HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 4 LT 11 & 12
MUNICIPALITY OF ANCHORAGE
[)EPARTMI=NT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SFWER AND WATER FACILITY
264-4720
1. GENERAL INFORMATION
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
~/~3~7~
(b) Applicant Name ~4/~G Telephone: Home
Applicant Address
(c) Applicant is (check one): Lending Institution ~; Owner/~r ~; Buyer []; Other ~ (explain);
(d) Lending Institutio~ Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(t)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family,S, Multi-Family
Number oF Bedrooms
Other
WATER SUPPLY
Individual Well,.'L~ Community [] Public []
Note: IF community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality end status.
4. SEWAGE DISPOSAL
Onsite [] Public'J~. Community [] Holding Tank []
Note: It community well system, musi have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/8,1)
ENGINEERING FIRM PROVIDING INSPECTIONS, TI"STS, 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 tile information obtaioed
from tire Municipality of Anchorage files and from my investigation and inspection, tile 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 Firrn _~/~'/'~/~,~//./~ ~(..,.,.,~ ,.EL--'7lt.r, JO Telephone ~-7~ - ~ 770
Engineer's Seal
DHEP APPROVAL
Approved for
Approved
bedroo ms by ~ .~ ~ ~-~--,--q~ ~'~;~ate _.,/'~/~%~'~-'/
Disapproved Conditional "'~ '-")
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Healtb Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a cedificate 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 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO~
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
DEPT. OF HFJ~,Lr~ &
ENVIRONNENTAL PROTECTION
1988
Legal Description: .~'-~ //F'~ ~¢L~'4~"~2~.,'~,C~,"~CL4¢'~
· _K :LJ:I V hL)
Well Classification
Well Log Present (Y/N) __At
Total Depth /'/~, ~ / Cased to
Static Water Level _./~' / ¢/
Casing Height Above Ground _1¢_ ,/
Electrical Wiring in Conduit (Y/N) __/t/
Separation Distances from Well:
To Septic/Holding Tank on Lot ~.5"
If A, B, C, D.E.C. Approved (Y/N)
Date Completed / ~'7 ~" Yield
Depth of Grouting _
Pump Set At /z/¢
__ Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot 11o'48.t,v.~.v¢~,; On Adjoining Lots
To Nearest Public Sewer Line /~l'_ To Nearest Public Sewer
Cleanout/Manhole _ /,~' _ To Nearest Sewer Service Line on Lot
Water Sample Collected by ~_E.~blZA - _["~¢~A~r4 ; Date
Water Sample Test Results
Comments /.dZ~/~_/..,'' .g',4~/¢,.".,¢~'~ ,6'~-' 7- /¢'//,-¢ L¢,'')/~) .///~ L ~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) _ _ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Size No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Po~d, Lak~ or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
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 Absorption 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
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)
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
Page 2 of 2
72-026 (11/84)
** Check Permitted Bedroom Rating Against HAA Request **
I certify that [ have checked, verified, or conformed to aJl M QA and
Signed (~ C'C.'c'NCf~ Date
Company (¢~//'~?"¢- ~& ~. MOA No.
Receipt No, ~ ~ ~ 5 ~ ~ :~.,?: ,,. ~%~
Date of Payment ~-~Q'~ ' ~ O~ ~
Amount: $ ~ /o0 ~.,,~"2,J,~.~..O-~
HAA guidelines in effect on the date of this inspection.
Engineer's Seal
M-W DRILLING INC.
P.O. BOX ~0'37EI
ANCHORAGE, ALASKA 99511
PHONE 344'0520
INVOICE N°.?. 1 6 1 2
MATERIALS AMOUNT
NAME
LEGAL DESCRIPTION
DESCRIPTION 01'" WORK
DATES
STATIC LEVEL
J~LOT SIZE
TOTAL MATERIALS
1 -
All charges sha// be paid in ful/ within ran
prior to dr/lling. The customer shall pay fi~-
pay may result h~ a lien against the property,
OUT
OTHER CHARGES
PAY THIS AMOUNT
SHEET NO. OF
CHECKED BY DATE
SCALE ,'. ~' ,'. z ~.,~/ C'¢~'¢'/
/_ ('III.;:WIf'AL & GizOLOGICAL LABORATORll'~S t~l' ALA$1(A, INC..
~~ Drinking Water A s s Report for Total Cohform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
o WA' E, SYS' EM ,."."
2'2~ PRIVA"i'E WATER SYSTEM
Name Phone No.
~/.-'" / /_t /77'/' '//1' t-.~
Mailing Address
State
City
Mo. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Cheek Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
'1 L/l'/,,',':.'"'//- :'"";" 1:';'
Time Collected
Collected By
.J
4 [ I
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
Satisfactory
E~] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delively mail.
Date Received -~ ~,~- ~9
Time Received /'? ¢~'~
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result* Analyst
J I-%1
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter: Direct Count
Verification: LTB__
Final Membrane Filter Results ,L~./) ,~
TNTC = Too Numberous To Count
OB == Other Bacteria
BGB_
CoilformllOOml
Coiilormll00ml
T,mo:_ t d':/~ ..m.
MUNICIPALITY OF ANCHORAGv
H~ .th and ]Environmental Pret~ aion
Fourth Floor West
825 L Street
Anchorage, Alaska 99!501
264-4720
.............. I-Ns-P-Ec'rlON REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~-~_~ ~LLS MAILING ADDRFSS~_5_~__._'~C~ . PHONE~'_~t'SS
SEPTIC TANK:
DISTANCE ~T
FROM WELL~L~ ---- MANUFAC1URER
NUMBER OF
MAFERIAL COMPARTMENTS Z
LIQUID DEPTH ~_]~'~____ LIQUID CAPACITY\~m GALLONS.
'FILE DRAIN FIELD:
~ ~ TOTAL LENGTH I
DISTANCE FReM WELL ~__ FOUNDATION \~_ _NEAREST LOl L NE ~) OF LINE
,~E~,: TO~ 0,~ ~,LE ~D ~:.'.,,S. ¢,~^D~ ~, ~ M^~.~,~L ~E~E^¥. ~,LE O_~:.__,N. ABOVE ~,LE '~ ,N.
SEEPAGE PIT:
Log Crib Rings
BUILDING FOUNDA'f ION
, DIAMETER
Crib Size:
NEARFST LOT [INE
OR WIDTH__--, LENGTH__, DEPTH
DIAMETER ...... DEPTH_____ DISTANCE FROM: WELL ,.
-IOT^L EFFECTIVE
ABS()RPTION AREA (WALL AREA) .SQ. FT.
Well ~t~
Class :\1~ ]Depth: _
Well Distance To: Lot Line __ i
Bldg: Sewer Line:
Pipe Materials: -I
~ of Bedrooms:
Installer: ~UC-~'% ~C~t~ ~D~t~ . .
L. 0 T z, ]. ,: .1:
....... I.L.. FIE c: "F?Iz, 'l'/i Z I",1 '" z z
THE R:I!];K.III:;?.I!{[:' !~;IZIE OF THE c ' . .: _ I....N I:E;:
'l'l"ll]]i: LE:NEirH [:,IMEr.d~/,ION :1:'.:!~ THE: L. Ei'.,IG"D..I ,::II'.,I FEEE!:"I"::, OF' THE TRENC:H C)F'.
-Il.liE [;,IEI::"FH OF: I::l TFRE:NE:H Ot:R F']:T ]:S l-HE [:,ISTFINCE~ DE'H.,IEEEN THE ~;I..II:;?.F;'F~CE: C:lI:::' ']'I.1E
I]il:?.CIl..ll",l[:, FII",I[:' THE[ IBO'T'TOMOF THE IE',:'::CF:I",'[I:t:IT :[ ON (II",l I:;EE'f').
"J"HEI:;~:IE ][~ I",lO ~51E]' I.'.IIDTI"'I I:':'OI;?. 'f'I:;~:EI",E:I-I[{:~.
'l"Hi~: C~ilq:l::l"/'lEI.. [:'EF:'TF~ I~i TI'IE FI ][ hl ]. f'IUM DEPTH OF (]iI:;?.I:Tv'EL.. E',E"II.'.IEEN THE OUTFFILI.
F:II",I[) THE E:OT'I"OM OF 'T'I-IE E]',:'::CF:I"/F~-I'ZOI",I (II",J IZlEET).
........................................................... E::::" ~::::~ EZ:: ~':C F~ CE~ IE F" L. F~ ~".~ '11- EZ" F:* -'IF' ][ CE" ~'"',,H .................................................
f:~ F:'FIC:I'::ZF:P]~iEE IZ'l..l:~t",l'l Mf:l"r' E:E] ]CF,I:E;TFILL,~EC' FIT '['I'I[E I::'f{RFI;['T'I"EE'"~; OP'I
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2. FI CONT I j'.~lJ([dJ~]; f"ll:;~ I NTE]'qFINCE F:IGREEMENT ]; ~:; ~:EQI..I ]: RJED. Z[ F' J:::l MR ~ NI'ENF~F,ICE;
F/GF?.EEMEN'T I:E; NOT I'::;EF'T CI.]I:;;:RIEhFt' "r'lZ]lU I'lf:J'a" EJlE I;~:E)]:~I..III~:IED -I'O LENL.F:Ifi?.GIE '{'J-lJ~; :E;OII
I:IE:~};OI:?.PTION ~:;"J"::~;TEM FII'.4[:M"IZ)J:;;: '¢OLI I"JF:l'-r'
DF:KZ:I'::]:::IL.I_II"4C~i OF f::IN"r' _:,' .:.IL.II I.'.IITHOUT F];NI:::I[ .... hlz, l:l::.~..I I..I,I FIN[:'
.,UE,.2b.L.I TO I:;'f;"Z'::;E-'
DIEI::'F:II:;i:"f'MEI',IT HII_.L E',E
i¥1]:i',lZf"lUH DIS-I'f::INC:E; IBIETI.,.IEEI',I I:::l HE;LL.. FIND FtN"r' ON-si-rE '.E.;E].,.IfqGE
:t. E1Ei F;:IEET F-'OI:?. IZl F'Ii;:I',/I::F['['-''] HIELL.. OF:: ;]r'_'OEI F:'E£E:71' FC)R !::t F:'LJE:L ]; C: NIEL. L..
ErT'HEI:;?. F;i:E(;!I..I I I:REP1EI'.,IT':2; MFI"r' I::IPI::'L"r'. L:];PEC ~ F I CI::IT I Ol',l'J~; I::11",tl) C:ON':'~;TRL.IC:T
I::I'v'F:I];LI::II~LEi; TO ][N':'~;UI:;?.E F'I::;'.OP[EI;?.
I CIEI:;".TIF:"r' -I'HI::Y['
:[.: [ 1::'11'4 FFIH:i:L.]:F'fi:R !-,.I;['l-I'"i THE I:;?.EI;!U]]:;;]E]"IEhlT% FOR OI"4'-S]~TE !SEHE:F?.:':; FIN[:' 14E[..L.:5 FI:E; '_'ii;E'r
FOI';i:TI-~ E','./ 'f'lqlE I'qL.II'.,JICIF'I.RL_ZT'T' Ell::'
2:.:: ]; H;[L.L.. ];N~;TI:::IL.L THE :ii;"r'%"lEH IIq FICCOFi:E)FIhE:E I,.I];'l"l~l THE E:O[:,E:'.:~;.
;!i:: I IJI'.,IDE~J'~'.~;'FFIN[) TblFIT '['HE: C.d",I"*'.:~;]~'I'E
J;?.JE'J:/,IE)IEI'.,K;:IT. I:~; REHOE:,ELIED TO II",ICI_L.IDE; PIEffRE; 'f'HFIF,I
MUNICIRAL[TY OF ANCHORAGE
Departm z of Health and Environmental
Performed for
Legal Description
SOILS LOG
D~:RCOi.ATION TEST
78-4
Jatmes Mills ~ate Perfomned
Lot 12, Block 4, ZodJak Manor Subdivision
2/23/78
o
Z
4
6
8
IO
12
14
16
0 - 1.5' - Frozen, silty,
250 ft.2/bdrm.
1.5- 2 .~-'Organ~lcs
sandy gravel fill (GM)
2 - 3.5' - Red-brown, gravelly silt (ML-GM)
275 ft.2/bdrm.
Perc tested from 5 to 8 feet, located 40' E
and 20' S of NW corner, lot ].2.
3.5-16.0'
- Gray-browll, silty gravel with some
sand (GM) and cobbles to 8 'inches
250 ft. 2/bdrm.
Total Deptb - 16 feet
NO Water Table Encounter.d
AVEI~AGE ABSORPTION AREA FROM SOILS LOG - 252 ft. 2/bdrm.
Date
2_/23/78
Net Time
0 min.
30 min.
Net Drop
0 in.
3.25 in.
Perc }{ate
9.2 min./in.
30 mill. 2.75 in. ].0.9 min./in.
30 min. 2.00 in. ].5.0 min./in.
30 min. ]..50 in. 20.0 min./in.
30 min. ]..40 Jrt. 22.0~i~-~'7~.
Percolation Rate 22 minute s/in.
February 1, 1978
8541 So,tar Drivo
Ancho:.~a¢3~, Alaska 99502
Siibj~ct'~ i,o~: ll and 12 Blook 4 Zodiak Manor S~bdivision
Th~ s~w~r syst~,~ on the ~jeot property fail~d to pas~
the adequacy tc~st tha~. was perfom~.ed.
?h~refore, befor(~ w~ ~ill approve the request for approval
~;e will requir~ an upgrade of the existing sys%:~m.
Speoifications for tbs upgrad~ can not be det~rmin~d until
a soil tast has been performed. Ono(~ we have the soil
t,<,s% r~sults we can desi~% a system. A permit must be
obtaine~[ prior to any construution.
T~3mpora~y approval may b~ granted if monies ar~ osorow~d
to cover the cost of the u[~rade and any pumping c~ost
that may be incunr(~d. '~he upgrade mu.~t be co~%pleted by
Jun~ 1, 1978.
if there are any further qu~sstions, pleas~ contaot this
offio~ at 264--4720.
Sincerely,
Robert C.. Pratt,
sanitar'~.an
99503
/~'-,~,~X ~IUNICIPALITY OF ANCHORAC
,~.~.~.~X~ DEPARTM~ OF HEALTH AND ENVIRONME[~ PROTECTION
/ Date Received: ~anuary 24, 1978
~1: Time .~q~ 42: Time ~C', ~ ~3: Time ~C>'. ~ __
Date /-~ Date ~ ~ ~-~ ~ ~. Date ~ - A~'%~ ,,~
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Jack White Company % Jon C. Dawson
Mailing Address: 3201 C Street 99503 Phone: 277-1553
Property Owner: James C./Diane W. Mills
Mailing Address: 8541 Solar Drive 99502
Phone: 344-7135
Deocrmpt~on. Lot 11 and 12 Block 4 Zodiak Manor Subdivision
3. Legal ,~ ' -' ·
Single Family Residence: (x)
Multiple Family Residence: (
Number (Df Bedrooms: Three
Number of Bedrooms:
Well System:
Permit
Construction
Individual well (x) Co]nmunz~y/Public System ( )
Depth of Well 145' Well Log on File
Bacterial Analysis
6. Sewage Disposal System: On-site System (x) Public Utility ( )
Permit ~ Installed
Septic Tank Size _~-~OO
1967 Installer
Man~u~a~ct ur er
Absorption Area Soils Rate
Material
Distances: Well ~o Septic Tank
~o Sewer LJ_ne Nearest Lot line
to NearesL Lot Line
to Absorption Area
Absorption
Area
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
;82.~"L" St. Anchorage, Alaska 99501 (4th Fl) 279-2511
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA
2. Property Owner: JAmes C, And DiAne W, MZlls
FHA CONV
Mailing Address:
Name of Buyer:
854.1
99507
Solar Dr., Anchorage, AK Day Phone 34~"7135 (276-2.363
Mailing Address:
4, Name of Lending Institution:
Mailing Address: Phone
5. Name of Realtor or Agent: Jori ~, ])aw,~On~ Jack White Corapany
3201 "C' S~o, Anchorage~ AK 995pOh3one
Mailing Address:
Day Phone
277-155~
Legal Description: _Z~ 11 & 12, B].ock 4, Zodiak Manor Subdiv~_sion
Location: ,qSA1 ,~r~?~r Drive.. Anchora?~e. Alaska 9950~'
7. Type of Facility to be inspected: Gi;og'l,~ f'~m~y w~?,~r~nn~ No. 13drms. 3 -
8. Water Supply
Type of Supply: Public Utility Individual
EQ.037 (1/74)
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System:
If Individual, date of installation
145
Public Utility
1967
Individual (on-site)
Page Two
Deparhment ef Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 11 and 12 Block 4 Zodiak Manor Subdivision
Cor~Rent s:
Af fadav:Lt Attached
Letter Attached: ( )
Department
Worksheet:
o ~ ~o~,~ ~omo ao~ --O]OIAOUd ]9V~]AO0 ]ONVH~SN{ OH
IOoo
4. Loca'bion: ..~_~/z~ ~/~m/~z' ~ '
5. Type of facility to be inspected .......
6. Well Data:
A. Type ~~
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection _~'
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
Approval requested by: ~.~' " '
Property Owner: ~' ~ ~' ~ '
B. Depth
No. of bedrooms
C. 6onstruction ~,,~l D. Bacterial Analysis
Sewage Disposal System://~'.)
A. Installed /¢~ B. Installer
C. Septic Tank: ~1. Size /~ 2. Manufacturer
D. Seepage Pit: sorption Area 2. Material
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank ., Absorption area
, Sewer Lines
Nearest lot line
Other contamination
B. Foundation to septic tank
C. Absorption area t~ nearest lot line
, Absorption area
EQ-034 (1/74) Page 1 of two pages
Comments
App~,e~d' ~~) Disapproved Date
~ , Appr~ Valid for one year fro~n~da~e s~'ne~t ~,~ ~:,.~,,.
Greater Anchorage Area Borough, Departme~ ,E!nv~i~'o'~m~flt~"l ~Qu~litY
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true'~nd
accurate representation of the subject sewer and water facilities and these facilities
are opera ti ng? ~c to~l y,~/~
SIGNED - ..~/~.._~/a.~-~ Date d~-~ ~/- ?~ _
EQ-034 (1/74)
