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Home My WebLink AboutZODIAK MANOR ALASKA BLK 6 LT 10' '7' i0 MUNICiPALI%Y OF ANCHORAGE DIVISION OF LNVIRONMENrAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR }MAI,TH AUTNORITY APPROVAL .LRIIFICA%E 1. ~.e_!!e.y~2.!. rn__~_r~r!~?_i_°!! Application Date .... _~(- (a) Legal Description (include lot, block, subdivisiou, section, township, range) Location (address or d:[rections) (b) Applicants Name 24th2U,,~:~' A/~bdj~ Telephone - Home' ~ ,// ~]usiness Applicants Address f~/~' .f~b/.)~), 7~>:~ Buyer [::'~j[ ; Other ~[:7[ (explain); ~I','L:D ') ~v' ~ ~ Telephone .2'/(- (d) Lending Iustitut:[on .... Z~._& .~.~:~.-~-~ ........... ~.: (e) Real Estate Co. & Agent .... ~.. Address Telephone ............................................. (f) Mail the ~A to the following address: Number of Bedrooms .......... :/~ Individual Well l:~;[ Community Ifil Note: If community well. system, must have wcittea co~irmation from the State Department of ~nvire~nenta.. C.msezwation attesting to the iega].lty and status, 4. ~ Di_~osal 21:[ Co,,,mu y Note: If community well ~;yster% must have ~itt:en co~irmation from the State Department of Environmental Conse~ation attesting to the legality and status. o t h e r .(_d e--?-9-' :JJ~ e__)_ ~]jl.J;neering Firm Providing.___..Inspections~ ..... ~ Testsz 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 Itealth Authority Approval shows that the on-site water sapply and/or wastewater disposal system is safe, functional and adeqnate for the number of bedrooms and type of structare indicated h~rein. I further verify that, based on the information obtained from the Mnnicipality of Aachorage files and from my investigation and inspection, the oa-site water supply and/or wastewater disposal system is in compliance with ~[1 Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of ~ir~_,~f- ~ ~ ' ~ zf,bp~ c Aoz/q Telephone ~/.~ (ENGINEER SEAL) DHEP Ap_pr ov al Approved for__~--.~ bedrooms By Approved _~,~<~, Disapproved Terms of Conditional Approval Condition~tl CAUTION TIlE MUNICIPALITY OF ANCHORAGE DEPAR'I%IENT OF l{EALfH AND ENVIRONMENTAL tRO%LCrlON (Di{EP) ISSUES Hb, AL]H AUTNORITY APPROVAL CER~I] ICArE,~ BASED SOLELY UPON THE REPRESENT- A'flONS GIVEN IN PA[~ACIQ%Pt{ !5 ABOVE BY AN INDEPENDENT PROFESSiOb~%L ENGINEER REGISTERED IN TI~~, STATI{ OF ALASKA° THE DIiEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES THEIR I~',NDING INSTITUTIONS IN ORDER TO SATISFY CF, RTAIN FEDE[IAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR /hNALYZE DATA BEFORE A CERTIFICATE IS ISSUED, TI.D:] MUNICIPALITY OF ANCHORAGE iS NOT RESPONSIBLE FOR ERRORS OR ONISolONS IN TIlE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (Hk~) CHECKLIST - FEBRUARY 1984 ao WELL DATA Well Classification ~/~g ~f.. Well Log P~esent JY/N) A/ Total Depth. -- Cased to Static Water £~vel - Pump Set At Casing Height Above Ground_ .)/~/ Electrical Wiring in Conduit ~(Y/N) Y If A, B, or C, D,E.C. App~oved(Y____~_) ~ Date Completed, __~_ Yield -- Depth of G~outin~ ~ Sanitary Seal on Casing Depression A~,ound Wellhead (Y/N~)~ Separation Distances f~c~ Well: To Septic/~oldin9 Tank on Lot~-- 3 On' Adjoinir~g Lots. To Nearest Edge of Absorptlon--~Field on Lot___~2~___; O~ Adjoining Lots__ To Nearest Public Sewer Lipe~. ~ ~ ~_ ~o Nearest Public ~wer ---C-te~/~anhole ~g.~--~>.~. To Nearest S~we_~ Service Line on Lot ,.. ___~ ~-_~=______ / / Water Sample Collected Bykh_. J~_~%t/~-__ ; Date----~2--~/--~/ .... Wate~ Sample Test Results ~ %~/%~¥-o Date Installed Size No. of Ccmpa~t~nts . Standpipes (Y/N) Aid-tight Caps (_~.Y~_~ .... Foundation Cleanout (_~Y/N Depression ove~ Tank (Y__~_) ... Date Last Pumped Pumping/Maintenance (k~nt~-~act on File (Y/N) ___; for Holding Tank High-Wate~ Alarm ~ Temporary Holding Tank Permit Separation Distances f~(~n Septic/Holding Tank: To Water-Supply Wall To Building Foundation To P~operty Lir~ To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, c~! Majo~ D~ainage COUrse Comments .....~ [Page 1 of 2] 2-],5-84 Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption A~ea Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes P~esent (Y/N) Date of Last Adsquacy Test Separation Distance from Absorption Field: To P~ter-Supply Well To Building Foundation Lot To Wate= Main/Service Line To P~operty Line To Existing Or Abandoned System ; On Adjoining Lots To Cutbank(if present) To Stream/Pond/Lake/c~ Major D~ainage Cot~se To D~iveway, Parking A~ea, c~Vehicle Storage A~ea .Comments Date Installed Size in Gallons "Pump On" Level at High Wate= Alarm Level at Tested for Elect=ical Codes(Y/N) Cor~nts Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA ** Check Permitted Bedroom Pating AGainst HAA Request ** I ce=tify that I have checked, verified, or confor~ed to all MOA HAA Guidelines in effect on the date of. this i~s~e.ct{o~. Signed ~- ~t~__~//~ Date ~//y~ Company /~,<g~ ~,J~D~ /*~ ~,/2~q MOA No. KB1/dS/s [Page 2 of 2] 2-15-84 Location: BF~SI~, EPP$ & P(3g~S 2220 EAST 88 AVENUE ANCdI~AGE, AK 99507 (907) 349-6451 subdivision: Lot: Block: Client's Name: Address: Tester: Initial Reading on Meter: Production Rat~: _~,~ --GPM 24-tlour Capacity_ '-~ Gallons BILl. SHEFFIELD, GOVE/~NO/~ SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 August 29, 1984 274-2533 Robert P. Wessels, Engineer Besse, Epps & Potts 2220 East 8Bth Avenue Anchorage, Alaska 99507 SUBJECT: Waiver Horizontal Separation between Private Well and Public Sewer Manhole, Lot 10, Block 6, Zodiac Manor S/D Anchorage 8521-WA-024 Deal' Mr. Wessels: Based upon additional information submitted August ~3, 1984, on subject waiver request, the Department has reviewed the request hereby waives the horizontal separation between the private we'll public sewer manhole to 65 fee~ on the subject property. Sincerely, Bruce E. Erickson ~ District Engineer the and and BEE/dd MUNICIPALITY OF ANCHORAGF' '~LOF -IFALTH AND ENVIRONMFI L ~ROTECTION Stree'l:, Anchora¢~e, A:L&~:a 99501 264-q720 Date Received: December 28, ].977 #1: Time ~!fhf~ D~5] _ ~2: Time I~3: Time Dat~ .L-I~)"-7~ ~'7~;,'~.~ Date Date Insp _~Az;FI~ Insp Insp R~QU~ST POR A~P~OVA~ O~ I~DZVZDUA~ S~DR A~D NA~R PACZ~ZTZ~S Lending Institution Request: Alaska National Bank of the North Mailing Address: 3301 C Street, Calais II Phone: 278--4581 o Property Owner: Robert/Bobbie Durado Phone: Mailing Address: 8445 Jupiter Drive ~ Elliot Lawson, 277-1553 3. Legal Description: Lot 10 Block 6 Zodiak Manor Subdivision Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Four Number of Bedrooms: Well System: Individual Well (x) Community/Public System ( ) Permit ~ Depth of Well Well Log on File Construction Bacterial Analysis Sewage Dmsposal System: On-site System Permit = Installed ( ) Public Utiliny (x) Installer Septic Tank Size Manufacturer Absorption Area Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Two Department of Health and Environmental Protection Request ~or Approval of Individual Sewer and Water Facilities Legal Description: Lot 10 Block 6 Zodiak Manor Subdivision. Co~aents: Af fadavit Attached Approved: Disapproved: Letter Attached: ( ) Date: Date: Department Worksheet: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SFWER and WATER FACILITIES 1. Type of Inspection: CMRO__ VA 2. Property Owner: Robert & Bobble Durado Mailing Address: 8445 Jupiter Drive. 3. Name of Buyer: Dr. & Mrs. Scott V. Linder FHA :CONV XXXx Day Phone: Both parties work during day Mailing Address: out-o£-S~:ate Bz~yer$ . Day Phone:_ 4. Name of Lending Institution: Alaska National Bank of the North Mailing Address: ~ol c ,qtreet. Calais II. ~ch .. Phone:_ 99503 5. Name of Realtor or Agent: Jack Whit~ Co, (Elliot Lawson) Mailing Address: 320 ~ c Street . Anchoraqe Rhone: 277-1553 6. Legal Description:. Lot 10, Block 6, Zodiak Manor Location: NOTE: CON~C~BOVE NOTED AGENT (ELLIO~ LAWSON) FOR ACCJ~S$ ~Q HOUSE .......... 278-4581 (Debbie Baker) N.E. corner of Abbott Road 7 Abbott Loop Road .... take Jupiter Drive on North side of Abbott Road, and go to 8445 Jupiter Dr. 7. Type of Facility to be Inspected; Sinole-Fa~il~ residence 8, Water Supply Type of Supply: Public Utility. If Individual, number of dwellings presently served If Individual, depth of well, 9. Sewage Disposal System Type of System: Public Utility xxx No. Bdrms. 4 ,Individual xxx Well one(l) per Owner .... well is 165 ' deep with water at approx. 125~ level If Individual, date of installation Individual (on-site), THANKS ..... Elliot Lawson 72 003(3/76) Approval req:ested by: Mailing Address: Property Owner: Mailing Address: 4. 5. 6. Loc'a ti on: Type of Facility to oe inspected No. of: bedrooms Well 3ara: A. 7. ~, Oeptil /~ 0 / E. u ~,2,s,d Field: Total length of Ines 8. Distances: tank , Absorption area f , Sewer {_in~s --- ComF:;en ts Approved l~ppro~lid for ene v~ar from da~e signed Greater Anchorage ~,,rea ~oro~gn, []em~r~$mer, t of E~ivironmental Quality