HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 8 LT 3Zodiak Mano
Block 8
Lot 3
#015-042-26
Municipality of Anchorage
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION POUCH 6-650
ANCHORAGE. ALASKA 99501
INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL
NAME ~'~)[C-_.'~.. ~.IS~.\(',,~T LOCATION ~'~r~R~.~ ~ '~
PERMIT NUMBER
ADD,ESS ~¢g ~ ~U¢~ ~ LEGAL DESCRIPTION
~0F BEDROOMS
MANUFACTURER (.._~'~.
MATERIAL ~'~-._-~:~L~ #OF COMPARTMENTS
INSIDE DIMENSIONl DEPTH
LENGTH ]WIDTH
SEPTIC TANK
CAPAC TY N GALS,
SEEPAGE SYSTEM
[] TiLE DBAINFIELD
UMBER OF LINES
LENGTH EACH
TOTAL LENGTH
DISTANCE BETWEEN LINES TRENCH W DTFI
OEPT~: ~ \(~" "-~ ~ ~0 ~"~
TILE TO GRADE FILL BELOW TILE FILL ABOVE TILE
~%SEEPAGE TRENCH OR [] PIT
\~, '~T' [] LOG CRIB
[] RINGS- DIA.
EILL MATERIAL DEPTH
G Y.,o
TOTAL EFFECTIVE ABSORPTION AREA;~ SG, PT.
CLASSIFICATION
INSTALLER
REMARKS
WELL
I DEPTH PiPE MATERIAL
DISTANCES
SEPTIC SEEPAGE SEWER
TANK SYSTEM LINE CESSPOOL WELL
WELL
LINE ~
SYSTEM DIAGRAM
P
PERHI].' NO. ( 777Z~4 )
FtF'F'L. i CRNT
L.OCR].' I ON
LEGFIL
. E,;E:.5 '"[.WSTREET., FINCHCF:FI::~E., Rf::L
279-25::LJ..
~-,'~ E: b.. I .... F~ [r-4~ []:, C~ t%t --- :~; Z 'T E"_=_ fiE; E..-Z i..4 E'C R
DICK NRI GH-f'
MHR'z) b, t.
SRFI BX. :L585-R
LT. 3BK. 8 ZO[:,IRI< MRNOR S,-'D
TYPE OF SOIL RF_','SORBTION S~'S]"EM IS: -FRENC:H
MRX]:MUM NLIP1BER OF BEDROOMS = 4 SOIL. RFITING (:5Q F']","BR)= ±5~}
THE RE(~UIRED =,I,,_E CF THE] -,U.£t.. ME,_,..RFTILN _,'r_,TEII t.:,.
E;:, El: F' ']" H == :l.. (_-Z~ b. EZ ~-~ ~2:~ 'T H ~-, E; :~... C~ F-: Fi '..-' E ~. .... [.'-, E; F> T' H = ~;
THE LENGTH DIMENSION IS THE LENGTH (:IN FEE:]") OF THE TRENCH OR DRFtlNFIEL[:,.
THE DEF'TH OF FI TRENCH OR PIT tS THE DISTI-qNCE 8ETHEEN ]''HE SLIRFRE:E OF' ]''HE
GROUND FIN[:, ]"HE BOTTOM OF THE EXCFt',/RTION ,:;IN FEET).
]"HERE I:]':; NO SE]" WI[:,TH FOR TRENCHES.
]'PIE GRR'.,,'EL [:,EPTH IS ]-HE f'lIi'.,~Ii'¢tUM DEPTH OF GRFIMEL BE].NEEN THE OUTFFtLL PIPE
FIN[:, THE BOTTOi"I OF THE EY, CRVRT];ON (IN FEE].').
i~: E] ,]:! Li ][ F-:: E] [:, ._z.. E F' ]- :[ C: '-IF R ~'-.t F::: :5 [ ;:-2: IrE = :L 2 .'~'~ ~:.--.~ EZ"Ji R L.. L.. (]) [¢-4t :}3
F'FI(::t-..%FIC:~I~; F'L. RI",~ ]'- CIP-'T' I i:] i'-,,l
R PRCKFIGE PLRNT MR'r' BE INSTRLLED RT ].'HE PERHITTEE"S OPTION SUE:JEE:T TO THE
FOLLOt4ING CONDITIONS:
:.I_. EITHER R CL. RL:;:5 I OR II NSF FIPPROVED PLRNT MR"r' BE INSTRL. L. ED.
2. R C:ONTINLIOUS MFIINTENRNC:E RGREEf'IENT IS REQUIRED. IF R MRIN]-ENFtNCE
FtGREEMENT IS NOT KEP].' CURRENT 'T'Ot_l i"lFl¥ BE REQUIRED TO ENLFIRGE THE SOIL
RE:LZ';ORPTIC~N L-X"r'LZ;TEM FtND,:OR "r'OU ['1R¥ BE SUBJECT TO PROSECUTION.
BF~CKFILLING OF RNY SYSTEM NI'I'HOUT FINAL INSPECTION FINE) APPRO"/RL B'9 THIS
[:,EPRRTMENT NILL BE SUBJECT TO F'ROSECUTION.
I'IINIFtljFi DISTRNCE E:ETNEEN R WELl- RND RNb' ON-SITE SEWRGE DI..c.;POSRI_ SYSTEM IS
:LO~ FEET FOR FI PRI',,,'FITE NELL OR 200 FEE-I' FOR FI PUE:LIC HELL.
HELL LOGS RRE REQUIRED RND MUS].' E:E RETURNE[:, 'T'O THE [:,EPRRTMENT WITHIN Z.:E~ DFYr"_'~;
(jIF ]"HE WELL COMPL.ETION.
OTHER REQUIREMENT'.q MFI"r' FtF'F'L"r'. :5PECIFICFtTIONS FIND CONSTRUCTION [:,IF4GRRMS RRE
RVFItLF~BLE '¥0 I NSI.JRE F'ROF'ER I NS].'FILLRTIO['4.
I
FORTH BY THE MUNICIF'FII_IT'¢ OF FtNCHORFIGE
2: I NILL INE;].'I'~LL THE: S"r'STEM IN FtCCORDRNCE NITH THE CO[:,ES.
E:: I UNDERSTRND ].'HRT THE ON-SITE SEWER Sb'S]"EM MFIV REQUIRE ENLRRGEMEN].' IF THE
RESIDENCE IS REMEIDELEI} TCI INCL. U[:,E MORE THFIN 4 BEDROOMS.
"-- ~~F~f CFIN]" [: I C:K HR~3HT
CERT I F"r' THR T
:[ RH FRMILIHR I4ITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELL:5 RE; SET
Dep.~, ~ent o£ Health and Environment~rotection
., . Anchora~e, Alaska 9950%
]
ibis tqrm re~urts; Soils log Percolation ~est--~---~
Deptll
Feet ,
3-
~ -
5-
6-
7-
8-
9-
] 0 ~
ll -
]2 -
13 -
l~ -
ground water encountered?
If yes, ~: w, lat ueJU,?
2 i'/ ~}ra~e! ~ st~bsoi]
}2 $7 broken i'oc].';~o!~:.N
(5S ,32 stave] ,
i.~} clay
~i0 i15 silt
i ~: 12} .~ ~ne( ..... er bearin{!l)
i2. i:?} cl;~c?'~broken rock
139 I~0 ~ravel(wa~er b~;ari~ )
i5~/ ft. of 6" black well casin;:
~ield.' ~
· ~gpm
'~ate~' levels : ~a~m~ 96 ~.
s horase ~
~" ~ ~ eo~k,~y 21, I9~/,::, Thomas Drillers
PhOne:
Number of Bedrooms: Four
Well Log o~ File~'6~)
Letter Attached': ( )
Date.
Department Worksheet:
MUNICIPALITY OF ANCHORA~I "P 'l"v
Department of Health and Environmental ~ Q
Protection r ~,'%'
825 L Street, Anchorage, Alaska 99501~ ~'
~quest for Approval of Individual Sewer and Water Facilities
Property Owner: _ ,'~"~ ' ? · ~'
"~'' ~" ~'" 1' ~/¢'.~: ;.-~;,~..,. Phone
Mailing Address: '1' n .~ / ~.~-.: ~4., ~ , '
Name of Buyer- ,.'f'",.~ P'/- ~'%
Mailing Address: -.'// P f ~'
Lending Institution:
Mailing Address
Realtor/Agent:,~fp.
Mailing Address
,2 ' ,/
( ", ,~' ~ ¥?" ~ s'' Phone
5. Legal Description:
Street Location:
6. Single Family Residence: (,;,~ Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
7. Water Supply: *Individual Well (P~ Public/Community System ( )
If Individual Well, well depth
If Con, unity System, name of system
Sewage Disposal System: *~n-site System (~,$~ Public System ( )
If On-site System, date of installation: ~p~. /?-,?
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
