HomeMy WebLinkAboutSEAVIEW HEIGHTS BLK 2 LT 5BOnsite File
Seaview
Heights
Block 2
Lot 5B
#011-261-23
(907) 243.2282
KEN JOHNSON
PAUL ROSELAND
P.O. BOX 4-1324
ANCHORAGE, ALASKA
KEN'S COMPANY
WATER WELL DRILLING
PUMP SALES & SERVICE
30 YEARS ALASKA DRILLING
( 5336 W. 80th )
99509
RE sOT_5B BLK 2 SEAVIE4l HEIGHTS SUBI).
WATER WELL LOG
3163 LINDEN DRIVE
ANCHORAGE, ALASKA 99502.
MAY 15, 1986
MUMaPAUrr OF ANCFIORAG;
DEPT, OF FIEALTI-1 &
r NvlRONMENTAL PROTECTION
0 ft to 4 ft Medium gravel & brown silt
4 ft to 38 ft Sand.. some pea, grav
38 ft -to 45 ft Same with dark brown silt
45 ft to 6o ft Light brn silt
60 ft to 73 ft .,let sand
73 ft to 85 ft Brn silt..some fine grav
85 ft to 87 ft Med. grav & gray silt
87 ft to 99 ft Brn silt with some fine grav
99 ft to 140 ft Wet sand..silty
140 ft to 142ft Same..trace of coal
142 ft -to 160 ft Sandy silt..heaves
160 ft to 175 ft Sandy clay
175 ft to 181 ft Net sand..dirty silty
181 ft to 193 ft Heaves 15'..fine sand dirty
193 ft to 201 ft Fine sand..trace med. gray..wet
201 ft to 205 ft Same ..more gray..dirty
205 ft to 210 ft Same with coal
210 ft to 219 ft Fine dirty sand
219 ft to 222 ft Heaves 20'., med. sand & fine gray..dirty
222 ft to 230 ft Same.. courser
230 ft -to 235 ft I-teaves 15' ..dirty some med. grav & 3" coal
235 ft to 243 ft fine dirty sand weft
243 ft to 250 ft heaves dirty sand 15'..W.L. overnite 1.05' GL
250 ft to 260 ft Same..very dirty
260 ft to 2.73 ft Sandy clay
273 ft to 283 ft Dirty silty sand ( casing tight )
283 ft -to 300-6 Fine sand with trace of clay
Soo®6 ft to301 ft Fine gravel & dirty fine sand.. 'Plater bearing
301 ft Fine gravel. & med. sand ( loose )
Casing 303-0 (Vater bearing
`Pest bailed one hour at 13 gallons per minute
4 hours developing
Static water level 106 ft 9 in. TOC top of casing
Drawdown six ft.
SEL PUMP TEST D1iTA
TOTAL DEPTH 303' ( 'SOC )
I I ,����'
DEPARTMENT .° HEALTH AND ENVIRONMENTAL TION
825 L STREET, ANCHORAGE, AK 99501 ' ��
(�
264~4720
PERMIT NO: 860292
DATE ISSUED: 08/19/86
APPL1CANT: PAUL ROSELAND
Cl BOX 4 1324
ANCHORAGE, AK 99509
CQNTACT PHDNE: 243~7723
LEGAL DESCRIP: SUBDIVISION: SEAVIEW HTS" OC�: 2
SECTI8N: 9 TOWNSHIP: 12N RANGE: 3W
LOT SIZE: 42000 (SQ"FT. OR ACRES>
I certiy that:
1" I am [amiliar with Lhe 1 .5ite sewers and wells as set
�orth by the Municipality of Anchorage (MOA> and the State oAlaska,
2, I will install the system in accordance with all MOA codes and regulations,
and in complianrmit.
3" I will adhere to all MOA and State ofAlaska rIquirements for the set back
distances �rom any existing we1l, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot"
r�
SIGNED
�.�\..��.��.���,��� _-,._.. ......_._.
� -``�`[Y �
APPLICANT: PAUL R LAND
lSSUED BY DATE:
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
��
NAME _,
PHONE
`�--,NEW
II
'- . L1 '�_ ��<,-�> C-_ b _�� ��� A
f✓.dI ,i> -- J J
❑ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION (j
LOCATION
NO. OF BEDROOMS
Well__ Absorption area
Dwelling
PERMIT NO.
DISTANCE TO:
N1 F-) I J� f'
7
// _y>
R, 1q 6(.I
.�
o
F- 2
Manufacturer
Material
No, of compartments
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
Uf)r"-)
❑
DISTANCE TO:
Well
Dwelling
PERMIT NO.
jaz
02
FQ-
Manufacturer
Material
Liquid capacity in gallons
❑
Well
Found do
Nearest lot line
PERMIT NO.
w S
DISTANCE TO:
N `yy,
j Cl
4J
J LL z
No. of lines
Length of each line
Total length of lines
Trench widthDistance
between lines
a L
3;5
j (
'?% t% T inches
Top finish
Material beneath
Total
ICC
of tile to grade _
tile _
effective absorption area
❑
(� j /�
/.-2 .—% inches
Length
Width
Depth
RMIT NO.
W
C7
ct H
Type of crib
Crib diameter
Crib depth
Total effective absorption area
to
,jj
Well
Building foundation
Nearest lot line
DISTANCE T0:
Class
Depth
Driller
Distance to lot line
PERMIT NO.
w
w
R:
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE T0:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
T
(114 ewe—P
JT.:-' �v •.'fir n° �/
i,ui-
J
f
t
• H?.
k.. • b
l
APPROVED DATE LEGAL
t /
72-013 (Rev. 3/78)
/
1: -11 .�
DEPHRTMENT UF
111EEH-TH HND ENV�RO�M�NTHL PROTECT�O�
825 L STREET/ HNCHORHGE/ HK 99501
264-4720
PERMIT NO:
DHTIE: ISSUED
HPPLICRNT
HDDRESS�
C�NTHCT PUO@E
840169
04/12/84
PHUL ROSELHND
BOX 4~1]24
HNCHQRHGE/ HK 99509
LEGHL DESCF"!IPSUBDIVISION: SEHVIEW HEIGHTS 1-0T: 5B C k: : 2
SEECTION: 9 TOWNSHIP: 12N RANGE: 4W
LOT SIZE540A5 ( FT. [)R RCR�S)
LOT LOCHTION� 62]] WDIMOND BLVD
MHX BEDROOMS� ]
LISTE� 8EL�1.4 HRE THE OPTIONS HVHILHBLFE: TO YOU IN DESIGNING YOUR �EPTIC
SYST�M� CHOOSE THE �PTION TI -I" BEST FITS YOUR SITE.
... ..... ...
������������
V4 IC:', 11-11
DEPTH TO PIPE BOTTOM (FT ) 110 //. �
GRRVEL DEPTH (FT )
!KV 11.)
TOTHL DEPTH (FT. ) 16.0 /7^0
QRf)VEL 1, 1IDT11 (FT.
1::ii 1-,�: f::]VJEE I. L.�P--I GTA (FT. ) 2 @
�RHV�L VOLUME (CUYDS) 1].2 --
SOIL RHTING KEEL FT./BR) 85
** TRNK MUST HHVE HT LEHST TWO CUMPARTMENTS
�..... ..... �..... ...
�����������������������������
I CERTIFY THHT:
1. I HM FHMILIRR WITH TFTH FOP! LS 'SIET
THE IT',.' ()P' HNCHORHGE (TlOf:) HND THE OF Fil-HSKH.
2 I W1:LL.INSTFALL TF*E: SYSTEM Iki F-1CCOP:DHNCE 141:7,H �I L, MOH
AND IN THIE" OF THIS PEI-,!IlIT.
] I WILL HDFIERE TO HLL I1OH HND STHTE OF HLHSKH REOUIREMFENTS FOR THE
DISTHNCES FROM HNY EXISTING WELL/ WHSTEWHTER DISPOSHL S��TEH OR PUBLIC
SE�ERHGE SYSTEM OQ T�IS OR HNY HD�HCIEE NT OR NEf-iRBY LOT.
4 I UNDERSTHND THfl, T1 P�RMIT 1S VHLID FOR A MHXIMUM Ol'-" ] BEDROOM� 8�D
HNY ENLHRGEMENT WILL REQUIRE AN HDDITIONHL PERMIT.
�
IF F? �IFT STHTION QINSTHLLED IN HN COVERED BY MOH BUILD�NG CO�ES/
THEN (1) HN ELECTRICHL P[:RMIT MND INSPECTION MUST BE BUILTS
WIUL NOT BE HPPROVED WIT-IOUT AN ELECTRICHL INSPECTiON REPORT/ f',4PID (]) THE
�LECTR�CA� �ORK �U�T B� DONE BY H LICENS�� ELECTRICIHN
�:-
/_��������^.����
HPPLICHNT: PROSELHND
ISSUED BY I,:' /
I� , SOILS LOG
MUNICIPALITY OF ANCHORAGE X,
�; ❑
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: -PA U L—RO S E LA N `..,t DATE PERFORMED:!/
LEGAL DESCRIPTION: 4o / gw . a6/5ri VIC--y&/ E'Y%'-`Ea 5 jffc c� '710 -NI 12 -
SLOPE SITE PLAN
( ) LL
NN
3 - - -> — -
5
6
COMMENTS 7sS-Z� r'70lie
7
PERFORMED BY:
Birt
72-008 (6/79)
4 ( \)v el,
WAS GROUND WATERS
ENCOUNTERED?
L" L
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Reading
Date Gross Net
Ti e Time
Depth to
Water
Net
Drop
7
8
--
�a L LT
9
6
H H
10
68
--
11
m®
12
����,•.. '� a5, 1971
13
64"D f:a0
14
fJf1nV/F—L
15
16
✓
18
ja (;�
19
P.
20
P
a
COMMENTS 7sS-Z� r'70lie
7
PERFORMED BY:
Birt
72-008 (6/79)
4 ( \)v el,
WAS GROUND WATERS
ENCOUNTERED?
L" L
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Reading
Date Gross Net
Ti e Time
Depth to
Water
Net
Drop
49L
68
--
0.....0 00
����,•.. '� a5, 1971
PERCOLATION RATE (minutes/inch)
TEST RU BETWEEN �''%� FT AND ®®J,� FT
�1--� `.� c� F�� /•c��v"tj��1 (� C' �t Cly �r'c-k1C � rcc�r,.-�
7
llmlG CERTIFIED BY: _ DATE:_. he _
Parcel I.D. 011-261-23
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Complete legal description Seaview Heights: Block 2, Lot 5B
Expiration Date: IZ? _2CH 9
Location (site address) 6325 West Dimond Blvd. *Anchorage, AK 99502
Current Property owner(s) Diann Sewald Day phone 243-7723
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
Z Single Family (w/wo ADU)
1771 Duplex
7 Multiple Dwellings (Single Family and/or Duplex)
Day phone
F E:
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
z
Individual Water Storage
E-71
Holding Tank
F-71
Community Class Well
7
Community
F❑I
Public Water System
El
Public Sewer
El
WaiverNariance request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise
requested by the
engineer.
Date of Payment q - 1(�-_ (-7
Receipt Number 07'YOq-7
COSA # oc C_ I -n q 3
Date of Payment
Receipt Number
Waiver #
M&
As certified bymyseal affixed hereto and esof the validation date shown below, |verify that myi a�n,
based on procedures outlined in the Ce�hoatanfDn-G�e Systems Approval Guidelines for this application,
shows that the on-site vvetersupply and/or vvaatewaterdisposal system is (are) aaha, functional and �dequete
for the number of bedrooms and typo of structure indicated herein. ( further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inepeotion, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes.
ordinances, and regulations ineffect gtthe time ofinstallation.
Name DfFirm: Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date:
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
System #1 Approved for bedrooms
System #2 Approved for bedrooms
B Original Certificate Date:
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 oromissions in the professional engineers work.
CO8ACheckikst Nitrate Advisory
Septic System Advisory
\A/eil Flow Advisory Other
��blue sheet-10-10-12.doc
1
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: SEAVIEW HEIGHTS, BLOCK 2. LOT 5B Parcel ID: 011-261-23
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES
Date completed 5115/86 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 303 ft. Cased to 303 ft. Casing height (above ground) t 2+' in.
FROM WELL LOG AT INSPECTION
Date of test 5/15/86 8/23/17
Static water level 106.75 ft. 104 ft.
Well production 13 g.p.m. 5.9+ g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd.
Arsenic 31.8 ug./L. Date of sample: 6/12/17
B. SEPTIC/HOLDING TANK DATA 1984 STEEL SEPTIC TANK IS APPROACHING THE
END OF IT'S USEFUL LIFE
Tank Type/Material SEPTIC/STEEL Date installed 8/20/84
Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 6/22/17 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA -EXISTING GRADE AT MT
Date installed 8/20/84 Soil rating (g.p.d./ft'or •/bdr ) 84 System type DEEP TRENCH
Length 31 ft. Width 3 ft. Gravel below pipe 5+ ft.
Total depth '13.5+ ft. Eff absorption area 310 ftMonitoring tube YES Depression over field NO
Date of adequacy test 8/23/17 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 2 in. Water added 720 gal. New depth 2 in.
Elapsed Time: 0 min. Final fluid depth 2 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo ) (Y/N & type) NONE KNOWN If yes, give date
-MT EXTENDS 5 91 FEET BELOW THE INVERT: NEW CLEAN-OUT AND MONITORING TUBE INSTALLED BY WILCO
CONTRACTORS
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at wa er alarm level at in.
I - _ •- Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout "100'+
Sewer/septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field UNKNOWN
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
41 14.
G. ENGINEER'S CERTIFICATION If .. ".. •• ,.. , .
i *• `fir *`
• 1. I
i certify that l have determined through field inspections and • 4 „ .. •, •
review of Municipal records that the above systems are in • • •
conformance with MOA COSA guidelines in effect on this •; tr i
date. s c^ •;'�A. Garn�ess:: Li N
Engineer's Printed ame JEFFREY A. GARNESS •0,1.♦J'� • .• 795 ;•.•• ��
Date q �,3�1 7" . •
t�; PROFESSI�P:4.
LICENSE �IIIiti%wav�.�
MAECCB84
(Rev. 10/12/12)
\ 8463P
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180\• -FF2 �
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471 O F 'b S� 'C \ \
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1e. \
»+‹■ co
E co
v
4 N
Flay pde° m
tae%
w
°light Pole a w op N
Lot 56 m zo
I o
8
Z
8
Lot 5C m / o.e.,••.h,°
Lot 4
r h . - Easement I
S89°51'10"W 145.10
0
of
M
0
8
z
1-25.0---25.0-1
''''''''''''.---125'Common Access Easement
0
d Lot 5A
mr
M
SCALE: 1"=50'
in
0
b
0
z
f`�
` ` ��e`\`\ 1 AS-BUILT NO CORNERS SET THIS DATE
p ,s.84.,? 8 to f �F'. OF p'--1.,s1 I hereby certify IMI I have PKkrmW■Mortgagee's inspection
vs '1' 0 Pe�P.• .4-1, of de following described property. LOT 58 BLOCK 2.
58p0,�� ---..."'IC�a� CO; 49th * •7 I,
i
ry Jnr /y�k/y / �� /��.JCJ•d*�I
�! yp %b'• }�i %
Improvements
Recording thereon
are
Mein
and thel property
Qrti1 1• �mgovemeMs utuate0 tMnon■e wfa n the properly Ynu
QNI'^ .Fred Woi Otka. and do not overtop or encroach on the property Mng
Q 1. 0. adjacent thereto,that no Improvements on the property lying
811/0 �,• 3255- $ e ee adjacent theretorad
rretc encroach on the premises in% on and
�'�o'e . moo that there w no roadways.transmission Ines or other
"*rSvisile easements on said property except as indicated1` Wei&, ��\���` Dated at Anchorage.Alaska
*kis 8th day al ..2017.
EASEMENTS OF RECORD,OTHER THAN wALATKA&ASSOCIATES
THOSE SHOWN ON THE RECORDED FREDEnsers and Surveyors
PLAT ARE NOT SHOWN HEREON Coope.. FB 1710.Pg 16 BE (907-24&1666)
UNLESS OTHERWISE NOTED.
Municipality of Anchorage
i_ Development Services Department
Building Safety Division - Tif
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Arsenic Advisory
Certificate of On-Site Systems Approval # OSC 171434
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 5B
of Seaview Heights Subdivision. This inspection revealed an arsenic
concentration of 31.8 micrograms per liter (ug/L) for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Information on
arsenic is available from the On-Site Water and Wastewater Program
website (www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
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 Aug , 14 , 19 8 6
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 5B, Block 2, Seaview Heights Subd.
Location (address or directions)
(b) Applicant Name Paul Roseland Telephone: Home 243-7723 Business _
Applicant Address _ Box n•-1324 Anchorage, AK 99509
(c) Applicant is (check one): Lending Institution ® ; Owner/builder TO ; Buyer ❑ ; Other 1.3 (explain); _
(d) Lending Institution �} t��a� t�� ►�Gi Telephone
Address II _
(e) Real Estate Company and Agent 1v _
Address
Telephone _
(f) Mail the HAA to the following address:
Box 4--J 32n t-ArUC 1} c)raae" AK 99503_
2. TYPE OF RESIDENCE
Single -Family 0 Multi -Family Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well GU Community ® Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite ® Public ® Community C7 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 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DAla 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 this inspection.
Name of Firm -Barnard Engineering Telephone 274-52315
Address 203 West 15th Ave. , Anchorage, AK 99501
Date
6. DHEP APPROV�
Approved for bedrooms
Approved _—_—� . Disappr
Terms of Conditional Approval
.y.�.a� OF Al It
W •°•n.n•ep• e3
v S
+ y� t 0
`I:'4Q l�i
6�U°pp 96p •• <e♦ sppN •ne••pp •1.
Engineer's Seal
Eai R. Barnard
o� Co5°•a•.r poo°°�.1 �`,,i.J(h
Conditio
L_r
CAUTION
Dateg —
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 (11/64)
MUNICIPALITY OF AidQIU AC;
DEPT. OF flEALF 1 &
MUNICIPALITY OF ANCHORAGE (MOH) ENVIROMMIENTAL PROT[CTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 1986
264-4720
Legal Description: Lot 5B, BlR G E IS IALW
Heiqhts Subdivision
A. WELL DATA
Well Classification Private If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Y Date Completed May 15-4 1986 Yield 7. 74 GPM +
Total Depth 303' TOC Cased to 301Depth of Grouting None
Static Water Level _106. 7 TOC _ Pump Set At 163' TOC
Casing Height Above Ground 2411
Sanitary Seal on Casing (Y/N) Y
Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) No
Separation Distances from Well:
To Septic/Holding Tank on Lot 160' ; On Adjoining Lots 100+
To Nearest Edge of Absorption Field on Lot _170' ; On Adjoining Lots 100+
To Nearest Public Sewer Line _ NA To Nearest Public Sewer NA
Cleanout/Manhole NA To Nearest Sewer Service Line on Lot NA
Water Sample Collected by Earl R. Barnard ; Date Aug. 11, 1986
Water Sample Test Results 0.0
Comments There is very
is clear and has a aoc
B. SEPTIC/HOLDING TANK DATA
Date Installed
Size
little drawdown at the rate
d taste.
Standpipes (Y/N) — Air -tight Caps (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
To Water Main/Service Line —
Course
Comments
Page 1 of 2
72-026(11/84)
d. The water
No. of Compartments
Foundation Cleanout(Y/N)
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
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
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Type of System Design
Length of Field
Depth of Field
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)
Dimensions
Manhole/Access (Y/N)
"Pump Off' Level at
— Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have the ked verified, or cc ormed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed � Date August 14, 1986
Company Barnard EnaineeringOA No.
Receipt No. UCA , 60 00
Date of Payment C6 A ^%�P
Amount: $ la 5 ,r
Page 2 of 2
72-028 (11/84)
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Engineer's Seal
NOTES
I. PLAT USED FOR THIS SURVEY WAS P 98-99.
2. NOTE THE ENCROACHMENT OF THE GRAVEL DRIVE
INTO LOT 5C.
I HERESY CERTIFY THAT I HAVE
SURVEYED THE DESCRIBED PROPERTY
HEREON AND THAT NO VISIBLE EI—
CROACFMFNT8 EXIST EXCEPT AS
INDICATED.
EXCLUSION NOTE
IT I8 THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE
OF ANY EASEMENTS, COVENANT$, OR
RESTRICTION$ WHICH 00 NOT APPEAR
ON THE RECORDED SUBDIVISION PLAT
UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CON-
STRUCTION OR FOR EBTABLISHINS
FBNCS OR BOUNDARY LIMB.
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