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HomeMy WebLinkAboutCOLEMAN Block 4 Lot 2D, INSPECTION ~EPORT, ON-SITE SEWAGE DISPOSAL B?STEM SEPTIC TANK: Distance from well capacity gallons. SEEPAGE SYSTEM: Material~__~. Number of compar~ments~LLiquid Inside lengTh~ ~ Inside wldth_~.! Liquid depth Seepage Pit: Number of pits,,,,!]~L,Outside diameter or width_~, length~, depth ~ , lining material L~9~' . Distance from well , building (wal~s foundation /~;, nearest lot line~ Total effective ~sorption area area c~ %ILE DRAIN FIELD: Distance from well ...... , fo~dation, ~, nearest lot line~ Total len~h of lines~ Nu~er of lines~ist~ce between lines ...... Trench width in. Total effective ~sorption area~ , ,,,sq. ft. Len~h of each line Depth: Top of ~ile to finish grade_ .. ~ ~pth of filter material beneath tile~nches, ~ove tile WELL: . / ' e~th ' Authority ....... .... DIAG~M OF SYSTEM SEWAGE DISPOSAL SYSTEM - APPLICATION § PERMIT Residence Addeess 7~ ~.~, &~ ~,.~ocation of insta~iat[°n '" ' .... Application to Install: Septic tank__~ , Seepage pit~, Drain field.__.., Other To Seers the Following Facility__. 3..~.e ~. f ~0 ~ ~~. Percolation Test e~ul~s . ~a ~ ........... : :. pate Date of Completion BELOW TO BE FILLED O~ BY HE~TH DEPART~NT DISTANCES: Size of unit to be served__ ~-~ ~J~'f3r);~4 ......... tank size/~O Type_ ,, ,~ Seepage ~ea~ ,, T~pe~ DIAGRAM OF SYSTEM ou'r · Hedlt~Autho~ity - -~ ~ ~ ~/~ I certify that I am fam~lia~ with the ~equi~emmnts of G~eate~ ~cho~aEe A~ea Borough O~din~ce No. 28-68 and that the ~ove described system ~ in aceo~d~ce with said code. DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR ~ I NSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~iViRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION OCT 2 2 1981 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proceed. Please allow ten (10) days for processing. MAILING ADDRESS ~ ' ' - PROPERTY RESIDENT (If different from abo~) ~ ~ - PHONE 2, BUYER~ [ ~ PHONE MAILING ADDRESS I -- ~ - 3. ~DINGINSTITUTION ~ ~HONE 4.~ALTOR/AG~NT ~ ' . PHONE' M~LIN6 ADDreSS 5. LE'GAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE .j~SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY [] INDIVIDUAL* [] COMMUNITY PUBLIC UTILITY NUMBER OF~BEDROOM~;~ [] One ~ Fou''~'~ r ~ Other r ~ ~ Five ee ~ Six ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available,) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. 6/79) 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] I NDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified [--]Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX [] OTHER PERMIT NUMBER DEPTH OF WELL ;)ATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area [Sewer Line INearest Lot Line 5. COMMENTS Conditional approval if monies are escrowed to connect the dwelling to the public sewer prior to November 1, 1981. DATE APPROVED FOR BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) DISAPPROVED 72-OLO (Rev. 6/79) FHA Form 2573 Form Approved Rev. Ju~!y~ 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. MORTGAGOR OR SPONSOR PROPERTY ADDRESS SUBDIVISION NAME BLOCK NO. LOT NO. [1 Can attic or other area be made into TOTAL NUMBER: BASEMENT New installation additional bedrooms? LIVING UNITS BEDROOMS BATHS (if Yes, how many?) x FilYes W1No WlYes lmo WATER SUPPLY BY: SYSTEM DESIGNED FOR [~] Public system [-'] Community system ~ Individual No. Gl~ SDRM$ GARBAGE DISPOSAL SEWAGE DISPOSAL BY: [--1 Public system [-1 Community system [] Individual ~ [~] Yes [] No PART II.raTa BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'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 O State O County [~] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: [~] Can be expected to function satisfactorily, and ~ Cannot be expected to function satisfactorily is not likely to create ~4~sanitary condition NOTE: The health authority should complete the appropriate opinlo, statement above and a~x date, sigflature and title in the spaces provided, Use of the above grid for Health Department Inspector's sketch as well as use o! the back o! this lorm Is at the optio~ o~ the health authority. 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 ~ Acceptable F-1 Not Acceptable Sewage disposal be considered [~ Acceptable [~ Not Acceptable. DATE SIGNATURE J'--i CHIEV ARCHiTeCT r--1 DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2573 Rev. July 1958 SE? 1988 GREATER ANCHORAGE AREA J~)ROUGH - HEALTH DEPARTMEN'~ 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_ ('nT,.) inches. Date of inspection. REPORT OF INSPECTIONmlNDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public 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 cast iron sewer, feet; tile sewer, seepage pit, feet; cesspool, Well construction: 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__ feet; nearest lot line at [] front, [] side, [] rear, feet; septic tank, feet; disposal field, . feet; other sources of possible pollution, feet. Depth of casing, .gallons per minute. gallons per minute. (TITLE) · ~, u. $. GOVERNMENT PRINTING OFFICE: 1957 O-F--4~7038 ,19 feet, feet; feet. 2. 3. 4. 5, REQUEST F~F INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in T~iplicate) N~e of property[owner ~~ ~,:& ~ : Number.,o~ ~ooms in house ~ _,, ..... . Wate n.,Analys i s: b. Detergent ..... Well data: c. Casing Size Distance from well to closest existing or proposed: t. Sewer line ,~0i 2. Septic tank . 3, Seepase Area 4. Cesspool' . Property Line_ ~/¢t . 5. de 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc, . ./~F~ ....... · 7. Sewage disposal system. a. Age of system . . . b. Septic tank capacity in gallons c. Name of septic tank manufactum~r 1. If "home made" show diagram on reverse side of this form, d.' Disposal field or seepage pit size and type ........ Distance to proper~cy line to house foundation Percolatlozk Test f. P~rcolation Test performed by Use the reverse.side of this form to show diagram, Diagram should include · ~he foil.owing information: p~operty lines~.well location, house location, ~!,'~'~c tank location, disposal area location, location of percolation test, a-~ d~rection of ground slope 9. The ~.n~,,~',r.~+~on on this form is true and correct to the best of my knowledge. SSgnature of ApPllC'a~t Date $zgned TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL The above described sanitary facilities are hereby approved, p~bject to the rol!owzng con~,i~'ions: - ~ '~" - · ' Conditions The above described sanitary facilities are disapproved for the following reasons: Signature of A~ro~al is valid for one year foIlowin~ the date of app~ovaI.