HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 5 LT 14
MUNICIPALITY OF ANCHORAGE
DEl: i'MENT OF HEALTH AND HUMAN Sr-:RV[
Environmental Health Division
825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SI:WAGE DISPOSAL SYSTI:!M AND/OR WELL INSPECTION REPORT
SEPTIC ABSOBPTION
Add TANK FIELD
LEGAL DESCRIPTION LOT LINE
TANKS
SEPTIC ~ HOLDING
TYPE OF SYSTEM
WELL
TRENCH [~J BED [] W. DRAIN [] OTHER
FT FT
F]
FT FT
S0 FT FT
SO FT
WELLS
~/-,.~ PRIVATE [] OTHER fldentifv)
REMARKS:
FT
certify thai Ihis inspection WaS podorolod eccor(fing lo all
hlunicillai and St~to guidelines in olfoct on Ihis dote:
ENGINEER'S SEAL
12 013 (3/85j
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CONTACT F:'I"IONIE ~,
L.,li~(3AL DE.A.,F .I.I.
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BL,,I::][i~K: 5
I c~r-Lify t, hat.:
:1,. I ~tr~t f'famil;i.i,~p w:i.t,h t.l"~ r, el::lLlir,~m[.~l~-.~ fop on-~iCe c~c.~wem~i ,and
roi'th By 't. hc~ Municil:)ality c~[ Anchor, age (MOA) arid the []'l'.a~ze of Alamka,,
~:]. :1'. will inst. aCl. 1 'Lhc.)) ~y[Mzem in ~::~(:c:o~,di:~r~c:(z~ wit. h ,all MOA cclde[~
and 'Ln c:oml:)].iamccf) wit. l't ti'm) dt)~sigu cPit, epiax of t. hi~t pf~Plni'L.
3,, I w:i, ll adhen, e t.o all MOA i:ll"l[[ ~]t.f~'l'.~e Clf Ala~l.c~ r'eqt.iiPe)m~.~rtt.~a fop t.h~a, set, back
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PI'lO f F(;1'ION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY hi,I'ROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application I role
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
· -1///J
Location (address or directions)
(b) Applicant Name ~h/'"'] ~hJ~/27~'~¢
Applicant Address ,/.~,~/ /-.?/~4¢/~~'~/~1~'~''
lc)
(d) Lending Institution ~k)~LC~q~-,'~,,,.~
Address
(e) Real Estate Company and Agent
Address
Applicant is (check one):, i.ending Institution []; Owner/builder"~; Buyer LTJ if ¢lher [] (explain);
(f)
Telephone
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~ Multi-Family []
Number of Bedrooms '-~)
Other
WATER SUPPLY
Individual Well~ Community [] Public []
Note: If community well system, must have written confirmation from the State Depei Illll:~nt of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank~
Note: If community well system, must have written confirmation from the State Depa~ IIIll~l~ of Envff'onmenta Conservation
attesting to the legality and status.
72-025 (11/84)
Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal alfixed 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, functiond.~pd adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the info~'~e, tion 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 inspection,
Name of Firm /]:~', /~;3¢'1/;,¢~'~. ~'['/xJ 7-/~L_ ~'~¢~. ,,~//-)~. Telep hone _'~-~g~ /.- .5"~ ¢
Date /<~ '/'5'~ ~ ~'~
D~I,,,)E P APPROVAL -.
-,~d. for ]~:P~--~q-~ ~Y_ bed r OD m s by [)ate
Approved Disapproved Gonditiond '~'
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DP~EP) issues Health 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 DI-IEP 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 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 (11/84)
MUNICIPALITY OF ANCHORAGE (MO~)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
Legal Description: ~--07~
DEI~T, OF HEALTH &
ENVIRONMENTAL PROTECTION
WELL DATA
Well Classification '~/~I V'/")"~'~" If A, B, C, D.E.C. Approved (Y/N)
Well Log Present(~N) Date Completed ?'-/3 ~"" Yield
Total Depth __//,~¢~') / Cased to /o~'~ / ,~"'/~-
Depth of Grouting _
Static Water Level /¢¢ / Pump Set At __
Casing Height Above Ground Sanitary Seal on Casin N)
Electrical Wiring in Conduit(~N) Depression Around Wellhead (Y~
Separation Distances from Well: / .. ,, ~.% /
To Septic~Holding Tank on Lot ~ ~,v r.l..~0 ; On Adjoining Lots
To Nearest Edge of Absorption Field on L.ot ,'~//."~ ~"OO~ Adjoining Lots ./~'~ / '/'
To Nearest Public Sewer Line ~/_,,4 _ To Nearest Public Sewer
Cleanout/Manhole ~/,~ To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Stand pipes(~)'N) Air-tight Caps,)
Depression over Tank (Y~)
Pumping/Maintenance Contract on File CN)
Holding Tank High-Water Alarm~l)
Separation Distances from Septic/Holding Tank:
77
?'
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course _
Comments
Size ~'¢'~ ~/~/¢' No. of Compartments
Foundation Cleanout (~N)
Date Last Pumped
;for
Temporary Holding Tank Permit(~)
/
To Building Foundation
To Disposal Field _ A"//
To Stream, Pond, Lake. or Major Drainage
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
bsorption Strata Type of System Design
Length of Field ____
Depth of Field ____
Gravel Bed Thickness ____
Square Feet of Absorption Area ~ Standpipes Present (Y/N)
Depression over Field (Y/N) ~ Date of Last Adequacy Test .
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well __ __'"'.T~operty Line __
To B~ilding Foundation _ ~ To Existing or Abandoned System on
Lot __
To Water Ma~nWService Line To Cutbank (if pres~__ __
Comments
LIFT STATION
Dimensions
,,S~ize 'm G~al, l, o7, ~ Manhole/Access (Y/N)
"Pump On" Level at ~ "Pump Off" Level at
High Water Alarm Level at ~ Vent (Y/N) .
Tested for ~ Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have..c.Y~eck, e~, verif[~.d, or conformed to all .M~O,A and HAA guidelines in effect on the date of this inspection.
Signed ~"~--- (/' ~ '¢~0'/~ Date
Company ~ MOA No.
ReceiptNo. ~ ~ Il
Date of Payment I O ' ~ '% ' ~
Page 2 of 2
72-026 (11/84)
//~HEMICAL & GEO,,OGICAL LABORATORIES Or' ALASKA, INC=.
TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER
5633 B Street
Drinking,~Vater Analysis~Report fo, r:['otal. CoJiform~acteria __
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM: [ I I I I J ] (*) See h on back
Water System Name ~'// ~_ ~ ~one No.
CiW S~te Zip C~
MO. Day Yeer
SAMPLE TYPE:
~'~ Routino
Check Sample (for routine sample
with lab ref, no._
[] Special Purpose
Treated Water
Untreated Water
SAMPLE
NO, LOCATION
3 l
4 l
Time Collected
Collected ~
Io~'o
TO BE COMPLETED BY LABORA'rORY
Analysis shows this Water SAMPLE to be:
[~Setisfactory
[] 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
I.ab Ref. No. Result* Analyst
L JI--FI
L IF-I-']
I Ji-F1
I JI-TI
eACTERIOLOG ICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filler; Direct Count
Coilformll00ml
Verlflcetlon: LTB.
Final Membrane Filter Results
Reported By /
BGB
Date
Time:
TNTC = 'Too Numerous To Count
Collformll00ml
/,0 ,.'~ e.m.
r pa at,
NORTHWIND ELECTRIC
7900 Kin§ Street
ANCHORAGE, ALASKA 99502
(907) 349-7568
CITY, STATE end ZiP CODE
JOB NAMI~
JOB LOCATION
l~le ~Iropose
DATE OF PLANS
JOB PHONE
hereby to furnish material end labor--complete in accordance with specifications below, for the sum of:
dollars ($
Payment to bo made as follows:
Authorized
Signature
Note: This proposal may be
withdrawn by us If not sccepted within
days.
We hereby submit specifications and estimates for:
SIGNED
'-- t~LF~-L~P-UHMJ® 4S 47] PART 3 WILL BE RETURNED WiTH REPLY.
POLY PAK (50 SETS) 4P47~
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
DATE:
TO:
FROM:
SUBJECT:
September 17, 1985
Susan Oswalt - Program Manager/Onsite Services
Department of Health & Human Services
Wallace No Cory, P.E. - Engineering Design Supervisor,
Scheduling for Construction of Zodiak Manor LID 154
AWWU
Pursuant to your request, this memorandum is being written to
inform you of the status of the subject LID. The project was
originally scheduled for construction this fall, but due to the
desire of certain property owners to have a WID included with the
LID, the bid opening was cancelled° We anticipate the creation
of a WID by the end of the year, which will be designed and
incorporated into the LID bid documents for advertisement early
next spring. The project will most likely be built early next
sununero
Since there is much public pressure to complete the Zodiak LID,
AWWU feels reasonably confident the schedule identified above
will prevail. However, there is no guarantee.
Engineerin~ Des/~v''~ig~'~'u~¢rvisOr
Anchorage ~~ater utility
cc: John Rupert
dwb2/lml
DATE:
TO:
FROM:
SUBJECT:
fiAunicipality oi Anchorage
MEMORANDUM
September 27, 1985
~Robbie Robinson, Manager
Environmental Health Division
HEALTH & HUMAN SERVICES
MUNIciPALiTY OF
DEPT. 0
ENVIRONMEN~AH~EA[TH &
~ PROTECTION:
.RECEIVED
Louis J. Bonito, Manager, Engineering Section
Engineering & Customer Service Division
ANCHORAGE WATER & WASTEWATER UTILITY
WELL PERMITS
An on-site well permit, No. 850351, was issued to Mr0 John D.
Ruppert by Health and Environmental Protection for construction
of a well in Zodiak Manor. A note was made on the permit that
public sewer would be available in August of 1985. Public sewer
will not likely be available until sometime in 1986. Bid opening
on the project was delayed until next spring so that an opportu-
nity could be afforded to give the subdivision a second opportu-
nity to approve a WID. Approval would'mean that both water and
sewer could be installed at the same time by the same contractor,
thus resulting in some savings to the Zodiak property owners.
We are always careful when discussing future plans with develop-
ers proposing construction in such an area so as not to give them
any guarantee of specific time of water or sewer construction.
The above incident caused the builder, Mr. Ru~Dert considerate
const rnq~9~ion upon constructing a home to find that he will not
have access to public sewer for approximately another year and
that there would be no guarantee of such service even then° We
would like to suggest that your people be instructed to be
equally circumspect when offering utility construction scheduling
information to developers. If you have any questions, please
call me.
Manager, Engineering
Anchorage Water & Wastewater Utility
WNC/dwT27
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-§040
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