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HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 6 LT 6Valli Estates Block 6 Lot 6 #015-123-12  Municipality of Anchorage .--~-- t Development Services Department *'- - :=,~ Building Safe~ Division On.ire Water & Wastewater P~mm, 4700 Sou~ Bragaw S~ P.O. Box 196650 ~chorage, AK 9951~650 ~.ci.anchorage.ak.us (907) ~79~ P~ge I of 3 On~lte Wastewater Disposal System and/or Well Inspection Repo~ Pe~it Numbe~ SW010106 PID Numbe~ 015--123--12 N°~:LORI C~MPION Wastewater System: D New ~ Upgrade 6661 ROUND ~EE DR~ ' ~CHO~GE, ~ 99516 ABSORPTION FIELD P~°n':(907) 346--4438 '3 . ~.p T~h ~ S~. ~h LEGAL DESCRIPTION 1.2 ~ ~ 9.75 - 10.17 6 6 VA~ ~E E~ATES ~2 1.65 - 2.07 ~ 8.1 - - - SEE DWG. ~ 32 WELL: D New D Upgrcd 2.5 ~ 1 -- _,,~~ ~ A+ HOME SE~CES 12/17-19/2001 SEPA~TION DISTANCES .~p., = ~'~ng = S.T.~P. s~o. To.~ ~CHO~GE T~K 1500 wetl 200'+ 200'+ 200'+ - 25'+ ~EEL 2 s,,~=. W~t,r ~00'+ ~00'+ ~00'+ - - LIFT STATION ~t Une 5'+ 10'+ 5'+ - - *'15001~CHO~GE TANK/ORENCO ~EUS Founda~on 5'+ 10'+ 5'+ - - 42" 42" 46" ~emarks: *THE SE~IC ~EM W~ SIZED FOR A BENCH MARK 4 BEDROOM HOUSE. BOSOM OF SIDING ~ POI~ **DEEP BUR~ T~K IN~411 NOTE: THE ~I~NG SE~C T~K W~ COMP~ELY 100.00 AB~DONED PER U.P.C. 2nd 12/18/01 Depadment of Health3nd H~a~ Se~ices approval ~, ,. [...~ .... ...~ ~: AS BUILT DRAWING // ~O FOR A 4 BEDROObl HOOSE.I / I / / "~.~°"~/ ~ ~ _~ / ~ 7 / (DEEP BUR~) ~ ~ / /~ ~ / l ~ ~ -~ ~ A RESE~ S~E. ~0.12 49.51 - 12/26/2001 Al ASI~ ~TER & WASTEWATER ~ ~j"'~ ~ ~/i~ '~ CONSULTANTS'INC'~ 1" = 30' ............... PR~ FOR: ~NE NUMBS: P~E NOUB~ LORI CHAMPION (907) ~46-4438 2 OF 3 ~0~'. Ic~-,~s~ ..."~ VALLI VUE SUBDIVISION ~2; LOT 6. BLOCK 6 ~e" ..A ........ AS-BUILT OF SEPTIC SYSEM UPGRADE AS BUILT DRAWING SWOIOI06 - 015-123-12 t-F1NAL GR~DE ~p ~ ~HO~ / ' 94'55 ~ - g4.81 (IN~ - ~.6~ ~ =~ = ~P OF T~K _ ~ (~ - ~.78 N~W I~ 101~9-101~~.~ ~ ~1~ ~ P;E IS 1.25 INCH SCH. 40 1 F~T ON C~R (30 HO~S TOT~). ~ ~ OF ~CH  .~ (A~.) ~SI~ ~TER & WASTEWATER ~ CONSULTANTS, INC. N.T.S. 1 ...... VALLI VUE SUBDIVISION ~21 LOT 6. BLOCK 6 PROFILE AS-BUILT OF SEPTIC SYSEM UPGRADE ALASIC,~ WATER & WASTEWATER q29.. ',~ 9 .ru ~?a ....-7,~ CONSULTANTS, INC. LE~ DmCRI~ON: EOT 6, BL~K S; V~ WE SUBDMSION ~2 PERFORMED FOR: LORI C~PION DA~: 12~4~2~1 R~ o.~,cs ITEST HOLE GM CL ~" GC OL 4~ ,* ~ SW HH oto,,o SP CH 8 , 'o' '* D~ 12/14/01 10~.j. · ...,, ~-e~E TIHE (HINUTES) READING (INCHES) 19 PERCO~TION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6' (INCHES) TEST R~ BETWEEN 6.0 FT. ~D 6.5 FT. 2 COMMENTS: ~E INS~ ~DY SOI~ SHOU~ A~ ~ A ~D RL~R. LOGGED ~ PERFORMED ~ JODY ~US PERFORMED ~ A~ WATER · W~ATER I, JEF~ ~ G~N~S, CER~ T~T THIS W~ ~ERFORMED IN ACCORD~CE WI~ ~ ~A~ ~D MUNIClP~ CUIDEUNES IN E~CT ON ~IS DA~: 12/22/2001 05:36 FAX 9078686770 A+ Home Services, Inc. [~001 ~* ~ - D~FAx1 12/20/01 8:18 MUNICIPAIXI~ OF ANCHORAGE -- BUILDING SAFETY DIVISION ,tnn~c~ 6661ROUNDIl~ DK LO~. 6 ~.6 ~ O~v MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 10, 2001 Expiration Date: May 10, 2002 Permit Number: SW010106 Legal Description: iVALLI VUE ESTATES #2 BLK 6 LT 6 Design Engineer: 0041 AK Water & Wastewatar Consultant Owner Name: GREGORY W. & LORI G. CHAMPION Owner Address: 6661 ROUND TREE DRIVE Total Bedrooms: 3 ANCHORAGE, AK 99516-6816 Parcel ID: 015-123-12 Site Address: 006661 ROUND TREE DR Lot Size: 25622 SQ. FT. Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage construction must be in accordance with: 1. The attached approved design. 2. AJI 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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: ~-//'0/ Municipality of Anchorage Development Services Department Building Safety Dlvlston On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (~07) 343-7~04 Parcel I.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 01~-123-12 Permit Number Property owner(s) Mailing address (1) Mailing address (2) LORI CHAMPION Day phone 6661 ROUND TREE DRIVE * ANCHORAGE. AK N/^ Zip Code Legal desc~pflon (Lot, Block& Sub'd.) LOT 6. BLOCK 6: VALLI VUE&SUBDIVISION Legal description (Section, Township & Range) Lot Size 25.,,~ Acres/~ Number of Bedrooms 346-4438 THIS APPUCATION I$ FOR: Sewer Only Sewer and Well Sewer Upgrade Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Water Softenlng Unit I certify that the above Information is correct. I further certify that this application Is being made for a Single Family Dwelling and is In accordance with applicable Municipal codes. ALASKA WATER &: WASTE'WATER CONSULTANTS~ INC. Pen'nit Fees,'~.~)- ~ Date of Payment: ~- '7'-(~/ Receipt Number:. ,:.~CJ rT~) Walver Fees: Date of Payment: Receipt Number:.. CONSULTANTS, INC. April 30, 2001 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 6, Block 6, Valli Vue Subdivision #2 To whom it may concern: The existing 3 bedroom house is served by a community water system and a private septic system. The existing septic system consists of a 1000 gallon septic tank and a deep trench type drainfield. The existing drainfield is in a state of failure and must be upgraded. A test hole was excavated east of the existing septic system in the area of the proposed septic upgrade. The proposed septic system will be designed around the 30 foot radius of this test hole. We are proposing that a 1250 gallon S.T.E.P. tank with dual outlets (deep burial) and a pressurized deep trench type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that the insitu sandy soils should act as a sand filter and that an application rate of 1.0 gallons/day/fi2 should be used. 2. TRENCII DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.0 gallons/day/fi2 c. NumberofBedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 450 ft2 f. Total Depth: 9.0 feet (max.) g. Effective Depth: 7 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 33 feet k. Effective absorption area = 462 ft2 Note: the distribution line is to 1-1/4 inch sch. 40 pvc with ¼ inch diameter holes spaced 1 foot on center (30 holes total). 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the attached site plan, the average topography in the vicinity of the drainfield site is 20 to 25 percent, running from approximately east/southeast to west/northwest. The septic system will be sited on a fiat bench at the top of a slope and will be approximately 40 feet from a slope that is approximately 100%. Given the porosity of the soil, wastewater should migrate downward rapidly, with limited lateral migration. We are requesting that you allow for a 35 foot setback to a slope greater than 25%. The trench will be installed parallel to the slope contours. I am 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. Thank you for your assistance. Je£ ?d . Games: hdent E.,M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soils 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 * Website: akwwc.com WATER SYSTEM AND PRIVATE ~ / I I , ~ ~ / ~ '~s~.~/ ~S~ WATER & ~STE~TER CONSULTANTS, lNG.PHONE N~: LORI CHAMPION VA~ VUE SUBDIVISION ~2~ LOT 6, BLOCK 6, SITE P~N FOR SEPTI~ SYSTEM UPORADE , CONSULTANTS, INC.~ ~ ~ K~r ~ ~. ~CEr ~ ~. ~ ~907~7~f79. F~ (~7~Z~6 1" = ~0' ~ ~::~ ........ PR~ FOR: P~E NUM~: P~E NUMBS: LORI CHAMPION 346-4438 2 OF 2 VALLI VUE SUBBIVISION ~2; LOT 6, BLOCK 6, DESIGN OF SEPTIC SYSTEM UPGRADE ~',.5,~ ....... ~-1 AI.AS~ WATER & WASTEB~TER CONSULTANTS, INC. ,,,~ .......... ISOIL LOG PERCO~TION TESTI ~ D[SORIP~ON: LOT 8, BL~K 8, V~ WI SUBD~SION J2 , PERFORMED FOR: LORI C~PION DATE: 4-19-01 ~~" °~ °~'c~ ITEST HOLE ~1I II NII U II GM - FILL? ~ I A ~ / / / ~ITE P~] I ~ Gw ' ~,ORG ' ~ GP ~ML GH CL ~c W OL SW HH SM OH SC DEPTH TO DATE GROUNDWATER D~ 4/19/2001 ~o I 11 DATE RE.lNG CLOCK NET TIME WATER LEVEL NET DROP TIHE (HINGES) RE. lNG (INCHES) 12 4/27/01 - R~ PERC ~ ~0 ~MES - EMP~ IN < 10 MIN~ 1 11:58 13 2 12:00 2 O' 6' 3 12:01 14 4 12:03 2 O' 5 12:06 6' 15 6 12:08 2 O' 6' 16 17 18 19 PERCO~TION ~TE <1 (HIN./INCH) PERC. H~E DIA. 6' (INCHES) TEST R~ BET~EN 5.0 FT. ~D 6.0 FT. 2 COHHENTS: ~E INS~ ~DY SOI~ SHOU~ A~ ~ A ~D RL~R. THE PROPOSED D~NR~ IS TO BE INkeD ~0~ ~E ~ HO~ ~D ~Y ~ ~SS R~ ~ERE. PERFORMED BY ~ WA~R & W~ATER,~ JE~ K ~NESS, CER~ ~T ~IS ~ERFORMED IN ACCORD~CE W~ ~ ~A~ ~D MUNICIPAL OUIDEUNES IN E~CT ON ~IS DA~: DEPTH TO DATE GROUNDWATER DRY 4/19/2001 DRY 4/27/2001 ~ GREA ,ER ANCHORAGE AREA BORudGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS '~ · E AL DESCR PT,ON PHONE SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH M AN U FACTU I~ E R ~-~J/~4~ 1 INSIDE WIDTH ~- MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY t/OD o GALLONS. SEEPAGE ~ ~En c~(~c NUMBER OF PITS DIAMETER __ OR WIDTH LENGTH DEPTH LINING MATERIAL BUILDING FOUNDATION ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION CRIB SIZE: DIAMETER__DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE__ ABSORPTION AREA (WALL AREA) ,SQ. FT. CONSTRUCTION DEPTH NEAREST NEAREST SEPTIC LOT LINE SEWER LINE TANK DISTANCE FROM: SEEPAGE SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: C~ (g~¢ LOT SLOPE: REMARKS: t-lng DATE ~)/) ~~'~ APPROVED G.A.A.B. : GEE:/ Er ANCHORAGE AREA BOF JGH DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT ~OIL TEST RESULTS . NOTE: THIG PERMIT IS NOT VALID WITHOUT ROIL 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 /~0 TYPE FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGe PIT SEEPAGE AREA SIZE TYPE ~IAGRAM OF SYSTEM SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK TO NEAREST LOT LINE. · SEEPAGE PIT WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC/r~T~NK ~ SEPTIC TANK, _, SEEPAGE PIT TO RIVER, LAKE, STREAM. DRAIN FIELD ., SEEPAGE PIT - ALSO CONSIDER AREA WELLS. SEEPAGE PIT -- -, DRAIN FIELD, CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGh[ ORDINANCE NO. 28-68 AND THAT THE ABOVE CONFORM To~?BOROUGH REGULATIONS RE RDING INSTALLATIO . GRA~/EL BACKFILL 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSINg GAP OF EXCAVATION 5 FEet INTO UNDISTURBED SO~L. Test Hole 15 Lot 6,'B~ock 6 Depth in Feet From 0.0' 1.5' 7.0~ 10.0' Elevation: Existing Ground W.O. #17378 To Soil Description 1.5I 7.0' 10.0' 16.0' Peat, Pt. F-l, ~ilty Sandy Gravel, GM, grayish tan, damp, Group F. F-2, Silty Gravelly Sand, SM, gray, damp, some sandy (NFS) layers, Group C. F-l, Silty Sandy Gravel, GM, gray, damp; Group F. Bottom of Test Hole: 1.0' Frost Line: None Free Water Level: None Type of Sample Depth M~ Sample Group I 5.0'- 6.0' Damp G F 2 % 8.0'- 9.0' Damp G C 3 15.0'-16.0' Dam~ G F Remarks: 1. Type of Sample, G = Grab. 2. Group refers to similar material, this study only. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 015-123-12 1. GENERAL INFORMATION Expiration Date:: Completelegaldescfiption tVALLI VUE ESTATES SUSDMSION ~2; LOT 6, BLOCK 6 Location (site address or directions) 6661 ROUND TREE DRIVE * ANCHORAGEt AK 99561 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent CAROL BUTLER W/ DYNAMIC PROPERTIES Mailing address LORI CHAMPION Day'phone 346-4458 6661 ROUND TREE DRIVE * ANCHORAGE~ AK 99561 Day phone Day phone 261-7625 3111 "C" STREET * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank Community On-site E]~ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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, sy.stem. DSD atso issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample results less than 30 days old. (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 responsible for errors or omissions in the professional engineer's work. INote: Alaska Water and Wastewater Consultants, Inc. shall be paid $1260.00 at, orpdor to closing for the engineering services provided. 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 on procedures outlined in the Health Authorify 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 ALASKA WATER & WASTE'WATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEt-I-t<EY A. OARNESS, P.E. Phone Date 337-6179 Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results desc#bed 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 ara outside the control of the evaluator of the system. Satisfactoq' test results do not guarantee future perormance of the system, nor do they guarantee that there ara no hidden defects or encroachments. AWWC, Inc. con therefore not provide any warranty or futura 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 right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditionalapproval for __ bedrooms, with the f]lowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Manitenance Agreements Supplemental Engineer's Reort Other Odginal Certificate Date: //2/~ ~- Municipality of Anchorage Development Services Department Building Safely Division On. Site Water & Wastewater Program 4700 ~oulh Bmgaw SL P.O. Box 196650 Andmmge, AK 99519-6650 www.ct.anchorage.ak.us (eoT) 343.7904 Legal Description: A. WELL DATA Co HEALTH AUTHORITY APPROVAL CHECKLIST VALU VUE SUBDNISION ~12i LOT 6t BLOCK 6 Parcel ID: 015-123-12 Welt type<:ouuuta/y IfA, B. or C provide PWSI~ N~ Date prope. prot ed T . Cased to ff. Casing height (above ground), in. FROM WELL LOG Date of test Static water levst ,,,'"' fl. Well production _J g.p.m. WATER SAMPLE RESULTS: Coliform - colonies/100 nd. Nllzate - mg./L. Date of sample: - Coltected by: SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tanksize 1500 gal. Number of Compa~"m~ents 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping NEW Pumper ABSORPTION FIELD OATA AT INSPECTION Other bacteria. - .colonies/100 nd. Dateinstelted 12/17-19/2001 Cleanoute (Y/N) YES High water alarm (Y/N) * THE: $~:.P)lC ~ IS SIZED FOR A FOUR BEDROOM RESIDENCE Date installed 12/17-19/2001 Soil rating (~ ff~odrm) 1.2 Length 32 fi. Width 2.5 ft. Totaldepth I1.7-11.~ft. Eff. absoq3tionarea 518 ft2 Monltorlngtuba YES Date of adequacy test NEW Results (Pass/Fall) - Fluid depth in absorption field batom test - in. El~.psed Time: - min. Final fluid depth - Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type DEEP TRENCH Gravel below pipe 8.1 ft. Depression over fleld,~t.~_ For..~be~ms Water added - gal. Now depth - in. in. Absorption rote >- - g.p.d. - If yes, give date - D. UFT STATION Date installed "Pump on" level at 42 in. Datum BO1TOM OF TANK E. SEPARATION DISTANCES Size in gallons 1500 'Pump off level at 42 in. Cycles tested NEW SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N) YES High water alarm level at 46 .in. Meets alarm & circuit requirements? YES COMMUNITY WATER Septic tankJlltt station on lot Absorption field on lot Public sewer main On adjacent lots ,,--- Public sewer manholeJdeanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation. 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water sewice line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN F. COMMENTS Building foundation 10'+ Sudace water 100'+ Wells on adjacent lots 200'+ Water main. 10'+ Driveway, perking/vehicle storage 25'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and ret4ew of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Englneer*s Printed Name Date J~PP~'Y ~ GARNESS HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 015-123-12 1. GENERAL INFORMATION Expiration Date: Complete legal description IVALU rUE ESTATES SUBDMSION f~2; LOT 6~ BLOCK 6' Location (site address ordlrections) 6661 ROUND TREE DRIVE * ANCHORAGE, AK 99561 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address LORI CHAMPION Day phone 346-4438 6661 ROUND TREE: DRIVE * ANCHORAGE, AK 99561 Day phone CAROL BUTLER W/ REMAX PROPERTIES Day phone 2600 CORDOVA STREET · ANCHORAGE, AK 99503 276-2761 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well DD Individual Water Storage Community Class A Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeownem. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of ~p 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. Municipality of Anchorage [ Development Services Department Bul~lng Safety Dlvtslon On-Site Water & Wasfewater Program 4700 South Bragaw St, P.O. Box 196650 Anchorage, AK 99519-6650 ,,wvw.cLanchorage.ak.us (9O7) ~43.7904 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescrlpfion: VALLI VUE ESTATES S/D ~2; LOT 6~ BLOCK 6~ ParcellD: 015-123-12 A. WELL DATA Well type COMUUNITY If A, B, or C provide PWSID~ ~-~ Date completed Sanitary 8~ Wires properly protected (Y/N) ~~a~~-to .It. Casing height (above ground) in. FROM WELL LOG Date of test Statlo water level Well production WATER SAMPLE RESULTS: Colifo;m - colonies/100 mi. Date of sample: - SEPTIC/HOLDING TANK DATA AT INSPECTION /- Nllrata - mg./L, Other bacteria - colonies/100 mi. Collected by: - Tank Type/Material = I ==- Tanksize 1500 gal. Number of Compertments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping NEW Pumper Date installed 12/17-19/2OOl Cleanouts (Y/N) YES High water alarm (Y/N) YES C."A~$ORI~IION FIEIn DATA .... D~te installed 12/17-1~/01 Langth ' ~2 lt. e11.lE S~allC SYS'~M IS a~.c.b FOR A FOUR BEDROOM RES~DI~ICE Soil mUng (~o,r ff~/t)drm) 1.2 system type DEEP TRENCH Width 2.5 ff. Gravel below pipe. 8.1 ,lt. Total depth 11.7-11,eft. Eft. absorption area *518 lt' Date of adequacy test NEW Results (Pass/Fall) - Fluid depth in absoq:~tion field before test - in. Water added - gal. · Elapsed Time: - min. Final fluid depth - in. Absorption rate >= Any mjuvenafion treatment (past 12 mo.) (Y/N & type) - If yes, give date Monitoring tube YES Depression over field NO For '3 bedrooms New depth - in. - g.p.d. D. UFT STATION Date installed 12/17-1S/2001 "Pump on' level at 42 in. Datum BOTrObl OF TANK E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot Absorption field on lot Publlo sewer main Size in gaflons 1500 'Pump off' level at 42 in. Cycles tested NEW Manhole/Access (Y/N) High water alarm level at 46 Meets alarm & drcult requirements?. COMMUNITY WATER On adjacent lots /-- ~nhole/cleenout '- Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ . Property line 5'+ Abeo~tJon field Water main 10'+ Water service line 10'+ Surface water Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:. Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN F. COMMENTS Building foundation 10'+ . Sun'ace water 100'+ Wells on adjacent lots 200'+ Water main, 5'+ 100'+ 10'+ Driveway, parldng/vehide storage 25'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and ret4ew of Municipal reconts that the above systems ere in conformance w~th MOA HAA guidelines in effect on this date. Engineers Printed NQme JEFFREY A. GARNESS Date I ~/~*~/0, HAA Fee $ ~ Date of Payment ~ (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number Parcel I.D; # 1. GENERAL INFORMATION '~ C~plete.]egal,.description · ~;:;'.~.':.~:.. ,,~,~:~;,;;:.H" .~/'~'~[ e-"~,~:~. DEPARTMENT OF HEALTH & HUMAN SERVICES ,~;~"~t~' :~;i~i;~?:'~? ~ ~ . Division of Environmental Se~lces . ............ ~c .... ""'~'~ ...... "' On-SteSe~cesSecfion .......... ~="~*'~'~" -*' .......... :~ P.O. Box 196650 Anchorage, Alaska~ 9951~650 CERTIFICATE OF H~LTH AUTHORI~ . '-~PPROVAL FOR A SINGLE FAMILY DWELLING directions) 6661 Round Tre~ Drive or ~-~Mark"~ Stcpha~¢ St~ph¢~ Day phone 346-2593 ' ,~ ~,~ ~201 "C" S~ S~ I00 Anchorage, AK 99503 ' Day~ ohone ng ."-¢'~.' L "C -'-:'*'.'t-~ h/ II ....... '"'" ......... ; '-;','.';. Y~(X · ~:- ¢-u .., ;: ,.ommunl.x. we,, -~.. X;;..~;.;;:~.NOTE: If communi~'well system,.provide wri~en coq(irmation.frqm._Sta~ ' ~ ' ~'~{.'.. ~ ~ ~:~. ing to the legali~ ~nd status of system. 4. ~PE OF WASTEWATER DISPOSAL: NOTE If commum~ wastewater system, prowoe wn~en - .,..r ':-' ... ;. a~esting to.the.!egah~ and status of system. r ~~STATEMENT ...... · 5' *' ' OF INSPECTION BY ENGINEER ..... *~ :.: ~..... ~ ;.~r '.~ --~ /~=^- certified'b~, my seal affix;ed hereto and as Of the validation date shov~h' ~elow I verify that my investigation of this Health Authori~ Approval application shows that the on-site water supply and/or wastewater disposal system is ~fe, functional and adequate for the number of b~rooms and ~pe of structure indicat~ herein. I fu~her veri~ that based on the information obtained from the Municipali~ of Anchorage files and from my inves~ation and inspection, the on-site water supply and/or wastewater dispo~l system is in compliance with all Municipal and State codes, ordinances, and r~ulations in eff~t on the date of this insp~tion. ~' ' Name'of Fi~ S & s ~GIN~E~INS ' "* Phone '~ q ~ - ~q 7 ~ 1~ ~e Riv~ ~ Road No. 2~ ' Engin~,s signature ~ ~ ~ Date '~ ~ ~/* r ......... __ . - [~ :g': '~"~'~? ?'Gondit ona approval 'forr~ '~-~ ~¢' :~* By: The Municipality of Anchorage D~partment 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not GOndUGt or .~-. inspections anmyze data before a certificate is issued, The Municipality of Anchorage is not responsible for errom or omissions in the professional engineer's work. * ' N~UNICIPALiTY OF A Municipality of Anchorag~NvlRo~, DEPARTMENT OF HEALTH & HUMAN Environmental Services Division o 825"L" Street, Room 502 · Anchorage, Alaska 99501· RE E!VED Health Authority Approval ChecklJst Legal Description: Z d/'~4 ~/~/~' ~/tP¢ ~L~Z_~/~ Parcel I.D.: A. WELL DATA Well type C_o~-~ d/~,'~ IfA, B, or C, attach ADEC letter. ADEC water system number Log present (Y/iq) -"¢///~ Date completed Total depth //~,//~ Cased to ,,d///~ Sanitary seal (Y/N) /v~///~ Casing height (above ground) Wires properly protected (Y/N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION · /L//,/~ WATER SAMPLE RESULTS: Coliform Date of sample: B.~OLDING TANK DATA Nitrate ,/~t/,~ Other bacteria Collected by: Date installed q~/'~- '?,ff~ Tmtk size//~ ~ d~/. Number of Compartments Fom~datiq.n~a~oiii'~Y/N). _/V Depression(Y/N) ~ ~ghwateral~ff~ Dat~'0f~U;~ing q/~[q~, Pumper ~ ~ ~m* c. A~SOR~ON m~ ~A ~ Dst~ inst~led ~ ~ ~/7-'7~ , Soil rating (g.p.d./fi2 o~ 22 ~ System ~e Leh~h , ~2 t. ,Wi;t~". !''' ~ / Gravel t~cknessbelowpipe EmctN~:a~owti6n area' ' F7 Z Monitoring Tube present(Y~ Date ofadequa~ test ~-/~ ~ ~ Results ~ass~ail) ~ Fluid dep~ in abso~tion field before test (in.); Fluiddep~ 2 ~ Minutes later: Peroxide tream~ent (past 12 months) (Y/N) ,,4// __ Cleanoutt (Y/N) ~p t Total depth / 2 / Depression over field (Y/N) For -~ bedrooms hnmediately after ~g~ gal. water added (in.): ~o~ ' (in.) Absorption rate = V3--c© ~ g.p.d. If yes, give date D. LII~ STATION Date installed /b Manhole/Access (Y/N) High water alarm level at* ~// Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~bolding tank on lot Absorption field on lot Public sewer main Sewer/septic service line Size iii gallons "Pump on" level at* .,,LJ,/..,~ *'Pnmp of?' level at* ; Oa adjacent lots ; Ou adjacent lots Public sewer mmfl~.ole/clemmut Lift station SEPARATION DISTANCES FROMO/HOLDING TANK ON LOT TO: Foundatioi~ t/~ (,~- Property line /d9 r./_ Absorption field Water main/service line o~ ~-/~- Surface water/draiaage /00//' Wells ou adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building fouudation Surface water Cuitain drain Water main/service line Driveway, parkiug/vehicle storage area Wells on adjacent lots Rev. 8/95 OSS: baa3vk.doc F. ENGINEER'S CERTIFICATION ~ ! certify that I have determined thrufield inspections and review of~gIunicipal re--ts are' ;~g~t°atunf°r' ff'a' ~;2jT: f~n effect °n this date' ~t3/~ HAAFee $ ~'~ Waiver Fees Date of Payment y//~¢~ Date of Payment Receipt Number /~W~/~ Receipt Number 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. # Of~'--- I_~'~" I 1. GENERAL INFORMATION Complete legal description Location (site address or directions) _ ~(¢~ / ~¢,J~¢,~ "~'-.c~_.-~_ Property owner Mailing address Lending agency Mailing address_ Day phone Day phone Agent '~1~'¢' ~-{¢_ ~.~-Jc- Address ~ ( ~ ~ ~ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ~ % 3. TYPE OF WATER SUPPLY: Individual well Community we~l ~ Public water Day phone. 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 I// Holding tank Community on-site Public sewer NOTE: 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 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 Address ¢~.O~ ~ ~,~~/....~ /:E ~7._42 ¢ Engineer's signature ~ ~ Phone D~HS SIGNATURE ./ Approved for Disapproved. Conditional approval for bedrooms. Date bedrooms, with the following stipulations: Additional Comments Date/0,///¢' ~//~? _. 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 th is 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 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: ~'/~' I,/4X~/~' [/'~-- ~2 ParcelI.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal(Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m, g.p.m. On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed q~//~ h ~ Tank size I ~ Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) ~' "/' Depression (Y/N) High water alarm (Y/N) ~'~//~, Alarm tested (Y/N) Date of pumping ~ ! ~I ?''/¢ ~-' Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To propertyline ~"o -+- Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (Rev. 7/91) Front ; ~ CONTINUED ON,BACK PAGE C. LIFT STATION ~ '~/,~.. Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date instarled ~/l~ Length ~ Z. Width Total absorption area ~ Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ~ System type Gravel thickness ,~ Total depth Cleanouts present (Y/N) Date of adequacy test for ,-~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~J//:k On adjacent lots N/~, bedrooms Property line '~ 2'0 To building foundation On adjacent lots Surface water Curtain drain ~'~'~ / Cutbank To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION 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 HAAFee$ /70 Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 WALTER J. HICKEL, GOVERNOR (907) 349-7755 October 1, 1992 Mr. James Sizemore SUBJECT: Valli Vue Subdivision Class "A" Public Water System, PWSID 210605 Dear Mr. Sizemeore: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on September 8, 1992. This does mee__t the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on August 13, 1992. This does m_c~t the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results Were submitted to the Department on September 9, 1992. This does_ mc_e,.t the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemicals were submitted to this Department on November 12, 1991. This do_cs m~e~t the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Environmental Eng. Asst. II MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL/~(~ OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township. Location (address or directions) (b) Properly Owner ~ ~~ Telephone: Home ~'~& Business Mailing Address ~ ~ ~/ ~ O ~ ~ ~ (c) Lending Institution ~ N ~ ~ A---~ Telephone Mailing Address ~ ~ ~ i (d) Real Estate Company and Agent ~ ~L~ Address Telephone (e) Mail the HAA to the followino address: or: Check here'~ if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Individual Well [] Community,,{~ Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,,~ Public [] Community [] Holding Tank [] Note: If gommunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 IRev 81861 Front 5. ~NGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or 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 Name of Firm ' ,~ ~ Telephone Address Date Engineer's Seal DHHS APPROVAL Approved for ¢'M,-~_- ('.¢/~ bedrooms by Approved Disapproved Conditional Terms of Conditional Approval Date /-~:2-~ ~ CAUTION 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. Page 2 of 2 72 025 IRev 81861 Back ,¢/\I',! 2; 1987 A. WELL DAT ECEIVED MUNICIPALITY OF ANCHORAGE (MOA) MUNIC~PALI'~ OF ANCH©~AG~HEALTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 264-4720 Legal Descr, iption: LO'/' /~-~; ~'~ Well Classification (~..t.~/~P~% /¢% I~A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) _ Date Completed Yield Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) ' Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) 0 Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ? ~ ~' To Property Line ~ To Water Main/Service Line Size 1~0~9 No. of Compartments C~I~./~ Air-tight Caps (Y/N) ~ Foundation Cleanout (.Y/N) Date Last Pumped It//A ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field Course To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72~026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata ¢'~r,¢~ ~ Date Installed q//TI/ 7~" Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance lrom Absorption Field: Type of System Design Length of Field /~/~- Depth of Field / Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Water-Supply Well ~.~ To Building Foundation Lot TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) I",,J ¢) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Commenls ** Check Permitted Bedroom Rating Against HAA Request ** MOA and HAA guidelines in effect on the date of this inspection. I certify that I have checked, verified, or conformed to all Signed ~'--~ ~"~/~J,4~-t¢?~,-'f~/ Date Company MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (~ 1/84) Engineer's Seal CONSULTING ENGINEER 202 W. 15th AVE "C" SUITE 203 ANCHORAGE ALASKA 99501 TELEPHONE (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: LOT 6, BLOCK 6, VALLI VUE ESTATE ~_~c,~.~ ~ ~. ..... ~,.~ 6661 ROUNDTREE .~.. SAM PESTINGER ~*~ 49~H~'~ SINGBE ~IBY~ THREE BEDROOMS ~ :i~..~.. · FROM MUNICIPAL RECORDS: ~%~'~?.~XL TANK: SUNSET PLASTIC ONE COMP. 1000 ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 672 SQ. FT. SOIL RATING: 225 INSTALLATION DATE: SEPTEMBER 1975 DATE OF PUMPING: JUNE 8, 1986. ISAACS PUMPING SERVICE DATE OF TEST: JANUARY 26, 1987 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND UNDER THE ENTRY STAIRWAY WITH DIFFICULT ACCESS FOR MEASURING AND PUMPING. TANK HAD VERY DENSE FLOATING GREASE LAYER. UNABLE TO MEASURE TOTAL DEPTH. WATER COULD BE HEARD ENTERING THE TANK FROM THE HOUSE. CLEAN OUT TO TRENCH WAS FOUND 4 FEET DEEP AND DRY. FOUNDATION CLEAN OUT WAS DRY. SUMP TO TRENCH COULD NOT BE LOCATED. 1000 GALLONS OF WATER WAS ADDED TO THE TRENCH CLEAN OUT WHILE THE FOUNDATION CLEAN OUT AND TANK WERE MONITORED. WATER WAS ADDED AT A CONSTANT RATE OF 5.5 GALLONS PER MINUTE. THE ADDITION OF 1000 GALLONS DID NOT CAUSE WATER TO BACK UP INTO THE TANK. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic syssems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long the syssem will continue to meeL the operational requi- rements of the Municipality and State. ?~UNICIPALITY OF ANCHORAGE,~-~, DEPARTMEt% JF HEALTH AND ENViRONMENT~ ~ROTECTION 825 L Street, Anchorac~, Alaska 99501 264-4720 Date Received: November 16, 1977 #1: Time 9:30 a.m. #2: Time #3: Date 11-18-77 Firday Date Date Insp Pratt Insp Insp 2 o REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER ~ACILtSI S Lending Institution Request: Alaska Bank of the North % Claudia Mailing Address: 3301 C Street, Calais II Phone 278-4581 Property Owner: Bill D. Burlingham Mailing Address: Post Office Box 4-2593 Phone 344-4956 Legal Description: Lot 6 Block 6 Valli Vue Estates Subdivision 6661 ~ound-=f~%-e Drive Single Family Residence: Number of Bedrooms: ~Thre~ ..... Multiple Family Residence: ( ) Number of Bedrooms: Well Ssstem: Permit # Construction Individual Well ( ) ConLmunity/Public System ~) Depth of Well Well Log on File Bacterial Analysis ( ) 6. Sewage Disposal System: Permit # Installed Septic Tank Size Absorption Area On-site System (~ Public utility ( ) 1975 Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line I I I~age ~wo Department of Health and Environmental Protection Request for Appro,al of individual Sewer and Water Facilities Legal Description: Lot 6 Block 6 Valli Vue Estates Sudivision Con~nent s: Disapproved: Letter Attached: ( ) Date: Department Worksheet: I · ' ,'bNICIPALITY OF ANCPORAGE · YO~ Department of Health and Environmental ~ ~ 825 L Street, ~chorage, Alaska · . ~ ~ 3. Lending Insti~=tion: .~Z~Z~ ~t'/~ Mailing Address: G ~ Mailing Address: Legal Description: Street Location: _~ Phone: 6. Single Family Residence: (~ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: If On-site System, date of installation: 7. Water Supply: * Individual Well ( ) Public/Con~nunity System If Individual Well, well depth _ If C on~nunity System, name of system _/~~'~ 8. Sewage Disposal System: *~Dn-site System ~ Public System ( ) I1,- *NOTE: A well log is required on ALL wells drilled since 6/75~ *~ If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77