HomeMy WebLinkAboutVALLI VUE ESTATES #1 BLK 3 LT 3Valli Vu¢
Estates
Block 3
Lot 3
#015-322-07
~ MUNICIPALITY OF ANCHORAGE
? D[ RTMENT OF HEALTH AND HUMAN SER !ES
Environmental Health Division
2- 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Nar~ DISTANCES
0-',¢' fi ,~ ¢'1,¢_ f~ ~ TI1 SEPTIC ABSORPTION
WELL
AddressFROM~ TANK FIELD
Phone(s)~ 7 y ' 0¢~ Z PermR~ 7 NO_¢¢~ NO. of~B~r°°ms WELL N, ~. ~' ~.
LEGAL OESCRIPTION LOT LINE ~l 3 I N, ~.
AS-BUILT DIAGRAM tShow location ol well, septic system, p~operty hnes, foundabon,
~ /~ ~/ ~ ~ ~ ~' /~' driveway, water bodies, etc)
TANKS N
~ SEPTIC (~'5~) ~ HOLDING
-
~ree r I 0 o~ ~ -~
TYPE OF SYSTEM ~f~d¢
~TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ ~T ~
or,gin~ g~ade ~ H ~
Total absorption area Distance between lines X C' '~
Instal[er ~¢tJl "Date Installed ~¢1 / ,~ ~
WELLS ~,fi. } .... ~hX¢
~ PRIVATE ~ OTHER {Identifv) /
q7--
REMARKS: ~ ~
J ~~ ¢~ ceflily thai Ibis inspeflion was ped,rmed according to all
muni~i,al and State guidelines in egect on this date: ~(E¢ ( ~ 7 Ye ~'% CE- 3,589
72-013 (3/85)
~-~.~
P.O. ,- ~X 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
June 10, 1987
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Waiver Request For Lot 3 Block 3 Valli Vue Estates
Waiver Number WR87-037
Dear Mr. Moore:
Approval has been given to the recently submitted lot line
waiver request for the above mentioned parcel. Distance from
the absorption field to the south lot line has been waived from
the required 10 feet to 3 feet.
This waiver applies to the recent upgrade only. Any future
upgrades may require another approval from D.H.H.S.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
cc: Gus Andress, P.E.
On-Site Services/Water Quality Program Manager
TOP TECHNICAL:SE .,.
CW~ & EN~ON~NT~ ENG~EER~G * ENERGY CONSERVA~ON & ~YS~
TI~ODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 ~CHO~GE, ~KA 99516
~ay 29, 1987
M.O.A. Dep't. of Health
P.O. Box 196650
Anchorage, AK 99519
and Human Services
RE: Lot Line Waiver L3, B3, Valli Vue est.
Dear Sirs:
In construction of the septic system upgrade for the subject
property (As-Built enclosed), it was decided to run a 25 foot
section of the trench parallel to the south property line in
order to maximize use of the cleanest sandy soil, and to avoid
buried utility lines at the north end of the trench. The closest
edge of the trench is 3 feet from the property line at the east
end and 6 feet from the line at the west end.
It is my opinion that this waiver can be justified on the
basis that all the adjacent lots have been developed, with the
closest portion of any soil absorption system being over 50 feet
away. There is no reason why granting this waiver will adversely
affect the ability to upgrade systems on adjoining lots, should
that become necessary in the future.
Thank you for your consideration.
cc. John Matus
Sincerely,
Ted Moore, P.E.
MUNICIPALITY OF ANCHORAGE
~NVIRONM~NTAL SERVICES DIVISION
MAY 2 9 1987
RECEIVED
Flattop Technica! SefVlc~
14530 Echo Street
L-.~, 8:~,, VAI..LI Vote
ION
i.,,! i I S :[ Z I!:!;:
BI...E}CI<:
ppp~-lq 7'0 pIpE I~oT}"PII
~ xlIyl/ob
] O0o 6 ,4.LZ o,~.r
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVlRONIViENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS (~o ~ t f~
PERFORMED BY:
t/alii 6/t~ e
SLOPE
DATE PERFORMED:
.S /D LT. 14..-~ 51..)
SITE PLAN
(i, oct'~eb off t~ll.)
WASGROUNDWATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Net
Gross Net Depth to Drop(*l n~
Reading Date Time Time (~li~) Wster
f'r~ -.gc, ak ..C'/~ 1:37 ~,? ~ -- t~." ~ ~,~o
ee
THEODORE f. MO0~: ~* ~O ,:,, O ,'~3 ~/,g O
CE - 3589 2: t~ ~3 I.
~ ~, ~ (minutes/inch)
TEST ~UU BET~EEU ~ FT ANO ~ a FT
~(a//ff ~cA~ica[ ~erv~e~ CERTIFIED BY: ~ ~ DATE:
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
8
Vail~ (,/~¢
SLOPE
DATE PERFORMED: ~' / 9
(-'rt./-/.
SITE PLAN
10
11
12
13
14
15
16
17
18
19
20
F. MOORE
WAS GROUND WATER
ENCOUNTERED?
IF YES AT WHAT
DEPTH'~
Gross Net Depth to Net
Reading Date Time Time L~ I~) Water Drop ~..~
PERCOLATION RATE I
'~. ~/'. -'~_. TEST RUN BETWEEN ~" '~' FT AND ~. O FT
COMMENTS ~n%~ ~C~ ~ ~,0'~ ~,0' ~e~ ~ [¢ ~J $tdI~/J ~ 1,~
PERFORMED aY: F[~b~f ~c~af ~erV;t~ CERTIFIED BY: ~~ DATE:
72-008 (6/79)
GRE~ ~.) ANCHORAGE AREA BORi ~H
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME /i/I/~.
LOCATION
MACLANG ADDRESS -g'£/¢
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH_
MATERIAl
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL('~g~J/J/~j FOUNDATION /'k'~ I
NUMBER OF LINES J DISTANCE BETWEEN LINES
ABSORPT,ON AREA /~O¢)
DEPTH: TOP OFTILE TO FINISH GRADE
~ TOTAL LENGTH
NEAREST LOT LINE /0 OF LINES
TRENCH WIDTH ,~*IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE ~) I
WELL: ~'~) ,~/~J~"~'¥'~"~,~
TYPE _
BUILDING
FOUNDATION
CESSPOOl
APPROVED
CONSTRUCTION DEPTH
NEAREST NEAREST SEPTIC SEEPAGE
LOT LINE SEWER LINE__ TANK SYSTEM
OTHER SOURCES
DISAPPROVED REMARKS
DISTANCE FROM:
DISTANCES:
INSTALLED BY: ~It~-
SEWER LINE DEPTH:
PIPE MATE RIAL: ~J~ ~
LOT SLOPE: ~-~
REMARKS:
DIAGRAM OF SYSTEM
':TELEPHONE 274-4561 ~ ~t~/~
NAME OF APPLICANT
INSTALLAT[ON LOCATION
PERMIT NO,
sEWAGE DISPOSAL SYSTEM -- APPLIC-ATION AND PERMIT
PHONE
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD
SO~L TEnor RES"LTS ~QO ~ //~.£YJ
COMPLETION DATE ANTICIPATED ~f~ ,~
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.
MINIMUM DISTANCES, REQUIREMENTS
DIAGRAM Of SYSTEM
] CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
,^T~ ?--/ ~'" 73'-- ^~"L'OANT'S S'~'^T""E,// - .
~GR~'~'~ER~ ANCHORAGE AREA. BOROUGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME /-,/~/~.L ;~)A/.:?~ MAILING ADDRESS .~0/~,/_~ ~._/~Z:~ PHONE ~/~'-~(/~2~
LOCATION /~?:'~/ /-~¢-~' ~'. LEGAL DESCRIPTION /-~-~-- ~ /Z~O~: ~ //~ ~" ~:
..~-11
SEPTIC TANK:
DISTANCE
FROM WELL (~')n?~ MANUFACTURER
INSIDE LENGTH INSIDE WIDTH
C~/~c- MATERIAL
LIQUID DEPTH
NUMBER OF
:2~ COMPARTMENTS /
.LIQUID CAPACITY (O~L) GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER OR WIDTH /~ / /
, LENGTH ~'('- DEPTH .,~ t
BUILDING FOUNDATION ~b ~/" NEAREST LOT LINE ~Z~ / TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA)
WELL ~g) 2~/)--).
SQ. FT.
ADDITIONAL ABSORPTION
WELL:
APPROVED
DISTANCES:
INSTALLED BY:
PIPE MATERIAL: ~]/),<;T' ~/~,~'~,~ /
LOT SLOPE:
REMARKS:
I~- /q/~ '/~.
Form No, EO-031
DIAGRAM OF SYSTEM
DATE
G.A.A.B.
GReATEr ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
PERMit NO,
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT ~ ., DRAIN FIELD OTHER
TYPE AND SIZE Of PACIL]TY TO BE SERVED
FINANCED THROUGH TO BE iNSTALLED BY
SOIL TEST RESULTS
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, REQUIREMENTS
FOUNDATION TO SEPTIC TANK ~f
FOUNDATION TO SEEPAGE PIt . DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL ~ ~'~
SEPTIC TANK ~'--/ , SEEPAGE PIT ~/' DRAIN FIELD TO NEAREST LOT LINE.
~ , SEEPAGE P[T
DRAIN FIELD ALSO CONSIDER AREA WELLS.
DRAIN FIELD
SePTiC TANK, j,~ f~) F ~) ~
. SEEPAGE Pit DRAIN FIELD
TO RIVE)~, LAKE, STREAM.
DIAGRAM OF' SYSTEM
CAST [R~3N iNTO AND OUT OF SEPTIC TANK AND iNTO CRIB CROSSING GAP OF
EXCAVATION ~ FEET INTO UND]STURE)ED SOIL.
4 INCH DIAMETER CAST iRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
T.H.I
10-4-74
Silt trace sand
SiIty sands (S~)
Sand, trace silt'& gravel (SP)
0.5'
2.5'
5.0'
Sand, some silt (SP)
'8.5'
Silty sands (SM)
11.5'
Sand, trace silt (SP)
NO WATER TABLE
t5.0'
NOTE: Test Hole Excavated With Tractor-Mounted Backh'oe.
Engineering ~ Geological Consultants Inc.
ANCHORAGE FAIRBANKS ALASKA JUNEAU
SCAL~ 1"- 3' BY BH
Linc Construction
Log of Test Hole
Anchorage, Alaska
CHKD BY !,~JD PROJ. NO. 462089 NO.
Linc Construction
Box 35P Star Rt. A
Anchorage, Alaska 99507
No. 462088
Re~ Test Hole and Soil Log Report for Sahitary System
Lot 3 Block 3 Valli-View Subdivision
Gentlemen:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This
investigation was performed-in accordance with your request of
October 4, 1974, and those procedures outlined in a letter dated
September 13, 1971 by Mr, Rolf Strickland of the Greater Anchorage
Area Borough Department of Environmental Quality.
A single test hole was put down within the Lot 3 area for the purpose
of defining general subsurface soil conditions for the proposed
sanitary system. Excavation was accomplished with a tractor-mounted
backhoe and the test hole was extended to a total depth of 15.0 feet
below ground surface. The final log prepared for the test hole has
been included in Drawing A-01.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
ENGINEERING & GEOLOGICAL CONSULTANTS
J%,;R:ng
xc: GAAB
\
47 X X
It is the responsibility of the o;vner or
builder, prior to construction, to
~roposed bu:Udin~ srade relative
hed grade and utility ¢on~teeL~orts and
to detern~lno the existence of any e~c-
~neats, covex~ants, or restrictions whici~
do not appear on the recorded subdivi-
SAoa plat,
LOT SURVEY CERTIFICATION
Lot ~ , Block ~
Anchorage Recording Precinct, Alaska
LEGEND: I
(~l Bros$ Oep Monument
® Iron Pipe
· Sfeel Pin
r~ Survey Hub & Tack
J REVISIONS j DATE J BY
Prepared ey ; DIC/(II~I$O/It-OSIF/iL8 E~ PART#ERSI Residence of:: (:/_//~-F C:/~KL~ ~"
Municipality of Anchorage
Development Sentices Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchomge.ak.us
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FORA SINGLEFAMILYDWELLING
Pa=ll.D. 015-522-07 HAA# ,1~11~ O/~) ~--//~
4. GENERAL INFORMATION Expiration Date: ¢~
CompletelegaldesQ'lpflon VALLI VUE ESTATES i~1 LOT 3~ BLOCK
LocaUon(slteaddrassordirections) 10514 MAIN TREE
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
JOAN ROHLF Dayphone 349-1337
10514 MNN TREE *ANCHORAGE AK 99514
Day phone
Day phone
Unless o~herwfse requested, ~ will be held by DSD for pickup.
2. NUMBEROF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Wall
Individual Water Storage
Community Class A Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~r~
Individual Holding tank
Community On-site B
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the reprasentafions given In paragraph 5 by an independent professional civil
engineer registered in the State of.Naska. CedJfioates of Health Authority Approval are required for the transfer
cf flue (except between spouses) for properties sewed by a single family on-site wastewater disposal and/or
water supply system. DSD also Issues ~ upon request to homeownem. Certificates of Health Authority
Approval ara 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 sample results less than 30 days old. (CerlJficates may be reissued for a pedod 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 responsible for errors or omissions In the
professional engineer's work.
Note: Alaska Water and Wastawatar Consultants, Inc. shall be paid $700.00 at, or pdor
to dosing for the enginsadng san/ices provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and ss of the validation date shown below, I varify that my
investigation, based on procedures ouffined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastawatar disposal system is(are) safe, functional and adequate
tor the number of bedrooms end type of struc~ure lndicated berein. I fur~her varify that based on the
information obtained from the Munidpallty of Anchorege files end from my Invesb'gation and inspection, the
on-site water supply and/or was~ewater disposal system Isle're) in' compliance with alt applicable Municipal
and State codes, ordinances, end regulations in effect at the time of lnstaltation.
NameofFirm ALASKA WATER x. WASTE'WATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORA(~E, AK 99504
Engineer's Pdnted Name JEPP~E-Y A. CARNESS. P.E.
Phone 337-6179
Date
Engineer's Comments:
In conducing this evaluation, AWWC, In~ attempted to provide · b~h,
conscisnffous engineering anal~s of the system in accordance v~h ADEC and MOA
DSD Guidelines & Regulations` The reported results described the peffon~ance of the
system under the conditions encountered at the Urns of the tes~ and separation
distances measured to madliy Identifiable features` The operational life of ail wells and
septic systems depend on the Iocal solls candlffon, groundwater levels that may
fluctuate dudng ~he year, and the water usage of b~e family being served by'the sy~em.
These conditions am ou~ide the ¢onffot of the evalueter of the system. Satisfactory test
results do not guarantee future parfonnanse of the system, nor do they guarantee that
them ere no hidden defects or encroachments. A WWC, inc mn therefore ~ot provide
any warranty or future est/male 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 b~e owner tisted ebeve. Any reliance upon or use of this report by any
other pe~on or party is not authorized, nor wlil It confer any legal rlght whatsoever.
5. DSD SIGNATURE
Approved for 3
Disapproved.
CondiUonal approval for
~. ON-SITE
~moms, ~ ~e fll~ng stipulations: ~ ~ ~ WATER AND
~ ~ WAST~ATER
Attachments:
HAA Checldist
Septic System Advisory
Well Row Advtsory
Manitenance Agreements
Supplemental Engineer's Reort
Ol~er
~r~' Odg;nalCertificeteDate: ~- -''') ~ 'C.O/
Municipality of Anchorage
Development Services Department
~,1.~ warm. & Wmstlvmt~ PlOgnlm
P.O. Box 196650 Andlomge, AK 99519.6850
Legal Descdpfion:
A. WELL DATA
HEALTH AUTHORITY APPROVAL CHECKLIST
LOT 3t BLOCK 3t VALM VUE ESTA(~r.~ ~1 Parcel lD:
IfA. B, ~x O provtde PWSlD~ Well Log (Y/N)
A
Oato completed Sanitary seal (Y/N) Wires
Total depth It. Cased t~ rc ~l~.~J~t (atx~ gnxmd) ,,
FROM WELL LOG //,./'~T INSPECTION
Stetlo water level (-I[ rc
Well production ,,,/ g.p.m, _ g.p.m.
WATER 8/0,1~
ample: Co~ected by:.
B. SEPTIC/NOLDING TANK DATA
Tank 'P/pe/Uatedal
Tank alzo lO00 gal. Number of Compartments
Date hlstelled 11/12/74
I Cleanou~ (Y/N) ~
Foundalloncleanout(Y/N) ~ Doprosaloflovertank(Y/N) NO Hlghwateralarm(Y/N)
Date of pumplflg 9/10/01 Pumper A+
C. ~ORJ~IlON FIELD DATA ~. ! q O
om wed ./~2/75-5/20/87 so~ ~.; ~r~r~rm) ~ 75 "i Symm t~
DEeP
Longlh 60/'/6 . It. W'm'th 3/3 fL Gravel below pipe , 5 fL
Totaldepth e.08 om. fL Eff. ob~jfl~'donaroa600+7601t=Moflltoflngtube YES
Date of adequacy test o/14/ot Requite(Pass/Fall) PAss
Ruld depth In absor~ field before test 30.5 In. Water added 804 gal.
ElapsedT]me: 31 min. Flnalfluiddepth 39.75 In. AbsorpUon rate >- 450+
Any mJuvenaUon treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yo~, OIVO date
Depresalon owr field NO
For 3 bedrooms
New depth 41.25 In.
g.p.d.
D. UFT STATION
Debt i=led Size In gtd]ons ~
'Pump on level 8t In. 'Pure n. High water 818rm level ~ In.
Datu.._~m Cyde~ tested Meet~ alarm & circuit requirements?
F_ SEPARATION DISTANCE5
FROM Wtm I ON LOT TO: ~
SEPARATION
OISTANCES
Absorption field on lot --~ On adjacent lots,
Publlc ~ver main / Public sewer manhole/cieanout
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Bulldlng foondallon 5'+ Properly line 5'+ Absorption field 5'+
Water main 10'+ Water seMce line 10'+ Surface water 100'+
Wells on adjacent Iota 200'+
Prope~ fine "5'+
Water service line 10'+
Curtalrldraln NONE KNOWN
F. COMMENT~
SEPARATION DISTANCE FROM ABSORP liON FIELD ON LOT TO:
Bulldlng foundation 10'+
Surface water lOO'+
Wells on adjacent lots 200'+
W~er main 10'+
Driveway, peking/vehicle ~orage ;~'+
*WAIVER REQUESTED ON 6/10/87 INSPECTION REPORT
O. ENGINEER'~ CERTIFICATION
I certify that I have determined through field ~specUorm end
mvtew of Municipal records that the above systems are/n
conformance ~ MOA HAA guidelines ~ effect on ~ds date.
Date ~
HAA Fee $ *~00 .c:,~ Waiver Fee $
Date of Payment '~'/'/,,~'/e ( Date of Payment
Receipt Number / ~ (oO ~ Receipt Number
~Rw. 12/oo)
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
1. GENERAL INFORMATION
Corn plete legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ~::~ 1,5-- ~ ~ ~- E 7'~ HAA#
Location (site address or directions)
~.-- ', Property-owner
Mailing' address'"
Agent
Address
Day phone
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3 '~
~_77 -3-CE7
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site ~
"' ~''; ' ~oidi'ng ta~k ' "':' ~
on-site ... " :" '
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.
NameofFirm I~l~/-:l~ 7-ecA,~'~c~/ _~"~ce,~ Phone
Address iq,5- ~2 ~c,~o ~/'..,~ ~c4o~q~, ~
Engineeffs signature ~~ ~ ~ Date
DHHS SIGNATURE
:[~'/ Approved for ~'/'-~/~ff bedrooms.
Disapproved.
Conditional approval for
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 theState of Alaska. The DHHS does this as a courtesy to pumhasers of homes
and their lending institutions in order.t0 satisfy certain federal and state requirements. Employees of DH HS do not
conduct inspections or analyze data' before a certificate is ~issued. The Municipality of Anchorage is not
responsible for errors or Omissions in the professional engineer's work.
RECEIVED
Municipality of Anchorage APR 2 ;~ 1999
DEPARTMENT Of HEALTH & HUMAN SERVICES~uNioP^U
Environmental Services Division ENViRONMENTALsERVlCES~i~/
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
LegaIDescription: .L,o~'~, ~//c~, V,~//,' V~-,~ ~x/ ~! ParcelI.D.: 0
A, WELL DATA
Well type C'"[~.xj '~" If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Date completed
Total depth Cased to
Casing height (above groundl
Sanitary seal (Y/N)
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
Well production g.p.m, g.p.m.
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed [; / ~-/ '7 y Tank size / 0o~' q, ,/
Foundation clea.nout (Y/N) Y Depression (Y/N)
Date of ~umping ~/~'~ Pumper ~ ·
ABSORPTION FIELDDATA ~ ~ ~ ~, ,
Date inst~led ~v z~/~ 7 ~; Soil rating (g.p.d./ff~ or
' ~ ,; .... '~','" :t~'
Len~h ~o ~ ' ;;,.;~,~z ~ ~',
Effective ~Sorp~onarea ~ ;,~ ~'
Date of adequacy test ~/~ / 2 7
Fluid depth in abso~tion field before test (in.); 3 /
Fluid depth ~ ~ ~ (ins) Minutes later;
Number of Compartments
High water alarm (Y/N) /',/,
J ~ ~-- tem ~pe
Grovel thickness below pipe ~, To~l depth
Monito~ng Tube present ~)~ Depression over field ~)
Results (Pass/Fail) ~',~,.r.r For .~ bedrooms
Immediately after,6?2 gal. water added (in.): "/¥ '/~"
Peroxide treatment (past 12 months) (Y/N) ~o~ e
(].p.d.
72-026 (Rev. 3/g6)*
LIFT STATION J',l. ,4.
Date installed
Manhole/Access (Y/N)
Size in gallons
"Pump on" level at*
*Datum
High water alarm level at*
Cycles tested
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation 3' Property line ~ Yo' Absorption field
Water main/service line ~. ~' Surface water/drainage '~ ~ ~'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line ~' ~' Building foundation /£'
Surface water 7~ (o~'
Curtain drain /do,, ~ F.~ ,,'~
F, ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review
in conformance with MOA HAA guidelines in effect on this date.
Signature ~--~ ~'.
Engineer's Name 7-',~
Date ,~/~ ~';/
"Pump off" level at*
/3 '
Wells on adjacent lots ~> ~ ~"
Water main/service line ;> ~ '
D~iveway, parking/vehicle storage area ~> ~'
Wells on adjacent lots ~ ~_oo,
are
HM Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
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.
0 ~/~o~
1. GENERALINFORMATION
Complete legal description
Location (site address or directions) lo.C/? ~ ,~;,~ 7"~ ~,*,v¢
Mailing address
Lending agency
Mailing address
Day phorla ~
Day phone
Agent ~,reen ~oh~nv Fo,-/~,e
Address ?~6-Z3- '~'" J'/-..., /t-,~¢~,or~.~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State AD~C
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 §esl 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.
NameofFirm ~'la/'~,,, 7-~c/~,~;c¢,/ .,qe,,-,,,'~ Phone
Address / ~ 5- 3o ~c~o ff/..,, ,'~cAo,--~--~ ,/~
V
Engineer's signature J~"~ ~'' ~ Date
DHHS SIGNATURE ..,
~ Approved for '~'~"('/"'~--~bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
By:
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 ~ending 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~Y25 (Rev. 1/91) O~ck MOA ~1
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343zq;~/4
Health Authority Approval Checklist J~)L["C~C/'
Legal Description:
A. WELL DATA
Well type C {a~_c "A"
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Bo
~'all; b"~t ~,c? t9'7 ParcelLD.:
IfA, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
SEPTIC/HOLDING TANK DATA
Dateinstallcd II/IZ / 7t/
Foundation cleanout (Y/N)
Date of Pumping 3-/E/? 7
FROM WELL LOG
g.p.m.
Casing height (above ground)
Wires properly protected (YiN)
AT INSPECTION
Nitrate Other bacteria
Collected by:
Tank size ~ Number of Compartments [ Cleanouts (Y/N)
y Depression (Y/N) N High water alarm (Y/N) H. ,4-.
Pumper R o ,'~ ~oo be '"'
ABSORPTION FIELD DATA
n/c'~/?¥ ..¢e¢,~. ?d' t7s.:
~[ I~,! 7,5- ~'fenc6 175
Dateinstalled.r(z4/~7 Tfen~ Soilra~g (g.p.d./fl~orfl~) lga Systemic
Length 7~v~,' Width $'
Effective absorption area ?~'~
,3~' Total depth t~,.~; ~,
Gravel thickness below pipe ~, ~. ~¢
Mouitofing Tube present(Y/N) 'r Depression over field (YfbO /,/
Date of adequacy test 3-/e o ( 9 7 Results (Pass/Fail) ?a.cj For .~ bedrooms
FluiddcpthinabsorpQonfleldbeforetast(in.); ~1 Immediately~ffer~9-~gal. watcradded (in.):
Fluid depth q ~ ?/'~ (ins.) Minutes later: ~-~ Abs6tption rate = ~ ~,,°O g.p.d.
Peroxide treatment (past 12 months) (Y/N) None kcnooa,, ffyes, give date
D. L~T STATION ~1, /~.
Date installed
Manhole/Access (YfN)
High ;vater alarm level at*
Cycles tested
Size in gallons
"Pump on" level at*
E. SEPARATION DISTANCES
*Datuln
SEPARATION DISTANCES FROM WELL ON LOT TO: /'4. A.
; On adjacent lots
.; On adjacent lots
Public sewer manhole/cleanout
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Lift station
Sewer/septic service line
"Pump off' level at*
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundatiou ~ ' Property line ~ ~'~" Absorption field
Water main/service line > to' Surface water/drainage > t ac,' Wells on adjacent lots _O Eoo '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation t3-' Property Line Water main/service line
Surface water > too '
Driveway, parking/vehicle storage area 5'0 '
Curtain drain No,~ E 5 ee,-, Wells on adjacent 10ts ~ Eoo'
F. ENGINEER'S CERTIFICATION .~;: ?f?;j~-;~,,,,,
1 certify that I have determined thru field inspections and review of Municipal record~ ~ that'~he~dl~ove. 'spstems'a;~e
itt confomuance with MOA HAA guidelines in effect on this date. ~.,..,,,. ,.. ,, .
Signature ~"~ -~.
Engineer's Name
Date tM c~y. ~-_~ ~9~ 7
; .Engiil~e~tiifg' Sefil Here *:
HAA Fee $ ~ Or7 ~
Date of Payment r~,/~¢~/,~Z~
Receipt Nun,her ~,q~3 /~
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE MO~I~'PALITY'~F AN,C, HORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT.
ENVIRONMENT/FL ".,.: :"-CTION
i,/~'~-~'~, IB2E L Street - A~chor~ge, Alaska 99501
[~' ¢~ J)) ENVIRONMENTAL ENGINEERING DIVISION OEO j 4 1978
~/ Telophone 264-4720
1. PROPERTY OWNER ~ PHONE
MAILING ADDRESS
SRA Box [786 A~cho~e, A[ask~ 99507
PROPERTY RESIDENT (If different from abovel PHONE
[0514 H~ T~ae 349-5887
~. 8uYEn P~ her
~TUS, John F. 8 Laura A. ~344-966i
MAILING ADDRESS
.. R~A Box 35-Zee Anchorage, Alaska 99507
Alaska USA Federal Credit Union (;[. Diane Gibson) J 277-5602x209
MAILING ADDRESS
777 ~Tu. neau Street Anchorage, Alaska 99501
4. REALTOR/AGENT J PHONE
I
n/a
MAILING ADDRESS
5. LEGAL DESCRIPTION
Lot 3, Block 3, Valli Vue Estates
TREET LOCATION
t0514 Hnin Tree
TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four
,~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [J~( Three [] Six
[] Other
7. WATER SUPPLY
[] INDIVIDUAL* * ATTACH WELL LOG. A well Icg ~s required for all wells drilled
E~X COI"AMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTILITY depth (attach log if available.
E. SEWAGE DISPOSAL SYSTEM
~,~ INDIVIDUAL/ON-SITE** **If htdividuel/on-sit¢, give installation date [974
If system is over two (2) cears old an adequacy test is required
[] PUBLIC UTI LITY by this Deparzment.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED
72-01013/78)
THIS SIDE FOR OFFICIAL USE ONlY
DAT~ ~ECE[VED
INSPECTION APPOINTMENTS
TIME TIME TIME
[)ATE ~TE 3ATE
'iNSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE E~] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL'
[] cOMMUNiTY
DATE DRILLED
[] PURLIC UTI LITY
Connection Verified LOG REGEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
L-J~ INr)l VI DIJAL/ON -SITE I DATE INSTALLED ,'-,,
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank'"~, ,..&A .'~ ~..c~)~_"~
Size: /~?O ]f Tank is homemade 8OILSRATING
live dimensions: I "~
TYPE OF TANK MANUFACTURE~ , ,, ~'
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank [Absorption Area Sewer Line Nearest Lot Line
WELL -FO:
Absorption Area to nearest Lo( Line
S. COMMENTS
~ APPROVED FOR '~ BEDROOMS
[---I CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
1. Approval requested by:
Mailing Address:
2. Property Owner:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITSES3
Mailing Address:
3. Legal ~De.sc~j}p, tio ~ /~l/~
4. L~.Cat,i6n~ ~ :' '>) ?/(~--~/~4.~?~
5'~;.. ~yp~ of facility to be i~spected~~~.~
A. Type B. Depth
No. of bedrooms
C. Construction
Sewage Disposal System:
A. Installed ~72'/ B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Bacterial Analysis
D. Seepage Pit: 1. Absorption Area
2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank
, Absorption area
, Sewer Lines ,
Nearest lot line
, Other contamination
B. Foundation to septic tank
C. Absorption area to nearest lot line __
, Absorption area
EQ-034 (1/74) Page 1 of two pa.g.i,_
Page .2 of two pages -'~' ;st for Approval
L~al Description
of IndividuX'-~'~ler & Water Facilities
Comments
Approved ~,7.~_~.~j. ,~,~?~¢~(~,~¢~, Disapproved Date 4~-
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental quality
DIAGRAH OF SYSTEH
certify that the information contained in this request for approval to be a true and
accurate representatio~ of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
GREATER ANCHORAGE AREA BOROUGH
FROM: DEPARTMENT: ..... ~: ,,~. ~-(~-.. ~ ] :
TO: DEPARTMENT ..... ~'~ ~ '- REQUESTED:
RECEIVER:
REQUESTED ACTION SCHEDULE
'~ ;~0R INFORMATION ONLY - ~ PREPARE BACK-UP INFORMATIO
~- ~ CALL ME BEFORE YOU ANSWER
~? FOR IMMEDIATE ACTION
~ FOR YOUR CONSIDERATION ~ NEED YOUR RECOMMENDATION
;~¥ OTHER
3330
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
"C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection:
2. Property Owner:
Mai-ling Address:
3. Name. of Buyer:
Mailing Address:
4. Name of Lending
CMRO VA FHA CONV
Day Phone
Day Phone
Institution:
o
Mailing Address:
Name of Realtor or.Agent.~
Mailin9 Address:
Phone
6. Legal Description:
Location: ~
7. Type of Facility to be inspected: ~ No. Bdrms.
8. Water Supply
Type of Supply: Public Utility /~ Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site) __
If Individual, date of installation /~/
EQ-037 (l/74)