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HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 6 LT 16 WELL CONSIRUCTION LOG Orilli,~ Co. Ak Now-Well/Vern's Drillin~ & Ent USDS .o,, Driller Vern Type of fl~ rotary we~ owne~ Gerhart Lehnerz location; (address & legal description) Zodiac Manor L 1~ B6~ 860252 Date well compllted Nearest community. An cho rage Locitlon Ikltch or remerkl Static water level i~6l It, Z~klike, below) lend surface, DAta Finish of well: (open-end, screen, perforated, I~[I.LD.:.JLILLA, other) Describe inlervais and size: Well yield tested by (pumplnE, bailing, Air) at 6-7 gpm lal/miflo for ,hours with __ft. of drawdown from static level, DRILLER'S MATERIAL LOG Depth below land surface in feel 0 ~o 12 12to 25 25 35 35 4o 40 64 64 66 66 67 to __to Dive description of strata penetrated (size of material, color, hardness of drilling, end water content) sandy till brn till boulder 11' brn gravely till gray, silt and gravel gray clay, gravel cemented silty~ sandy gravel-:Little H20 gravel-sandy 6-7 gpm MUNICIPALITY OF ANCHORAOE DEPT. ©b tdeALTH & ENVIRONMENTAL PROTEC I-EON __to -tO tO RECEIVFD I I.Idt 1 I',10: ~d ....... !},q I I~ii ]:,%SUIii]} :: 07130186 COr',I'I ACI F:fl-IE)NI!ii: ANE;I)/]RAf~I!L, AK 995()7 2'7 6" ? 4 3 9 I...[]'l SUBDIVISION: ZOD]:AC MAN(IR LO'I: I. SI~iC 1'II3N: :1 ') 'il]WN?31'tI P',', 12N F~ANGI']::: 3W BL. OCI<: 6 ~ctr'Lh by (.lie Mur',:i.c:il:),:~l:ity of Anchl::~r'age (MEIA) ar'id the State of Alaska. ~::'.r, :1 W:i.i] .irish:a] t. N"~e sy~;t, em Jn ac:cc)r'dar'lce with ail MOA cc)des and alu::l Jn comp].:iaric(t., wJ'l.h thc, cl~:~s:i. Un c~'iter.:i.a c)t I:.h:i.s 4;,, :1 ~,,~:i:t] ,::~dlu.,.~l'(:~ I.c) a:l:l Ifl(]P~ ar"[d ~[;~a'l'.(~e (::if Alaska r.e,~ql.til'(:~)m(~)r~Ls ~'c)r' k:.he set back A:::'I:::'i iCANI~ G[iLRII~:~ I..E'H. NIEI::~ ] S SLII~ J.) J.'Y "~..~'-m~ ................................ DA'I"E: FII:::'F'L, i C:f'IN't I. CI C:I:I'J ii; (li'.,f L I:i; (iiil":ll. ;;:.' fL,':l. OI.flO '.i!i;E;!lJl:::ll:~E FLEET 'l ;I; 1::: "," Ii'IF II I:"11"t F F:tI"i]I...]I:'IF;: !,!Zi IH 'ltll:] MUNICIPALITY OF ANCHORAGE Water and Wastewater Utility 3000 Arctic Boulevard Phone 786-5557 WATER LOCATE_._ .,~LOCATE LOCATORS FINDINGS ~ [] NO APPARENT CONFLICT DATE: TIME: AM LOCATION ADDRESS: SUBDIVISION LOT BLK REQUES~OR: FOREMAN: PHONE: ADVISED TO CHECK WITH OTHER UTILITIES ~ FACILITIES LOCATED AND MARKED ,~ MANHOLE LOCATION ,~ MAINLINE LOCATION [] SERVICE LINE LOCATION [] EXPOSURE BY HAND DIGGING ADVISED (Within Feet of Marked Location) PLEASE REPORT DAMAGE IMMEDIATELY TO our OFFICE -- 786-5557 DAMAGE: [] REPORTED [] NOT REPORTED (THE LOCATION OF FACILITrE$ PERFORMED BY THIS UTILITY DOES NOT RELIEVE THE CONTRACTOR OF HIS RESPONSIEIL/TY) DATE L'OCATION COMPLETED: REMARKS: ARRIVED AM DEPARTED AM PM PM k~ / F~ COMPANY MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMEN'rAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L,nfi 1 glnatb6 Zodi~k_.~nnr T12N R~W_ Sec. 10 Location (address or directions) (bi Applicant Name ~2.~,a~y f,ehnm*'/ __-relephone: Home 346-3677 Business Applicant Address ~1_ JLLtpi:[-, e r (c) Applicant is (cheek one): Lending Institution []; Owner/builder []; Buyer n; Other [] (explain); (d) Lending Institution Alaska C~o~tinental Ban]{ Telephone 561-5250 Address 10t6..[~. Northern Li~ts Anchorage, Alaska 99~08_ (e) Real Estate Company and Agent N/A Address Telephone (fi Mail the HAA to the following address: Pi ckl]p hy a.pplir~nt 2. TYPE OF RESIOENCE Single-Family ~] Multi-FamilyJ~ Otber Number of Bedrooms ,~ WATER SUPPLY Individual Well [~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL ..4,~..,,~ /~ , Onsite [] Public ~:] Community [-i Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72025 (I ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, D~-~ fA 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 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. *letter from owner stating that previous well is abandoned should be required. Name of Firm _ J~C~(]l;['q"'d~GIb~k~HIt%~ .... Telephone Address DHEP APPROVAL Approved for Approved bedrooms by ._--~'~/~/'J;;~ /''~' '~:~_'~?'~':'-¢ Date Disapproved Conditional _ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of 14ealth and Environmental Protection (DHEP) 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 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 DI-tEP 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 WELL DATA MUNICIPALITY OF ANCHORAGE (MOAJ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FERRIJARY 1984 264-4720 Legal Description: /- ~ ~ / Well Classification _z~'~/~1 7-/z-' If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Y Date Completed ,.~- /-,J'~'g Yield ~ r,,/ t G lng Total Depth _~ Cased to .~. ~ ~} ~ Static Water Level ~ ~ ~e~ /~~ ~'~p Set At ~/ Casing Height Above Ground ~ ~ / Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ,~/~o ' Water Sample Collected by Water Sample Test Results ,/',"/~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ,~,:~, ~,e~,",~,~ ;Date ~- ~,.'"~'" ; On Adjoining Lots B. SEPTIC/HOLDING TANK DA'rA ,V/,~ /q,.,~l,¢ £~¢4_ Date Installed Standpipes (Y/N) _ Air-tight Caps (WN) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding 'rank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Coursa 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, Pond, Lake, 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) D. 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 ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guideliqes in effect on the date of this inspection. ,,~-- Signed ~~--~ ---' Date Company ~/~-~'~'z/~ /¢'~ ~/~_¢~'~*'~ MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (1 $/84) Seal APPLI¢ NT FILLS OUT UPPER HA[ ONLY Property Owner i~)( ~r~~ ~ f'~ ~ ~'C~t ?1 ~..~ '~, ~. '~ Phone :~,/,i ~/,/~,~ MagingAddre~ ~.fC / .~i.~ Jc ~ t~' ' r~ ~ ~. ~.~,~ ZipCode Buyer (~ "'~ [ ' -'~. ?, '~'.~: ' ~ , .-~ ~- ~ ~ J -,~- '~C '~ ~ddres8 ~ ,.~ ~:' '~ ~: ~:~;?C. /),..,= /, J:~/'~ ZipC°de~7~'~-/~' Phone Lendinglnstitution ~ '~ ~ t~::% , ~.~ ,~: ~ -L~t~,_,:.,~ Address ~ZII (:, ~(,~2~ ~,,: j~, ~ _ ~L~ ZipCode ~:,( ~ Phone Realty Co. & Agent ~',~r, ~',c ~,,~%~..~., t k~ZuL/:j;?-~,q -:> z ~ f) Zip Code Address ~ ~- ~,.:~ ,,~,.,; ~ i ,, Legal Description Street Locali~ ~/[] / ~ 'i'") ~ Type of Residence Single Family ~Multiple Family No. of Bedroon~ [/ _ ~ Other Water Supply ~ .,),:/ , A~ACH WELL LOG. A w~l Icg is required for all weJls drilled since June 1975. Community For wells drilled prio~ to that date, give well depth (aRach Io9 if available). ~ Public Utility ~D~(~ - ~ · Sewer Disposal ~ Individual Year Individual Installed: ~ Public Utility Whe Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time [)ate Date Date Date Inspector Inspector Inspector Inspector ]c~[ ;~y~, MUNICIPALITy OF ANCHORAGE ~) ~.~(~ DEPT. OF HEALTH & RECEIVED ( 1~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' Soils Rating Date Sewer Inslalled Well To Absorption Area Well Log Received Well to Tank Septic Tank Size ;,lay !) ~ 1983 Donald & i-;dihh Joy 840.! d up:i. tex' An(~;hcrage, Z~< 9950't 't'N, ' i;i.l, led w:Lt:h J[t})er.'viotls t:~pe RP 3f:i/e ]/!; 1 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: 4. 5. 6. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Cate Received July Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Coast Mortg.a. ge Cqmpany 4450 Business Park Boulevard 9 , 1976 11:00 a.m. 7-12-76 Pratt Rainb low Enterprises 5306 Arctic Boulevard Lot 1 Block 6 Zodiak Manor Monday Phone: 274-9504 Phone: 276-6242 Location: 1st house on the leift on Jupiter. Driv____e,___~ju__st off of Abbott Loop Type of facility to be inspected _Single Family No. of bedrooms 4 Well Data: A. Type B. Depth 65' D. Bacterial Analysis Zndividual Public Utility B. Installer 1. Size 2. Manufacturer 1. Absorption Area 2. Material Total length of lines C. Construction 7. Sewage Disposal A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: 8. Distances: ., Absorption area , Other contamination , Absorption area System: , Sewer Lines A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages ~ge 2 of two pages - Req~ t for Approval of Individual S~ r & Water Facilities Legal Description Lot 1 Block 6 Zodiak Manor Subdivision Comments Approved .~.[~ yj Disapproved Date Approval~Valid for one year from date signed Greater 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) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVlRONMI:NTAL PROTECTION 2510 East Tudor Road, Anchora§o, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA /,-'~' _FHA 2. Property Owner: Mailing Address: 'f'--'~'~'¢ .r~"c//- /"~/"~q/~/ _ Day Phone: 3. Name of Buver:__~/¢ Mailing Address: 4. Name of Lending Institution: Mailing Address: ¢/~;~ 5. Name of Realtor or Agent:_ Mailing Address:_, CONY. Day Phone:_ .Phone:_ ~ Legal Description: Location: Type of Facility to be Inspected: Water Supply Type of Supply: Public Utility. If Individual, number of dwellings presently served If Individual, depth of well. ,~, f'~ Individual / Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3/76) ' ~'-~'~,~ , ANCHOt~AGE, ALASI<A 99502 April 21, 1976 4.1 Veterars Administration Anchorage, Subject: Dear Sir: Alaska Lots 1 and 2 Block 6 Zodiak Manor It is not economically feasible for the subject property to be connected 'to public water. The area is served by individual wells and public water is not available to serve these lots. If you have any further questions, please do not hesitate to contact this office. Sincerely, Les N. Bucbholz Sanitarian LNB/ljh 4,1