HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 5 LT 25
SIX INCH WATER WI-"LL DRILLED AND CASED OUT TO THE DEPTH OF '/,37 %e. eJ... '-,!;
277-3485
: DRILLED AT THE RATE Of. $19.00 PER FOOT.
PROPERTY OWNER Sd'.zb/,dd.or~ Bu. aLLdo~. 34/~-7750
LOCATION OF WELL
"WELL LOG:
0 .... 26' Sdd~d. t, Ca~,e.L, 30¢
26---69t Co~ztce..L. Sz~e.4~ ,~r,.add.
69--121~ ge2. ¢.J-~,t. ~.D~h. 15¢ ¢4~{¢eJ~.
.' 121-136~ Sd. Ott~ .oaazbd. cZc~d, ocditd~ .~Z,zo_al~ o.g Ctatred.. So~e..¢,L¢~ o¢.
136-137~ t~a2.e.z ~e~tAn,¢ cZe. c~ ¢~o_Z p,todu, c,i~ 8 ¢¢f~ o~,tz/r g 30 ¢~oo,f. ,o,t.o~.d oZ ~a, eea. :-
d.n.
l/Jedd. Sea.b: ,¢24.00
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING,
":~/RI'TE~ CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF_
TFIANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART I~RILLING WORKS
SERVICE CHARGEOF I~/~% PER MONTH WILL E~E ASSESSED ON PAST DUE ACCOUNTS,
MUNICIPALITV OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEC'TION
DIVISION OF E'NVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTN AUTHOBITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
GENERAL INFORMATION
(a)
Application Date
Legal Description (include lot, block, subdivision, section, township, range)
_Loq._25. ~_~_9_c~._5__, zoaiak F~anor Suba±vJ.s±on Sect.
Location (address or directions)
8610 Jupiter
May 21, 1985
10 ~'wp.12N R3~
(b)
(c)
(d)
Applicant Name ]~u_c q._!~_'.d_zE.~__.e_'E_~b_ ..... Telephone: Home 3 4 6 - 3 6 5 3 Business
AppticantAddress __ 8~6_]_0~__O'u_p_i_[-.er
Applicant is (chock one): Lending Institution []; Owner/builder ~; Buyer [~; Other ~ (explain);
Lending Institution ................................ Telephone
Address
(e) Real Estate Cornpany and Agent
Address 207 Last Northern Lights
276-1333
lelephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~] Multi-Famdy []
Number of Bedrooms 3
Other
WATER SUPPLY
Individual Well [T~ community [] Public []
Note: If cornmanity well systern, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status,
SEWAGE DISPOSAL
Onsite [] Pablic ~] Community [] Holding Tank []
Note: 11 comrnumty well system, must have written conlirrnation from tho State Department of Erlvironmental Oonservation
attesting to the Iogahty and status.
Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCN, 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 Approvat 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 ferther vedfy that based on the information obtained
from the Municipality of Anchora0e files and Irom my investigation and inspection, the on-site water supply and/or
wastewater d[sposaJ system is in compliance with all Municipal and State cedes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm _~UADRA ~n~e~.~_ Telephone (907) 276~3770
Address 401 East Fireweed Lane Anchorage, Alaska 99503
Date ___M_~az 21, 1985
Engineer's Seal
Approved for ~E~[~J%~.,'bedrooms by/Ty/~ ¢~';~%--.-2~ ..... c .... %Ef~;~% [3ate =~::=.=_~,%'*'¢- .....;
Approved ,~% ..... Disapproved-- ...... ~ ..... Cond(tiohal
Terms of ConditioF~al Approval
CAUTION
The Muncipality of Anchorage Department ol Health and Environmental Protection (DHEP) issues Health Authority
Approval certificatos based solely upon the ropresentations given in paragraph 5 abeve by an independent professional
ongmeer registered in the State ct 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, Elnployeos ol DHEP do Rot conduct inspections or
analyze data beforo a certificato is issued 'the Menicipality of Anchorage ~s not responsible for errors or omissions in the
profossional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
AIOllg-310;~d 1VIN:'IWNO~IIAN~
Legal Description: ;Lot 25 BC4¢49.'~V~IH .40 'J_aaa
zoa±ak M a n o r ai :liV± 5 _dvdl Nnv
WELL DATA
Well Classification Pvt. Single Familylf A, B, C, D.E.C. Approved (Y/N) Pvt. Sinqle Family
; On Adjoining Lots
Y Date Completed 10/12/78 Yield 8 _gpm
137 ' Depth of Grouting
Pump Set At 132 '
Sanitary Seal on Casing (Y/N) Y
Y Depression Around Wellhead (Y/N) N
None in Area
None
27'
1985
for 3 bedroom home on lot
None ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
McFadden ; Date __May 20,
Satis factor, y
is adequate
Well Log Present (Y/N)
Total Depth 137 ' Cased to
Static Water Level 115 ' 7"
Casing Height Above Ground 12"
Electrical Wiring in Conduit iY/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot None
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line 66 '
Cleanout/Manhole 183 '
Water Sample Collected by
Water Sample Test Results
Comments Well
B. SEPTIC/HOLDING TANK DATA Public Sewer
Date Installed
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Mairltenance 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
Air-tight Caps (Y/N) Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Suilding Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA Public Sewer
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 Cutbenk (if present)
D. LIFT STATION Public Sewer
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 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date
Company MOA No.
Receipt No. '~'LL
Date of Payment
Amount: $ ~ ~ .OO. Engineer's Seal
Page 2 of 2
72-026 (11/84}
~ /~' TELEPHONE {90~ 562-2343 ANCHORAGE INDUSTRIAL CENTER
' Drinking Water,Analysis Repo~ for Total Cohform~Bactena
· TO BE COMPLETED aY WATER SUPPLIER
SAMPLE TYPE: :: . . ~ : ,
[] Routine
[] ,Che~k Sample (for routine aample
with lab ref, no, t E] Treated Water
,(~['Spe~lal Purpose [] Untreated Water
SAMPLE
NO. ~ LOCATION : r
, I
TO BE COMPLETED BY LABORATORY
Analysis shows th s Water.SAMPLE to be:
[~, Unsatisfactory [: ,'
· [] Sample too long In transit; sample should
not be over 30 hours old at examination to
:: ~lndicate reliable results, Please send new
sample via special delivery mall,
Date ReGelved ~'
~Analyflcal Method:
[] Fermentation Tube
,L~Membrane Filter
Time cou~ted , Lab Ref. No.. Result* -Analyst
· Collected ' By
/o,~. ff/'F~*/ L~'~-/~dl' ~ ~ -
.... L I E~
I _~, ,.. -L ' I E~ ~:
·
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
Membrane FIItec Direct Count
: Collformll00ml
· Verification: LTB_ BGB
Final Membrane Filter Results ~'~ !' Coilformll00ml
TNTC= Too Numerous To Count ~ : '
,, COLLECTING SAMPLE
I --~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY
ENT OF HEALTH & ENVIRONMENTAL PRO'rECTIONDEI~T
~/~ OEPARTM ....... ~ ~'"'
ENVIRONMENTAL ENGINEERING DIVISION
Telepho0e 264-4720
REOuEST FOR APPROVAL OF INDIVIDUAL WATER AND
~LING ~DDR~ - -
~IL~6 ADDRESS
ADDRESS
'~. ~EA L.TOR/AG ENT
~NG A~DDR ESS
PHONE
'~WATER SDPPLY
J~'~N [)t V I DUAL'
[~ COMMUNITY
E3 PUBLIC UTi LITY
'B~,, SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON'SITE*'
PHONE
r~]'UMBER OF SEDROOMS
[] One [] [:our
[] TWO [] Five
[] Three [] Six
Other
' ATTACH WELL. LOG. A well Jog is required for all wells drilled
sinc( June 1975 For wells dr lied p.d. or to that date, give well
depth (attach Jog if available.)
"If indlvidua,/on.site, [live ins,a,,ation dat'~/~
~BLIC UTI LJTY ....................
NOTE'. THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
;2-010(3/78]
THIS SIDE FOR OFFICIAL USE ONLY
INSPECTIOi~ APPOINTMENTS
TIME
DATE
INSPECTOR
DIRECTIONS:
RTE
INSPE~R
TIME
INSPEC~
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE [] OTHER
[] TWO [] FOUR [] SIX
PERMITNUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
E3 INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank Or [~Holding Tank
Size;__ _ If Tank is homemad
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA --
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
DATEINSTALLED
INSTALLER --
SOILS RATING
MANUFACTURER
~TERIA~
Septic/HoJ~ing Tank Absorption Area Sewer Line Nearest Lot Line
5. COMMENTS
DATE
LEGAL DESCRIPTION
~//APPROVED FOR __ _ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~
72-010 (Rev, 3/78)
P,O, SOX 4-1276 ANCHORAGE, ALASKA 99~09 484B BUSINESS PARK BLVD.
Drinking Water Analysis Report for Total Coliform Bacteria
TO lie COMPLETE[) BY WATI::R SUPPLIER
PUBLIC WATER SYSTEM:
Public Water System Name
Mailing Address ~ v
City
State
Zip Code
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. rio. )
[] Special Purpose
E3 Treated Water
[] Untreated Water
SAMPLE
NO.
1
2
3
4
5
LOCATION
Time Collected
Collected By
I //'"" P/°
TELEPHONE
(gO7) 279-4014
TO BE COMPLETED BY'LABORATORY
LABORATORY:
NAME
r ADDRESS
CITY
Date Received
Time Received . ~
Analytical Method:
[3 Fermentation Tube
Membrane Filter
Lab Ref. No. Result* Analyst
I ~
L J FT~
READ INSTRUCTIONS
BEF:ORE
COLLECTING SAMPLE
Form No. 18-310 (3-78)
06-}220 (b)
Rev. }978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected _
Date Received---
PreSumpUve
24 Hours
48 Hours
Confirmatory
Final MembraneFIItor ~lt.~ (/~' ?
~-c~( (/,
MARION K. LAMPMAN
Associate (3roker
207 E. Northern Lights Blvd.
Anchorage, Alaska 99503
Business (907) 276-1333 Direct 263-2438
Residence (907) 243-837o~
/ \
· ' LENGTH OF SUR~EN
POUCH 6-650
ANCIqORAGE, ALASKA 99502
(907) 279 2511
GEORGE M. SULLIVAN,
MA YOR
April 2, 1979
Bruce M. Barrett
333 Raspberry Road
Anchorage, Alaska
99502
Subject: Lot 25 Block 5 Zodiak Manor Subdivision
Approval for your individual sewer and water facilities
will not be granted until the following items have been
completed:
(1) A well log is submitted to this department
(2)
The water analysis report be delivered to this office
from Chem Lab, 5633 B Street, for our review.
(3)
Expose the well for our inspection to determine
proper construction, also, to insure the minimum
distance requirements are met between your well and
sewer system.
Notify this department for a re-inspection when descrepancies
have been corrected. If there are any further questions,
please contact this office at 264-4720.
Sincerely,
Robert C.
Associate
RCP/ljw
CC:
Pratt, R.S.
Specialist
Alaska Mutual Savings Bank
1503 West 31 Avenue 99503