on Lot 44, Block 3, Valli Vue Estates, Unit #2. Although the gravel depth in the trench is reported on the inspection report as being 9 feet, the original Orangeburg sump at the end of the trench actually extends approximately 11.25 feet below the invert of the horizontal distribution pipe. In order to enable a more accurate measurement ofthe fluid level in the trench I arranged to have a new independent monitor tube installed on 7/15/02 approximately 3.5 feet upstream ofthe sump. The initial fluid level in the trenchwas 15 inches below the too ofthe distribution pipe. Because the present pfimary absorption level of the trench is near the top, I discussed this with Dan Roth on July 15 and confirmed that an acceptable absorption rate must be documented with the maximum fluid level below the top ofthe horizontal distribution pipe. On 7/16/02 1 added 736 gallons of water to'the system through the second compartment ofthe septic tank, which brought the fluid level in the new monitor tube up 13 7/8 inches to a level approximately I inch below the top ofthe horizontal distribution pipe. This represents a uniform rise of 53 gallons per inch. I then monitored the reabsorption rate over the next 233 minutes, during which period the fluid level receded 3 3/8 inches. This corresponds to an absorption rate significantly in excess of 600 gallons per day, which indicates the system is still adequate for a 4-bedroom residence. Two other observations regarding the system deserve mention. (1) At the start of the test the fluid depth in the first compartment of the septic tank was 54 inches. Because the significant quantity ofwater I added to the tank was able to flow freely on into the trench, this indicates that there is an approximately 6-inch high "bump" in the discharge line downstream of the tank, however it does not appear to adversely affect the performance ofthe system. (2) As already documented in the files, the trench is partially in a platted drainage easement. This easement is dry, vegetated, and indistinguishable on the ground with no indication ofany surface flow, so there should be no problem with it. Please give me a call ifyou have any questions. Sincerely, Ted Moore, P.E. cc: Nick Bakic LOT 5 LOT 4 BgHSgN 8~, ~ lg~ ALASKA g950~ (gO7) .~-~=o~ LOT 44, BLOCK ' 3, Jf[~ lO, 1~95 I t -50 JUaXl O0~ ~4~ _._~.~,,,,,,,,,,~.:,~.~,,,, ~ ,,,-.,,,, VALLI VUE ESTATES UNIT NO. 2