HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 6 LT 4
GAAB-HD-2
GREATEI]'',NCHORAGE AREA -' ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case N o.~,-~ ~/
SEWAGE DISPOSAL SYSTEM - APPLICATION 8, PERMIT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
MAILING ADDRESS
LOCATION OF INSTALLATION F,~,/,'
]*st ,¢
/ , SEEPAGE PIT J, DRAIN FIELD , OTHER
TO BE INSTALLED BY
/oo £~ ,~o~/ ANTICIPATED DATE OF COMPLETION
,/
BEL[~W T/O BE FILLED OUT BY HEALTH DEPARTMENT
PHONE NO.
~"-~.,~,~o,~ PERMIT TO INSTALL A ~" ~' 7Z''' .~ ,,-.a~, -,~
THIS
IS
TO
SERVE
AS
AS DESCRIBED BELOW. SIZE OF UN'~O ~.S~RVED ,~ ~''-~'
. SEPTIC TANK SIZE /0oo TYPE~ .SEEPAGE AREA,~~ TYPE
~f~'~{"/ DIAGRAM 0F SYSTEM /
DISTANCES:
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./f~/o//I/,~JTf/ "(~''/~'~/->'~ ~'~
DATE 7- ~-~' APPLICANTS SIGNATURE ~ ~'~~~
GRr.~TER ANCHORAGE AREA BOROLL~-~I
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
NUMBER OF
LIQUID CAPACITY xx~ ~S~ ~ GALLONS. INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
/
NUMBER OF PITS OUTSIDE DIAMETER
LINING MATERIAL
NEAREST LOT LINE
'--"-'--' OR WIDTH / ~ ' LENGTH /~' / DEPTH ~' /'
DISTANCE FROM WELL ~'~:~,"~7.~ /~/'.~m--~" , BUILDING FOUNDATION~''~' ~,
~,~'"'/" TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) 3 ~ ~') SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
.. .EO DAT,ON --? GE L,NES .
NUMBER OF LINES ..~-- DISTANCE BE TRENCH WID!H
ABSORPTI~EA SQ. FT. LENGTH
OF
EACH
LINE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
· ' DISTANCE FROM WATER
WELL: TYPE ~-. ~--('~/:~/?~'/z~TDEPTH -"--~' ,BUILDING FOUNDATION. ~' SAMPLE NEAREST
._....~. NEAREST __....~ SEPTIC ~ SEEPAGE OTHER ~
SYSTEM ~ CESSPOOl .... SOURCES
LOT LINE SEWER LINE TANK
DISTANCES: Jj
D AGRAM OF SYSTEM
DATE
APPROVED _ ~~' HE/~L'TH AUTHORITY
2573
U.S. DEPARTMENT OF hOUSiNG AND URBAN DEvELoPMENT '
FEDERAL HOUSING ADMINISTRATEDN ,
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
F~'m Approved
Budget Bureau No. 63-R0296
PART I --TO BE COMPLETED BY FHA
Office
ANCH0t~kGE
Name, Address and Zip Code
Matanuska Valley B~nk
Pouch 7012
Anchorage, Alaska 99501
59021 OO1 2
L /
111-013626-203
SCHELL, Clifford L. & Renae M.
P*operty Address:
102 Corv±lle Street~ Anchorage, Alaska
Subdivision:
Eagle River Heights t Block 6
BAI~EMENT
i 3 i Yes So
#ATER SUPPLY BY:
~ Public System
New Installation
[] Community System
[-'~ Individuol
BY:
Public System [] Community System [-x~ Individual
Ean Attic or other Area be made into additional
aedrooms? (I[ yes; how many?)
Yes
SYSTEM DESIGNED FOR
No. of
Garbage Disposal
~-] Yes [] No.
PARTII.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR°S SKETCH
It is the opinionof the [~ State [] County X Local Department of tlealth that this individual water-supply system
~-~ is [] is not satisfactory as a domestic water supply for the subject property. P IJ b 1 i C W a t e r'
It is the opinion of the [] State [] County ~] Local Department of Health that this individual sewage-disposal system
with proper maintenance:
[~ Can be expected to function satisfactorily, and [-~ Cannot be expected to function satisfactorily
is not likely to create an insanitary condition
DATE $,9N 'I'URE 2 //:) ,TITLE'.--- '
Oct. 12, 197 Environmental S _ cialist
NOTE: The healfh authority should ~:omplete tho appropriate opnfon statement above and affix dJte;"si~nature 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 opinion of the
hen Ith {~utho~it¥o
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 E~ Acceptable [--] Not Acceptable
Sewage disposal be considered [] Acceptable ~ Not Acceptable;
DATE
SIGNATURE I~ CHIEF ARCHITECT
[~] DEPUTY FOR CHIEF ARCIFITEC'[
ttEALTtl AUTilORITY APPROVAL FHA FDRa NQ~ 2573
IIIDIVID!IAL WAYER SUPFLY Alll) SEWAGE DISPOSA,L SYSTEM Re¥. 10/70
% ~ 5Y
GREATER ANCHORAGE. AREA BOROUGH
/
~¢,, , DEPAP~'~NT OF ENVIRONMENTAL QUALITY
· , ~' .q . .~ ,/~ ~"~. 3500 TUDOR ROAD
~, ~,~-":~,,\'~ / ~-~C~ORAGE, ALASKA 99507
/~ ~ ~, ,,~ ~ ~1 279-8686
~ . ]" '"<~",~"~' ]~V" DATE RECEZVED:
~ INSPECT'
~' . TIME: , F/~' ?,, ~-~'?~.
~ REQUEST FOR APPROVAL OF
~ ,~,,:,~ INDIVIDUAL SEWER AND WATER FACILITIES
~ FOR
1. APPROVAL REQUESTED BY: /.";!/~;~;;'F ~/
ADDRESS: ~ ~ ~,, :2
PHONE: < .
2. PROPERTY OWNER: .~ "~'~:? T~/ ~.,TM'' /~?;~';' ' '~,~'2~ ~'~. 'PHONE:
4 TYPE FACILITY TO BE INSPECTED:
NUMBER OF BEDROOMS:
B. DEPTH
C. SIZE
E. BACTERIAL ANALYSIS/~,, ~ z,/~,~,-~'~"->
/
6. SEWAGE DISPOSAL SYSTEM: .,.~,
A SEPTIC TANK (IF HOMEMADE SHO~ DIAGRAM ON BACK)
2. AGE ~ /.-. Cr-: ,.._2~
3. MANUFACTURER <~'<, ..c~ .
4. INSTALLER ~ c'~ ~ ~ ~
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
7,
B. SEEPAGE PIT
DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL k~GTH
REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE
D. WELL TO PROPERTY LINE
E o
F.
G.
H.
WELL TO OTHER POSSIBLE CONTAMINATION
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEEPAGE PIT TO PROPERTY LINE
8. COMMENTS:
APPROVED: --~t, ISAPPROVED:
DATE:/~'~'~--/~ - ~7/' DATE:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY