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Home My WebLink AboutZODIAK MANOR ALASKA BLK 2 LT 18ZoD iA-K. ~ '. Lc,- t~J~.J 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 MAILING ADDRESS LEGAL DESCRIPTION Well Manufacturer Liq. capacity in gallons IF HOMEMADE: DISTANC T : Well Well DISTANCE TO: · No. of lines ~ Length of each I~e{~ Top of tile to finish grade Length Type of crib Material Foundation ~'~ Nearestlotline ~ Total length of lines Trench w~c~th Material beneath tile ~, O\ O inches DISTANCE TO: Depth PHONE ~UPGRADE NO. OF BEDROOMS PERMIT NO. No, of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO' '~ ~O ~1, ~ I Distance b~e[l~nes Total effective absorption area PERMIT NO. lmeter Crib depth Total effective absorption area Building foundation Nearest lot line Depth Driller Distance to tot line PERMIT NO, Building foundation Sewer line Septic tank Absorption area(s) OTHER SOl L TEST I~'A~I~IG ' P ROVED DATE LEGAL 72-013 (Rev. 3/78) ifil:: [;:~EI::"!'[I LU-:: I:1 I[~'l':?',!(:11 iil,::!ll !i.~[;:, iff,il:, tH[: t' I II}lf"l iii:. I,.~Fh-: i'.:, i'.,{ll :::;h:! !q.li:,il'i I!1:: -h: ',/~:. !:q'l:'!i-! I':, t :i 'd:il I Iii ;;::1::~[I I'[CI ! !:!,i%lFi I'! I'll!qt i+:.: !,Iii! i f:'bF:'!:!r-,i['' t b,!l~i t.t?l. Ip,l t!Ii i 'r'l:'l~ i)i: !,:'1 I!',i I!: r,!! ! i ! Fv'k:! J ! !!lr~i !'. t I I f [',,?:;I li;;:f: [::'t,;¢l~ll:'~;i.i: J i',!":, [ !!1 ! [! { I [] SOILS LOG MUNICIPALITY O-F ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-~221 SOILS LOG - PERCOLATION TEST PERPORMED EOR: LEGAl_ DESCRIPTION: DATE PERFORMED: PERCOLATION TEST 4- 5 6 7 8 9 10 11 12 13 14 15- 16- 17- 18- 19- 20- COMMENTS SLOPE SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~:~ ~') (minutes/inch) TEST RUN BETWEEN Z)_ FT AND ~-- FT 72 0O8 (7/76) ~] BOILB LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99602 276-222~ SOILS LOG - PERCOLATION TEST PERCOLATION TEST 1 2 3 4 5 6 7 8 9- 10- 11 13 14 15 16 17 18 19 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? Gross Net Depth to Net Reading Date Time Time Water Drop ~-~ ~h~ ~ ~1~." PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT 72 008 (7/7G) GRE ER ANCHORAGE AREA BOROU , DEPAflTIVlENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPOR'r ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: LIQUID CAPACITY .. GALLONS. NUMBER OF / gOMPARI'MENTS INSIDE LENGTH __ INSIDE WIDTH____ DEPTH SEEPAGE SYSTEM: SEEPAGE NLJMBER OF PIIR _ / __ OUTS DE DIAMETER LINING MA1ERIAL _ NEARESJ LOT LINE__ ~(;'VrZ,: (/' ('.2;//.( :¢ .4 OR WIDTH .......... LENGTH , DEPTH_ DISTANCE FROM WELL ~~'-~ BUILDING FOUNDATION TOTAL EFFECTIVE ABSORPTION AREA (WALl AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE EROM WELl NUMBER OF LINES A B SORPTIO N/7\/R'R EA DEPTH: TOP OF T~LE TO FINISH GRADE TOTAl. LENGTH .~ ..... FOtJNDAfJ_ON , NEAREST LOT LINE , OF LINES .DISTANCE BETWEEN LINES~_ TREIqCII WIDTH IN. TO~.~L/EFFECTIVE WELL: Typ E/~)k~,// DEPI'H 1/~/ NEAREST SEPTIC LOT LiNE , SEWER LINE_ , TANK DISTANCE FROM /~5~ / WATER , ,BUILDING FOUNDATION. /_~._ ..... S A M P L E ~.~.-//~//~? / SEEPAGE ("/~' ~ '/~"' , SYSIEM CESSPOOL_ , NEAREST OTHER , SOURCES DIAGRAM OF SYSfEM DISTANCES: GREATE,~ .,NCHORAGE AREA ,~ ~ROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Ala&a 99501 279-2511 Case No. ~4. /~:~ SEWAGE DISPOSAL SYS'rEM - APPLICATION & PERMII' NAME OF APPLICANT. RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWlNQ FACILITY MA,LING ADDRESS 7,~q-~-~75'r/~,'~M/~,'~_ PHONE NO._ . LOCATION OF INSTALLATION ~-,~',¥'/,¢,,~ /~/',,~fl,"~ ,DRAIN FIELD ,OTHER. FINANCED THROUGH '~La /- ~ TO BE INSTALLED BY PE'FCOLA'-T'rgN TEST RESULTS ANTICIPATED BATE OF COMPLETION. ~-1'~¢~114 BELOW TO BE FILLED OUT BY HEALTH DEPARTMEBT THIS IS TO SERVE AS t~/~t ~/eGeA/ , PERMIT TO INSTALL A AS DESCRIBEB BELOW. SIZE OF UNIT TO RESERVEB__ . SEPTIC TANK SIZE. //~t~t~ TYPE ~-?-tCd"~ S~EEPAGE AREA ~/~ DIAGRAM OF SYSTEM DISTANCES: ~' ~ ~' / I / ~y t~;lt;;:tl;;Jii;i2r wit'2 requkements of Gre¢~e ~nchorage~o;ug¢ above described system)s in accordance with said code. TYPE the MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ~""~o/- ~' GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Owner~,'~/~-'~¢~¢ <E~/./~ __ Telephone: Home .-~¢¢'~' "-~/,,¢'~' Business (c) Len'ding Institution " Telephone Mai]in~ Address (d) Real Estate Company and Agent Address ' !' ~ ' ' ~ (e) Telephone . , Mail the H,~A.tb, the f011o'~vrn'a address: or: Check here D, if hold for pick up. List contact person and day phone number below. .~'-~:-~z -/r~'~ 5' ~ TYPE OF RESIDENCE Single-Family.J~" Number of Bedrooms WATER SUPPLY Individual Well~ 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 [] 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 fRr, v 8/86i Fronl ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 inspectLon. Name of Firm ~-/-_2~"/./',::~.,~ ~.~-'...-~ Telephone ~ - /~ Date DHHS APPROVAL Approved for .~ Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION 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 th is as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DF{I-{S 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 trey 8/861 Back WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECI(LIST- FEBRUARY 1984 264-4744 Legal Description: ~/~':;~" Well Classification Well Log Present (Y/N) "%/ Total Depth /~/~ Cased to Static Water Level .~ -~ ,,¢/t¢.''~' Casing Height Above Ground J~ Electrical Wiring in Conduit (Y/N) If A, B, C, D.E.C. Approved (Y/N) /¢'//~ Date Completed ~/,*¢/,~5¢¢~'~'3 Yield Depth of Grouting ~ Pump Set At ~~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: y/~¢,¢ ) To Septic/Holding Tank on Lot ~2'c~ k ,/-.~p._~r..~- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ ~ ; On Adjoining Lots To Nearest Public Sewer Line ~ ~ To Nearest Public Sewer Cleanout/Manhole -~ ~ To Nearest Sewer Service Line on Water Sample Collected by ~/ ~'~ ; Date ~'" ~/- Water Sample Test Results ¢~:~' ~: B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) /~/ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) Size ./¢.>o,~ No. of Compartments / Air-tight Caps (Y/N) / Foundation Cleanout (Y/N) /¢¢',,~/'-.~.~"/ ; for Temporary Holding Tank Permit (Y/N) Holding Tank High-Water Alarm (Y/N) '- Separation Distances from Septic/Holding Tank: To Water-Supply Well '~'¢' To Property Line Jr~ .~x To Water Main/Service Line ~'~ ~'~ Course~, ~ ,¢'1//~4' To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 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 A~.~,4~on 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 .4~- z~.5'c'J ¢,.~ .J'-¢//'¢'~,¢' 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) D. LIFT STATION ~/.~ 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 h. av~e chec, k~, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~ Date Company~',¢--o ~/'~ MOA No. ReceiptNo. /¢0 / 00/ ¢ Date of Payment ~__~/~¢ Amount: $ /~¢ ¢~ ~.. '~ngi~eP~J~. Page 2 of 2 BEVAN ENGIINEERING P.O. Box t12852 Anchorage, AK 995! t (907) 522. t383 al::l!~il::)l'"l::~l!:¢(:l at; a ["a't':c~, ~:).F ~=i~4.+ (]a:l.;l.c:)r'l~ per- day (9pcl). "l'l"l:i.~i~ e),(l::ec~l::h~¢ 't.:lte flSl~i gpd LOT 18, [~LOCK 2 ZODI,91~' l~l,z?k*/O,~ ~L i~I~/:? SUB, PREPARED FOR: JIM AS-BUILT ~,~ ~v.~.[ '/'~'~1 e~ KA RA DEL NIKOFF SURVEYING ~r.~'~ .,, ~.~ BACTERIOLOGICAL'-I~ATER ANALYSIS ." , ', , TO.BE COMPLETED By WATER SUPPLIER 'I~ATE Co.LILE~T~:D ' J TiNE COLLECTED I TYPE OF SYSTEM MONTH/~ DAY Y~!Ag _-' I , AM I [] PUBLIC,~3-I~HDIVIDUAL I I NAME OF SYSTEM TELEPHONE NU~,IBER ZIP CODE CITY_~ STATE LOCATION WHERE SAMPLE WAS COLLECTED 'COLLECTED BY:(SIGHATURE) TYPE OF SAMPLE (CHECK ONLY ONE TItIS COLUMN) C) DRINKING WATER %/'CHECK TREATMENT []]CHLORINATED I-1FILTERED []UNTREATED OR OTHER [ P~qW SOURCE WATER L-] NEW CONSTRUCTION OR REPAIRS [] OTHER(Specify) _ IS TltIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON-CONFORMING SAMPLE? F~YES ~NO PRE~IOUS COLLECTION DATE ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM) SEND REPORT TO:(PRINT FUEL NAME,ADDRESS AND ZIP CODE NAME t. ~ 1~-~ ['E~"~,..)~T?~'~. ~ ~ ~. ADDRESS { ( (, %~j C~(~-- ~ CITY ~L~,~- _ STATE .~__ Z[~ ,FOR LAB USE ONLY E] RESUBMIT SAMPLE Sample rejected because: CHECK ONE OR MORE [] Sample too long in transit. Ssmple should not he over 30 hours, [] Sample received too 18te i~ week []Not in proper container E] Leaked out [] Insufficient information provided. Please read instructions on form. [] Other (Specify) RECEIVED FROM ~7~. _~ ,/ R~cnw~ ~Y .~/~,~,~,~ OAT~ ~.-~.-~ Tree q.:~ ANALYTICAL METHOD: [~MRRANE FILTER ~FERMENTATION TUBE Date & Time Started .~'~-~7 4.j~"J Date & Time Completed q')y~-'~ ,~tO6'~,/r~; ~BO~TORY RESULTS ~ Other Bacteria I ~ Test unsuitable because: [ Confluent Growth ~ T~C SATISFACTORY ~ ~SATISFACTORY ~/ BACTERIOLOGICAL WATER ANALYSIS RECORD FOR LAB USE ONLY Membrane Filter: Direct Count Verification: LTB ~.~ Final ~embrane Filter Results_ !.. ~ Coliform/lOOml ~DB ,, ~':, . ~ ... Colifom/lOOml TOTAL COLIFORMS FECAL COLIFORMS OILIER IIEAD SAMPLE COLLECTI~ INSTflUqTIONS ON BACK OF FORM GREATER ANCHORAGE AREA BOROUGH HI~ALTH D£PARTMeNT 527 EAGLE STREET 0 P. O. BOX 968 January 19, 1971 Mr. John Niesen 7524 Zurich Anchorage, Alaska 99!;02 SUBJECT: Permit and Application for Sewage Disposal System, Lot 18, Block 2, Zodiak iqanor Dear ~lr. Niesen: August 1.4, 1969, you obtained a permit front this Department for the installation of a sewage disposal system. As of this date, the permit is still outstanding. Please advise this Department if you have installed, or still intend to install, a sewer STstem on tile subject property and wish your permit kept pending in our files. Sincere ly, ~ynn '~. Coa¢ Sanitarian rn AIR MAIL TO ALASKA IS FASTER