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Home My WebLink AboutEAGLE RIVER HEIGHTS NORTH BLK 4 LT 5 G~"~.TER ANCHORAGE AREA BORO'~rq HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N? 671 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION SEPTIC TANK: MAILING ADDRESS ~'"'~' ~'~.- .-'~"~ PHONE "' LEGAL DESCRIPTION /~Y ~ ~1~ ~-~'~ ~/~ ~ DISTANCE FROM WELL LIQUID CAPACITY //~ MATERIAL ~-/J~"~'~' GALLONS. INSIDE LENGTH NUMBER OF ~ ~OMPARTM~TS ~- LIQUID INSIDE WIDTH DEPTH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAl /~ NEAREST LOT LiNE SEEPAGE PIT: OUTSIDE DIAMETER / OR WIDTH /Z . DISTANCE FROM WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ! ) , LENGTH '~'~ , DEPTH ~ BUILDING FOUNDATION ~- ~', .SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL .,~'~:ro U N D ATTON~ ~ , NEAREST LOT LINE NUMBER OF UNES ///DISTANCEBETWEEN LINES~ TRENCHWIDTH ABSORPTION SQ. ET. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH , OF LINES IN.I~FFECTIVE IN. ABOVE TILE__ C~- )~(~/~)~ ~ DISTANCE FROM WELL: TYPE /~ ' , DEPTH , BUILDING FOUNDATION. ! NEAREST SEPTIC SEEPAGE LOT LINE ~ , SEWER LINE ~ , TANK -- , SYSTEM WATER SAMPLE w~;~,~ ~-- , NEAREST ~ OTHER . CESSPOOL , SOURCES DISTANCES: DATE DIAGRAM OF SYSTEM (,"'~ /~_w-.~w~,~ GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 DATE RECEIVED: INSPECT: TIME: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. APPROVAL REQUESTED BY: ADDRESS: PHONE: 2. PROPERTY OWNER: 3. LEGAL DESCRIPTION: 4. TYPE FACILITY TO BE FOR -'" PHONE: NUMBER OF 8EDROOMS:.~_~. WELL DATA: A. TYPE B. DEPTH C. SIZE D. CONSTRUCTION E. BACTERIAL ANALYSIS SEWAGE DISPOSAL SYSTEM: A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK) 1. SIZE /0 i~Z)O 2. AGE 4. INSTALLER APPROVAL REQUEST FOR SEWER & WATER FACILITIES PAGE TWO B. SEEPAGE PIT 1. SIZE 2. LINING C. DISPOSAL FIELD 1. NUMB[R~ LINES 2. TOTAL LENgtH REQUIRED MEASUREMENTS A. WELL TO SEPTIC TANK B. WELL TO SEEPAGE PIT C. WELL TO SEWER LINE D. WELL TO PROPERTY LINE E. WELL TO OTHER POSSIBLE CONTAMINATION F. FOUNDATION TO SEPTIC TANK ~-- G. FOUNDATION TO SEEPAGE PIT ::2--3 H. SEEPAGE PIT TO PROPERTY LINE /~! 8. COMMENTS: DATE:- -'~ ,f'"'" "~' r DATE: APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY FHA Form :IS73 Form Approve&. U. S. DEPARTMEHT OF HOUSLNG AND URBAN DEVELOPMENT Budget Bureau No, 63.R0296 FEDERAL HOUSING ADh~tNISTRATION HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND ,SEWAGE DISPO,SAL SY,STEM PART I.wTO BE COMPLETED BY FHA INSURtt4G OFFICE Anchorage. Alaska MORTGAGOR OI1 SPONSOR Assocl at~: P, ui 1 d~rs SUi~IVISION NAM~ Ea.ql e River TOTAL NUMIIR: BASEMENT Yes' [] No MORTGAGEE SERIAL HO. Peo,?lcs ~ank and Trust ,EO"E"~ ^.O.ESS Chatanika ]New installation WAllI SUPllLY BY: .l~.Public system [] Community system S~WAGE DISPOSAL IY~ [] Public system [] Community system PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT Loop, Eagle River ~6c~a.o. LOT NO. 5 Can attic er ~ erie bi made Info eddi~l bldfeeml? (If YII, ~w m~) Individual indi~idual . ~ Yes D No HEALTH DEPARTMENT INSPECTOII'S SKETCH It is the opinion of the '[~] State [] County ~ local Department of Health that this individual water-supply system Public Water r~is [] is not Mtisfactory as a domestic water supply for the subject property. It is the opinion of the ['--I State [] County tern with proper maintenance: ~Can be expected to function satisfactorily, and is not likel'y to create an insanitary condition [~ Local Department of Health that this individual sewage,disposal sys- [] Cannot' be expected to function Satisfactorily , L Environincntal Specialist NC)TI: The health authority ihould complete the appropriotl opinion statement above and af~x dote, IiIaaturI arid title In the ipaces provided. Use of the above grid for Health Dipartment Inipactor'l sketch oi well om use of the back of this form I~ at thI option of the health authority. PART Ill.--FOR USE OF FHA OFFICE TO THI CHIIF UNDIRWRITIR: I have reviewed thc foregoing and thc pertinent FHA Compliance Inspection Report, and recommend that the tAT[ Individual water-supply system be considered [] Acceptable [] Not Acceptable Sewage dispOsal be considered [] Acceptable [-I Not Acceptable. SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATIR SUPPLY AND IIWAII DISPOSAL SYSTEM [_iCHtEF ARCHITECT DEFUTY FOR CHIEF ARCHITECT FHA Irerm REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septi~ tank, [] Cesspool. 8el~k Tonk: Distance fn)m well. Total liquid tapactty. Inside length.__ Distance fi,m: Well Inside diameter, gallons Capac.ty inh. t ~ompartment. gallons. fret Inside w~dth feet. Liquid depth, feet. feet; fl~undamm .... feet; nearest lot line at [] front. [] side, [] rear. feel Depth.__ feet. Liquid capacity, gallons Lining material UCONDARY TREATMENT consists of ~ Tile disposal field ~ Seepage pits, Other Tlb ~oNI ~l*ld: Dis~nce from: Well (~t; foundation f~t; nearest lot line a~ ~ front. ~ side, ~ rear,. Tn~al len~h of tile lines f~t. Numar of lines, Distance ~w~n lines. Trench width __inches. Total eff~tive absorpmm area in bo.om of trenches ~ngth of each line f~t. ~pth, top of tile to finish g~e, Ty~ of filter material: ~ Gravel. ~ Brok~ s~one Other ~pth of filter material ~neath tile~ inches. [~pth of filter material over tile, ' ~poge P~: Numar of pies .... Outside diameter, fr.. ~pth, f~t. Lining material Distance Ir.m: Well feet. feet. square feet. , inches. Insl~ctlon made by: [] State inches. feet; building foundation, . feet; nearest lot line at [] front. [] side, [] rear,__ [] County. [] Local Health Autbor~ry. Inspected by 19 (TlrtS) REPORT OF INSPECTIONmlNDIVIDUAL WATER-SUPPLY SYSTEM Individual wells [] are [] are not tust(.naty in neighbgrho~d. Properties ~n neighborht~d [] are [] are not being deveh)ped with both individual water*supply and sewage-disposal systems. Lot s~e' feet wide .... feet deep. Dwelling set hack from front property line, feet. Individual wamr supply from: ~ Drdled well ~ Driven well. ~ Dug well. ~ Bored well. ~s~nce of well from: I~u ilding fimndation seepage p~t, feet; cesspool, Diameter, inches. Total depth1 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 ~ell, [] Deep well, Length of drop pipe, feel. %rap capacity Located in: [] I:Lasement. l~ Pumproom off basement, [] Pumphouse ab~e 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." g~ve 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. [] Lo~al Health Authority. Inspected by Date of inspection 19 __feet; nearest lot line at [] front, [] side. [] rear tree; septic tank, feet; disposal field, feet; other sources o£ possible pollution, .feet. Depth of casing~ .gallons per minute. gallons per minute. ,19 (TITLe) feet; GPO 88g-0 B8