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Home My WebLink AboutEAGLE RIVER HEIGHTS BLK 5 LT 17 MUNICIPALITY OF ANCHORAGF .-.DEPARTME.._~OF HEALTH AND ENVIRONMEN, ~ PROTECTION 825 L Street, Anchorage, Alask--a -99501 279-2511, ext. 224 or 225 ~1: Time Date Insp #2: Date Received: Time ~', ~O Date ~/6/7~ Insp ~ t ~ ~dr~ April 28, 1977 #3: Time Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Alaska Pacific Bank Mailing Address: 601 West 5th Avenue 2. Property Owner: Mailing Address: 3. Legal Description: 4: Single Family Residence: ~ ) Multiple Family Residence: ( ) Patrick/Jean Marine 111 Colville, 99577 Phone: 276-3110 Phone: 694-2519 Lot 17 Block 5 Eagle River Heights Number of Bedrooms: Number of Bedrooms: Well System: Permit # Construction Sewage Disposal System: Permit # ~ ~? ~Q> Septic Tank Size On-site System ( ) Public Utility % I~.led~ ~/· ~ Installer Absorption Area Material Distances: Well ~ic Tank ~/ ~ t~D Absorption Area Individual well ( ) CoP~nunity/Public System k ) Depth of ~].~ .--~- Well l',og on ~'il~_~ ~ ~..~'..~37~ Bacterial Analysis ~(~ - Area MUNICIPALITY OF ANCHO~'~',G''': DEPT. OF HEALTH ~, ~ --_ ENVlROI~h',E.%I AL PROTECTION MUNICIPALITY OF ANCHORAGE APR 2 8 1,g77 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510East Tudor Road, Anchorage, Alaska99504 276-2221 REcEiVED REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA 2. Property Owner: ~ 7'/L://C_~' Mailing Address: /// ~'~~~/ , DayPhone: 3. Nam. of Buyer: ~/~,~ ~'~ ~/ -~/ ~/, Mailing Address: ~/~o~ 4. Name of Lending Institution: ~~ Mailing Address: ~/ ~ ~~. ~dC~ ~e: 5. Name of Realtor or Agent: ~ ~a,ing A~dre,,: ~ ~ /~¢ ~¢~ ~one: 6. Legal Description: ~ /7 ~ocation: ~c~ ~l~_ 7. Type of Facility to be Inspected: ~t-IF CONV Day Phone: 75'3 - ?~/_~' No. Bdrms. '~ 8. Water Supply Type of Supply: Public Utility /~ Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3/76) Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 17 Block 5 Eagle River Heights Subdivision Comments: Affadavit Attached Approved: ~r~~~ Disapproved: Letter Attached: ( ) Date: Date: Department Worksheet: 06-1220(a) Re~. 1973 DATE ALA,~ JEPARTMENT OF HEALTH AND SOCIAL SE ;S DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI.PUBLIC BACTERIOLOGICAL WATER ANALYSIS Lab No. OFFICE INDIVIDUAL [] NAME SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO ADDRESS CITY ADDRESS OF SOURCE COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY DATE COLLECTED TIME COLLECTED Sample Collected From [] Kitchen Tap [] Bathroom Tap [] Other (List) Well- [~ Dug [] Driven [~ Drilled SOURCE: [] Spring [] Cistern [] Other· Dug Well or Cistern Construction: Walls--[] Wood [] Concrete [] Metal Tap -- [] Wood [] Concrete [] Metal LOCATION: [] Zn Basement [] Basement Offset []In Yard [] Other Building Sewer DISTANCE TO: or Other Drainage Pipe Feet. Tile Seepage Cess- Field -- Feet. Pit -- Feet. Pool Other Passible Sources of Contamination MATERIAL: Bu~ldlng Sewer- [] Cast Iron [] Wood [] Tile [] Plastic Joint MaterTal - Type GENERAL: Does Water Become Muddy or Discolored? ZIP CODE When? Diameter of Well Well Casing Material Diameter Length of Drop Pipe Offset in PUMP LOCATION: [] In Well [] Basement On Top [] Of Well [] Other PURPOSE OF EXAMINATION: Illness Suspected? Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Questionable ~ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. [] Bottle broken in transit, please send new sample. SANITARIAN'S REMARKS [] Basement Tap [] Bored [] Tile Brick or [] Open Top [] Concrete [] Under House Septic TanL Feet. Feet. Privy __Feet. [] Fibre [] Asbestos Cement [] Yes [] No Depth Feet. Depth Water Depth From Bottom Feet. In Utility [] In Basement [] Room New Source of Supply? [] Yes READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE [] Yes [] No [~ No Repairs to System? [] Yes [] No Signature 064~20 Ibl BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1973 Date Received , Time Received 'pm Lab. No. Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0cc 24 Hours Brilliant Green 24 Hours 48 Hours EMB AGAR Lactose Broth, 24 hrs. 48 hrs. Gram's stain Coliform Density (Most probable No. per 10CIcc) MF Results Reported by / ~': .J-' , This analysis indicates Coliform Organisms to be: Date . · Absent Present GREATER Ak~HORAG5 AREA BOROUGH Department of 5nvironmental quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received ~' Time of InsDection Date oS Ins,~ection ~-~-';~- RSQUHST FOR APPROVAL OF INDIVIDUAl. S£WER g WA/ER FACILITISS Phone: Address: Locat:on: ,l! %+.Z _ . Number of Bedrooms: A. Type C. Construction D, Bacteria] Analysis Sewage Disoosal System: A. Insta lied Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Size 2. Material E. Disposal Field: Tot,al Length of Lines Distances: A. Well To: Septic Tank__ ~ ,... , Nearest Lot line Foundation to Septic Tank Absorption Are~ to Nearest Lot Line , Absorption Ares "' , Sewer Lines -"' Other Contaminetion "'"' · '~ Ab~orption Area · Request for Approval of ~, zvidual Sewer & Water Factlitt,_.__ Page Two Comments: Ap~roved~ Disapproved Date Approval Valid for One Year ~rom Date Signed Greater Anchorage Area Borough, Department of 5nvironmentel Quality DIAGRAM OF SYSTE~ I certify that the information contained in this request for approval to be a true and accurate represe~gatJon of the subiecg sewer and wager facilities locaged at: ee~"July 19~8 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGOR OR SPONSOR jMORTGAGEE Ll ldm SERIAL NO. SUBDIVISION NAME TOTAL NUMBEI~: BASEMENT LI¥1NG U~ITS BEDROOMS BATHS 1 ~ 1 ~ Yes ~ No WATER SUPPLY BY: [] Public system -"lq New installation BLOCK NO. LOT NO. Can attic or other area be made into additional bedrooms? (If Yes, how rnany~I SYSTEM DESIGNED FOR [~ Community system ~ Individual NO. OF BDKMS. GARBAa[ DISPOSAL SEWAGE DISPOSAL BY: [] Public system [--] Community system [] Individual ~ [--] Yes [] No PART fl.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [~] State ~] County [] Local Department of Health that this individual water-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the N State [~] County [] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: [~i Can be expected to function satisfactorily, and [---] Cannot be expected to function satisfactorily '' is not likely to create an insanitary condition · [SIGNATURE.' ITM DATE NOTE: The health authority should complete the appropriate.opinion statement able and afflx date, signature and title in the spaces provided. Use of the above grid for Health Department Inspector's sketch as well as use of the back of this form is at the option of the health authority. PART III.~FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the Individual water-supply system be considered [~ Acceptable ~] Not Acceptable Sewage disposal be considered Acceptable [] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form Rev. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists offfSeptic tank. [] Cesspool. Septic Tank: Distance from well, feet. ,j~aterial C,~,. Total liquid capacity, y~/'~ C~ gallons. '~11'~" ~'/~'~'~5~7'/3Number°fc°mpartments / Capacity inlet compartment, .gallons. Inside length,, feet. Inside width, feet. Liquid depth, feet. Cesspool: Distance from: Well, feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. Inside diameter, feet. Depth, feet. Liquid capacity, .gallons. Lining material $[CONDARY ?RIAT~N? consists of [] Tile disposal field. '~Seepage pits. Other Tile Disposal Field: Distance from: Well, feet; foundation, feet; nearest lot line at [] front, [] side, [] rear,, feet. Total length of tile lines,. .feet. Number of lines, Distance between lines, feet. Trench width inches. Total effective absorption area in bottom of trenches square feet. Length of each line, feet. Depth, top of tile to finish grade, inches. Type of filter material: [] Gravel. [] Broken stone. Other. Depth of filter material beneath tile, inches. Depth of filter material over tile, inches. Seepage Pits: ~ ..~- , Number of pits { . Outside diameter ~' /r~ feet. Depth, ~ feet. Lining material Distance from: Well,.~ ~ feet; building foundation, ,~ ~ feet; nearest lot line at [] front, '~side, [] re~,~feet. Inspe~tion made by: ~tate. [] County. [] Local Health Authority. ~ // /~ ..... Inspected by "' ~ /~g~ ,'~ Date of inspection ''?[ '(xm.e)' ' ' REPORT OF INSPECTION---INDIV~~ATER-SUPPLY SYSTEM Distance to nearest public water main, .feet. Size of main,, inches. Individual wells [] are [] are not customary in neighborhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems. Lot size: feet wide, feet deep. Dwelling set back from front property line, feet. Individual water supply from: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. Distance of well from: Building foundation, cast iron sewer~ feet; tile sewer, seepage pit, .feet; cesspool, Well construction: Diameter, inches. Total depth, Approximate depth to pumping level of water in well, Sealed watertight to depth of feet. feet; nearest lot line at [] front, [] side, [] rear, feet; septic tank, feet; disposal field, feet; other sources of possible pollution, feet. feet. Type of casing, Depth of casing, feet. Approximate yield, _gallons per minute. Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. Pump: [] Shallow well. [] Deep well. Length of drop pipe,, feet. Pump capadty, Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No. Type of storage: [] Pressure. [] Gravity. Capacity,. gallons. Has bacteriological examination of water been made? [] Yes. [] No. If answer is "yes," give date Quality of water [] is [] is not satisfactory for human consumption. Installation [] does [] does not comply with approved exhibits, if any. Inspection made by: [] State. [] County. [] Local Health Authority. Inspected by Date of inspection 19__ .gallons per minute. , I9