The URL can be used to link to this page

Home My WebLink AboutVALLI VUE ESTATES #2 BLK 6 LT 29Vol li Vue Block 6 Lot 29 #01§- 123- 23 Municipality of Anchorage · Development Services Department..=-"-":: Building Safety DMslon On~ite Water & Wastewater program, 4700 8outh Bragaw SL www.cLanchomge.ak.us (907) 343-7904 Page 1 of On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:. SW010599 PlO Number:. 015--125--23 "ama:REX WILHELM WastewaterSystem: [] New · Upgrade Addrel$: ~oo CROOKEa mEE C~RC[[ ABSORPTION FIELD No, of Bedroome: ~Othe Ph°ne:(907) 346--1978 4 [3Deep Trench DShollow Trench E]Bed E3Mound LEGAL DESCRIPTION Lot: BIotic Subdlviaion: ~ ~ 1~" ~ f~m e~g~4 ~*: I r. mv~U~ ~ 2g 6 VALU VUE #2 rL township: _ Range: -- Section: -- Fo added ~ave e~91~ ~.~_~.~/~gJrL ~ length: WELL: B New I-I Upgrade rt SEPARATION DISTANOES ,s,pua ~Ho~,, ~S.T.~,. To 5epic A~loFierl~c~tion StationUff HoldingTank~'~ ANCHORAGE TANK 1500 Weft 200'+ - - -- 25'+ STEEL 2 s~oc. wot,, lOO'+ .... LIFT STATION Curtain Dmln · N(~NE KNOW /, r ,,ma~k,: BENCH MARK NE CORNER OF BOTI'OM CORNER STEP IN FRONT OF HOUSE. 100.00 .... : ........ Department of Health and Human Services approval ~';t. II _ ...... D ~[~ o fe,,~o~_°~:~ R~vlewad and approved b ate:~._,,~, -~-/-- I '~e*e ....... ~ ~.o.: AS- BUILT DRAWING $W010599 015-125-25 . / ~...~,o~ / ; ' /~1 ~ ~NO D~NB~ /II . / ~S~ W~I'ER, CONSULTANTS, & h~ASTEWATERiNc. ~1" -- 40' REX WILHELM (907) ~46-19~8 2 OF 2 I WLU vU[ ~2. ~9. SS ~;;, -. ........... .',~ AS-~UILT DRAWING OF SEPTIC TANK UPGRADE A B ST2 20.6 DBL1 i 22.5 39.3 OBL2 I 23.,3 38.6 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: Sep 27, 2001 Expiration Date: Sep 27, 2002 Permit Number: SW010399 Legal Description: VALLI VUE ESTATES #2 BLK 6 LT 29 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Rex Wilhelm Owner Address: 6800 CROOKED TREE CIR ANCHORAGE, AK 99516-6824 Parcel ID: 015-123-23 Site Address: 006800 CROOKED TREE ClR Lot Size: 29377 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage construction must be in accordance with: 1. The attached approved design. 2. mi 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. Municipality of Anchorage Development Services Department Building Safely Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 ~vw.d.nnchorage.ak.us (~07) 343-79O4 Parcel I.D. ON-SITE SEWER/WELL PERMIT ~,PPLICATION FOR .b. SINGLE FAMILY DWELLING Permit Number Property owner(s) REX WILHELM Dayphone ~4~-1978 Mailing address (1) {~800 CROOKED TREE CIRCLE * ANCHORAGE. AK Mailing address (2) Zip Code 99516 Legal description (Lot, Block& Sub'd.) VALLI VUE~SUBDIViSION Legal description (Section, Township & Range) Lot Size o~-~ .~"7 '7 Acres/Sq. FL Number of Bedrooms 4 THIS APPUCATION IS FOR: Sewer Only ~E] Sewer and Well Sewer Upgrade · Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Water Softening 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 &: WASTEWATER CONSULTAN3Sf INC. PermltFees: · ~ ~ · Date or Payment: ¢~/~.~'/ot Receipt Numben Waiver Fees; Date of Payment: Receipt Number:. ALAS-IfA'WATER & WASTEWATER CONSULTANTS, INC, ~ September 25, 2001 Municipality of Anchorage Developmental Services Department Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Septic Tank Upgrade for Lot 29, Block 6, Valli Vue Subdivision//2 To whom it may concern: The existing 4 bedroom house is currently served by an community water system and a private septic system. The existing 1250 septic tank is collapsed and needs to be replaced. We are proposing that the existing septic tank be replace with a 1500 gallon septic tank. 1. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 2. TOPOGRAPHY: There are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If assistance. Presi~n(-{ you have any questions, please contact us at 337-6179. ~ E., M.S. Thank you for your NOTE: Attached is a site plan drawing, a design drawing, and a $ 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 NOTE: ALL LOTS SHOWN I ~,,'"~-, //,," SERVED 8Y CUSS 'A' WELq 2,'~' "-.'~.-:// I II 2':" '"--I ~ I'"-:. / I / ,,.", ~'g',, /.~' /_~/ / ~ //:~ /~' / "---L/! .e~ ..x~ ! CO,S~, T^,~. ~c. ~"~;~ ~,.~.E,. "~4~;~- ragu rUB SU.DIVISlO. ~2= LOT 29, BLOCK SITE P~N FOR PROPOSED SEPTIC TANK UPORADE i ~- WAI-r.R UNE APPROXIMA~ /~ / \~ / ~ I LOCATION. PROFT~ONN,.LY / / I D~S~N= s~mc ~ / I /// '~"~"~"~~ ~// / , / ~NG D~Nn~ ~ , I , / X N ~/ / / I ~ ~N~ ~u~ , .................. REX WILHELM 546-1978 2 OF 2 ~.~.,..o.: .o~$.... '~.....~2 VALU VUE SUBDIVISION ~2; LOT 29, BLOCK 6, ~.,_" ~ ....... . DESIGN OF PROPOSED SEPTIC TANK UPGRADE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 %" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAl SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~],Z~v/~J'~. (~[?--fl~'~AL-~-- ~ SEPTIC ABSORPTION WELL ~d~ / TANK FIELD CEGACDE,CRIPTJON LOT LINE ~5' J ~ / [ownship, Range, Section AS-BUILT DIAGRA~ (Show IocaUon o~ Well septic system, properly lines, foundation, TANKS (~S?l' ~ driveway' water b°d'es' etc') ~ SEPTIC ~ HOLDING ~ ~ x ~" / TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~ OTHER Installer ~5~-- [~ Oate Installed )~ ~ PRIVATE ~ OTHER lldentifv) " b/ / / Installer Datelnstalled: [4 'a ~ 0 I ~0~) kll~,~._.~__~ cedilythatlhisinspe~ionwaspedormedaccordingloall ~:~'~ Robert E. ~.nicipalandS:ateguidelin. inellectonlhisda~ 7~q~O ~ ~'~%. No. ~14~-E Health Depadment Approval: ~ Date: / / 72-013 (3/85) :[I',I(~:IP.,I...L I:)ER ENG:[i',!IEER:3 AT']ACHIED F'L.ANS,, I',IOTII=Y ).)HHS F'RIOF;~ 'f'O IEAE;H 1!: ix!SI:::'i:~X]T .( ON ,, I'I'I I S l='!i:]:i',M I '1 I El :[ SSL,iED Fi)i:;' THtE E X I S'T I NG 4 B!ZDREK)t~! ',31NGLiE F:APiZ[!..Y DWf:i]..!..!txlL:} ONL.Y AND !EXF:'J:I:;~ES Oh! "'¢IEFi]:I:::Y S!]i:I:::'i]Xi; 'l'¢-'d',!!< Zi',ITiEE'iF;:ZfY~ i tF:R'i LI-' '/ 7 HA'f ~; ..... il"i c:omp].iarlc:i:~, **~:i.'t.h ti'-.':, clesign cr':i.'Lis-ria c)i th:i.s per'mit,, :];,, i .gJ.l.~ adher's~) 'i;.(] ,~,;i.;f. PI(IA and / it I / II/ t i 1. This is a system upgrade to ~eplaee a failed field. System Design = ~ bedmooms x 150 sf/bedmoom = 600 sf TPeneh Design = 6' depth x 50' x 2~ = 600 sf of apda 2. All mate~ials~ constPuction methods and inspections to follow MOA Pegulations and pPoeeduPes. 3. Community~well~ fo~ all lots; Septic tank is 1':250 gal steel in good condition. ~.. Maintain 1~' mlnim~ fPom pPopemty line to new t~eneh. SEPTIC SYSTEM DESIGN Lot 29~ Block 6 Valli' Vue Subdivision OATE PREPARED FOR: 'June 24, 1990 Wayne Cpg~Z ~" : 50' K.i~t~l E.oin~ri.g ~OA OE ~0-0~0 page 1/2 ~AF__.V. F I L.L LOT 2-9~ 6L-oCl<. G~ dAUul UU~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST AL) PERFORMED FOR:. DATE PERFOI LEGAL DESCRIPTION: 0'5 I--. 5- 6- 7 8 SA~,by 10 11 13 14 tS'-" 17 18 19 20 COMMENTS WAS GRO~JND ENCOUNTERED? Township, Range, Section: ~' ~'iT~'K,) SLOPE SITE PLAN IF YES, AT WHAT DEPTH? Depth Io Water Allerl%e.~.., Menitorino? ~,~' Date: Reading Date Cross Net Depth to Net Time Time Water Drop · ~o :~,-~-~)0~ Io:$3 · G"I t o:4,3, , ri ID:f3 LO .L~ .~ PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER ~J~ ~? TEST RUN BETWEEN . . FT PERFORMED BY; ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) oGRE~ fER ANCHORAGE AREA BO~C'UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCAT,ON LEGAL DESCR,PTION SEPTIC TANK: DISTANCE ~ INSIDE LENGTH MANUFACTURER ~ INSIDE WIDTH MATER,AL NUMBER DE / . COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY¢~-~'~ ~GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL~J~/~ FOUNDATION NUMBER OF LINES / DISTANCE BETWEEN LINES ABSORPTION AREA ~2~¢) SQ. FT. DEPTH: TOP OF TILE TO FINISH GRADE / TOTAL LENGTH ,~ NEAREST LOT LINE /~ .~t.~ OF LINES ~ ~//~ TRENCH WIDTH _~IN. TOTAL EFFECTIVE LENGTH OF EACH LINE _%¢'/~ DEPTH OF FILTER ~ MATERIAL BENEATH TILE~~/~ I~ ABOVE TILE y IN. WELL: TYPE ~g~'~ t'~ BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST LOT LINE SEWER LINE_ OTHER SOURCES DISAPPROVED DEPTH SEPTIC SEEPAGE TANK SYSTEM REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: ~' SEWER LINE DEPTH: DIAGRAM OF SYSTEM PIPE MATERIAL: LOT SLOPE: REMARKS: For~ LQ-032 GRE:' =r ANCHORAGE ArEA BO. ~gh DEPARTMENT OF ENVIRONMENTAL QUALI TELEPHONE 274-4561 J SEWAGE DISPOSAL sYSTEM ~ APPLICATION A~ PERMIT FINANCED THROU~ - ~ I / TO BE INSTALLE~ DEPRRTMENT Of ENVIRONMENTAL QUALITY AUTHORITY WILL FOUNDATION TO SEPTIC TANK ~l SEPTIC TANK TO SEEPAGE Pit WALL .SEEPAGE AREA SIZE -- DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK /~' DRAIN FIELD WATE~ MAIN TO SEPTIC TANK . D~A]N FIELD SEPTIC TANK, , SEEPAGE PIT TO RIVER, LAKE, STREAM. ALSO CONSIDER AREA WELLS. , SEEPAGE PIT /¢6' CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIE~ CROSSING GAP/ Of EXCAVATION 5 FEET [NTO UNDISTURBED SOIL. = 4 INC~ DIAMETER C~~T IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE pI~T F]TTED WITH AIRTIGHT REMOVABLE CAPS. TYPE GRAVEL BACKFILL BOROUGH ATIONS REGARD G INSTALLATION- 6 The sediments were fair] { loose with a low to Gm ! moderate moisture toI The depth to the 6w Gw layer was no constant. Gw Cfm to Gw 'y. * ANCHORAGE UNIMPALITY OF S, Aw- Development Services Uepartment one: 9U7--S43-1V 4 On -Site - - On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 015-123-23 Certificate of On -Site Systems Approval Expiration Date: cW 3 1. GENERAL INFORMATION Complete legal description VALLI VUE ESTATES #2 BLK 6 LT 29 Location (site address) 6800 Crooked Tree Cir Current property owner(s) WILHELM Mailing address Real estate agent 2. TYPE OF DWELLING: ® Single Family (w/ADU) F-1 Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: NONE Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment 13 2021 Receipt Number Q ��J9(0 COSA # O S C 2 t l 5'(S Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 9/8/21 OF A/-. etb -7 �$d 49TH 6. DSD SIGNATURE ®" ' ,Z System #1 Approved for bedrooms • '� '' ' '�' ' ' CHARLES G BALZARINI System #2 Approved for bedrooms �� _"Fc •. CE -13854 .•�� Disapproved ��F�PROFEss\o�t� onditiona approva __ or bedrooms -1 With the . o owing"stlpu atlons: QF (('r6(r X20 VN-51TE g �� ►,TER AND J WAST'-v:!ATER oma= SE9j,GW�� By: LOriginal Certificate Date: ?1161.202 1 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other T•Ar. QQQ 0.yisor4 X COSA Checklist blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: 67((/ Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping D.ABSORPTION FIELD DATA ______________________ Which system tested (date installed) VALLI VUE ESTATES #2 BLK 6 LT 29 015-123-23 11 1 Served by Public Water 20 SEPTIC 50 4/22/21 Trench 1990 8/26/21 4 9 35 3 600 41 1440 35 600 NA NA note that system is insulated per records. ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10’ Yes if No ft Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date.9/8/21 +5 ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ The sewer line was repaired near the tank outlet. Engineer verified all standpipes shown on record drawings were present. MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Septic Tank Advisory Certificate of On‐Site Systems Approval # OSC211545 Subdivision: Valli Vue Estates #2 Block:6, Lot: 29 The septic tank for this property is 20 years old. The average life for a steel septic tank is 20 years. Typical replacement cost for a septic tank is $9,500+. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. N39° 14' 39"E 30.00'MBLOT 30 ℄ CROOKED TREE CIRCLE10' UTILITY EASEMENTEE T T TT LOT 28 LOT 30 LOT 30 LOT 7 LOT 6 LOT 5 LOT 4 LOT 8 LOT 31 PAVED DRIVEWAYPAVER RET. WALL2ND STORY KICKOUT 40. 4 WOOD DECK 28.8 1 8 . 1 52.2EDGE OF PAVEMENTN 4 6 ° 0 5 ' 5 8 "W 1 5 0 . 0 0 'N35° 09' 23"E 268.94'N14° 24' 52"E 296.66'22.921.764. 4 34. 4 22.39.87.0 12.13.3 L=50.00R=50.00 50' R A D I U S Lot 29, Block 6 Valli Vue Estates Unit No. 2 29,377 Sq. Ft. +/- 6800 Crooked Tree Circle 2 Story Wood Frame House With Attached 2 Car Garage CULVERT G E SS S S SSSS SSS S S PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. September 7th, 2021. Legend: Scale 1" = 50' Gas Meter Electric Meter/Outside Power Deck Septic Fence Mailbox S G E Lot 29, Block 6 Valli Vue Estates Unit No. 2 General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Charles Balzarini (James Wilhelm) 21-658 09/08/2021 77-296 2539 E T Elec. Pedestal Tel. Pedestalx STA T E O F ALA S K A49 TH ROYEVRUSDNALLANOISSEFORP DERE T S IGER Pierre M. Stragier NO. LS-9812 09/08/2021 MBConcrete MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~L,~A~J'E Mailing Address ~ ~0 (c) Lending institution Telephone: (hqme) ~-I~"/0 Business. Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ~ if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE .~, _ Single-Family ~ Number of bedrooms ! 3. WATER SUPPLY Individual Well [] Communityj~ Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 5. ENGINEERING 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 end 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 K~E[~--I~ ~l~J~l'Jt."~("~l/~J(.~' Telephone Address 8~'~'1 /~ ~'[,' ~'~ ~--'~' Date Approved Disapproved Conditional Terms of Conditional Approval ,/~¢ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Beck Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 MUNiCIPALiTY OF ANCHORAGE 343-4744 ENVIP'ONMENTALSERVICESDIVISION Legal Description: L A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well log Present (Y/N) Date Completed j/ Yield TotaIDepth~ Cased to. ___~____ __z Static Water Leyel ~ Pump Set At Casing H~d __ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) El~iring in CondLdt (Y/N) Y To Nearest Edge of Absorption Field on Lot / ; On Adjoining _ots To Nearest Public Sewer Line -- ~arest Public Sewer Cleanout/Manhoie To Nearest Sewer Service Line oJ Water Sample Collected by/ ; Date _ Water Sample Test~ ..... C~' J B. SEPTIC/HOLDING TANK DATA Date Installed ~Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact 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 '~ TO Stream, Pond, Lake or Major Drainage Course J~ ~.'~O NO. of Compartments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Y Date Last Pumped ~"t O ;for · ~-)/~' Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Oate Installed "~ [ q 1~ Width of Field -' ~rL. Type of System Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area Depression over Field (Y/N) N Results of Last Adequacy Test ~ lA Design Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot ( O To Water Main/Service Line /ge ! To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area · To Property Line ~ ~' To Existin~ or Abandoned System on ; On Adjoining Lots '~(00 To Cutback (if present) Comments D, LIFT STATION ~ Date Installed Dimensions Size in Gallons Manhole/Acces~,%~'"TN) "Pump On" Level at ~"~" Level at High Water Alarm Level at / Vent (Y/N) Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical~) **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOANo. ~0- O~'O Receipt No. Date of Payment Amount: $ / 70.0 2 72 026 (Rev. 7/88) Back Receipt No Waiver Fee: $ Date of Payment Page 2 of 2