HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 4 LT 9 MUNICIPALITY OF ANCHORAGE h and Environmental Prote [on Fourth Floor West 825 iL Street Anchorage, Alaska 99501 279-2511, x 224, 225 INS~,~ECT!ON REPORT ON-SIT~,SEWA©E DISPOSAL SYSTEM SEPTIC 'TAidA 1¢1, NUMBER OF I'AAP.~Ui /,CIURER ,,~. ~,.~t~_~ _ _ _ MAll:RIAL .......... COMPARTMENTS___"~__ It'~SIDE LEfI(iTII __ INSI[)E WID!H .... LIQUI[) DEPTH ..... LIOUIO CAPACIFY /~_GALLONS. TILE DRAIN FIELD: /) ~/'~¢ TOTAL LENGTH DISIANCF I ROM WELl_ _FOUPli)ATION ........ NEARESI Lei LINE ....... OF LINE ~l: of Lines DISTANCE BE1 WEEN LINES ......... TRENCH WIOTII_~[ IN. TOTAE EFFECTIVE (3Epl~l: 'IOF ()1 IHt L lO I. INISII GRAI)E .... IvlAtEfMAL RENEATII TI[ E ~ ~ ABOVE T LE ~/ IN SEEPAGE PI'F; Well Class: Depth: Well Distance To: Lot Line Bldg: Sewg[ L,~ne: Pipe Materials: Q~- t~ of Bedrooms: Installer: Remarks: - Log Crib Rings_ Crib Size: DtAME'I [_ii _DI-PI It .__ DISTANCE FI)OM: WELL TOT/U_ Il PECTIVE BtJILIOIIN, i [ OUi.~DA'! ION .. , NEAREST LO F LINE .... A[~SORPTION ARFA (WALL ARFA) .SO. FT, '7 -' ?:~ '- 7 n Jog o:[ maberiala 0 9' topsoil io ii Sr. svel 12 15 boulder 16 22 sand 25 zl-5 ~1.6 60 clay 6i 26 ciay,~broken , / 2:} small sravel '79 8z~ bootleggers claF 85I~9 clay,broken rock II0 II5 gravel ~ sand 116 14.0 saad IZl.i IZl-2 shale l[}~ I}~. {{ravel~black sand 151 lees of 6" black casl. n{~ SSa'bio water:level i2} feet Plow:5 sallons pop compleSed ]}lock 4- lo~3 9 Comet C~ Zodiac Rasor 11:30 a.m. 9at:e 12-16-77 Pr iday DaLe 1 ri r p Buchholz nap '1 lisp R]~(~(JES'F i"OR APPROVI\I 0].' JNI')ZViI)UAL S]~Wi']R AND WATNR P:AC."L.['~.I [itS'' ],end MailJ. nq Inst:ituu:LOn ]%oquesc: Leonard Realty, Beth Holland Addrc s s: 530 East 4th Avenue Phone: 344-6150 2. PFO!-nrty Ownor: Dick Wright Phorie: 344-4214 Mai.lit9 Addre:-;s: I,oqal D~scripu:~on: Lot 9 Block 4 Zodiak Manor Subdivision olnq].e 5 ami] y Rn,<.;Jdence: (x) Ntlraber off Bedr:)oms: Hu] Lqp]e ~:un]_ly Res: ~tonce: ( ) Number of Bedrooms: 5. Well. System: Individual We].t (X) ConmmnJ.'hy/Public Svstcra Wc, l,]. L:O Sopti. c Tank ~o Absorp:'lot~ Area uo Nearea t Lot L.IlI¢. Absor~ 'hion Area Page %'wo Departmenn of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 9 Block 4 Zodiak Manor Subdivision Conunent s: Disapproved: Date: Department Werksheet: MUNICIPALITY OF ANCI'IORAG[ . Department of Health and EnwLronmental ProtectJo~ uest for Approval of Individual Sewer and Water l.'ac~ditSes Property Owner: Mailing Address: Mailing Address: Phone: Mailing Address: o Rea~ tor/Agent: ~__~/~ m~ _~_/~ MaiL[ J_ng Address: __ _~_)~ Legal Description: Street Location: Single Family Residence: Multiple Family Residence: (~'~' Number of Bedrooms: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well (-'"'[' Public/Conm~unJty System ( ) ? If Individual Well, well depth If Co~nunity System, name of system Sewage Disposal System: *~Dn-si. te System (w~ Public System ( ) If On-site System, date of installation: *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 befo~e plloeessJnq can bo initiahed. 3/77 06-1220(a) Rev. 1933 DATE AL/ ~ DEPARTMENT OF HEALTH AND SOCIAL S ICES ::' DIVISION OF PUBLIC HEALTH Lab No. INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS - OE.CE INDIVIDUAL [] NAME SEMI-PUBI. IC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY DATE COLLBCTED ~' i~iJ" ' i! i -- TIME COLLECTED ~ [] Well - [] Dug [] DrJver& [] Drilled [] Bored SOURCE: [] Spring E] Cistern [] Other__ LOCATION: E~ln Yard [] Other ___ MATERIAL~ Buildlng Sewer- [] Cast Iron [] Wood [] Tile [] Fibre [~ Asbeslos GENERAL: Does Water Become Muddy or Discolored? [] Yes [] No PURPOSE OF EXAMINATION: Illness Suspecled? O Yes [] No READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE · ~naJysis shows this Water SAMPLE to be: [] SatisFactory [] Unsatisfactory ~] Questionable E] Sample ioo long in transU; sample should nol be over 4B hours old at examinal~on to indicate reliable results. Please send new sample. ~] Bollle broken Jn transit, please send new sample. SANITARIAN'S REMARKS 06.1220 (bi BACTERIOLOGICAL WATER ANALYSIS RECORD dose Broth 10cc 1Oct 10cc 10cc 10cc 1.0cc 1,0cc 24 Hours