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HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 6 LT 2l b,So GS~ATER ANCHORAGE AREA BORO~"'~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279~2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM GALLONS.  NUMBER OF MATERIAL COMPARTMENTS ~ INSIDE LENGTH ~ j ~ j LIQUID~/~ ~~ SEPTIC TANK: D~STANCE FROM WELL LIQUID CAPACITY / SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH . LENGTH , DEPTH LINING MATERIAL DISTANCE FROM WELL BUILDING FOUNDATION NEAREST LOT L,NE O~'~ ' ,.~-- TILE DRAIN FIELD: DISTANCE FROM WELl TOTAL LENGTH FOUNDATION_ , NEAREST LOT LINE OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE . WELL: TYPE H NEAREST LOT LINE , SEWER LINE SEPTIC , TANK DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE DISTANCE FROM , BUILDING FOUNDATION, SEEPAGE , SYSTEM WATER SAMPLE CESSPOOt DIAGRAM OF SYSTEM , NEAREST OTHER · SOURCES__ DISTANCES: ~-.-> 8- I~ DATE ~ ;AB-HD-2 GREATE .kNCHORAGE AREA ._. ~ROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alask~ 99501 279-2511 Case No. ~.-~- SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT ,ESIDENCE ADD,ESS ~-",~"-- R-~X.~-..., ,OCAT,O, O~ ,NSTALLAT,O~"~ p./~ APPLICATION TO INSTALL: SEPTIC TANK ~, SEEPAGE PIT ~ , DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY ~ ~ ~ .~ PE~C0LAT'0N TEST ~,/ '~ ANT'C'PATEO OATE 0F COMPLET'0N . BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED .SEPTIC TANK SIZE ,/~~c'~ TYPE~' ~'~¢-~/ SEEPAGE AREA~-~/-TYPE DIAGRAM OF SYSTEM DI~ANCES: ~ ~N'~ ~ ' ~- ~Health Authority 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 ~ '~--~-~ - ~ APPLICANTS SIGNATURE ~ ~ -_ FHA Form 2573 Rev. July'1958 HEALTH AUTHORITY APP~ROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. MORTGAGOR OR SPONSOR PROPERTY ADDRESS SUBOIVISION NAME TOTAL NUMBIRi BASEMENT ~]Yes [] No ~]New installation WATER SUP~,Y iYI ~] Public system [~ Community system SiWAOE DISPOSAL BY: [] Public system O Community system ~,-~o ~v~, ~ (~) I Con ~ (If Yes, ~w man~) ~ Individual ~. OF ~. aXe,GE DISPOS*L PART li.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH D~PARTMENT INSPECfOR'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 [] State [] County rem with proper maintenance: F~Can be expected to function satisfactorily, and is not likely to create an insanitary condition [] Local Department of Health that this individual sewage-disposal sys- -']Cannot be expected to function satisfactorily Apt. iX 23t lg~g ' :~'-t NOTE: Tho heal~uth~ should complete the appropriate o~nlon statement above and a~x date, signature and flHe in ~e spac~ provided. ~ U~e of the above g~d for Health Department inspector's sketch as well as use of the back of this form Is at the option of the heal~ au~ority. PART Ill.--FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliaqce Inspection Report, and recommend that the Individual water-supply system be considered N Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM ECH~EF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 Rev. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. [] Cesspool. Septk Tank: Distance frnm well,__ Total liquid capacity, Inside length. Cesspool: Distance from: Well, Inside diameter, .feet. Material gallons. Capacity inlet compartment, feet. Inside width, f;eet. Liquid depth, feet. Number of compartments , gallons. feet; fi~undation, feet; nearest lot line at [] front, [] side, [] rear, feet. Depth, ,feet, Liquid capacity, _gallons, Lining material S~COf4DARY TREATMENT consists of [] Tile disposal field. [] Seepage pits. Other Tile Disposal Field: Distance from: Well, Total length of tile lines~ Trench width Length of each line square feet. inches. Depth of filter material over tile,. feet. Lining material feet; foundation, feet; nearest lot line at [~ front, [] side, [] rear, .__feet. Number of lines, __ Distance between lines, inches. Total effective absorption area in bottom of trenches, feet. Depth, top of tile to finish grade, __ Type of filter material: [] Gravel, [] Broken stone. Other Deptb of filter material beneath tile. inches. Seepage Pits: Number of pits .... Outside diameter, feet. Depth, Distance from: Well, Inspection made by: [] State. inches. feet; building foundation,__ feet; nearest lot line at [] front, [] side, [-] rear,_ [] Cnunty. [] Local Health Authority. Inspected by 19.__ Date of inspection_ REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main, feet. Size of main,. .inches. Individual wells [] ar{. [] are not customary in neighborho~<l. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood [] are [] are not being deveh)ped with both individual water-supply and sewage-disposal systems. L,t size: feet wide, .feet deep. Dwelling set back from front property line, feet. Individual water supply fi'om: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. I)iatanca of wall from: Building foundation cast irnn sewer, feet; tile sewer, seepage pit, feet; cesspool. 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,_ f~et; septic tank, feet; disposal field, feet; other sources of possible pollution, ~'eet. 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 capacity, lx~cated 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. [] L(xal Health Authority. Inspected by __ Date of inspection 19 gallons per minute. (TITLE) ,19 feet, feet; feet. HUD-Wash., D. C.