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Home My WebLink AboutEAGLE RIVER HEIGHTS BLK 6 LT 305o ooo GAAB-HD I G~:ATER ANCHORAGE AREA BORO~'"~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY JZ GALLONS. PHONE NUMBER OF MATER~A~_ COMPARTMENTS INSIDE LENGTH g ! .INSIDE WIDTH ~ j LIQUID DEPTH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH DISTANCE FROM WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) DEPTH sQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE_ WELL: ~ TYPE FOUNDATION. DISTANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE . DEPTH , NEAREST LOT LINE TRENCH WIDTH TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE , NEAREST NEAREST LOT LINE ., SEWER LiNE SEPTIC , TANK DISTANCE FROM WATER , BUILDING FOUNDATION.~SAMPLE SEEPAGE , SYSTEM , CESSPOOL OTHER , SOURCES__ DISTANCES: DIAGRAM OF SYSTEM DATE APPROVED. ?'~-~% , GREATE~,~~ ~tNCHORAGE AREA .~ ./ROUGH Case No. 'Z/ HEALTH DEPARTMENT 327Eagle St. Anchorage, Alaska 99501 279-2511 ~~ ~ SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPL,CANT/ ; ' T MAIL,NGAODRESS - // LEGAL BESCRIPTION /L/o7'' ~ ~ & g'~' ~~ ~/~ APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT ~ , DRAIN FIELB , OTHER TO SERVE THE FOLLOWING FACILITY ~ ~~&~¢ ~¢~ PERCOLATION TEST RESULTS Z ~/~/~ .ANTICIPATED DATE OF COMPLETION &/~ I~-- BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THiS IS TO SERVE AS//'~L~ '-~--~'~'~:'Z-'¢ ~' PERMIT TO INSTALL A ~~ ~~- ASBESCRIBEB BELOW. SIZE OF UNITTO RESERVED ~ ~'~~ . SEPTIC TANK SIZE /~ TYPE~ SEEPA~EAflEA ~ ~ TYPE~~ DIAGRAM OF SYSTEm 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 SIGNATUI~F . _ F~A 'F~m 2S73 Rev. July 19511 U. S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT FEDERAL HOUSING ADMINISTRATION HEALTH AUTHOfllTY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM Form Approved Budget Bureau No. 63-11296.E PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE MORTGAGOR OR SPONSOR PROPERTY ADDRESS ISER, AL No. !'11=4X77860- 3 SUBOIVISION NAME TOTAL NUMBER: BASEMENT Iii Yes [] No [~] New installation WATER SUPPLY BY: [~] Public system I OCK No. 6 LoT 3 Can attic or other area be made into additional bedroomsT (If Yes, how martyr) SYSTEM DESIGNED Fait ~ Community system [] Individual .o. o, sos,~s, o^ss~oE u~sPos^t SEWAGE DISPOSAL BY: ~ ~blic system ~ ~mmunity system ~ Individual ~ Y~ ~ No PART IL--TO BE COMPLETED BY HEALTH DEPARTMENT ~EALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State {--{ County ~-{ Local Department of Health that this individual water-supply system ~'] is F-] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the ~l State F'~ 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- F"] Cannot be expected to function satisfactorily I DATE SIGNATURE NOTE:. The h~ ~ s~ld. compbte ~e uV~;Gprim o~nion ~ment above and affix data, signature and title in the spaces provl~d. -- ~ Use of the above grid for Health Department Inspector's sketch as well os use of the back of this form is at the option of ~e hea~ ou~orl~. PART Ill.--FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: 1 have reviewed the foregoing and the pertinent FHA Compli~mce Inspection Report, and t~commend that the Individual warer-supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. DATE SIGNATURE CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 257;~ REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY 111EATMENT consists of [] Septic tank, [] Cesspool Septk Teak: Distance from well,__feet. Material Total liquid capacity, Inside length,__ feet. Inside width, Ce~s~ol: Distance from: Well, feet; foundation, Inside diameter~ feet, Depth, SICONDARY TREATMENT consists of [] Tile disposal field. Tile INspoNI Field: Distance from: Well, Total length of tile lines, Trench width Length of each line, gallons. Capacity inlet compartment, t~et. Liquid depth, .feet. Number of compartments . .gallons. square feet. inches. feet; nearest Itn line at [] front, [] side, [] rear, feet, Liquid'capacity, gallons. Lining material [] Seepage pits. Other inches. feet. feet. Lining material __ feet; nearest lot line at [] front, [] sid$', [] rear, [] County, [] Local Health Authority. Inspected by. 19__ (TITLE) 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 Depth of filter material beneath tile~, inches. Depth of filter material over tile, Number of pits .... Outside diameter, feet. Depth, Distance from: Well,_ feet; building foundation, Inspection mode by: [] State. Date of inspextion_ REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main, feet. Size of main, _inches. Individual wells [] are [] are not customary in neighborho~M. Give most recent r¢<ord 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 ii'om: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. O~stance of well from: Building foundation seepage pit,. W~II conatrq~cflon: feet; tile sewer, feet; cesspool, feet; nearest lot line at [] front, [] side, [] rear, f~et; septic tank, feet; disposal field, feet; other sources o( possible pollution~ i'eet. Diameter, .inches. Total depth, .feet. Type of casing,. Approximate depth to pumping level of water in well,, feet. Approximate yield, Sealed watertight to depth of feet. 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, 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.__ Depth of casing, .gallons per minute. .gallons per minute. ,19 feet; HUD*W~h., D. C.