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Home My WebLink AboutSCHROEDER LT 71der a52 2VO7 SIO Lo to wo Ci►oc.K G"^ATER ANCHORAGE AREA B®RG"SH HEALTH DEPARTMENT N? 337 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 _ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRE S c- c" t PHONE_-- - LOCATION. — u SEPTIC TANK: TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION F NCE BETWEEN LI SQ. FT. LENGTH �-E-iCH LINE , NEAREST -VINE TRENCH TOTAL LENGTH OF LINES_ TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL:DISTANCE FROM -2(o, WATER TYPE DEPTH BUILDING FOUNDATION. _SAMI LE , NEAREST NEAREST SEPTIC -i SEEPAGEOTHER /�'J CESSPOOL SOURCES DIAGRAM LINE , SEWER LINE_ , TANK / —, SYSTEM DIAGRAM OF SYSTEM DISTANCES: APPROVEDf NUMBER F G�vrL%- NTS DISTANCE FROM WELL � —7;- MATERIAL OMPARTME — l�f Jr LIQUID LIQUID CAPACITY C��%IL�LclC GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH -- SEEPAGE SYSTEM: SEEPAGE PIT: WIDTH / z_, LENGTH Z=" DEPTH_—, NUMBER OF PITS r OUTSIDE DIAMETER —OR ,. ��tiLl DISTANCE FROM WELL �L� BUILDING FOUNDATION 2 , LINING MATERIAL . ` TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)_ �!'3 SQ. FT. NEAREST LOT LINE TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION F NCE BETWEEN LI SQ. FT. LENGTH �-E-iCH LINE , NEAREST -VINE TRENCH TOTAL LENGTH OF LINES_ TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL:DISTANCE FROM -2(o, WATER TYPE DEPTH BUILDING FOUNDATION. _SAMI LE , NEAREST NEAREST SEPTIC -i SEEPAGEOTHER /�'J CESSPOOL SOURCES DIAGRAM LINE , SEWER LINE_ , TANK / —, SYSTEM DIAGRAM OF SYSTEM DISTANCES: APPROVEDf GAAB-11D-2 GREATE. ANCHORAGE AREA OROUGH Case No.��'�?�' HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279.2511 ^ SEWAGE DISPOSAL SYSTEM e APPLICATION & PERMIT NAME OF APPLICANT MAILING MAILING ADDRESS /�O {��^'�'NONE N0. RESIDENCE ADDRESS �-- _ LOCATION OF INSTALLATION ---- LEGAL /�f) LEGAL DESCRIPTION V, APPLICATION TO INSTALL: SEPTIC TANK SEEPAGE PIT_ , Q -MSL - �QTF4-Efi-- TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ,/L( -TO BE INSTALLED PERCOLATION TEST RESULTS DATE OF COMPLETION-2-0— BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT C� THIS IS TO SERVE AS PERMIT TO INSTALL A SIZE OF UNIT TO BE: SERVED �fe 4 -_ AS DESCRIBED BELOW. �•_ SEPTIC TANK SIZE 4�02� TYPE u'7zLI;t! SEEPAGE AREA —TYPE DIAGRAM OF SYSTEM / DISTANCES It HEALTH AUTHORITY OR LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE __L �' LC I SL APPLICANTS SIGNATURE I MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HF.UTH DEPARRIENt OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTI[ AUTHOR:I:TY APPROVAL CERTIFICATE 1.. General Information Application Date (a) Legal Description (inclu(�e,lot•, block, subdivision, section, towuship, range) Location (address or direct_ ns) _ P n� __ r St. / CJ (b) Applicants Name Z�/ %1 (//�l tL(� TeeThone - Home Business �_A_. .___. Applicants Address (c) Applicant. is (check one) Lending Institution Buyer Other �V�l (explain); (d) Lending InstitutionJ,- Telephone Telephone Address ;% � (e) Real. [,state Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Tyke of Residence Single -Family Vis, Number of Bedrooms 3. Fater S�IY Individual Well rJ� multi -Family Community 1= Other (describe Public E--1 Note: If community well system, must have written conf:i.rmatiou from the State Department of. Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite F—=1Publi.� Community �� Holding Tante E ---b Note: If community wellsystem, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page I of 21 5. Engineering Firm ProvidindInspections, Tests 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 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 onsite water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Address Date D. 1.2111 1 (ENGINEER SEAL) 6. DHEP Approval. Approved for -.__2j__ bedrooms Approved % Disapproved P P Terms of Conditional Approval Telephone By Conditional. CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMRNT.AL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 SLATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZI: DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/DI8 7-19-84 (Page 2 of 21 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AU'T'HORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA L� Well Classification If A, B, or Cr D.E.C. Approved(Y/N) Well Log Present (Y 5 Date Completed _ _ Yield $-6/7tvlkl f Total Depthj%, C�Cased to �>/ Depth of Grouting Static Water Level Pump Set At�� Casing Height AbOve Ground (� Sanitary Seal on Casing C N) in Conduit-( ) Depression Around Wbllhead ( ` Electrical Wiring ___ — Separation Distances . from Well: To Septic/Holding Tank ori Lot l lOON�!� ; On Adjoining Lots' _1226 T.®.%arest;. Edge of Absorption field on Lot On Adjoining Lot ' �' J To Nearest Publ ie Sewer Line �/ To Nearest Public Sewer _-��-�- mCleancu Martliole / To Nearest-. Sewer Service Line on Lot 3b Water Sample'Collectec] By ��. `S' - Date 2"6 6? ell' Water Sample Test Results �� ✓ r l �J J /3 %�=_`-- - B. SEPTIC/HOLDING TANK DATA F-' 7?L C Date Installed Size Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N)- _ D %-S Pe)-sAL No. of Compartments Depression over Tank (Y/N) Date Pumping/Maintenance Contract on File Holding Tank High -Water Alarm. Separation Distances from Sept To Water -Supply Well To Property Line To Water Main/Service Line Course Comments for Temporary Holding Tank Permit (Y/N)�� To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage [Page 1 of 21 2-15-84 C. ABSORPTION FIELD TA 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 F To Water -Supply Wb 11 ' To Building Foundation Lot To Water Main/Service Line Type of System Design Length of Field Depth of Field Gravel Bed Thickness _ Standpipes Present (YIN) of Last Adequacy Test To Property Line To Existing or Abandoned System on On Adjoining Lots To Cutbank(if :)resent) To Stream/Pond/Lake/or Major, Drainage Course__ To Driveway, Parking Areal or Vehicle Storage Area Comments 1). LIFT STATION Date Installed Size in Gallons _ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes Counts ns ions .e/Access LY/N) Off" Level at _ Vent during Adequacy Test. Meets MOA * Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or, conformed to all MOA HAA Gu on the date of this inspection. _ Signed R��•� v Date L e. 0 sP,i3 look � Company .4 mi 1SIVEMOA N od KB1/d5/s ;„i [Page 2 of 2) L-4 ines in effect 2-15-84 October G, 1982 Ms. Linda Kross Grants Administrator Anchorage ;dater & Wastewater Utilities 3000 Arctic Boulevard Anchorage, Alaska 99503 RIs: Approval to waive wall radius regulations Fire Lake Interceptor, Fhase II S81-1 Dear Mr. Kross: c Your request for waiver to construct, maintain and operate a portion of Fire Lake Interceptor, Phase II closer to drinking water sources than specified in the State Drinking, Plater Re;ulationn has been reviewed for Matters of concern to this Department. The request for waiver is hereb granted. GM/d j f Sincerely, Greg P1 gee Construction Grants Engineer ANCHOK GE WATER & SEWER U1 TIES 3000 Arctic Boulevard Anchorage, Alaska 99503 (907)277-762.2 June 16, 1.982 Tony Knowles Mayor Mr. Reford G. Reid Construction Grants Project Alaska Dept. of Environmental Conservation 437 "E" Street, Suite 200 Anchorage, Alaska 99501 REFEM- CE: Fire Lake Interceptor, Phase II Dear Mr. Reid: Owned by the Mun1c1pa!11y o/ Anchorage The Anchorage Water and Sewer Utilities (AWSU) seek ADEC approval to construct, maintain and operate a portion of the Fire Lake Interceptor Sewer, Phase II closer to drinking water sources than established separa- tion distances specified in State Drinking Water Regulations. In request of a regulation waiver and in accordance with Title 18 of the Alaska Administrative Code Chapter 80 (18 AAC 80.020.d.), Anchorage Water and Sewer Utilities submits the following report for your review and con- sideration. The subject wells are located in the Regional Park subdivision in Eagle River, Alaska. A listing of well locations within a 100 -foot proximity of proposed manholes is given in Table 1. A listing of well locations within a 75 -foot proximity of the proposed mainline sewer is given in Table 2. All wells are private systems serving individual dwelling units. Within the subject well radius "waiver" area, the sewer pipe will be 24 - through 36 -inch Ductile Iron Pipe, Class 52. The subject pipe has a working pressure of 350 psi plus a surge allowance of 100 psi. This particular sewer trkuik is a gravity system which will be 0.0 psi working pressure, making it ideal for construction within well radius. On a Mr. Reford G. Reid Page 2 gravity system there is more static pressure on the outside of the pipe than on the inside, thus giving more concern to infiltration than exfiltration. Ductile iron pipe has a life expectancy greater than other conduit materials because of its structural strength, resistance to abuse, abrasive elements and corrosion. All manholes constructed within 100 feet of a private well shall be spe- cially constructed to watertight standards using a water containment membrane. All pipe penetrations in and out of the manholes shall be sealed with reinforced flashing to prevent leakage, and the membrane will be covered by protection boards to prevent damage. Details of construction are described in the attached drawings and specifications. A review of the soils report for this project shows that Davis Street and Iris Way to Marcus Drive is generally a uniform, dense, sandy gravel material.. The remainder of Iris Way and Mercy Drive are a very dense, sandy silt in the lower trench zones. Well logs for two wells along Davis Street show the following information: Lot 60: 52' well, cased to 40' Gravel and sand (no apparent impervious layers) Lot 79: 60' well Silty with cobbles, silty sand and silty gravels; shale at 60' The above situation represents the "worst case" for wells closer than 75' to the proposed sewer. The soils profiles along upper Iris and Mercy Drive appear to be more impervious at lower levels. Air. Reford G. Reid Page 2 In recognition of the frequency and degree of sanitary sewer en- croachn-ent inside well protection radii, AMM sought an opinion and advice from the PAunicipal Department of Health and Envirommntal Protection. Their convents and supportive statenant are attached. Respectfully, ATJT,ED E. SU:IDC�i9�ST, P,E, Engineering Design Supervisor Anchorage Water & Wastewater Utility DCK:deb Attactvnents: DHEP Statemnt Plans €N Specifications ,...../.moo.»,.�,�.�..a., Mr. Reford G. Reid Page 3 Table 1 Distances -Between Existing Private Wells and Proposed Special Manholes (within 100 -foot proximity) Well Location i.' 1. Lot 57, Davis St. from Iris Way to end 2. Lot 61, Davis St. from Iris Way to end 3. Lot 62, Davis St. from Iris Way to end 4. Lot 69, Davis St. from Iris Way to end 'S.O/ Lot 30, Iris Way between Marcus Dr. and Davis St. 6. Lot at SE Corner of Mercy and Elenora ,-7. Lot 1, NW Corner of Mercy and Iris Proposed Special Distance Manhole No. 94' FL -11 75' FL -10 77' FL -10 78' FL -9 45FL-14 68' FL -17 72' FL -18 Mr. Reford G. Reid Page 3 Table 1 Distances -Between Existing Private Wells and Proposed Special Manholes (within 100 -foot proximity) Well Location i.' 1. Lot 57, Davis St. from Iris Way to end 2. Lot 61, Davis St. from Iris Way to end 3. Lot 62, Davis St. from Iris Way to end 4. Lot 69, Davis St. from Iris Way to end 'S.O/ Lot 30, Iris Way between Marcus Dr. and Davis St. 6. Lot at SE Corner of Mercy and Elenora ,-7. Lot 1, NW Corner of Mercy and Iris Proposed Special Distance Manhole No. 94' FL -11 75' FL -10 77' FL -10 78' FL -9 45FL-14 68' FL -17 72' FL -18 Mr. Reford G. Reid Page 4 Table 2 Distances Between Existing Private Wells and Proposed Mainline Sewer (within 75 -foot proximity) Distance to Proposed Well Location Mainline Sewer 1. Lot 57, Davis St. from Iris Way to end 431 Z. Lot 58, Davis St. from _- Iris Way to end 38' 3. Lot 59, Davis St. from Iris Way to end 451 4. Lot 60, Davis St. from Iris Way to end 401 S. Lot 61, Davis St. from Iris Way to end 47' 6. Lots 62/63, Davis St. from Iris Way to end 60' '-=7. Lots 64/65, Davis St. from Iris Way to end 60' Lot 66, Davis St. from Iris Way to end 38' 9. Lot 68, Davis St. from Iris Way to end 40' n 10. 4•` Lot 69, Davis St. from 35' Iris Way to end 11. Lot 69, Davis St. from Iris Way to end 35' 12. Lot 70, Davis St. from Iris Way to end 35' 13. Lot 71, Davis St. from Iris Way to end 43' 14. Lot 72, Davis St. from Iris Way to end 48' Mr. Re£ord G. Reid Page 5 Table 2 Continued Well Location Distance to Proposed Mainline Sewer 15. Lot 73, Davis St. from Iris Way to end 48' 16. Lot 76, Davis St. from Iris Way to end 55' 17. Lot 77, Davis St. from Iris Way to end 40' 3.8. Lot 79, Davis St. from Iris Way to end 35' 1c✓(Jr' Lot , Iris Way from Marcus g� � Dr. to Davis St. 5� _i 20. Lot at SG corner of Mercy Dr. & Elenora 45' 21. Lot 10, Iris Way from Mercy Dr. to Marcus Dr. 62' 22. Lot 1, h'W corner of Mercy Dr. and Iris 651 23. Lot 3, Marcy Dr. from Iris to Old Glenn Highway 58 24. Lot 7, Mercy Dr. from Iris to Old Glenn Highway 70' ;x,25. Lot 7, Mercy Dr. from Iris to Old Glenn Highway 55' 26. Lot 10, Mercy Dr. from Iris to O,l.d Glean Highway 62' v,27. Lot 12, Mercy Dr. from Iris to Old Glenn Highway 30' 28. Lot 15, Mercy Dr. from Iris to Old Glenn Highway 22' 29. Lot 15, Mercy Dr. from Iris to Old Glenn Highw-ly 231 (o-nL`).. Cl,\- oC.(A_A C% r— ATE RECEIVED INSPECTION APPOINTMENTS STFIEET LOCATION TIME TIME TIME SINGLE FAMILY ❑ One CI Four El Other _ DATED f.` ATE DATE fli ,X INDIVIDUAL* INSPECTOR "q INSPECTOR gp INSPECTOR ❑ PUBLIC UTILITY depth (attach log if available.) M 8. SEWAGE DISPOSAL SYSTEM MUNICIPALITY OF ANCHO— R�^� MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTL(MIRONMENTAL Pi;OTL-CTION 825 L Street - Anchorage, Alaska 99501 ,i i� id • 1981 2 �, ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R E C r I+ F ED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten 110) days for processing. 1. PROPERTY OWNER Ts F, a !,�ONNIE :S�hv.eA\C=_� PHONE MAILING ADDR SS - ZO-L 941 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE mo_r`4\n W -�- --TciL\ VmL, FcL eet z/P 7-'/,S 7 9 MAILING ADDRESS zvx \ic C ctecl S�r�pc�2 QEIVrEA� u qxt M. y9�i9 3. LENDING INSTITUTION PHONE \��c�� a OskcL J)aat2V�. MAI LING ADDRESS No QA1, ell _Vt 4. REALTOR/AGENT PHONE S«.� - 'Ta �� MAI LING ADDRESS CA LE a (0 1 T11 o vt IZ o= �l fL 1- C 't U V_ o, �9s 5. LEGAL DESCRIPTION \..- Q) k r11 C� YLD � ISL s STFIEET LOCATION 6. 'TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One CI Four El Other _ ❑ Two ❑ Five ❑ MULTIPLE= FAMILY % Three El Six _ 7. WATER SUPPLY ,X INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) M 8. SEWAGE DISPOSAL SYSTEM P< INDIV] DUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) —` THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ 'THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified__ PERMIT NUMBER - - DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified _ PERMIT NUMBER —�— DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: 1000 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL , 4. DISTANCES WELL TO: Septic/Holding Tank ) ,` Absorption Area j�5:t( Sewer Line � e Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS --- — —� P APPROVED FOR ��_ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72-010 (Rev. 6/79) 5 DAVID A. SLENKAMP MECHANICAL ENGINEER 694-9055 June 29, 1.9£31_ Dynamic Realty ATTENTION: Susan Taplin 501 West Northern Lights Boulevard Anchorage, Alaska 99503 Dear Ms. Taplin, ROBERT A. SHAFER CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHORAGE. DEPT. OF HEALTH $ ENVIRONMENTAL i'::�: i ECTION ,) lj I , 7 I Y 8, 1 RECEIVED Reference: Lot 717 Schroeder Subdivision; 'ferry Shurtleff property. A sewer system adequacy test was performed on the system Located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of .7.000 gallons. The seepage pit was charged with 1000 gallons of water and after a period of 24 hours all the water that had been added had percolated out of the crib. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. however, the system cannot be guaranteed against subsequent failures. If we may be of further assistance, pleas(, do not hesitate to cal -1. Sincerely, OB PRT A. I r, I .RAS/ss cc: Alaska Pacific Bank Municipality of Anchorage Department of Health and Environmental. 1'rotection SRB 196X EAGLE RIVER. ALASKA GREATER ANCHORAGE AREA 'BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 2798686 Date Received112.4 7!4 . Time of Inspection Date of Inspect:[ on_IR5 7/ _4„•„�T REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR VA 1. Aorroval Requested 8y: Terry Shurtleff Address: � P.O._ Box 968 EN.J e River AK 99577 Phone:— 6`�4- . 2 . P n e r t ; Owner:— Gul l and _ --.—Phone:-. 3, l.e,�l Description: Lot 71 Schroeder Subdivision 4. Location: 5. Tv, of F,)cil.i_ty to be Inspected' Sincgle Num:nor rc !3�d Y'OOms 5. We11 Dt;a: A, Tvne..a_ B. Depth— 571 CF Cc.^s>t,uci;i en Standaad D. Bacterial Analysi.s�Satis'Factory 7, Sewage Disposal Svstem: A. TrrLalled — 8. Installer -- C:, Ser,tic Tank: 1. Size 1000 ga12, Manufacturer— Wallace D, Seepage Pi.t: 1, Size 12x12X6' 2. Material—., ra D:isnosal Field: Total Length of Lines______ 8. DIst.ances: A, We.11 To: Septic Tank 72' _, Absorption Area 102' , Sewer Lines 1•Iaarest Lot Line --y Other Contamination V. 1'o;ndation to Snotic Tank Absorption Area C A�)sorpti.on Area to Nearest Lot Line Roq jest for Approval of 7 gage Two 9, Comments: A.nnr viauai Sewer & Water Facilitie Disa^proved Date Approval Valid for One Year From Date Signed ter Anchorage Area 3orough, Department of Environmental (duality DIAGRAM OF SYSTIM.. cert) f `,' thattho inf nroatlon conN nod in tnis ^p :--'� 1: -yin �.. v:.� t -- - .. r-; o r]'i @crurote rCpreseY`%WOn Of the su iect BMW W water facilities located at' 1 FIItk ;'urm 2573 Form A ro.eJ HOUSING ADMINISTRATIOP! BvJ5Tc1 Pareav No. 63-R496.6 R�.. I„ly ,^5R • FEDERA6 HEALTH H Au'rHORITY APPROVAL "101VIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART 1.—TO BE COMPLETED BY FHA I INSURING uIFICE MORTGAGEE k)"Oh"W- p, AK MORTGAGOR OR SPONSOR j SUBDIVISION NAME p POTAL NUMBER: -� i!NITS - BEDROOMS BATAS Mataauku v. .r Idle I PROPERTY ADDRESS Davie Jut. BASEMENT r 1 New instfflation i 1'es 1;j N SERIAL NO. 59%a j o. - -� BLOCK NO. -rLOT �. Can attic or othor area bo made Into uddI lonal bedrooms? (If Yes, how many?) Yes 6�d No WATER SUPPLY BY: �_._.__ Individual SYSTEM DESIGNED FOR .a _...�_ _ _..�^__.e.�_�JI _ Public sv1tcm I I �.ommunity Si StC[ll ,NO. Of BDRMS, GARBAGE DISPOSAL SEWAGE DISPOSAL BY: r_l - pubtlr s}'stern U C,onununity s stem 751 InJn-u.ual Yes No FART II.—TO BE COMPLETED BY HEALTH DEPARTMENT i I HEALTH DEPARTMENT INSPECTOR'S SKETCH 1 Name 2 . flame TIM REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES �nC (Fil.l out in Triplicate) of person requesting approval��*" - of property! owner 3. Legal descript_ion_ 4, Number of bedrooms in house ��. S+ct N 1� „ 5. Water,.Analysis: a. Bacterial b. Detergent` 6, Well data: / a. Type Gi�dt'�ltfB b. Depth. .� C. Casing Size (0 d. Distance from well to closest existing or proposed: l," Sewer line_��. 2. Septic tank j j �q,:,.&�- 3. Seepage Area__I(i . 4. Cesspool' 5. Property Line ' I 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc.�� ,___• 7, Sewage disposal system. a. Age of system b. Septic tank capacity in gallons_ (p-�- c. Name of septic tank'lanufacturpr 1. If "home made" show diagram on reverse side of this form. d: Disposal. field or seepage pit size and type L Y.I., L �A. a— 1, Distance to propertyl-ine 00 to house foundation �� r e. PercoJ_ation Test 'results f, Percolation Test performed by Use the reverse.side of this form to show diagram. Diagram should include he following information: property lines;.well location, house location, ' Septic tank location, disposal area location, location of percolation testa an� direction of ground slope, 9. The 1n-formati.on on this form is true and correct to the best of my knowledge. S gnat ire of Applicant Date Signed 4 TO BE PILLED OUT BY HEALTH DEPARTMENT PERSONNEL he above described sanitary facilities are hereby approved, subject to the .... ollowinp conditions: Conditions: The above described sanitary facilities are disapproved for the following reasons: Sign ur o Affae aJ., `,... -6at �:. .'x....' Approval is valid for one year following the date of approval, CPJ:cw