HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 4 LT 29
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Ancl~orage, Alaska 9950'1 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
LEGAL DESCRIPTION
LOCATION
' We
.~ 2 Manufacturer
I ~'t&> ,(~; ] IF HOMEMADE:
OISTANCETO:
~ IMan~ Manufacturer
ISTANCE TO:
~ ..... Length Width
~ D Type of cri~--
~ DISTANCE TO: Well
Absorption area
Dwelling
£"ffe I
Inside length Width
Dwelling
Total length of lines
Material beneath tile
Depth
Material
Nearest lot li~.)
~4,JEGRADE
NO. OF BEDROOMS
PERMIT NO. ~:
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines
Total effective absorpdon~area
~%'z /-7
PERMIT NO.
Crih depth Total effective absorption area
Building foundation Nearest lot line
Driller Distance to lot line PERMIT NO.
Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
/5,cbe. I IO6
/0o4-
APPROVED
72-013 (Rev. 3/78)
DATE LEGAL J
QGRE
ER ANCHORAGE AREA B0[ JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION RI:PORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME Z~)/~)/t)C~-/~ '° /-~/q~/O~ZZ~ MAILING ADDRESS
/
LOCATION i~/U/~ ~/~/C~'L"-~' _ LEGAL DESCRIPTION__
SEPTIC TANK:
DISTANCE
FROM WELL/~)OI~'~_ MANUFACTURER ~,~¥/L~Q/¥ MATERIAL
INSIDE LENGTN INSIDE WIDTH LIQUID DEPTH
NUMBER OF
~ ~/t~ __ COMPARTMENTS
LIQUID CAPACITY. /~(~ C) GALLONS.
SEEPAGE PIT:
NUMBER OF PITS__ / DIAMETER OR WIDTH ~'~ LENGTH~/~, DEPTH
LINING MATERIAL<_~'~='~O*L . CRIB SIZE: DIAMETER ~¢~ DEPTH ~' DISTANCE FROM: WELL /~Or~.
BUILDING FOUNDATION ~ NEAREST LOT LINE~-Ot~ /~o~lJ TOTAL EFFECTIVE
, ABSORPTION AREA (WALL AREA) c~~/2- SQ. FI.
WELL:/L2~) 7' /~d -
TYPE CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION _, LOT LINE SEWER LINE
CESSPOOL _, OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE.
TANK SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL.:
LOT SLOPE: /~-'/~)--
Form NO, EQ-031
DIAGRAM OF SYSTEM
APPROVED
! /
G.A.A.B./
264.'.4'720
DA'HE] ISSUE'D~ - =~ !' 4/8',:'5
AI:r:'F:'L. I C A N"I' ::
I/) )! d ........
CONTA[D" F'I IONI!il:
BII.L¥ (3,, AIxlDRI!i:WS;
iiiI'7:56
/M',I(]t IORAE"}E: ~ Al':::
2 76-4ZlZ[ :]
[._OT ,::t .I.. k. ',~
MA),' BEDRO[IME~ ~
SLH)D I V ]: S :1: (])lxl: ,.(Il) .t. A(, MA.I',Ii IF;' I..L) I . .;:..'"'°,
SI~:CT '[ ON: :l () 'I"OWIxlSH I t:::' ',~ .I ,=.,',1 I,.AI,t(AI ........ :,1,~
'I 't i ...... (,:4., F']'. (]I::R ACI::~'[!!:S )
zl.
1[ }1 . l .,, I [I L, II , ~!D', lEE ]E:],
DI!!:I:::']'I't 'fl:] F :l:l"li": :00'I'-f'OM (F:T.) Zl. () 4.0 q. 0
GRAVE]_ DEEF'TIt (I:::-T'.) 6." (). 5 3. ,J
TOTAL )])E!]::"HI ( .... ) :f.O. C) Zl. 5 '7 5
['3I::U~VI[]]. WIDTH (F:T,,) ,:~.."". '::',. E?4 . (') ,:. C:,.
E;RAVI~[.. L.E~]q(}]'I'H (F::"['.) 59,,0 ~,;:~ (') 7'7
I"ANK S]:ZE: (GALS) I. 250. () .~"~; 1~ 250.0 '~'E~ !, 2'.50.0
S 0 ]: L. R A T ]: N G ( S (7;~ .. I::: T ,, / ~3 R ) :[ 77 .l 'x, -, :t '77'
:!7 c:ev't.i ~y
:!,, t am fam:i.] iai' ~,,~:i.'kti 'k.l-~:~ veqt.l:i.r'i.;:miert{:.!i; ~'C)l' Oll-'!i;:i.L.~::! !:;(.:!w(.:.~i'!i and
fc:)r'k.h by 'k. lm. Mun:i.c:ipal:i.!:.y ¢::)I' (~cl'u:)pago (tvlOA) and 4'_I~ S't_a'k¢::; c:)f' Alaska.
2. I w:iJ1 :in~La].]. 'k.l'..~ '.uiys'k~..~m i.n acc:c.'dancu wi'L.h ali HOA cc:)de::~s
and :ia cc)mp].:i, anc¢:~ ~,o:i.'t'.l'l I:lm~ dc:s:ign ,::p:i. 4:c.~l':Ja ,::){' tl-~:is i::v¢~vmi'f:.:,,
3. I t,~:i.]l adh~'2pt...~ Lo al] MOA ,'.t~::l StatC7~ of AJI. a~d.::a pequ:i, Pc. nen('.s fen' 'i',I~c~ sc:l:, back
t:l :i.s'kar~cE's [' v (::)m a~P/ ~.~x :i. s'k i n(~ ~/,~ :1. ] ~, t,,~as'l'.~e,/~ak.,~n' d :i, ~;l::~o.~;a ]. ~;yskem
4.. 1: L.UldC~r'E;'!'.Z:U'W:I 'rheA' 't'lqis I~(::)l'~/iJ(:, :i.?;i valid fc:)v &t max:imum of 4 l:)odvoc)ms .and
any en).apgum,:::~trt': ~qi]l i~E)qu:[P~y2 &hi a-~cl(::lJ.'l',:i.c:)r~a],
1]I:::' A Ir.:$:F']' S'I'/YI"JI:OIq ]:S :[Ns'r(~l.m...m~:D :I:N AN AREUt COVE]ZRI~ED BY ["IOA BUILDING CODE:S,
TI IEIxt (1) AN ELLI~ZE:'I'I:r¢ ICAI. F:'E~:RM I T AND ):I~SI::'I~:C'i":I;ON MUST BE (]BT~IlxlE:D~I (2) ASr"BUII..TS
NIL. L N(3T BIE AF::'F:'ROVED I, qiTItOUT AN E].J:~CTF~ICAL :IZIxEff::'I~:C'I'I[JN F:~EFq]RT':; AND (3) ]'HE:
lEI I?.CTRIC&I.. N{::)I::~I::: MIE;T BE: DONE BY A I..ICE:NSE[D
....
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
PERMIT NO,
SEWAGE DISPOSAL SYSTEM -- APPLICATION At,ID PERMIT
INSTALLATION LOCATION
SOIL TEST RESULTS .
TO BE INSTALLED BY
TI41~ PERMIT IS NOT VALIt} WITHOUT SOIL
FOUNDATION TO SEEPAGE Pit ~0 , DRAIN FIELD --
SEPTIC TANK TO SEEPAGE PIT WALL / ~'
GRAVEL BAE:K I~1 LL
CONFORM TO BOROUGH REGULATIONS REGAROING INSTALLATION.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HFALTH AND ENVIRONMENTAL PROTECTION
~325 L. Street, Anchoraoo, Alaska 99!301 2G4-4720
SOILS LOG - PFRCOLATION TEST
,~! SOILS LOG
Cbc" PERCOLATION
TEST
LEGAL DESCRIPTION:
1
3
Lot'
fl',j h F
5-
6-
7-
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
SITE PLAN
C)
d
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
PERFORMED BY:
Reading [)ate
Time Drop
iZ.y'L . ~
Net Depth to
Time Water
t;. '
TEST RUN BETWEEN ~ ..... FT AND '~¢'--~--- FT
72-008 (6/79)
"On~ test is worth a thousand opinions"
Legal ~escrio'tion: "L'O't ~C~Block.~_Subdivision
This Form Reports Soils Loq____kld~t~
~enth
Feet Soil Characteristics
Was Ground Water Encountered?_/{./~)
IF Yes, At what Depth?
Percolation Test
Readinq Date Gross Time Net Time Depth to H20 Net Drop
Percolation Rate !linute
Proposed Installation: Seenaee Pit Drain Field
Depth of Inlet Depth To Bottom Of.2it Or Trench
_ te o_~,",_~/',,~ X. ~ ~o~, "75 Y~, ~ ./~ ~
ALASKA lldlROF/melqTAL COI TROL SE!RuICeS, IllC.
Cnqincerinq $ ~uironmenlal $1udies
2/21/85
BILLY ANDREWS
8736 PLUTO
ANCHORAGE Al( 99507
SELLER - BILLY ANDREWS BUYER ~-
SUBDIVISION - ZODIAK MANOR BLOCK -- 4 LOT - 29
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS~fCRIB-~ITH AN AREA OF 512 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 120 ~ALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM~8-~%'~GALLONS.
THE SYSTEM IS UNACCEPTABLE BECAUSE THE SURGE CAPACITY IS LESS THAN
75 GALLONS·
TIlE SYSTEM IS NOT CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY.
A FLOW TEST WAS PREFORMED ON THE WELL. 596 GALLONS OF WATER WAS
PUMPED AT A RATE OF 4 GPM OVER A DURATION OF 2,5 HOURS.
THE DRAWDOWN WAS 7.4' WITH A RECOVERY TIME OF 40 MINUTES
AND THE STATIC WATER LEVEL WAS 75.4 FEET.
THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 GALLONS IS INADEQUATE BY
250 GALLONS FOR THIS ItOUSE OF 4 BEDROOMS.
1200 ~Jcsl 33rd Aucnue, Suite B. Anchort~§¢, Al,~sk,~ 99503 ,(907) 561-5040
Use of
Location (address of: Township, Range, fi Section (if known); distance from road:
Size of Cas,ng_~_{,eptn. of Hole/~qfeet. ~to~. _/..~q -... ...... ..~feet.
Static water level_/~ 3eet (above) (be~) l~d s=face. F,n,sh of ~11
(check one) Open end ~: Screen ( ): Perforated ( ).
Describe screen or pe~f,~ations: ,
Wel! pu~ng test at--gallon's per (hr)
.... ~_) feet Of drawdown from static level'.
4
___~epth in feet from
ground surface
Clive details of formations penetrated,
color, and hardness.
hours with
size of material,
AS_ to -/~ . _
~0
tO
tO
to
NOi,LD] J,gi~ ~¥J.N~WNO~JIANB
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF [{EALTlt AND ENVIRONMENTAL PROTECTION
APPLICATION FOR t'H~]ALTH AUTHORITY APPROVAl, CERTIFICATE
1o General Informatiou
Application Date
(a)
Legal Desc:iption (include lot, block~ subdivision,,, section, township, range)
~,'[ .?-.9 ?~./f ,~ ' ~ '~ ~_ //~-/-, ~.~, ~',, 5Z~. /0
Location (address or directions).
(b) Applicants Name D,Lz-? /]~,o,),~:/.J.5
Telephone =' Home
Business
Applicants Address
(d) Lending Institution Tele_ph~o.n_:e
Address
(e) Real Estate Co, & Agent
Address
Telephone
(f) Mail the HAA to the following address:
Single-Family L~:~.-~ ~ [
Number of Bedrooms
Other describe)
ommunity [ZZ[ Pu li¢ -
Note: If community well system, must have written confi]~aation from the. State
Department of Environmental Conservation attesting to the legality and status°
Onsite F.'--~ ~ Public
Not. e: If community well system, must have written cortfirmation from the State
Department of Environmental Conse~zation attesting to the legality and status.
[Page 1 of 2]
Engineering Firm Providin~g~fj~.!p~e3ti~igs_n.o~%_'~.sJ:_~ I,'il~: Search, Data and In~'~,,~. [~,.
As certified by my seal affixed hereto and as of the w~lidation date shows below~ 1
verify that my investigation of this Health Authority Approval shows ~hat. the on~,Oi~o
water supply and/or wastewater disposal system im ~afe, functiongl and adequate ~Or
the number of bedrooms and type of structure indicated herein~ I further verify that,
based on the information obtained from the ~nicipality of Anchorage files aad f~om my
investigation and inspection~ the sa-site water supply and/or wastewater disposal
system is in compliance with all M~nicipal aad State codes, ordinances, and regula-
tions in effect on the date of this inspection~
Name of Firm /~,~. Z~J ~hi~,J,'~'>~'~. f~u/'7~'z3z'~,~ ,/.~/<~, Te].ephone .:~'~/-~,c~
D~H_EP A~pproval
Approved for
Approved
bedrooms
Disapproved
Terms of Conditional Approval
(ENGINEER SEAL)
Conditional
CAUTION
TNE t~INICIPALITY OF ANCHORAGE DEPARTbIENT OF HEALTH AND ENVIRONb~NTAL PROTECTION
(DHEP) iSSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOIgLY UPON THE REPRESENT''
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER i~'GISTERED
IN TPU~ 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 REQUIRE''
MENTS0 ~MPLOYEES OF DHEP DO MOT CONDUCT INSPECTIONS OR ANAI, YZE DATA BEFORE A
CERTIFICATE IS ISSL~D. THE MUNICIPALITY OF ANCIIORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAl, ENGINEER'S WORK°
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7~.19~84
A. WELL DATA
Well ClassJfication _~R~4~ffE
Well Log I%.~esent (_(Y~N)
Total Depth /~/~t Cased to.
Static Water Level )3Z~
MUNICIPALITY. OF ANCHORAGE (MOA)
CHECKLIST - FEBRUARY 1984
Legal De s c r.zp t z q.n..,.~L~
,)ate Cc~let-ed
Casing Height Above G]:ound t~'
Electlzical Wi~ing ~n Conduit ~Y~. )
Sepa~ation Distances f~om ~].1:
To Septic/Holding Tar~¢ on Lot .~ fl~
TO Nearest Edge of Absorption Field on Lot_2
Depth of G~outi~g
Sanitary Seal on Casing
Depression a~ound Wellhead (~>
; On Adjoining Lots 100/~ .....
; On Adjoining Ixots_ .lOo'q- . _
To Neap. est Public Sewe~ Line ~/~ To Nearest Pub].ic Sewe~
Cleancut/Manhole ~!l~ To Nearest Sewez: Service Line on Lot _~ .-
Wate~ Sample Collected By ~. ~1~"- ~65 ; Dat~__
Wate~ Sample ~%st Results
o 'r
SE]~IC~O[DING T~ ~TA
~te Installed J-Zz-fm~ Si~ ~ ~4Z.~ No. of C~p~nts _. /
Sta~i~s ~) Aid%tight Caps ~) FouM~tion Clea~o~t
~ession o~ Ta~ (Y~'' ~te ~st P~d.
P~i.~g~inteMan~ Con~a~ on File (Y~)~/~._; fo~. ~/~
Holding Ta~ High-Wate~ Ala~ (Y~) ~/~ . ~ra~y Holdi~ Tank ~r~t (Y~) ~/~..~
Sep~ation Distan~s ~ ~ptic~olding Tank:
To Water-Supply ~11 )F l}j~z To ~ilding Foundation
To ~o~rty Li~ .~ ~ To Dis~sal Field
To ~ter ~in/Se~vi~ Li~ _ ~/~ To S~e~, ~nd, ~e, ~ ~jor ~aina~
Date Paid:
~oun ~:
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 3-Z~-F~,
Width of Field
Square Feet of Absorption A~ea
Depression over Field (Y~
~'/
Length of Field 71
Depth of Field , II,.~!
Gravel Bed Thickness
~/ , Standpipes P~esent ~N),
Date of Last Adsquacy Test~'~/
Type of System Design ~-~
Results of Last Adequacy Test
Separation Distan~ from Absorption Field:
To Wate~-SupDly Well ~ I~; To ~o~ty Li~
To Building Foun~tion ~ J~,5'' To Existing
; ~ ~joining ~ts ....
To Wate~ Main/~vi~ Line ~/~ To ~t~~e~nt) ~/~
To St~e~ond~ks/~ ~jo~ ~aina~ C~
To ~iveway, P~ki~ ~ea, ~ Vehicle St~a~ ~ea
D. LIFT STATION
D~ , Di~nsions
Size in Gallons~-~,~ / M~nhole/Aecess (Y/N)
".P~, On" Level at ~ ~ ~_Off" Level at.
H:~gh Wets= Alarm Level at ,~C...~ _~ --Vent (Y/N)
Tested.for ~ Cyele~ ~uacy Test. Meets MOA
Elect~t~al Codes(Y/N) ~
Comments _~'~_
** Check Permitted Bedroom Rating Agairlst HAA Bequest
I c~rtify that I h. ave. cheeks, d, verified, or ~onfoL~msd to all MOA HAA ~li,~d~%~Des in effect
on the date of ~s ~nspe~ion.
Signed ~- Date ~ ~F~ ~5~,~.,~.'~, ' ~ °.;~ I~ % ~'~ ~" '
KB1/dS/s · ·
2-15-84
TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED (3Y WATER SUPPLIER
WATER SYSTEM:
Water System Name
LO. NO.
Phone No.
S*MPLE DATE: PT;;t3
Mo. Dey Yeer
SAMPLE TYPE:
"~ Routine
I~ Check Sample (for routine sample
with lab ref. no,_
C] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATIOR
Collected Sy
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~ Satisfactory
[] 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 delivery mail.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
~\Membrane Filter
Lab ReL No. Result'
J
Analyst
06-1220 (b)
Rev. 1983
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Flitch Direct Count
Verification: LTB ___BGB
Filter Res~dts , ~
Final Membrane ~/i?~'~77~¢~'~~ ~,, ~.~:::~/~ ~
Repealed
Time:
TNTC= Too Numerous To Count
ColllormllOOml
ColtlormllOOml
TIME
DATE
INSPECTOR
'D,~ I~ RECEIVED
INSPECTION APPOINTMENTS
TIME TIME
DATE DA'rE
INSPECTOR I NSP ECT O,E[.
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPt. OF ~E/,LIH &
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten [10) davs for processing,
PROPERTY OWNER
_ ,~//!~/ ~.,
MAILING AD, OR ESS
PROPERTY RESIDENT I[f dlfferen/t from above)
2, BUYER
PHONE
IPHONE
PHONE
MAILING ADDRESS
3~ LENDING INSTITUTION
MAILING ADD~ESS
~:' REALTOR/AGENT
~AILING ADDRESS
PHONE
:27& -//
PHONE
5, LEGAL DESCRIPTION
STREET LOCATION
TYPE OF RESIDENCE NUMBER OF,BEDROOMS
E-I One I~ Four
~ SINGLE FAMILY [] Two [] Five
E] MULTIPLE FAMILY E~'" Three [] Six
WATER SUPPLY
[] Other
[~]~'* INDIVI DUAL" '~ ATTACH WELl.. LOG. A well log is reauired for all wells drilled
[] COMMUNITY since June 1975. For wells drilled grior to that date, give well
[] PUBLIC UTI LITY aepth (attach log if available.)
8, SEWAGE DISPOSAL SYSTEM
[~' INDIVIDUAL/ON-SITE*~ /? '7 ~ YEAR ON-SITE SYSTEM WAS INSTALLED,
[] PUBLIC UTILITY
NOTE: THE INSPEC'rlON FEE MUST ACCOMPANY FACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY "~ TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
~ INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED \.~_~/
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
~INDIVIDUAL/ON -SITE DATE iNSTALLED
[~PUBLIC UTILITY L[ -,5C'
Connection Verified
INSTALLER
~Septic Tank or [] Holding Tank
Size: I ('--.-~)() If Tank is homemade SOILS RATING
give dimensions: .-'~.~- (~7~
TYPE OF TANK
MANUFACTURE
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holding'Tank b, bs~rption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[~SAPPROVED
72 O10 (Rev, 6/79)
,CHEMICAL& G, LOGICAL LABORATORIES ~ ALASKA, INC.
TE'LEPHONE (907 -279-4014 ANCHORAGE INDUSTRIAL CENTER --
274-3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED SY WATER SUPPLIER
I.D. NO.
Mo, Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no. )
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
2 I
4 I
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~:-~atisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
~ew sample.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
E~ Membrane Filter
[.ab Ref. No. Result* Analyst
~
EEE~
EEE~
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (bi
Rev, 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected, Source
e
4.
5.
6.
GREATER ANCHORAGE AREA BOROUGH
13epartment of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Time of Inspection ___~_~
Date of Inspection
~ REQUEST FOR APPROVAL OF
/ INDIVIDUAL SEWER & WATER FACILITIES
z ~ ~FOR
//
' ' ~' ~¢~~--¢~~--__ Phone:
Ma~l~ng Address:
Property Owner: ~~~ __ . Phone:
Mailing Address:
Location:Legal Descripti°n; ~~~~~~z~~~.
Type of facility to be inspected ~~~. _. No. of bedrooms
Well Data:
C. Construction ~'/ ~f~dz~..o /6.~2 D. Bacterial Analysis
Sewage Disposal System:
A. Installed X.~2 ,'~
C. Septic 'rank:
B. Installer
D. Seepage Pit:
1. Size /Fg~)O d:]~,.__~____ 2. Menu. lecturer _~-~-~a~L ,~-
1. Absorption Area?~/?,~2 2. Material ~-
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank.~mm~ _, Absorption area //~
Nearest lot line _~ , Other contamination
B. Foundation to septic tank c~y , Absorption area
C. Absorption area to nearest lot line ~ F ~/
.__., Sewer Lines
EQ-034 (1/74) Page 1 of two pages
Page ~ ~ two pages - Re~, ~st for Approval of Individual ~ .er & Water Facilities
Comments
Approved ~ ,~m.g~.~_:: Disapproved Date
~)~ Approval Valid for one year from date signed
Gre~r~ef 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)
06-1220(a)
Rev. 1973
DATE
ALA' DEPARTMENT OF' HEALTH AND SOCIAL St ;ES
DIVISION OF PUBLIC UEALTH
INDIVIDUAL AND SEMI-PUBLiC
BACTERIOt. OGICAL WATER ANALYSIS
Lab No.
OFFICE
INDIVIDUAL[]
NAME
SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
ADDRESS
CITY
ADDRESS
OF SOURCE
ZIP CODE ___
Analysis shows this Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
[] C~ueslJonable
[] Sample too long in transit; sample should not be over 48
hours old at examination to indlcate reJJabb results. Please
send new s~mple.
[] Bottle broken in transit, please send new sample.
SANI'rARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER I$ AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
DATE COLLECTED .
Sampb Collaclecl Fram
[] Other (List)
TIME COLLECTED
[] Kitchen Tap [] Balhroom Tap E] Basemenl Tap
Well - (~ Dug [/1 Driven ~l Drilled [~] Bored
BOURCEJ [~ Spring [] Cistern [] Oilier
Dug WeB or Cistern Constructiom
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
06.1220 (bi BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1973
'
Lactose Broth 1Eec 10cc 10c¢ 10cc 10c¢ 1.0cc 1,0cc
24 Hours
48 Hours
ALASKA
FIUIBOrlm rlTAL COIgTROL
~nqineerinq & ~nuironmenml $lu~ies
11/25/81
BILLY ANDREWS
P.O. BOX 560
ANCHORAGE AK 99510
SELLER - BILLY ANDREWS
SUBDIVISION-ZODIAK MANOR
BLOCK- 4
BUYER-
LOT,-29
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 512 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 360 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 75 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
2 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON 11/13/81
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF
'~HIS 2 BEDROOM HOUSE.
1000 IS ADEQUATE FOR
1220 LUcs125lh Aucnu¢ · Anchoroq~, Alesko 99503 · (907) 276-1361
February 12, 1982
Billy G. Andrews
g736 Pluto
Anchorage, AK 99.507
Dear Mr. Andrews:
'l~h¢~ adequacy test perforrged on your sewer system reveals the
system is not functioning properly for a three bedroom resi-
dence, and an upgrade will be necessary.
Prior to the upgrade a soils test will be required so that a
permit may be issued with specifications.
If you have any questions, please call 254-4722 or 264-4720.
Sincerely,
Robert C,. Pratt
Associate Environmental Specialist
ReP/el
99507
Prior to approval of the system, an upq~ade w]].l be ne~tef{.
~'rior to the upr~rate~ a permit must be obtained from this
Th~ speeific, ations of the upqra~]e a~re as follows:
l) 25' of tronch with 6' qravgl backfill.
If there ar~? any qu~stions, please call this office at
~64-4720o
Robert C, Pratt
A.qsoc].at~ ~.nvironmental ,qpecialist
9, CP/cl
•
• Municipality of Anchorage a 9 1017 P,.`t
-4( On-Site Water&Wastewater Program �/ , cies
(907) 343-7904 / ;Y'''' S• c Y
tes DEC 21 2.017 �=
CERTIFICATE OF ON—SITE SYSTEMS .� •VAL �1
A
11 01 6 -
Parcel I.D. 015-011-42 Expiration Date: g -�"? �� 7
1. GENERAL INFORMATION
Complete legal description ZODIAK MANOR ALASKA; BLOCK 4, LOT 29
Location (site address) 8736 PLUTO DRIVE*ANCHORAGE,ALASKA 99507
Current Property owner(s) SCOTT WINNFIELD Day phone
Mailing address 8736 PLUTO DRIVE*ANCHORAGE,ALASKA 99507
Real Estate Agent STEPHANIE OLDENDORFF Day phone 229-6099
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual On-site 0
Individual Water Storage ❑ Individual Holding tank ❑
Community Class Well 0 Community On-site 0
Public Water System 0 Public Sewer
•
WaiverNariance request for. N/A Distance: -
•
Received by: ' Date: /�/ f 7
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee$ 5A(P Waiver Fee$
Date of Payment I � l Date of Payment
Receipt Number `i{Q cotc 7 Receipt Number
COSA# 05C1�(5 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE,AK,99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date i Z/Zl//.
Engineer's Comments:
In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system in accordance with the ok.111All\
guidelines and regulations established by the Municipality of Anchorage and industry practices.The reported results describe the 44....%. OF 1'44♦
condition of the system/s on the date's of the evaluation.Separation distances were measured to readily identifiable features. .�•f> ••• .♦.
Hidden defects or encroachments may exist that were not identified during the evaluation.The operational life of all wells and septic a r••.•••,••• .,k.....47.
L��ys •
systems depend on a variety of variables including,but not limited to,soil conditions,groundwater levels(that may fluctuate during
the year),quality of construction(materials and workmanship),and the water usage of the family utilizing the system's.These 47 i.
49r,1 I/\ "'
conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of the * •
system's;therefore,GEG makes no warranty(express or implied)regarding the future performance of the well or septic system. /A 0
GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the %1 r
)
current systems fail.The content of this report is for the sole benefit of the person/party who retained GEG.Reliance upon the • •• ° Gam(` ` =
information provided in this report by any other person or party,including but not limited to subsequent property purchasers,is not •i
o A. Gam I
authorized.In short,GEG disavows any legal duty to anyone other than the person/party who paid for this report. � tP� 795 _=
V1� •••,•142_ ;t i,
6. DSD SIGNATURE �1* H. �``• ►�'F ``r,
!.
#AECC884
Illi `'••
System#1 Approved for i bedrooms. _ Oj�J_SITE
System#2 Approved for bedrooms. WASTER ANvvAD m
Disapproved. 1'ROGi T�R �'
oo RAM o=
P •Conditional approval for ' bedrooms, with the following stipulations: �F
(Aja(ll`Or Gc,s S v,�'`�%( p:r (Al , As L c-i, a.. . -i�� ��
re vfruc L in 0....zjaar(vi,6
.. „-ec...crwlyv-42-a4 414,u..4 (Afokbt- c 0.412‘.
By: \ , '�" or Original Certificate Date: / � - 22 -1
The Municipality or Anchorage Develop,emt Services Division(DSD)issues Certificates of On-Site Systems Approval(COSA)based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other .
(Rav 1nr12r171
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: ZODIAK MANOR ALASKA; BLOCK 4, LOT 29 Parcel ID: 015-011-42
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 5-18-1974 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 164 ft. Cased to 164 ft. Casing height(above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 5-18-1974 12-12-2017
Static water level 132 ft. 115.7 ft.
Well production 12 g.p.m. 8.0+ g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd 12/11&13/17&APWS 12/18/17
Arsenic: 3.93 ug./L. Date of sample: 12/11,13418/2017
B. SEPTIC/HOLDING TANK DATA AWWU SEWER
Tank Type/Material Date installed
Tank size gal. Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N) - Depression over tank(Y/N) High water alar• /N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ftzor ft2/bd • System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorptio : ea -ft2 Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absor• field before test in. Water added gal. New depth in.
Elapsed Ti ••. min. Final fluid depth in. Absorption rate >= g.p.d.
A• ejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on"level at in. "Pump off"level at •• .• a er alarm level at in.
Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots 100'+
Absorption field on lot WA On adjacent lots 100'+
Public sewer main *39'(APPROX) Public sewer manhole/cleanout *50'(APPROX)
Sewer/septic service line `°25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIEL• e • OT TO:
Property line Buil.'•: •undation Water main
Water service line Surface water Driveway, parking/vehicle storage
Curain Wells on adjacent lots
F. COMMENTS
'SEE ATTACHED RECORD DRAWINGS FROM AWWU SHOWING THE WELL LOCATION,SEWER MAIN AND
MANHOLE LOCATIONS;ADDITIONALLY SEE ATTACHED SURVEY WITH APPROXIMATE SEWER MAIN LOCATION
SHOWN.ASSUMED WAIVERS WERE GRANTED BY ADEC TO AWWU(WELL SHOWN ON AWWU RECORD DRAWINGS)
"ASSUMED BASED UPON SEWER CLEANOUT LOCATION AND AWWU CONNECT CARD-SEE ATTACHED
G. ENGINEER'S CERTIFICATION •\0P�E OF 1'*1
•
I certify that I have determined through field inspections and • , 9 I• �-jc .'* •�•0
review of Municipal records that the above systems are in • •1•• ••' •
•
conformance with MOA COSA guidelines in effect on this •• ►• ••• •• • ••'�
•
date. ♦ = J:f - •. Games c w.
Engineer's Printed Name JEFFREY A.GARNESS •t5,•=., 'E-79531 **,_ ,
Date i 2 Z� 11�- .���f'�Cp*''••i2' 1- •P_c:
Date
LICENSE •%%„"*
#AECC884
(Rev.10/12/12)
_ Frontier Surveys,LLC Project No:17-382 Date:December 18th,2017
Scale Ordered By:Stephanie Olendorff PIat:65-92 Grid:N/A
\
t\
t\
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os
- \
\ LOT 28 1
m
1
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\ _ RETAIN.WALL_ _L---- C I
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\ 16442._ _ -- - \ �
N83'20' ---
•E
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• ..
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_•=�,33�F 174.31 O ^ 35,9 I
W I _• :r\
tl _= '
I t WELL. ---
1.00 ` RETAIN.WALL
: \--
J Zodiak Manor Alaska Subdivision
/ / Lot 29, Block 4
\ 13,920 sq.ft.+/- %
LOT 30 \ 8736 Pluto Drive
/
2 Story Wood Framed House /
w/Attached 2 Car Garage
Legend:
/
Q Electric Meter/Outside Power tT Telephone Pole El Concrete
n Gas Meter ii Deck -0- Fence -ar-Over Hanging Power 0 15 30 60
• Tel.Corn. (t^2i) Water Well ® Mailbox rie
ii.r. "' Feet
General Notes: r t
1.This document Is created for the purpose of a single property transaction and is subject to Federal Copyright Law.
2.Excepting for gross negligence,the liability for this survey shall not exceed the cost of preparing this survey.
3.All measurements/setbacks are to the visual/apparent building footprint. b
n.Dimensions to property lines are plus/minus 0.1ft.
This
PLS Mortgage
ation
s.The
represents
e
^-� `Q F 4�t 11111 conditions yat thcomplies
time of the survey.This document does constitute ayboundary surveyland improvements
sub subject to any
A q 11 Inaccuracies that a subsequent boundary survey may reveal.It is the responsibility of the Owner to determine
_",tQ'.•' ••.!r4. 11' the existence of any easements,covenants,or restrictions which do not appear on the record plat.Under no
4) .. '' '.9 ,� circumstances should this document be used for construction or for establishing a boundary or fence line.
s"*: 49TH�\ * i As-Buil Survey of:
Lot 29, Block 4,Zodiak Manor Alaska Subdivision
p • ntroePucw. ^ I,Frederic Wagner,hereby certify that this Mortgage Inspection Survey was performed by me,or
i, -,I, .0....s..9946 under my direct supervision on December 15th,2017.
i, � . 12/19/2017
_
111714611: -.•c 1• ;"`ONA.;���� er Surveys,LLC FRONTIER
650 W.58 h Ave.Suite E Anchorage,Alaska 99518
907.460.1686-info@frontiersurveys.com
PROFESSIONAL SEAL www.frontiersurveys.com
•
SUBOI'VI`,ION Ead/0 k Aln»a j - BLOCK- LCIT Z ( _
SIZE CONN /'�' 14 DOMESTIC., ONI Y 0 BOTH FIRE •. 00MESlc( SIZE CONN —,_.. .
3/41 CORP STOP !JN 1-.,,^pIrv,
3, ❑ FIRE LANE ONLY ❑ t-►RE HYDRANT ONLY
CUR? STOP C TO C TAPPING VALVE
50 IT r,OPPEP PIPE DATE OF TAP A, R4/ 86 r,v ea 4.7i/ Cra. f X x ' ti
/ 1/4 t••" ,7r 2 KEY BOX SIZE MAIN e" ❑ ALLEY X STREET 0 EASEMENT M i VALVE
_ Cr-sC.)_._ I THAW WIRE TYPE MAIN !/i P FXCAVATOR I-T _ C) ^IS-1
THAW Pt-ATE N!. - DISCONNECTS Ci `'E`, ❑ NO SIZE OF DISCONNECT VALVE D.-ix (7.*A P: f
___ KEARN', t.C)NNEI TOP. COMMENTS TIE FF0r) � .
OTHER - - •. WASHERS
----- — --
TEST TAP MADE G ,_: `-
KEY BOX LOCATION 05-e A/Qt:..�_._.Q. _$taceli? OTHER _ .----
INDICATE NORTH INSPECTION REPORT — - -
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VI
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GRAF:'HiCtecisects
RD BOOKS REV DATE DISCRIIMON • BY TIM NO. LOCATION
Drawl Al ASKA I AND DEVELOPMENT
SEpVICES F.B.NO 38&322
STAKING AWWG, E9 303
Assusu 1-29-87
TaACT"8.1USti consr
"InCT" G.GARNET
CONSTRUCTION RECORD REVISIONS VERTICAL DATUM
