HomeMy WebLinkAboutVALLEY VIEW ESTATES #1 BLK 1 LT 4Valley View
Estates
Block
Lot 4
#050-521-65
MUNICIPALITY OF ANCHORAGE
· · DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DIspOSAL SYSTEM AND/OR WELL INSPECTION REPORT
. [] UPGRADE
Well Absorp,'o are~ Dwelling ~/
Liq.~ gallons IF HOMEMADE: Inside le~/~ Width Liquid depth
O DISTANCE TO; Well /~O / ~ Total le~lI of ~les '~ Tren~w~(~ Distance be~7~e~
~ No. of lines/ Length of each lin inches
~ Topoftilotofin,sh, ~ ~ . inche, Tot. I ~ffecti~on area
~ ~Cl~.. } Depth ' Driller Distance to lot llne PERMIT NO.
OTHER
SOILTESTRATING /~ ~ ~ ' ~ ~ ~
INSTALLER ~/ ' .~ ~ ~
I
- , . __, ~ :_ ~_ ~
72-01; w, 3/78)
PERHIT hi!,').
DEPFIRTM[F. NT OF HEFtLTH FINf> EN',,,':[RONMENT'RL. PRCITEC]"~ON
;E:64-472. E~
( F':'~E~iL~:5 >
FIF'F'L I CFINT
I..OCf:l]' I ON
[..EGf::IL
HI'--'II"t M N N C:ONST.
B I F'.CFI E;T.
L. 4 E::L 'v'f::lL.I...E¥ VIEH EST.
P. 0. 80:4 6:t7 E. R,
[.OT '_"'~ I Z'E
c/.,3{3
E;E:~4,:'- ';'. ]-. r-;::
8?J..2EI S(;!IJFff;:'.'E F'EET
'T'"r'PE OF SOIL FIE:S;ORE:TICIN Z"r'?I'EH IS: "FRENCH
I"II::I',~..','IHU["I tqUklBER OF E:E[:,ROOMS .... ;:ii:
:E]OIL RFrT'ING (SI_.] FT,."E:R)= :LSEI
.:,_,;:[:. OF THE ':;-'[ FIE':;-RPT"Fdq ....... ]Ell .[::,.
'['HE F'E'I:)III'F~'F[:, -'f='-' :' : ..... '-'
]HE L.ENGTH [:,IHEN':2;tON I2: THE LENGTH <IN FEET) OF THE: TRENCH OR f)RI:~INFIEI..D.
THE DEPTH OF' Fl TRE:NCH OR PIT ]:S THE DI:T:,TFINCE E:ETFHE:EN THE ZURFFICE OF THE:
· '.'3ROUND f:ll'4E:, THE BOTTOM CIF:' THE E:::.:',CFIVFITION ,::!l'.,I FEET).
THEF,'E IS NCI 'ZET 14ZDTH FOR TREENCHEE;.
THE GRR',,,'EL. [:,EPTH IE; THE HINtMLIH E)EF'TI.I CiE: GRFIVE:L BETWEEN THE OUTF'FILI.. PIF'E
FIi',I[:, 'THE BOT'f'OH OF THE E',:.,',CaVR'F I oN < IN F:E:ET ).
F'ERH I T RPF:'L I E:RNT HR::; ]"HE: RE'::qPONS'; ! t31 L. I T'¢ TO INFORM TH I Z DEPFIRTr,IENT DUR I I'..!(:i THE
II'.,!STRLLFI-FION ~NSF'EC:TIOi',I::.; OF Ri'.,lY' HELLS RDJRC:ENT '1"C~ 'TH!::5 PROPERT"r' RI",I[> ]'HE
NUMBER OF RESIDENCES 'FHRT THE HEL.L HtI_L. SERVE.
MINIMUM DI~¢-f'FINCE E[ETF.IEEN 8 !.,lEI..[.. laND RN"r' ON-SITE %EF!FIGE [)]:E;F'O'.:_'iFIL. :5h":~;'FE:{'I ]:S
:t_E)E~ F:'EE:T FOR FI PRI',/FI"rE: I.,.IELL.~ OR
:LSE1 TO ;:2EI6:i FEET FROM FI [::'UE}LIC HELL DEF'EN[:'ING LIPON THE '["¢F'E OF F'IJIEd..IC HE:L[ ....
OTFIER REQUIREMENTS P1FI"r' FtPF:'L."r'. E;F'ECIFIC:f:Yf'ION~; FIND CONS;TRIJC:'FtON DII:aEiRFIHS FIF:E
FI',,,'FII LF'IBLE TO INE:LIRE PROF'ER INS-rF:ILL.FtT!ON.
E=" E: Eqt' IP'I :E 'T E: ::-:,1F"' :¢:: ~:a: E] :E~ E':" EEZ C: EEZ F"1 E: El l:E'.' :Z_f:: ~ ..... £L :E~ ]:-"
~ CEF'.TZF"r' 'THRT
t: I RM FRHIL. II::tR FILTH 'T'HE REQUIREHENTS FOR ON-E;I-I"E SEI4ERS RN[:, klEL.LS RS SET
!:::ORTH EFt' THE h'IUNIC:IPF'I[..I]'¥ OF FINCHORFIGE.
2: I HILL ZN'.!STF]L.L THE S"r'!5"['EM ]:i",l RCC:ORDF~NC:E [4ITH THE E:O[:,EE;.
3:: t Lh",I[)ERSTFII"~D THFIT THE ON-':E;ITE :SEI.,IEF:: E;'¢:E;TEM HFI'¢ F~:EI]:!UIF:ffE ENLFIR(:iEMENT IF THE
RE:E;tE:,EI'qC:I'Z IE; REMODELED TO INCLLJ[:'E HORE THFII",I 3: E:E:[:'ROOMS.
¥1PP[ I CFII",IT (/H'RNFINN CONS'IL
",':,::' '. £ ".,ccrF / ...........................¥]!:. '-"
............................................................. e -D .............. ............
Performed for
Legal Description:
This Fo~n reports:
CONSTRUCTION TEST LAB
"One '~'~
Tf ~.. is .worth a Thousand OpirZ~?ns"
2204 Clevel~hd Anchorage, Alaska 9950~' 277-0231
SOILS TEST
Su~ivision/~'J-Z,'~Z~ ~.~z~/-~c
PERCOLaTiON ~ST
Depth
Feet
/,
Soil Characteristics
p~ ~
Was Ground Water Encountered_~L~"
If YES, What depth?
Reading Date Gross TLme Net TLme Depth to H20 Net Drainage
Percolation Rate Minute
Proposed Installation: SEEPAGE PIT DPQAIN FIELD
Depth of Inlet , . Depth to Bottom of Pit or Trench
COMMENTS:-/~3 _~.,~ ,~ /'/,-~ ;~,~z~.~ ~-z~-a ~
~' z ~ ,'~','7/ '/ - ' ' - /
Test Performed by /~Z~'/~' Data Certified By:
/ .... Date ': ''
~ APPLIC-'~IT FILLS O0T UPPER H;A["-~ONLY
Phone
Mailing Addre~ /0 ~0% /~4 /'i Il[Y 1 ¢~: Zip Code
Phone
Street Locati~
Type of Resi~nce
~;Single Family
~ Multiple Family No. of Bedrooms _
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A w~t log is required for ~11 wells drifted since June 1975.
Community For wells drilled prior 1o that date, give well depth (attach log if available).
Public Utility
' Individual
When Connected ~o Public Utilit~ _
~ Public Utility
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time
Time Time Time
Date Date Date Oate ~. ~ ~L\ ~ ~'~
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALT~-f
ENVIRONMENTAL PROT~.CTION
MAY 2, 0 i983
RECEIVED
( ~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) COND[ ONAL A PROVAL*
Soils Rating Date Sewer Installed ~WJell To Absorption Area Well Log Received
~"~ ~ ~- Well to Tank Septic Tank Size //.)Od -- ~>'~O
· Municipality ot' Ancliorage
Development Services Department
Building Safety Division
On-SRo Water and Wastewa{er Program
~,700 Sou~h Bragaw St.
.~9~ P.O. Box '196650 ,~chorage. AK 99519-6650
wv.~.ct.anch0rage.ak.Us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
ParcelI.D. 0~-'0" ,..b'-,;,O. I - G..4"-
1. G EN ERAL'IN Fo~,M/~TI_O N
Coi~p~et'~'l~al des~riptiod- Lot
' birorJ~'~it "
Loc e address or ebons
Cu~r~nt Properly owner,s)':
~iling address."
Lending figeney
Expiration Date:
Block 1; Valley View Estates #1
25805 Wildflower Cir.
Shelly Smith Dayphone 783-2653
PO Box 803 Girdwood, AK 99587
Day phone
...:... Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSO for pickup.
2. NUMBER OF BEDROOMS: ?
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site [~
Individual. Holding tank
Community On-site
[] Public Sewer
The Municipality of Anchorage Development Sen/Ices 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 el' Heallh Aulhodty Approval are required [or the Iransfer of
title (except between spouses) for propedies served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Cedificales of Health Aulhori[y Approval are
valid for 90 days from the date of issue for properties served by a private or Class C we!l and may be reissued wilh
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid waler samples.) Cedific~les are valid for one year [or properties served by Class A or B wells or a public
water system. The Mupicipality et Anchorage Is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as et Ihe validation date shown below, I verify Ihat my Inves[Iga{ion,
based on procedures outlined In Ihe Health Authority Approval Guldelines for this application, shows that Ihe
on-site water supply and/or wastewa[er disposal systent Is(are) safe, functional and adequate fo( Ihe~number of
bedrooms and type of structure Indicated herein. I further Verify that based on Ihe Information ob{~in~d.~[om the
Municipality of Anchorage files and from my Investigation and Inspection, Ihe on-site water
wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes o~lin'a'nc~s~.
and regulations In effect at the time oflnstallafion '" ~..,
NameofFirm S & S ~.n§ineering Phone 696'-2979 '
Address 17034 N. EaRle River Loop Ste. 204 EaRle River, AK 99577
Engineer's Printed Name Robert C. Cowan Dale ~/3.-~'/o 7--.
5. DSD SIGNATURE
b-'"" Approved for ~-
Disapproved.
Conditional approval for
...... ,
c. cow*
bedrooms. It ?~:-.. ..... .."~.-"',~
t~, ¢,., ~. ....... .....~
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
. Maintenance Agreements
SUpplemental Engineer's Report
Other
Original Cedificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box lg6650 Anchorage, AK 99519-6650
www.ci.anchomge.ak.ue
(g07) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
A. WELL DATA
Well type/~ ~/~ rE
Date completed '~' I'~
Total depth I'tf'lF ft.
IfA, B, orC provide PWSlD #
Sanitary seal ~N) ¥~ J
Casedto ~/0 ~
FROM WELL LOG
Date of test
Static water level
Wall production
WATER SAMPLE RESULTS:
Coliform O colonies/100 mi.
ft.
g.p.m.
N~te o. "5
Date of sample:
Wall Log (Y/I~.
Wires pmpsrly protected
Casing height (above ground)
AT INSPECTION
in.
Other bacteda o colonies/100 mi.
Gravel below pipe ~ f.
Depression over field
Absorption rate >=
For ~-- bedrooms
New depth ? m.
:~OO g.p.d.
If yes, give date. ~'
B. SEPTIC/HOLDING TANK OATA
Ta,n,k~Type/Material ~ /~ PT , c.. /
?anksize ,/oO0 gal~ Number of Compartments ~--
"Foundation cleanout~l) ¥'~J Depression overtank (Y~[~
.... O~te of pumping' '' 'y:/~ / o ~- Pumper
C. ABSORPTION FIELD QATA
Length. ~ ft ¥~,qdth ~ fl.
Total depth ~ '~,- fl. EfT. absorption Brae Afr° · Monitoring tube
Dam of adequacy test ~ Results~as _s/l=,il)
Fluid depth in absorption field before test ½ $' in. Water added''~)''O gal.
Elapsed Time: ~'0 min. Final fluid depth ~ m in.
Any rejuvenation tmalznent (past 12 mo.) (Y/N & type)
LIFT STATION
Date installed
'Pump on' level at
Datum
Size in gallons ~
in~ High water alarm level at
es tested M~t~ alarm & circuit requirements?
E. SEPARATION DISTANCES
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot / O ~ "f
Absorption field on lot / 0
Public sewer main
Sewer/septic sen~ce line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank /,//,4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation $ Property line 5-/~ Absorption field ,.C /
Water main /J//~ '~ " Water service line /0 ~
· . Surface water /o0 ~J
Wells on adjacent lots ! 0 0 ~ '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
t
Property line / ~) 4- Building foundation tO -~- Water main
Water Sewice line 10 '~' Surface water ~/00
Curtain' dra~n · ~ ,) ~ ~-' ~,'*,'~' Wells on adjacent lots
F. COMMEI~8
G. ENGINEER'S CERTIFICATION
I cerSfy that I have determined through field inspections and
review of Municipal records that ;he above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Pdnted Name
Date
Waiver Fee $
Date of Payment
Receipt Number
CE-8801
Municipality of Anchorage
Development Services Department
Building Safety Division
.On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Health Authority Approval # 020290
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block 1, Lot 4 of Valley View Estates #1
subdivision, the well's productivity was determined to be 0.324 gallons per
minute. The minimum well productivity required by this Department (AMC
15.55) for a 2-bedro6m residence is 0.2 gallons per minute. Although the
subject well currently exceeds this minimum requirement, all parties
concerned are advised that the production capacity of the well may fluctuate.
Restriction of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
CLIENT:
LEOAL DESCRIPTION:
WELL DEPTII: I
DATE DRILLINO COMPLETED:
WELL FLOW TEST DATA
'[FIOBERI''~f C. COWAN. RE.
ROBERTA. St La.CER. PF.
CIV1L ENGINEEr'sS
(907) 694-2979
FAX (907) 694-f211
CASINO DEPTIh
~IISc. DATA: CASINO IIEIOHT:
DRILLER:
SANITARY SEAL:
WIRES IN CONDUIT: ~,~ ¢ ORADINO O.K..* Y ,f .,f
DACTERIA AND NITR,~TE SAMPLES COLLECTED (date): ~/~'/O ~-
TEST DATA:
METER PUMPINO DEPTH TO ·
cLOCK I~EADINO hATE WATER '; REMARKS
TIME (GAL) (GPM) (FT) ':
. I ~-~ '.,.. P*'~ ~ e ,v
~:lfl ~x~TY6eL z'"~.?'3~' t~':""'." ~.e
I~ESUL'IS; WELL CURRENTLY PRODUCES O.J.tq OPM WITH A '7~) · DRAWDOWN
~ESTED e¥: ~00B
FLow RAtE NOT OUARANTEEb-sUeSEQUENT VARIATIONS CA.N oCCUR.
7034 NORTH EAGLE Fro/ER LOOP * SUITE 204 ~ EAGLE RIVER, ALASKA 99577
LOT 2
PREUSS AV[NUE
~ N 89'~7'14' E 510.00'
1
[ N~9*S7*I4'E { 467.96'