HomeMy WebLinkAboutGOLDEN VIEW HEIGHTS LT 7B
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICI-'S
Environmental Health Division
825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name~...~.--. ~ A
Address
P~'~ne(s) ' Permit NOl -- NOI Ol Bedrooms
TANKS
~' SEPTIC ~ HOLDING
,,, TYPE OF SYSTEM
~TRENCH J~ BED [] W. DRAIN [] OTHER
Depth to pipe botlom from
original grade
FT
Fill added above original grade
Gravel lenglh
'~" ~) FT
Total depth from origJnal grade
/0 FT
Gravel depth beneath pipe
ravel width
Dislance between hnes
~,'~ FT
late Installed
WELLS
[~PRIVATE [] OTHER (Identify)
Classilica[ion {A,B,C) Total Depth Cased to
Installer Date InstaZ:
REMARKS:
DISTANCES 02o-- o~2.-,~5
SEPTIC ABSORPTION WELL
TANK FIELD
I WELL
LOT LINE
FOUNDATION
/
!
$ & S ENGINEERING
1 ~'O,~,~t ~£agle Eiver Loop I{oad i~o. 204
Municipal a~ ~la~:
Health Depadment Approval: ~'~'~ ~Z c,~'~t-'
I.Scale:
Inspections Pedormed by:
· Da[e:
cedily thai Ihi~nspecti~ was periormed according to all
/ /
, /
.:/ IA/..e.P /~Z /?/.~ /'l 2 / Pq/2,d , ~' /
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION 'rEST
SLOPE
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
Township, Range, Section:
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
S
IF YES, AT WHAT ~)
DEPTH? p
Depth to Water Aller
Mor~ilorino? ~.~ Oate:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER
COMMENTS TEST RUN BETWEI ~FT AND FT
PERFORMEI~[Y~4 E~g~iYe. L~qp ~e=d 2~u 20~/~ ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
AOOORDA~I~['L~'¢~ ~¢'~UNICIPA~ G~~CT ON THIS DATE. DATE: ~ ~ ~/¢~
z~-0o~ (R.~. 4/~) ~ / ' /
GP"~,TER ANCHORAGE AREA BORO"~'-H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-25]1
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
MAILING ·
ADDRESS/~ ,,2F
LEGAL DESCRIPTION ~/~
SEPTIC TANK:
DISTANCE FROM WELL fi/ /
LIQUID CAPACITY /~7..,_~.~) .GALLONS. INSIDE LENGTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS ~' OUTSIDE DIAMETER
LINING M A T E R I A L __ ~/~JF~.//'~'~7~-.~-,~~'''~
NEAREST LOT LINE__
NUMBER OF
MATERIAL ~ ~'~-~:':'~--~"'-- COMPARTMENTS
LIQUID
INSIDE WIDT~ DEPTH
, _ , DEPTH
. DISTANCE FROM WELL~/.~'1 ~d') /
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
. BUILDING FOUNDATION ~'~'?~' ,/'
sa. ET.
TILEE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE OF LINES
NUMBER OF LINES~7,-./ ISTANCE BETWEEN~L,U:4E5'~¢ TREN~C.,U~'C~IF~rF] ~_ ~IN?'%~Z EFFECTIV~
ABSORPTI~ AREA / SQ, ~ LENGTH OF EACHb~E
DEP'~: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
DISTANCE FROM //~,.>/' WATER
WELL: TYPE ~-~'~,/~-/.~--~4'--~.~:-~, DEPTH , BUILDING FOUNDATION. SAMPLE
NEAREST .... SEPTIC SEEPAGE,,
LOT LINE '"~'-~ SEWER LINE ., TANK , SYSTEM /¢'~ ~) , CESSPOOL
DIAGRAM OF SYSTEM
DISTANCES:
· NEAREST
OTHER ~-
, SOURCES__
GAAB-HD-2
GREATE ,. ANCH.0,.RAG.,E' A~EA _J,@R@UGH, C~eN0, .
327 Eagle St. Anchorage, Alaska 99,,01 2~9[2511
SEWAGE DISPOSAl. SYSTE~ ~. APPLICATION
LEGAL DESCRIPTION__
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY_
FINANCED THROUGH
PERCOLATION TEST RESULTS
NAME OF APPLICAN (ZLff f MAILING ADDRESS ~"~.Z/,~¢c; PHONE NO.~"~
~ , SEEPAGE PIT ~/ , DRAIN FIELD , OTHER
TO BE INSTALLE[] 8Y_~~J~
BEkO~ T0 B~ ~lkkED OUT BY R~AkTH D~PARTMENT
THIS IS TO SERVE AS
, PERMIT TO INSTALL A
DISTANCES:
'50
Health Authority
I certify that I am familiar with the requh'ements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
__ ~/~'/~ APPLICANTS SIGNATURE
DATE ~ , ~
[iREATER ANCHORAGE AREA BOROUG,
HEALTH DEPARTMENT
397 EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE
· '' Date Performed
rformed For , -/ ' '
Lega~ Description: Lot 7/? ~.ocK ~uo~vls~on ~)/H~o~ ///~.~ //1~
Tha. s Form deports a: Soils Log ....... ~ ..... k ...... L~~
Depth
Feet Soil Characteristics Location Sketch
Was Ground '/later Encountered?__.~.
if Yes, At h[at Depth
Reading
Date
Gross Ti me
N e ~ Time
Depth To H20
Net Drop
Proposed Insta.l~Seepage Pit
Depth Of Inlet
om~.~'u'~ .... "~ __,~~ ,;~.p~n ~o ~ottom Of Pit Or
' -'7 ....
Test Performed B3,:~~
Date:
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. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
020-042-33 HAA# ~1\ ¢'~,C'~C~ (0 i'"k O~ ~-
1. GENERAL INFORMATION
Complete legal description
Lot 7B; Goldenview Heights
Location(siteaddressordirections) 6446 West Circle
Anchorage , AK
Property owner
Mailing address
Kris Abegg
6446 West Circle
Day phone 349-1200
Anchorage, AK 99516
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
o
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4 '
TYPE OF WATER SUPPLY:
Individual well x×
Community well
Public water
NOTE:
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
NOTE:
XX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA~21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/orwastewaterdisposal system is safe. functional and adequate for the number of bedrooms
and type of structure indicated herein, lfurtherverifythatbasedontheinformationobtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in
ordinances, and regulations in effect on the dar,
/
Name of Firm
Address ~O[ ,~~-'"')f~'~/~,~'
Engineer s s,gnature /
bedrooms.
DHHS SIGNATURE
/~</ Approved for
;ompliance with all Municipal and State codes,
of this inspection.
~ Date / Z/TA 8
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date //2 -/¢-
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
724)25{Rev. 1,'91) Back MOA¢~21
Municipality of AnchorageR E C E IV E
DEPARTMENT OF HEALTH & HUMAN SERVICES DEC 08 1998
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)7~iV~4r^LSERWCES D~VlSlON-~I~4"C~Y4OF ANCHOP. A~?
Health Authority Approval Checklist
Legal Description: gO/d~/'/~'/~-~C4.~ //-///~ ~o-/ 7..~ Parcel I.D.:
A, WELL DATA
We,, /pe
Log present (Y~)
!
Total depth ~"
Sanitary seal ON)
FROM WELL LOG
IfA, B, or C, attach ADEC letter. ADEC water system number
Date completed
!
Cased to 'jo'' ~(~ Casing height (above ground)
Wires properly protected CN) _
AT INSPECTION
Date of test
Static water level
/
Well production ~ ~
g.p.m.
WATER SAMPLI~ RESULTS:
Coliform ~
Date of sample: / ~/~37/¢~
B. SEPTIC/HOLDING TANK DATA
Date installed 7/! 7/c]~ Tank size
Nitrate
.
Collected by: '-~'//~
9.3
g.p.m.
Other bacteria
/ ~ 5'~) Number of Compartments oO~ Cieanouts~JN) .
Foundation cleanout(~/N~ ~S ~?0~,/~'" '~'Depression (Y~,) /(.l High water alarm (Y(~
Date of Pumping /~"23 - ~'¢ Pumper /Z¢¢.- //~/I4~_ ~
C. ABSORPTION FIELD DATA
Dateinstalled "F/ / 7/ q~)
Length ,,~¢ ! Width o,~, ..~ Gravel thickness below pipe.
Effective absorption area ~ O0 $¢ Monitoring Tube present {~,1) y
Date of adequacy test _ ! 0 ~ ! '7- ¢) ~) Results (Pass/Fail) ~,S g
Fluid depth in absorption field before test (in.); ~ Immediately after ga. water added (in,): __
Soil rati,g (g.p.d./fF o(ff~----~r~m
_Total depth
· Depression over field (Y{~).~_
For /c~ ~/--
g.p.d.
Absorption rate =
If yes, give date
Fluid depth <~ (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/~ /~0~ [1'~
72-026 (Rev. 3/96)*
.bedrooms~__ '
D. LIFT STATI~q~
Date installed
Manhole/Access (Y/N)
High water alar~Jev~[~i';
,¢,~,Cy~i~ tested
E. SEPARATION DISTANCES
~~ekat*~ "Pump off" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 1 6o -F
Absorption field on lot too/'P
sewer main /~//~ /
Public
Sewer/septic service line ~-- 5 ~
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
!
Foundation , ~ .-/- Property line ~ '/'- Absorption field
/
Water main/service line /¢ '/" Surface water/drainage /0¢ ¥- Wells on adjacentlots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line I ~/~' Building foundation /0 '/- Water main/service line
Sudace water ?~)~ '~ Driveway, parking/vehicle storage area
Curtain drain /t/'O/?~_ ,/C'/3 0/..O/~ Wells on adjacent lots
ENGINEER'S CERTIFICATIOL/~
I cedi~ that l ~e~in~ ~u fi, d inspections and review of Municipal~
in confo~ w~h~~g~ mas in effect on this date.
Signature[~/['~TM~ ~ ~ ~
Date ~/W~ 8
are
HAAFee $ r.._'~¢O., oO
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
6B1B$OI T-g20 P.01/02 F-054
g~69~7001
AK Water & Wastcwa~er Con~ultams Lac,
Golden View Ht~ Lo; ?B
Golden ¥1~w H~ Lot 7B
Driukin8 Wa~er
Client ~
Printed l~ate/Tlme 12/07/98 09:55
Collected Dat~/~mc 12/02/98 l 1:00
R~eived ~e/Ttmo 12/02/9~ 11 55
T~hnl~l ~re~: ~ephen C,
._
Toter
9 cot/lOOmk $H18
0,~ 0,100 fl~/L EPA
RECEIVED
DEC 8 199~
Mur'4olpality ~1 ,,~.m.;m..'~ ~:tge
Oept. Health & Human Services
C~u \%x .
- . ~.~ .~.9.¢'~"-. MUNICIPALITY OF ANCHORAGE
.4. o'~ ..t\0'~ ~
- ¢ ¢ ~ Department of Health & Human Se~ice,
.~c~ ~/ DIVISION OF ENVIRONMENTAL SERVICES
>~ ;~ ~ ~ 343-4744
~" C~%TE OF ~SP~CT~ON FOR ~EALT~ AUTHORITY ~PPROVAL
~TE SEWER ~m~ W~TER FAC~UTY ~OR S~mGLE F~LY
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal ~escription (include lot, block, subdivision, section, township, range)
(b)
(c)
Lot 78; Golden Vie~ Hc_.~qhts
Location (address or directions)
6446 W6~t Circle
Property owner Joe Abcgg
Mailing Address 6446
Lending Institution
Mailing Address
West Circle,
Telephone:(home)
Anchorage, Ak. 99516
Telephone
Business 562-20~8
(d)
Real Estate Company and Agent .
Address 3201 C Street
Telephone 563-5500
.I~ek WhJ~¢_ ¢.nmp~y ATTN: K;~2~
Suite #100 Anchorage, Alaska 99503
(e) Mail the HAA to the following address: (or check here ~(if hold for pick up,)
List contact person and day phone number below:
ENGINEERING
River, Alaska 99577
2, TYPE OF RESIDENCE
Single-Family,~ Number of bedrooms 4
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 [] Flolding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and statusl ..... ·
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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
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
LOT 7B; GOLDE~VIEW HEIGHTS
Location (address or directions)
6446 We. st C,Lr~tt~
(b) Property owner
Mailing Address
(c) Lending Institution
Telephone :(home) Business
Telephone
Mailing Address
(d) Real Estate Company and Agent
Address _~201 C _qtreet,
Telephone 563-550¢
Su;te !00,
~nc~or~ge, ~K, ~q503
(e) Mail the HAA to the following address: (or check here~ if hold for pick up.)
List contact person and day phone number below:
~. ~.,~ ~ ;~IqGINEERING
i 7t:~34 Eagle ~.',ter Loop ,~ead
g~i~,~ ;~.iver, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family~ Number of bedrooms ¢
3. WATER SUPPLY
Individual Well 6~X 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 legality and status.
72 025 (Rev. 7/88) Page 1 of 2
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A, WELL DATA
Well Classification
Well Log Present (Y/~F~_
MUNICIPALITY OF ANCHORAGE (MOA)
,;~ i-,' ;i, Health~AutttlCrity Approval (HAA)
~,:/~EhrrAt. ¢.Id~'~KII~IS3'Ot'FEB RUARY 1984
,-,_ , o
RECEIVED
343-4744
Legal Description: L~-.~qr ~ [~
Date Completed
Total Depth
Static Water Level
Casing Height Above Ground
If A, B, C, D.E.C. Approved (Y/N)
/L. \ ~ o Yield
Cased to ,¢~1~ Depth of Grouting - --
Electrical Wiring in Conduit(.C~N) _ y
SEPARATION DISTANCES FROM WELL:
To Septic/Pt'e4d~g Tank on Lot ~ ~
Ci _
Pump Set At
Sanitary Seal on Casing(JC~N)
Depression Around Wellhead (Y~)
To Nearest Edge of Absorption Field or) Lot
To Nearest Public Sewer Line /,4/A
To Nearest Sewer Service Line on Lot ~.. ~' I..~.__
Water Sample Collected by ~ ~ ¢> ~r'~(:::;l I/',.)¢~¢'Z-CrO~ ; Date
Water Sample Test Results
Comments ~ //V' A'¢~/"~C_-.~
; On Adjoining Lots
/.Oc.~ ! ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
B, SEPTIC/HOLDING TANK DATA
Date Installed _~-~-- '~¢ Size
Standpipes43'/N)
Depression over Tank
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING -I'ANK:
To Water-Supply Well
To Property Line
To Water Main/Service Line
'~¢'~ No. of Compartments /
Air-tight Caps (.~/N) _ ~ Foundation Cleanout
/'J Date Last Pumped
I ; for
Temporary Holding Tank Permit
To Building Foundation
To Disposal Field
To Stream, Pond, Lake or Major Drainage Course
Comments '""T'-'~ ~7'-¢ ~' /---/~
72-026 (Rev. 7/881 Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ ~
Width of Field I '~
Square Feet of Absortion Area
Depression over Field (Y/,~
Results of Last Adequacy Test
Type of System Design
Length of Field I "~
Depth of Field / ~
Gravel Bed Thickness ~'
Statndpipes Present4~/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation .
Lot
To Water Main/Service Line
I
lc, 14-
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~c~ J+
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION ~///~
Date Installed
Size ~ns
"Pump On" ~
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)
~~during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
"~'~'* ~'~' f his
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effeet~q~e ~"~:te,o t
inspection.
17034 sagle Rive,' Loop Roa~ NO. 204
Company .... ,_ ~ .... ~.k. ~9577 ~~ .~.~ ..... ~.
Date Z./¢~ '" "'~.""
MOA NO. ~
Receipt No. ~/
Date of Payment
Amount: $
72-026 (Rev 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
A cHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
e
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL l--.I (~/,'~
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date '[ I '~/~'~'
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
[. .~ ,.¢ .: '., .. fi=u.
Location (address or directions)
(b) Applicant Name _ (?.Sl',~ h~/4'..~ ~¢, Telephone: Home :~ ~'~'~/~ '~ ~ Business
Applicant Address ~., ~/~/; ~-' ()-'/~ ,:'-,~ '{' (~'- ~' /
(c) Applicant is (check one): Lending Institution D; Owner/builder ~; Buyer ~; Other ~ (explain);
(d) Lending Institution ~,, !¢= ~l ,~,.. 't~ .... ',,.%d.~ Telephone
, "i?~' / I,~, ,, ~,, I.~ .... ~.
(e) Real Estate Company and Agent , -[.¢
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single- Family~.E]I Multi-~amily [] Other
Number of Bedrooms _~ '<- .__
WATER SUPPLY
Individual Well/E~],. 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 DISPOSAL
Onsite/~ Public [] Community [] Holding Tank
D
/
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 (tl/84)
ENGINEERING FIRM PROVIDI, .~ INSPECTIONS, TESTS, FILE SEARCH, I~ .A 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~qua~-
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 °f this in~~'¢4//
Name of Firm ~ Telephone ~"7~~ '~ ~
Address /-~ /'} ~
Date ~N~o c,/' ~ l ~
Engineer's Seal
6. ';)HEP APPROVAL ~-~,~ ~ ~--"/~-,----'~¢~L--~Dat
Approved f~ ¢ bedrooms by
Approved ~ Disapproved Conditional
Terms of Conditional Approval ~ ~_~ . ~~
CAUTIO,,,N ' :" ' '
'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 DHFP 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-o25 (11/84)
MU, C PAUTY OF A,C.O.AGE (MOA)
__~ ~O~ HEALTH AUTHORITY APPROVAL (NAA)
~ ~ ~+' ~ ~ 264-4720
WELL DATA ~
Well Classification
Well Log Present (Y/N) ~'1
Total Depth c~'O f' Cased to ~ 'f'
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
If A, [3, C, D.E.C. Approved (Y/N) '~/,'~
Date Completed I¢~fo q Yield
Depth of Grouting
Pump Set At ~
~ ~ Sanitary Seal on Casing (Y/N)
~¢~ Depression Around Wellhead (Y/N)
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments ~'~ ~
.; On Adjoining Lots 1~-'-~(~
IO¢:O~ ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
', _;Date /0/~o/~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)
Depression over Tank (Y/N)
Size 7~O 7~ No. of Compartments /
Air-tight Caps (Y/N) ~/ Foundation Cleanout (Y/N) ~
J~/ Date Last Pumped lO/~'z-/0~;~
I~////"~ . ;for ~/~
_ 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 "~
To Property Line
To Water Main/Service Line
Course
Comments
· To Building Foundation ~" ¥~
To Disposal Field ~ Y
To Stream, Pond, Lake, or Major Drainage
Page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/~' _t.,~
Width of Field / ~' ",4 ! ~,
155,
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
/¢'o /-
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
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of/La, st/~dequ~cy Test
,/
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present) /N//d ~ ~'
Comments
D. LIFT STATION N 0 N ,~'"""-'
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 ~;onformed to all ~OA end HAA guidelines in effect on the date of this inspection.
Signed .~-~.~-¢~.,~¢~ Date
MOA No.
Company
Receipt No.
Date of Payment ///"~/~
Amount: $ ~
Page 2 of 2
72-026 (11/84)
Engineer's Seal
MUNICIPALITY OF ANCHORAGE NOVEMBER 4, 1986
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Re: Request for Conditional Health Authority Approval4fO~/~ ,
Lot 7B Goldenview Heights
Gentlemen ;
On behalf of our client, Jack West, we request a conditional
approval of the septic system serving his residence. This system
was installed as a two bedroom system in 1970 and inspected by
Municipal Inspectors at that time.
At this time the system operates sufficiently for the residence,
but does not meet Municipal criteria. There is no danger for the
system to fail or cause a nuisance. The owner of the house intend
to escrow funds to upgrade the system next spring.
Yours
cc J~ck West
~ [~Q ~ ANCHORAGE, ALASKA 99501
CONSULTING ENGINEER TELEPHONE: (907) 279-3916
RESIDENTIAL WELL INSPECTION
LEGAL:
LOCATION:
OWNER:
TYPE OF WELL:
WELL LOG AVAILABLE:
INSTALLATION REQUIREMENTS MET:
LOT 7B, GOLDENVIEW HEIGHTS
6446 WEST CIRCLE
JACK WEST
SINGLE FAMILY
NO
NO. WELL CAP IS FLUSH WITH GROUND
LEVEL. CABLE ID BURRIED, NOT IN CONDUIT. WELL IS LOCATED ON
HIGHSPOT. WATER CAN NOT FLOOD WELL OR BE STANDING AROUND CASING.
PUMP YIELD:
8 GALLONS P[ER MINUTE
DATE OF INSPECTION: OCTOBER 20, 1986
TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 8
GALLONS PER MINUTE WHILE THE DRAWDOWN WAS
MONITORED WITH AN ACOUSTIC PROBE. STATIC WATER LEVEL WAS FOUND AT
41 FEET BELOW TOP OF CASING. AFTER PUMPING FOR 20 MINUTES 170
GALLONS HAD BEEN WITHDRAWN. WELL RECOVERED ].00% IN 23 MINUTES.
TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON
OCTOBER 21, 1986. TEST WAS NEGATIVE.
TEST RESULT:
THIS WELL MEETS THE REQUIREMENTS OF THE
MUNICIPALITY OF ANCHORAGE.
The Municipal requirement for well flow is 150 gallons of water
per bedroom per 24 hours.This well surpasses this requirement.
The assessment of the condition of this well applies only to the
conditions as of this date. The flow rate of the well may change
due to subsurface conditions that may not be observed from the
surface, and changes in land use and other factors that may
impact the conditions of the aquifer feeding the well.
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
CONSULTING ENGINEER
SEPTIC SYSTEM ADEQUACY TEST
LEGAL:
LOCATION:
OWNER:
RESIDENCE:
WELL:
SEPTIC SYSTEM:
LOT 7B, GOLDENVIEW HEIGHTS
6446 WEST CIRCLE ~,. ~.,;~ ..~,'~
'I '~".
PRIVATE, ON SITE
FROM MUNICIPAL RECORDS:
TANK: STEEL FAB. ONE COMP. 750 GAL.
ABSORPTION SYSTEM: CONCRETE CRIB
ABSORPTION AREA: 312 SQ. FT.
SOIL RATING: 155
INSTALLATION DATE: JUNE 1970
DATE OF PUMPING:
OCTOBER 22, 1986
DATE OF TEST:
OCTOBER 23, 1986
TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED ON OCTOBER 20,
1986. TANK WAS FOUND WITH ONE FOOT OF COVER AND
64 INCHES OF LIQUID. TOTAL TANK DEPTH IS 70 INCHES. CONCRETE CRIB
WAS FOUND 83 INCHES DEEP AND WITH A LIQUID DEPTH OF 60 INCHES. CRIB
IS 4 FEET DEEP. SYSTEM WAS DETERMINED TO BE SURCHARGED. ON
OCTOBER 22 THE TANK WAS PUMPED. ON INSPECTION THE NEST DAY LIQUID
DEPTH IN CRIB WAS 19 INCHES. 300 GALLONS OF WATER WAS ADDED TO
THE CRIB. THIS CAUSED THE WATER LEVEL TO RISE 20 INCHES TO A
TOTAL DEPTH OF 39 INCHES. THE CRIB WAS THEN MONOTORED FOR FOUR
HOURS DURING WHICH TIME THE WATER LEVEL DROPPED .5 INCHES
INDICATING THAT THE SOIL AROUND THE CRIB IS CLOGGED AND THAT THE
SOIL IS NOT ABLE TO ABSORB THE REQUIRED AMOUNT OF LIQUID.
TEST RESULT:
THIS SYSTEM DOES NOT MEET THE CODE REQUIREMENTS
OF THE MUNICIPALITY OF ANCHORAGE.
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 outs'ide 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 requi-
rements of the Municipality and State.
MA!I. ING ADDPrbS
N/A
~ Alas~ Mutual Savings Bank Attnl Debbte Johnson [ 274-3561 ext t49
~ P. 0. Box 1120, Anchorage, Alaska 99510
I M,",J 1! NG A L D'-~
I
('X SINGt.[- FAMILY ~ '[v,m [[Jl Five
.. , ~flLILTIPLE FAMILY [i'] 'r ~r,':e ' Sb.
L ] ,p;.~,"lr,. r LTl I_ ITY depth (utt~ch
LJJ PUBL.;C U] I I..IT'¢
f, ;Y... 'fl I[: li~SF'EC'rlCI';I FEE MUSY /',C;(;OF/iP!xNY FAt f.i
~EI L) ..: I,/,~ ,,~:,,..:,~.,.; Ib/'d'.,l fie ff~IT AT[iD.
t, '1 YPE OF RI~SIDENCE hhJr¢,'~;F:R OF
"H-] SiNGLh FAMILY E~ ONE ~_J TIIREE ~ FIVE ~! ()TILER
;E-i ;';UI..'I IPLE FAMII_Y ['1 TWO ~_1 FOUR [~] SIX
J2, WATEIq ~;LJPPI.Y PEI~i,,4I'F NUMUEH
-~] INI)IVIbUAi DEP'Ill OF WELL
[~] OOM k~ilj J'.~ I TY ,
DATE DRILLED
~] PLIBL.tC UTIL_ITY
Connaction Verified ........... LOG RECEIVED
,-',.~:,',~,~ ,,-:. L)I,~;P()SAL SYSTEM
-[4_' hid V DU/'~L/ON-SITE
FZ IF'UBLIC LITILITY
l::]JSeptic Fanko; i~nolmn9
Sixc:~.~.~)_, ___ If Tank is homemade
II'J~4TAI I_ER
SOil S ,~IAI'I NG
TYPE OF- TANK tvL&NUFAC'FUII[JR
~:_, n ~' c ......................
'fOrA I. A E;S()R PT!ON /',REA N1A'~R IA L
[~. [,,) ,,IA' J.,,J I ¢~
. - t .......... ,~ ................ ~-; .....................
.-~ , ,-. ~ ~, --I' ............... ; ......... ~ ~,..~,~.::-'~ ........ ~ .......... ~ .....
IJL] CONDITION,%I.. ,APPI'~OV/d. (h)ttu~ mtitt ~:,1:~I1~¥' CZl dHC~tu)
~,;.:~:,~ : ....... ~ x ~ :/-*.-g-%~-,¥~-~// ....................................... : .................
7:] (Ii [) G U,,L
,~',,HCI IOi*',iGE, ,,',,.1S <A 99,502
~ 07) ;~,,~.c~ 251 I
November 5, ].979
Jack S./A. [)arlene West
Star Route A Box 471F
Anchorage, Alaska 99507
Subject: I,ot 7B Golden View Heights Subdivision
Approval for your individual sewer and water facilities
can not be granted until the following items have been
completed:
(1) The septic tank pumped with a receipt submitted to
this office.
(2) Expose the well for our inspection to determine proper
construction, also to insure the minimum distance
requirements are inet between your well and sewer
system.
Please notify 'this department for a re-inspection when
the noted descrepancy has been corrected. If there are
any further questions, please contact this office at
264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Alaska Hutual Savings Bank
Post Office Box 1120 99510