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Home My WebLink AboutCOLEMAN Block 1 Lot 2 GAAB-HD- I GRr ER ANCHORAGE AREA BOROUr"~ HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY ..... /~AT'E-'~ I A L GALLONS. INSIDE LENGTH NUMBER OF COMPARTMENTS LIQUID INSIDE WIDTH DEPTH__ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE _OUTSIDE DIAMETER. ....__·. OR WIDTH / ,~ · TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH / '~ /', DEPTH ,BUILDING FOUNDATION ~ ._~" SQ. FT. TILE DRAIN FIELD: / DISTANCE FROM WELt FOUNDATION ~'~'"~ NEAREST LOT LINE NUMBER OF LINES DISTANCc. E.~B'ET'C,/"~'~'N LINES TRENCH WIDTH ABSORPTION AREA .~.~.~" SO. FI. LENGIH OF EACH LINE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE. IN. ABOVE TILE ~/~9./~ DISTANCE FROM WELL: TYPE ¢ DEPTH BUILDING FOUNDATION NEAREST SEPTIC SEEPAGE LOT LINE SEWER LINE , TANK SYSTEM WATER SAMPLE , CESSPOOL , NEAREST OTHER , SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE APPROVED GAAB-H D-2 GREATEk ANCHORAGE AREA ._. ROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No. ~ SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME 0F APPLICANT RESIDENCE ADDRESS LEGAL BESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS ~J/'~ ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT MAILING ADDRESS ~::~[~ ~['~ ~"-PHONE NO. LOCATION OF INSTALLATION ,~'-~ SEEPAGE PIT. , DRAIN FIELD , OTHER . ,0 BE IN~TAL~ED BY ~~ THIS IS TO SERVE AS ~~ I~~ ,PERMITT01NSTALLA ~~~~ AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE .TYPE SEEPAGE AREA DIAGRAM OF SYSTEM DISTANCES: of Greater Anchorage Area Bo[Ough Ordinance No. 28-68 and that the a code. DATE - FHA Form 2573 Form Approved Rev. July 1958 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 MORTGAGEE SERIAL NO. pROpERTY A~DRES~' MORTGAGOR OR SPONSOR " SUBDI'~N NAME,/.I. ~ ~ BLOCK NOi LOT NO.. Can a~ic or other area be made into TOTAL NUMBER: BASEMENT ew installation additional bedlams? LIVING UNITS BEDROOMS BATHS C::~ (~, s ~ No ~ Yes SEWAGE DISPOSAL BY: ~ ~blic system ~ ~mmunity system ~ndividual (~)__ ~ No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH '~ 7 ~'~ is ~ is ~ot s~ds~cto~y ~s a domestic w~te~ s~pply ~o~ t~e subject mm wit~ ptoger ~n expected to satisfactorily, ~ expected to satisfactorily be function and Cannot be function is not likely to create an insanita~ condition NOTE, The health authority ~oUjd comgJete the appropriate opinion statement above and am. date, signature and title tn 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 pe~inent FHA Compli~ce Ins~ion Repom and recommend that'the Individual water-supply system be considered ~ Acceptable ~ Not Accepmble ~wage dis~sal 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 2573 Rev. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. Septic Tank: Distance from well,~feet. Material Total liquid capacity, Inside length, feet. Inside width, Cesspool: Distance from: Well, feet; foundation, Inside diameter,, feet. Depth, SECONDARY TREATMENT consists of [] Tile disposal field. Number of compartments [] Cesspool. gallons. Capacity inlet compartment, feet. Liquid depth, _feet. feet; nearest lot line at [] front, [] side, [] rear, feet. Liquid capacity, gallons. Lining material [] Seepage pits. Other Depth of filter material over tile, .gallons. Tile Disposal Field: Distance from: Well, Total length of tile lines~ Trench width. Length of each line Type of filter material: [] Gravel. Depth of filter material beneath tile,~ Seepage Pits: Number of pits . Outside diameter, feet. Distance from: Well, feet; building foundation,_ inspection made by: [] State. 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, [] Broken stone. Other. inches. feet. feet. square feet. inches. Depth, feet. Lining material feet; nearest lot line at [] front, [] side, [] rear, [] County. [] Local Health Authority. Inspected by , 19 (TITLB) inches. Date of inspection feet. REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest punic 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 feet; nearest lot line at [] front, [] side, [] rear, 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. Exterior space around casing sealed with: [] Cement grout. 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. [] 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__ .gallons per minute. (TITLE) 19 . 5~ U. S. GOVERNMENT PRINTIHG OFFICE: 1957 O-F--427038 feet; feet.