HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 8 LT 6Zodiak Manor
Block 8
Lot 6
#015-042--23
' 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 [] NEW
' [A J D UPG.ADE
MAILING ADDRESS
LOCATION
DISTANCE TO:
IF HOMENLADE:
Well
Well
DISTANCE TO: \ O 8
No. of lines Length of each line
t
Insidel~ngth~) I j~
Dwelling
Top of tile to finish grade ~-~ ~
Length Width t~t~~
Type of crib Cri~a
DISTANCE TO: We
DISTANCE TO: Buildi~g~f° on
Foundation
Total length of lines
Material beneath tile
Depth
Dwelling
Material
Material
Nearest tot lin~o'~T'
Tren~¢dthinches
inches
NO. OF BEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO. ~'80
Distance between lines
Total effective ab orption area
PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Driller
Sewer line
Distance to lot line
PERMIT NO.
Absorpt on area(s}
Septic tank
OTHER
PIPE MATERIALS
SOl L TEST RATING
REMARKS
72-013 (Rev. 3/78}
DATE
LEGAL
~ .~I~ DEPORTMENT OIIq~L~'~LTH FIND -~/!2~_ "~ ~ ~
~ 825 'L~ STREET~ 8NCHORBG~ BK. ~50~ }~.~
O~I--SITE SEWER UPGR8DE PERMIT
PERMIT NO.
8PPLICRNT
LOCBTION
LEGRL
DRVID BRRUNNER
47t0 MRR5 DR
L6 B8 ZODIRC MBNOR S/D
4900 ZENITH ST
LOT SIZE
274 55ii
14080 SQURRE FEET
TYPE OF SOIL 8BSORBTION SYSTEM IS: TRENCH
MBXIMUM NUMBER OF BEDROOMS = 4
SOIL RBTING (SQ FT?BR)= 225
THE REQUIRED SIZE OF THE SOIL 8BSORPTION SYSTEM IS:
DEPTH= -~ LEI~IGTH= ~ GRI~IVEL
[:~EPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRBINFIELD.
THE DEPTH Of 8 TRENCH OR Pit IS THE DISTRNCE BETWEEN THE SURFBCE OF THE
GROUND 8ND THE BOTTOM Of THE EXCBVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRYEL DEPTH IS THE MINIMUM DEPTH OF GRBVEL BETWEEN THE OUTFRLL PIPE
8ND THE BOTTOM Of .THE EXCRVRTION (IN FEET).
REQUIRED SEPTII: Ti=INK SIZE= 500 GFILLOI4S z c---
PERMIT RPPLICBNT HRS THE RESPONSIBILITY'TO INFORM THIS DEPARTMENT DURING THE
INSTBLEBTION INSPECTIONS OF 8NY WELLS 8DJBCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THBT THE WELL WILL SERVE.
------ TL~O (~') I NSPECTIO~4S i=tRE REL~UIRED~
BRCKFILLINO OF 8NY SYSTEM WITHOUT FINAL INSPECTION RND 8PPROVBL BY THIS
DEPBRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN 8 WELL'BND 8NY ON-SITE SEWBGE DISPOSBL SYSTEM IS
100 FEET FOR 8 PRIVATE WELL~ OR
i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
OTHER REQUIREMENTS MBY APPLY. SPECIFICBTIONS 8ND CONSTRUCTION DIRGRAMS 8RE
8VBILBBLE TO INSURE PROPER INSTBLLBTION.
PERF! I t EXP I RES DEC:EMBER _--<-i . ~1_978
I CERTIFY THAT
t:~I 8M FAMILIBR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS RS SET
FORTH BY THE MUNICIPBLITY OF 8NCHORAGE.
2~ I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTBND THAT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT If THE
RESIDENCE IS REMODELED~T~NCLUDE MORE THAN 4 BEDROOMS.
ISSUED BY~_-,~~' ~_~, ~¢'~, ........
Department Of Environment Quality
3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
DISTANCE
FROM WELL~/~-O
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
NUMBER OF (
MATE RIAL ~----~-,~ "~-~ ~'~' cOMPARTMENTS
LIQUID DEPTH LIQUID CAPACITY/0OO GALLONS.
NUMB INES TANCE BE LINES IN. TOTAL'7'EEF-ECTIVE
S/R ~ ~.FT. LENGTH OF EACH LINE
AB PTION AREA '~
DEPTH OF FILTER
DE~I'H: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE IN. ABOVE TILE IN.
WELL:
TYPE ~"~ ~ ~ Lt'-~-
CONSTRUCTION .DEPTH
DISTANCE FROM:
BUILDING NEAREST jr NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LiNE 3 ~ SEWER LINE ~c~ TANK+~--O , SYSTEM ~ 0 ~ ~--~-
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES: -
INSTALLED BY:
SEWER LINE DEPTH=
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
/
/
/
G.A,A.B.
Form P'~/,027
qeoth
Soil with
h~d q hl-h fine sq? "
silt content with ? .... ~r~--~ic
M1 h,y-rs.
9
Was C-rou~d Water
It Yes, At what Denth?
Test
Date 11- ~l-77 Monday
,,~UNiCIPALITY OF ANCt!ORAGE ~
P~\R.i't, iEN~F HEAl TH AND Et'P/iRON/'.iENTA~<')TECTiON
825 ], :Stcz:eet~ fn~chor~:~r,. Alaska
2 6 4 - ./7 ~ 0
DaL(: Receivec~: Novembe~ 17
Real Estate % Mary Leu Cacy
[4ali. Jag A,id:;ess: 2804 West Northern Lights Phon.'_. 276-2804
Property Owner: Bert Slezinger Phone
.~ ~.3. nj:.~';~ '-c Adam*es.-,:' - '- out of state
Legal ' , ;-', , ' ... Lot ~ Block 8 Zodiak Manor Subdivision -~Tlq/~qa~-s~ r iv e
Single FamJP,~ Residence: (x)
Hu![iple Family [{esidence: {
Well SvsSem:~ INdividual ~,~'e''.·
Permit {! .............. Depkh o.f Well
Constrllct J.CN
Nv. tuber o:[ Bedrooms: FOU~,=~_
(X) Community/Public Syshem ( )
Well Leg en File
bacue~ _al Analvs~s
6. Sewage Disposal System: On-stke SysLem (x)
Public ' ' '~'
Ut:L} ZL ~, ( )
PermiL 5 instal led 197~ In:-~tal. ler /
o~-pt lC Tank Size /dOG ~Ma.~Lhn ~ acta_ e.,_'r ,-
Absorption
A~._( ,_ Soils
Materma±
7. Distances: Well to Sept
Sewer Line
Lot line
to Absorption Area
Absorption Area
Page. t/~g
Depa:l:tmenh o:f fIealth and Environr;enkal Prohection
R(eOkl6:s~. Fr,]~ Ap~rovai of Individual Sewer ~ s ~ ~ · ·
Legal Description: Lot ~Block 8 Zodiak Manor Subdivision
A~_.~da~lt Attached:
Approved: ._~2I,
Disapproved:
Lehher Attached: { )
Department Worksheet:
//-/~- 77
· ' '} _ PALl'FY OF ANCIiORAGE
j-~l~,- %, Department of ttealth and Nnvirou~nentat Protection
"e~g~" 825 L Street, Anchorage, Alaska 99501
~=~ ;'Request for Approval
of indiv_dua! Sewer a,fld'Nater Naci}.~_hies ¥ N~'
P:ope:/:y Owner: ~_e_r.tS.l_e__z~e__r ...................... :_.._~:_ _~_ ....................
Piai.] ing Address: ~8_p__4.._W_9_sk_N_p_~i!Rs ~0_M__ar__s.~to__n~R?al Estfl~-~3ne: _2_1_6 28_0
Attn Mary Lou Gac¥
2, Narfie Of~.u)-~ ~6...~--.' ......................................................................
Hailing Address: ....................................... P?lone: ...........
Le~o]_.~ institution:
Mai ling A6dress: Phone:
Realtor/Agent;:
Mai ling Address:
Legal. Eescription:
,Street Location:
____Ma4.ston REal Estate ~ .... _M_~r3L~L_o_u_~Ga:y .....................
2804 West No Lites
_~p?~ mo ~k ~_ _z_2 d~a__k_S_:bN_ ...........................
4 7.10__M_~ s~
Family Residence:
Multiple Namily Residence:
(1) Number off 2edrooms: 4
( ) Number of Bedrooms:
7. Water Supply: * Indivi. dual Nell (x} Public/Coimnunity System ( )
If Individual Well, well depth unkn
If Community System, name of system
8. Sewage Disposal System: *"On-site System (x) Public System ( )
If On-site SysCem, date ef installatien:
George O ollins Builder
*NOTE: A well log is required on A!,L wells drilled since 6/75.
** If eh-site sewe: system is ever twe(2) years o].d, an adequacy
test is required by this departmlenL.
A fee ef $25.00 must accompany each request before processing
3/77
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received ~-~//~
1. Approval requested by:
4.
5.
6.
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Mailing Address: ~/Y~ 0 /~~, Phone:
Mailing Address:
Legal Description:
2. Property Owner: ~t__~ j Phone:
bedrom
Location:
Type of facility to be inspected ,~/~,~,
Well Data:
A. Type ~.
B.
Depth
C. Construction~~O~
D. Bacterial Analysis
Sewage Disposal System:~
C. Septic Tank: 1. Size )00~ 2. Manufacturer~[<
D. Seepage Pit: 1 Absorption Area :~/f~
· 2. Material
E. Disposal Field: Total length of lines ~
8. Distances:
A. Well to: Septic tank~O ~
, Absorption area /00~ ., 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 - Re~m~.st for Approval of Individual
?
~egal Description
& Water Facilities
Comments ~~ ?~ ~~/~/'J~77~ ~
Approved ~, ~-~)~ ~ Disapproved Date ~[I Q- I ~/~
APProval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
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
EQ-034 (1/74)