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Home My WebLink AboutVALLI VUE ESTATES #2 BLK 1 LT 73Vol li Vu¢ Block 1, Lot 73 #015-123- 36 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~'("~:~:~)"~/'-IL( PID Number: 01 Name: ~ ~ ~ ~0/~ Wastewater System: ~New ~ Upgrade Address: ~00 ~r~o~Tr~e~r. ,~¢¢4/~¢5/~ ABSORPTION FIELD ,~o.~: ~_ ~llq ~ Deep Trench ~ShallowTrench ~Bed ~Mound ~Other LEGAL DESCRIPTION so~,,~t,.~: ~,'~,~/s,.,,. To,~,.~pth,~o~o,,~i.~,.r~d~: Subd[v~ion; Depth t0 pipe bosom from original grade: Gravel depth beneath pipe ~ ~ Ft. I ¢¢¢, Township: IRange: is c,io.: :i.'lTddedeb°ve°riginalgr'de:0 Ft. Gravellength: :~, Ft. : I WELL: ~ New D Upg Gravelwidth:Ft. Number oflines:~ Oistance~e~eenlin~:~/~ Ft. Classification (Private. A.B.C,: ~ Cased To: Total absorption area:5 ~0 Pipe materiah ' : ...... Date Dril,ed: Static Water Level: I,stalier: Date ,.stalled: '~ ~ Pump Set at: ~ Casing Height Above Ground: ~.~ ~,. .,. TANK SEPARATION DISTANCES ~s~,t~c ~ .o~d~.g ~ S.~.E.~. TO Septic Absorptioa Lift Holding 'ublic/Private Manufacturer: . Cap~city in gallons: From Tank Field Statio. Tank Sewer Li,es ~ F~ ~ ~ Wel~ ~,~ .~0~,~ .-- ~ Material:~ I NumberofCompadments: ~ su,~c~ LIFT STATION Line Foundation '~0' ~], "Pump on" level at:~ievel at: I High water alarm at: C~a?~n .~)~l~e~,)~. ~ I Electrical Inspections pedormedby: Remarks: ~ Y/5 ~ C- s~.~, ~ T~ BENCH MARK Assumed Elevatlo.: Inspections pedormed by: ~gleRIv. r, Ala~ka t~5~ D~ks: 1st ~-I~'-~.... . Department of Health and Human ~e~ces approva~ ,~[~t~ ,~ ~ .... ............. Reviewed and approved by ~. ~ Date: ~' ~¢ - ~ 72-013 (Rev. 9/91) MOA 25 PERMIT NO SW990246 PACE 2 OR 3 DEPARTMENT OF HEA~_THAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION p,FI, ]Box 196650 eAnchor'~ge, AL~sI<~ 99519 6650®Telephone, 343 4744 ON-SITE WASTEWATER DISPOSAL SYSTEN AND/OR WELL INSPECTION REPORT LgOAL LOT 73, BLOCK 1, VALLIVUE ESTATES #2 P.I.D. NO. 015--123--36 C, COWAN CE -8801 PERMIT NO SW990246 PAGE 3 OF -~ Nu nic ip..~_U ~. y_o. F Anchomaqe DEPARTMENT OF HI-AL/Id AND HUMAN SERVICES ENVIRONMENTAL SF:RVlCES DIVISION P.B. ]}ox 196650 e~nchomoge, ~toska 99519-6650 e Telephone~ 343 4744 ON-SITE WASTEWATER DISPOSAL SYSTEN AND/OR WELL INSPECTION REPORT LEGAL LOT 75, BLOCK 1, VALLIVUE ESTATES #2 P.I.D. NO. 015--125--56 1250 GAL 9 SEPTIC 92.9' TANK MT2 CO1 MT2 COZ MT1 CO1 = 94.4' ~~_~AL GRADE III ~co:t = 90.0' IC02 = 90.0' 85.9'j ~-MT1 = 85.9' · NO WATER FOUND 78.9' B.0.H. A B C :CO - 40.0 14.0 ST1 - 37.0 36.0 ST2 - 35.0 44.0 DBL1 - 55.5 46.5 DBL2 - 35.0 47.0 DV - 35.0 47.5 CO1 36.5 59.0 - MT1 35.0 57.0 - CO2 50.0 42.0 - MT2 48.0 40.0 - CO3 62.0 42.5 - MT3 60.0 40.0 - MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 04, 1999 Expiration Date: Aug 03, 2000 Permit Number: SW990246 Legal Description: VALLI VUE ESTATES #2 BLK 1 LT 73 Design Engineer: 0003 S & S Engineering Owner Name: SUSIE ARNOLD Owner Address: 6900 CROOKED TREE DRIVE Total Bedrooms: 4 ANCHORAGE , AK 99516-6807 Parcel ID: 015-123-36 Site Address: 006900 CROOKED TREE DR Lot Size: 20635 SQ. FT. Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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: f~Z ~.z'~- Issued By: Date: ~ -~ -~ July 9, 1999 ROBERT C. COWAN, P.E, CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 WI[U_iNSPECTION & FLOWTEST PEROOLATION TEST MU3~CIPALITY OF ANCHORAGE Department ofHealthand Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 73, Block 1, Vallivue Estates #2 Request you issue a permit to install a septic system to serve the existing four bedroom dwelling on the referenced property. ~ ~ ~,o g~ao**~ /* Lo ~ ~,~. ¢ One test hole was excavated, and a percolation test was performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation, 6-16-99 water was not found. After seven days of ground water monitoring, no water was found. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or dra'mage pattems by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/bjj Enclosure 17034 NORTH EAGLE RIVER LOOP ~' SUITE 204 ~, EAGLE RIVER, ALASKA 99577 .' "1"' = 60' SCALE DESIGN SITE-PLAN m ~ o ce} I" "1~' = ,30' DESIGN SITE-PLAN SCALE -- -- "'""',~. ~ _. _____ -,, ~ \ / ~ ~ ~ / / ~ 8~ "~ I I ~ / / ~ : ~ / , / ,~.~,::.-"~'.....,.:~ "N. T. S. DESIGN PROFILE C~mmm Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:. S ~J S I t~.. ~ ~J0 ~J~ DATE PERFORMEr L-O'T' "/~ GL. oc.~ I LEGAL DESCRIPTION: ~j ~C,L,I ¥1~1~ ~...{'-J-~.7~l~_~' '/~[ Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS 13~0.H, WAS GROUND WATER ~ 0 ENCOUNTERED? S IF YES, AT WHAT ~ ~) DEPTH? p E SLOPE SITE PLAN Depth to Water Alter _ Mo~litorin~? ~/~¥ Dale: ")/'"t/~¢/ Gross Net Depth to Net Reading Date Time Time Water Drop ?~ ¢0/~/~ o .- ~ ~/~" - ,, ,' V'/~'' ~o ~ ~/~" 7~/~'' ,, ,, ~%" 3o ~'/~" 5 ~, ,, ~ " ~ ~ ,/~; ~ ,/~,, 6~ ? 'Y~" 3 ~/~" PERCOLATION RATE --~ {minutes/inch) PERC HOLE DIAMETER (~ 1~ j 0 TEST RUN BETWEEN ('~ FT AND "7 FT S & S ENGINEERING ACCO R DANCE WI'rEad{eL I~AelrE '~'l~L G UIDELI N ES I NPERFORMED BY: ~ ............ ~.s ~.~1~ ~ .*..~.. ..... ~ '--r- .-~--m--'~ .~..~'- .~1~~EFFECT ON THIS DATE. DATE:CERTIFY~TI~AT/~/THIS/ c~TEST WAS PERFORMED IN 72-008 (Rev. 4/85) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 73, Block 1, Vallivue Estates #2 July 9, 1999 GENERAL: The scope of this project includes the installation of a 1250 gallon septic tanked leachfield trench for the existing four bedroom house located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifhng of the tank. All standpipes on the septic tank shall extend a nfinimum of 12 inches above final grade. Page 2 Lot 73, Block 1, Vallivue Estates #2 July 9, 1999 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched ~ ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pape is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must he installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 73, Block 1, Vallivue Estates #2 July 9, 1999 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: T_vpe of Pipe Perforated. Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt ban:ier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 73, Block 1, Vallivue Estates #2 July 9, 1999 The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The f'mal inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry ont the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 htlp://www.ci.anchorage.ak.us S & S Engineering ATTN: Robert Cowan, PE 17034 Eagle River Loop Rd, #204 Eagle River, AK 99577-0000 August 30, 1999 Subject: Waiver Request forVALLI VUE ESTATES #2 BLK 1 LT 73 Waiver # WR990065 Lot Line Request for Parcel ID 015-123-36 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the tot line has been approved. The approved separation distance is 1 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely'c~ JeffPoet Engineering Technician III On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet Permit Date Received: Legal Description: Points: Applicant: Waiver Requested: ~ I~ (~,~%~n c~ Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: Na~ ,ef'ff Reviewer Date Paid: ~.~/ MUNICIPALITY OF ANCHORAGE ~_. ~. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 TeJephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME/), .. ' P'ONE [] UPGRADE LEGAL DESCRIPTION ~ Manuf~~ ] ¢ ~ No, of~partments ~ ILiq ca~qcity2nnallons ~ ~ ~O F HOMEMADE: inside length Width Li~ui~ depth ~0z DISTANCE TO: ~ BISTA"OE TO: W~ ~/O' F~~L Bistance Nearest lot 2~ , PERMIT NO~/0 ~ N°'~ Length ~ e~lL~ Total lengtb °~e~ Trench wi~ ~ches ~ Top of tile to finish grade Material abso~ ~ O ,~ 1~ beneath tile ~. Total effective Length Width Depth PERMIT NO. ~' Type / Crib d~ ,Crib depth / ~effec~~ ~ & ~ISTANCE TO~ ~ ~' ~ation Nearest lot line ~ Cfas~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER F'ERMIT NO. ( FFLI _.HNT LOCRT I ON LEGRL OONIFER CONST. F'. 0. C:RGOKED TREE LOT 7L< BLK ! '¢RLLI ',,,'UE ~UE, BL,, 18-7t2 LOT "- -' --.I~:E ,:.±t,.,E SC!URRE FEET TYPE ElF SOIL HB_-,0F. FTI_N :,T_,TEM h,. TRENCH BEDROUM_, = 4 MR,':4IMUM NUMBER ElF -' - ': SI]ilL RFtTING ,.':SC! FT/'BR)= ±SE~ THE REQUIRE[:' _I~E OF THE SOIL RBSORPTION _r:TErl I:,: [ EF ] k~-- 13: LEr4~STH= ~$---': _~RI4 . EL [;.EF"TH--" 7 THE LENGTH [:,IMENSION IS THE LENGTH (IN FEET::, OF THE TREN_.H OR DRRINFIE:L[:,. THE [:,EPTH QF R TF. EN,H 3R PIT I:, THE [.I:,THNL. E E'ETNEEN THE SUF.:FRCE OF THE GR.E_ND RND THE BOTTOM OF THE E)4CR',/FITION (IN FEET). THERE IS NO --,ET I, II[TH FOR TRENL. HE_,. THE GRR',,.'EL DEPTH IS THE MINIMUM DEPTH OF ~3RR',,,'EL BETWEEN THE OUTFR'LL PIPE RND THE BOTTQM OF THE EiC:RVRTION (IN FEET). REC.qJ I E:E[) : 2=.EPT ! C: TRb~k': PERMIT RPPLIE:~4;,T HR_-] THE RE_,FUN_,IBILIT¢ TO INFORM THIS DEPRRTMENT DJRING THE ,- , -. "- , ~ RDJRCENT Ti] TNIS PROPERT'¢ RND THE INSTRLLRTION INz, FEL. TION:, OF RNY ~ELL_ NLHBEF. OF RESIDENCES THFIT THE WELL WILL : L, iq:. F.'EC!LI I RE[;. TI41: ( '2 -, I [qSF'EC:T I - ¢-- F~F~:E BML. k. FILLIN= OF RN'? _.LTEft WITHOUT FINRL INqPECTION RN[:, RFFRL,ML · THI=, [:,EPRRTMENT WILL E,E JJBJEL. T TO F~.u=,ELJTILN MINIMUM DISTRNC:E BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SMSTEM IS 100 FEET FOR Ft PRIVBTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TMPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MR9 RPPLM. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE . RVRILRBLE TO INSURE PROPER INSTRLLRTION. F'EF-:~"I I T E::<F' I F-:ES [;.EC:EPIE:ER _:..': :'L. I CERTIFY THRT 1: I RM FFIMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET' FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SgSTEM IN RCCORDRNCE WITH THE CODES. 3: I UNDERSTRND THRT THE ON-SITE SEWER S~STEM MR9 REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. SIGNED: ........................................ RPF'L i ~T CONIFER. CONST. zzL, D .............. ..... .... ',,,'4. 0 ~'~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: 1 2 3 4- 5- 6- 7 8 9- 10- 11 12- 13- 14- 15- 16- 17- 18- 19 20 DATEPERFO"MED; /~?l~iC. ~ /?~ . / SLOPE WAS GROUND WATER ,~j ~) S ENCOUNTERED? OL P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net. Reading · Date Time Time Water Drop PERCOLATION RATE Iminutes/inch ) COM,M_ E N~i~S ..... TEST RUN BETWEEN FT AND FT PERFORMED BY: ~a/~/Y ~-~7 ~ CERTIFIED. DATE:~7~C~, ~/~/ 72*008 {6/79) / Mumcl On-Site Water & Wastevyater Program P.O. Box 196650 Anbl~gej'A~ 995i'9.6650 www.ci.anchorage.ak.us (907i 3~3~7904 . FOR A SINGEEi: HiLy DWELLING Parcel I.D. O15,123-36-, ,,~..,: ....... :~:,: -,, ~,~,~,, ~, 1. GENERAL INFORMATION Complete legaldescription VALLI VUE SUBDIVISION; LOT 7,.3, BLOCK 1 Location (site address or directions) 6900 CROOKED TREE * ANCHORAGE, AK Current Property owner(s) Mailing address [._ending agency ' Ma 'ling address BOB CRONEN Dayphone 3~9-6961 6900 CROOKED TREE * ANCHORAGE, AK phon~ Real Estate Agent Mailing address PEGGY. GONZALES .w/DYNAMIC Day phone ,3111 "C" STREET.* ANCHORAGE, AK 99503 261-7669 Unless otherwise requested, HAA will be held by DSD for PiCkup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site [] Individual Water Storage [] Individual Holding tank [] Community Class_ "A" Well [] Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Cedificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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 homeowners. Certificates of Health Authority Approval are 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Cedificates 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. 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 Authority Approval Guidelines for this appficatlon, 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 bn the information obtained from the MunicipaNy of Anchorage files and £¢om my investigation and inspect/on, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and reguiations in effect at tl~e time Of installation. Name of Firm ALASKA WATER 84 WASTEWATER CONSULTANTS. INC. Phone Address 6901 DEBARR 'ROAD. SUITE 2B ' ANCHORAGE AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation. AKWWC. Inc. attempted to provide a morougn, conscientious engineering analysis of the system in accordance with AD£C and MQA DSD Guidelines & Regulations. The reported results described 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 alt wefts 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 are outside the control of the evaluator of the system. Satisfactory test results do not guarantee futu~'e performance of the system, nor do they gbarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system wilt continue to meet tile 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. DSD SIGNATURE Approved for ~ Disapproved. Conditional approval for __ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms. bedrooms, with the fllowin9 stipulations: Supplemental Engineers Reo~ Other (Rev, 12/01) Original Certificate Date: .D'~: LIFT STATION 'Date installed Size' i'n' g~iisns.' "'" ' ,'~'' "pump on" level:at in'. "Pump'6~'"i~?~!i~ i. in:".- Datum Cycles tested ....... ':' ' -" Manhole/Acce.s High" Water alarm :level at' Meets alarm & circuit requirements?. E. SEPARATION DISTANCES" SEPARATION DISTANCES FROM WELL ON .LOT.TO:, Septic tank/lift station on lot Public sewer main Sewer/ocpIic service, line On adjacent lots On adjacent .lots Public seWer:manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING= TANK ON LOTTO: Bu ding [oundation - 5'+ Water main 10'+ Property ine 5'+ Water se'~vice line 10"+ Absorption field Surface water 5'+ 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD, ON LOT TO: .~['operty line *6' Water service line ** 10'+ Curtain drain NONE KNOWN F. COMMENTS - ~"#WR990065' Building foundation 10'+ 'Sdrfabe water 1..00'+ Wells on adjacent lots 200'~- Water main 1'0'+ Driveway, parking/vehicle storage __ **PER..-,1999:.:.1N SP ECTION R-EPORT G, ENGINEER'S.CERTIFICATION -'1 ce~tify..that I.ha've' determined through field inspections and · revieW.of Municipal'records that lhe above systems are in conformance with MOA HAA guidelines in effect on this date. Engin~.p!i?!etd Ng?e JEFFREY A. OARNESS 10'+ Date of Payment (Rev. 12101 ) Waiver Fee $ Date of. Payment Receipt Number THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.(UNLESS INDICATED) NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. ANY PAVING SHOWN MAY BE APPRGXIMATE DUE TO SNOW CONDITIONS. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THiS __7TH .... DAY OF __JANUARY_ ........... 2003____. HOLT LAND SURVEYING 8821, FB103-44 TEL. 345-5513 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 1. GENERAL INFORMATION Lot 73, Complete'legal description CERTIFICATE OF HEALTH AUTHORITY A'PPROVAL FOR A SINGLE FAMILY DWELLING 015-123-~6 .HAA# I~ Block 1, Valli Vue Estates #2 Location (site address or directions) Pro~e~y owne~-"-_S~s.~e Arnold ~- '.. ' ', 7~1~ Tree Top Circle, · Madmg address 6900 Crooked Tree Drive 786-1114 Day phone Anchorage, AK 99516 Lending agency Mail!.n.g 'address Day phone Age. pt -,. Add tess .Day phone Unless otherwise requested, HAA will be held for pickup. 4 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: Individual well Cqmmunity well Public water XXX 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 XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. Se 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 Engineeds signatur(; s & S ENGINEERING 17034 Eagle River L~op Road No. 204 I:agle RJver~ Alask~a.99577 Phone Date_ = DHHS SIGNATURE ~ Approved for F~ U/~ bedrooms. __ Disapproved. Conditional approval for cE-88o bedrooms, with th~ following stipulations: Additional Comments The Municipality of Anchorage Department of'Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska, The 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 engineers work. ,<ECEIVED Municipality of Anchorage AUG DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY OF 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) ~I~LP'~,~NTALSERw~'~ ulVI$1ON Health Authority Approval Checklist LegalDescription: ~OT- '7 ~ ,~ac~ I ParcelI.D.: 01"c'-I~"$ ~ C V/diLl-/ YU/~ ~;~71:'}T'~$ 7fi- ~ A. WELL DATA Welltype ~-&sS 4 IfA, B, orC, attach ADEC letter. ADEC water system number '~/ n 1. o,~' Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to FROM WELL LOG Date of test Static water level / Well production / g.p.m. WATE~ SAMPL~ Coliform ~ Nitrate Date, O~sample: Collected by: Casing hei~nd) Wires pro~ protected (Y/N) T INSPECTION g.p.m. Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~' / !'1 / ~ ~l Tank size Number of Compartments ~-- Cleanouts J~'/N). Y,'Z 3 Depression (Y~ /~ o High water alarm (Y/~ ,~ o System type 3-,~ ~,,~ cj./ Total depth ~ bedrooms Foundation c!eanbbt (~[/N) '~*--~ · . ':. Date of Pbmping ~ /~ ~- ~u Pumper - C. ABSORPT ON F ELD DATA Date irfstalled ~ //~ / ~l ~ Length '~- 3 .Width Effective absorption area ~ 30 Date of adequacy test/J/4- - · Soil rating ~./ff~or ff~/bdrm) ,). ~-- Gravel thickness below pipe Monitoring Tube presenti~N) Y~ Depression over field (y~ __ "~ ~'~ Results (Pass/Fail) For Fluid depth in absorption rield before tes~ ~al. water added (in.): Fluid depth ~r:. Absorption rate g.p.d. Peroxide~st 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed ~ Manhole/Access (Y/N) ~,~3,f~3~evel at* "Pump off" level at* ;,;~ wa~~~- *Datum E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lets Absorption field on lot ~s__ ~ ..... Public sewer main ~ Public sewer manhole/cleanout Sewe~ nee-lfd~e'~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ,~, o Property lide ;~ (~ Absorption field. Water main/service line )0 ~ Surface water/drainage ) Oo -¢-- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line (J ( ~ 4,.¢,~,~) Building foundation. 3 I Water main/service line Surface water ! o 0 ~ Driveway, parking/vehicle storage area Curtain drain Wells on adjacent lots F. ENGINEER'S CERTIFICATION ~c~rtifythat~ha~d~t~rminedthrufi~dinsp~cti~nsandre~iew~fMunicip~r~t~;~i ~msare in conformance with M(~A HAA guidelines in effect on this date. I~¢~ 7 '~ ' "t ~ ~. "'- -- L..i~...~...,,,.~ :...,;~?.",,~' HAA Fee $. Date of Payment / 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel i.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~\,Z.~.. ~0~, ,9~lr~ NAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~¢'~a,o ¢" ,7o ;~r'ocor) Telephone: (home) '~Cxa'"'6'O~ Business Mailing Address (~00 ~¢oo/~r¢o¢ '-r?-~,g ~r~;~ (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address ,~ 0 C) 0 ~" Telephone ff~ ~ - 7~ (e) Mail the HAA to the following address: (or check here ~, if hold for pick up.) List contact person and day phone number below: - Co.r~o [~. IXeon e f 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3. WATER SUPPLY Individual Well [] Community ~ 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 legailty and status. 72-025 (Rev. 7/88) 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 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 investigalion 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 _~/~f-/c'f_ 7-¢c4~ ~c~/ -~*~'~'(~3 Telephone Address //i/..¢'30 ~(./~o .~'/.y ./~rnC~Of'C~¢¢;,'~., .,~¢r Date /\(cc, 8¢-2/ 6. DHHS APPROVAL Approved for~ bedrooms by Approved __~&~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DH HS) 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. · ,~_~O~O~-~ MUNICIPALITY Of ANCHORAGE (MOA) ~o ~- t,¥"~l,~.,/J Health Authority Approval (HAA) ~ ~ ~/ CHECKLIST - FEBRUARY 1984 ~ ~ ~ 343-4744 ~- ~ ~ / ~ Legal Description: L .A.B.C.D.EC. A .,ove Well Log Present (Y/N) 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 To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Date Completed Yield 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 Cleanout/Manhole ; Date [DEC LE"rTE~ O~- ('.~P!,PL IANCF A'T?ACH~b B. SEPTIC/HOLDING TANK DATA uate installed g'/'~l Size [:~5o G. No. of Compartments Standpipes (Y/N) "// Air'tight Gaps (Y/N) Foundation Cleanout (Y/N) ~" Depression over Tank (Y/N) I'~ Date Last Pumped Pumping/Maintenance Contact on File (Y/N) N .A, ; for N ./~, Holding Tank High-Water Alarm (Y/N) I'~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well '~ 2o0 To Property Line ~ To Water Main/Service Line I To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field ~ IOo 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed .5'/81 Width of Field Square Feet of Absortion Area ~,o2. Depression over Field (Y/N) Results of Last Adequacy 'rest Type of System Design Length of Field Depth of Field lo Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test _ I I /1'~/¢t o SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ 2 cO To Building Foundation _ ~ Lot bloke To Water Main/Service Line 2o To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line Io¢ To Existing or Abandoned System on ; On Adjoining Lots ~ 3O To Cutback (if present) "Z /oO~ Comments D. LIFT STATION N,/~. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA g.~jdeL~e~i~n effect on inspection. Signed .¢r~~ Company ~ l~ MOA NO, Date of Payment Amount: $ // 72 026 (Rev. 7/88) Back Receipt No, Waiver Fee: $ Date of Payment Page 2 of 2 the date of this Engineer's Seal DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 November 14, 1990 STEVE COWPER, GOVERNOR 563-6775 FOR: TED MOORE PWSID: !1210605 According to the records on file in this office, the Valli rue Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VEC:pf MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~/~.~ ~,/~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~/L~P.,~.. II. LT,~c/.~ Telephone: Home Applicant Address Business (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent ~ ~ rz.,'r-,~. ~. Address ..¢-O '7 ~, ~.~ y~.~-t~_J~-_ ,o_/,J Telephone ~ "7~, -/~, ~ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family J~ Multi-Family [] Number of Bedrooms ~ Other 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 community 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 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 and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtaieed 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 "~"-'. ~-~~ Telephone / Address ,¢~. P~ /~ Date Engineer's Seal DHEP APPROVAL Approved for Approved bedrooms b ,/~)1./~-¢:~¢ L(;/~ ~ Date . Disapproved Condition~a/ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 (1 ~/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST ~ FEBRUARY 1984 MUNICIPALIT~ OF ANCHORAGE DEPT. OF HEALTtt & ENVIRONMENTAL PROTECTION 'AAY 0 5 1986 264-4720 WELL DATA Well Classification ~1f,,,./~¢,¢''¢' ~ If 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 Comments 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 B. SEPTIC/HOLDING TANK DATA Date Installed J"(/~ "¢. Standpipes (Y/N) 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 Size / ,~, '¢~' No. of Compartments Air-tight Caps (Y/N) '~ Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation ,~, O To Disposal Field ~ To Water Main/Service Line Course To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorptioq Strata Date Installed ~. N"¢ Width of Field Type of System Design Length of Field Depth of Field t Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test oNE To Property Line I O To Existing or Abandoned System on ; On Adjoining Lots ~; ~ ~ To Cutbank (if present) b4 c~ ~ ¢:~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: 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 '~._c.~.~_ ~..~ ~.~¢~4 ~/~.~.~,~-J¢' ~-£~._ .~l~.,~,~z I~,'*~.~ . D. LIFT STATION N LO l'~ ~~' 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 Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or c~onformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~ ~ Date Company MOA No. Receipt No. ¢~,~" ~'~ ~ Date of Payment ~¢~-~ ~ Amount: $ ~ ~ ~ ~ ~, ~; ~ ? ~ Engineer's Seal ~*: ~,, MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE (a) Legal__Description (include lot, block, subdivision, s~ection, township, range). (b) (c) (d) Location (address or directions) Applicants Name Vf~iL ~ Applicants Address ~ ~ Telephone - Home Business Applicant is (chec~on~) Lending Institution Buyer ~-~.; Other~ (explain); Lending Ins%itution ~; Owner/builder~; Telephone Address (e) Real Estate Co. & Agent. Address ~0~ ~ ' Telephone ~-~G ~ ] (f) Mail the ~ to the follo~ng ~dress: 2. Type of Residence Single-Family~ Number of Bedrooms 3. Water Supply Individual Well~l Multt-Family~--~ Other (describe) Community~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. _Sewage Dispgsal 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] 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, ~ verify that my investigation of this Health Authority Approval shows that the on-site i~.~ ~ water supply and/or wastewater disposal system is safe, functional and adequate for ~k the number of bedrooms and type of structure indicated herein. I further verify that, i~:~ ~;; ![~ based om~ 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 regula- tions in effect on the date of this inspection. ~., . ~ , . (gNGINEER SEAL) ~/*:4VZ~ ,~' 6. DIiEP Approval ,o Approved ~ Disapproved ~ CoMition~ Te~s of Condltion~ Approval CAUTION 'THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN TN~. STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCtfORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 J~UNICIPALiTY OF ANCI-tO~AQE DEPT, OF H[ALTH & ENVIRONMENTAL PROTECTIo~ JUN j Legal Description: "7'~ '~1~... *-- ~¢.e_ 1~ TIC. N: -'-~"~l,~'- '" "" ' L~ WELL DATA Well Classification ~-----"~-~,~ ""~ K 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 ~ 4* ' To Nearest Edge of Absorption Field on Lot ,,'~,~ '("" 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 Line Cleanout/Manhole- Water Sample Collected by Water Sample Test Results To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~ Size 1~..~ No. of Compartments '"r Standpipes (Y/N) I~'~''/~) Air-tight Caps (Y/N) ~1~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~/ Date Last Pumped ~:~//~ Temporary Holding Tank Permit (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 ~.~l~ ~' To Building Foundation To Property Line To Water Main/Service Line Course Comments To.Disposal Field ~' TO stream, Pond, Lake, or Major Drainage Page I of 2 72 026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area ~ O,~. Depression over Field (Y/N) Results of Last Adequacy ]'est Separation Distance from Absorption Field: To Water-Supply Well ,,~ ~"'~ To Building Foundation _ Lot · ~'/O N~''~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~'" ~ Depth of Field J ~) Gravel Bed Thickness ~ Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Comments D. LIFT STATION N 0 tlk/ J-~, 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 Comments ** 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 tile date of this inspection. i ~__Pate Date of Payment ~ 0 - I~-~ ,~t&~'~.' '-. /¢ -~, ~(,:,:.~ .~ Engineer's Seal Amount: $ L[~ , O0 ,':'~?.' ~l~ · Page2of2 ~3.~'. JUNE 25~ 1971 . 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: 1907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: TEST PROCEDURE: LOT 73, BK. 1, VALLI VUE 6900 CROOKED TREE VIRGIL PYATT SINGLE FAMILY, FOUR BEDROOMS CLASS A COMMUNITY SYSTEM FROM MUNICIPAL RECORDS: TANK: 1250 GAL. ABSORPTION SYSTEM: ABSORPTION AREA: SOIL RATING: INSTALLATION DATE: STEEL TANK, TWO COMPARTMENTS TRENCH 602 SQ. FT. 150 MAY 1981 JUNE 19, 1985 JUNE 18, 1985 SYSTEM WAS INSPECTED ON JUNE 19, 1985. THERE WAS NO SUMP ,AT THE END OF THE TRENCH AS INDICATED BY THE AS-BUILTS, BUT A.CLEAN OUT. THE WATER DEPTH IN THE TRENCH COULD THEREFORE NOT BE MEASURED. WATER WAS ADDED TO THE TRENCH CLEAN OUT AT A CONSTANT RATE OF 7 GAL. PER MINUTE. THE LIQUID DEPTH IN THE SEPTIC TANK WAS MONITORED. AFTER THE ADDITION OF 600 GALLONS THE WATER DEPTH IN THE TANK HAD NOT CHANGED. TEST RESULT .' · A '. ~, . J~N~ [971 THIS SYSTEM MEETS THE OPERATIONAL REQUIREMENTS OF THE MUNICIPAL CODE. The operational life of all septic systems 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 system will continue to meet the operational requirements of the Municipality and State.