The URL can be used to link to this page

Home My WebLink AboutZODIAK MANOR ALASKA BLK 13 LT 15MUNICIPALITY OF ANCHORAGE ® ~� DEPARTMENT OF HEALTH & HUMAN SERVICESp} Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# ?��-��Z�-�� HAA# �fz)� 012D,(I I� 1. GENERAL INFORMATION Complete legal description Lot 15; Zodiak ManorPSubdivision ?>LOCIC 13, Location (site address or directions) 4801 Zenith Drive, Anchorage, Alaska Property owner L= nn Eastb_ r pk \ Day phone 346-3511 hm Mailing address 4801 Zenith Drive, Anchorage, Alaska • 272-0008 wk Lending agency Day phone Mailing address Agent Colleen Mcening/JACK WHITE COMPANY Day phone •`:563-5500 Address 3201 C Street, Anchorage, Alaska 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ` 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. 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. 72-025 (Rev. 1/91) Front MOA H21 0 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/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 S & S ENGINEERING Phone Address 17034 Eagle River Loop Road No. Z04 age River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for rWo!-- bedrooms. Disapproved. Conditional approval for Additional Comments Date bedrooms, with the following stipulations: Date 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 orderto 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. 72-025(Aev.1/91) Back MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LJ -)-T s I -I CWctc « Parcel I.D. 61u 'Q 141 "/9 2--U171 A -C NA/,--,JVR Sly 1 A. WELL DATA Well type ` RkUPRE- If A, B, or C, attach ADEC letter ADEC water system number Log present (Y/N-) No Date completed uk Driller f AX Total depth �� r� Cased to Casing height '?,y �I t Sanitary seal &N) y�S Wires properly protected �YI) Date of test Static water level Well flow Pump level FROM WELL LOG lUl/� 9 -p.m SEPARATION DISTANCES FROM WELL TO: AT INSPECTION �Z ��. g.p.m. Septic/holding tank on lot NA ; On adjacent lots 6� A Absorption field on lot _ LV ; On adjacent lots Public sewer mainO r Public sewer manhole/cleanout 5614 Sewer service line IE -,Q 4- Petroleum tank foOnuF- mwr WATER SAMPLE RESULTS: Coliform Nitrate ma/t Other bacteria d Date of sample: alit b2, J Collected by: S � S tr,3�Ali�r,%x- B. SEPTIC/HOLDING TANK DATA installed Cleanouts High water alarm (Y/N) Date of pumping P3/NaI�u�aLc- S�wa� nk size Foundation cleanout (Y/N) SEPARATION DISTANCES FROM SEP,-YfC/HOLDING Well(s) on lot To property line Surface r/drainage 72-026 (Rev. 7/91) Front On adjacent lots Absorption field ents Depression (Y/N) Km --tested (Y/N) Pumper TO: 0undation Water main/servic e— CONTINUED ON BACK PAGE C. LIFT STATION ,, 1 Date installed N Size in gallons Vent (Y/N) High water alarm level "Pump on Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) I at "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date insta Length Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (Past 12 months) (Y/N) Soil rating Gravel thickness Surface water System type Cleanouts present (Y/N) for SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ►v To building foundation On adjacent lots Surface water Curtain drain E. ENGINEER'S CERTIFICATION On adjacent lots C to of adequacy test Total depth If yes, give date Property line To existing or abandoned system on lot Water main/service line Driveway; parking/vehicle storage area bedrooms 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the dat-e-o-ftW inspection. S & S ENGINEERING ��;"�. Signature 1. 7034 Eagle River !®op Road No. 204 River, Alaska 99577 Engineer's Name o� Date ` P' — ►�i ®� DA60 va 0. Rt7ta_P, J SHAFEP, a No. x1215 HAA Fee $ 1 -)t-- Date ).C- Date of Payment Receipt Number 9 v'o -`1 72-02R (R- 3/Gil R -k KAr)A 91 D-1 251A,5 Waiver Fee: $ Date of Payment Receipt Number u��4�S NgCNO�AG[ AyFA� g'G u t JARVO �. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received January 11, 1977 Time of Inspection 10:00 a.m. Date of Inspection 1-12-77 Wednesday uc zo z REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR V.A. Approval requested by: Lomas and Nettleton Mailing Address: 4449 Business Park Boulevard 2. Property Owner: Larry Dale Mailing Address: 4801 Zenith Street 3. Legal Description: Lot 15 Block 13 Zodiak Manor 4. Location: 4801 Zenith Street 5. Type of facility to be inspected Single Family No. of bedrooms 4 6. Well Data: A. Type Individual B. Depth 170' C. Construction D. Bacterial Analysis �� l / Z 7 7. Sewage Disposal System: A. Installed Public B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line Phone: Phone: 349-2788 EQ -034 (1/74) , Sewer Lines , Page 1 of two pages F F F Page 2 of two pages - Req. ;t for Approval of Individual S r & Water Facilities Legal Description Comments Appro Lot 15 Block 13 Zodiak Manor Disapproved Date/—/ 2f —717 App o 1 -,Val id for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date F EQ -034 (1/74) F tA�'��4 TpC%Ot AG[ Apf� gaa �yFfl JATIIT4y � GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 r Date Received Time of I s Date of Inspection 1` REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: o l�J C�,,,-e � ao� Phone: 9 2. Property Owner: �� _ Phone: Mailing Address: 3. Legal Description: 4. Location: A -A d Q, 5. Type of facility to be inspected s T= No. of bedrooms 6. Well Data: A. Type &J-�' B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System:,'. A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Req, :st for Approval of Individual S ar & Water Facilities Legal Description Comments Approved Disapproved Date/u> � -). Apo.roVal Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date