HomeMy WebLinkAboutSWISS AIRE LT 11OIq
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-251'1
NAME_
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION ~)/~ (--/-,/~/~' _
SEPTIC TANK:
/
DISTANCE FROM WELl 'Z~5~
L,ou,D c~.~,.~ /~ ~o.~.
INSIDE LENGTH
NUMBER OF /
I DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
SEEPAGE PIT:
OUTSIDE DIAMETER
NEAREST LOT LINE
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
O,W,DTH /~'.LENGT, /X~/.OEPT,
D,BTANCE EROM WEL' --Z &~'
, BUILDING FOUNDATION
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
.~ ~EARESTLOTL,NE_
DISTANCE BETWEENzbI~~~ TRENCH WIDTH
SQ. FT E~NGTH OF EACH LINE
TOTAL LENGTH
, OF LINES
N. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE.
.DEPTH OF F LTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
WELL: TYPE~"/g"~I'~[J/~ J"~ DEPTH
NEAREST/~
LOT LINE SEWER LINE
DISTANCE FROM
· BUILDING FOUNDATION.
SEPTIC SEEPAGE
. TANK , SYSTEM
- "OTHER
CESSPOOl . SOURCES
D AGRAM OF SYSTEM
GAAB-HD-2
GREATEL. ANCHORAGE AREA L OROUGH
0 HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No. ':~'~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~-~ 7
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
MAILING ADDRESS PHONE
.,SEEPAGE PIT />" ,DRAIN FIELD ,OTHER
TO SERVETHE FOLLOWING FACILITY //- .~:?/~',4~ , /.~- J/3 -- ~~
EINA"DED THROUGH PW'~ . · T0 BE I"STALLED BY ~h~
/ / ~ ~ ~
PFRROLATION TEST RESULTS ~ / .ANTICIPATED DATE OF COMPLE~ION ~ ~
THIS IS TO SERVE AS ~ , ,~f~..~ PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE Of: UNIT TO BE SERVED
-Z~//- .~z~o
. SEPTIC TANK SIZE TYPE
~ [y.~/~ -- ~ DIAGRAM OF
DISTANCES:
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.~//////~ fAPPLICANTS SIGNATURE
DATE / (//
Legal Deserlptlon: Lot~...~lock
This Form Reports a: Soils Log
Depth ' ' s __
Feet Soil Characteristic
2
Was Ground Water Encountered?
If Yes, At W~at Depths_
327 EAGLE oTREET
ANCHORAGE, ALASKA 99501
Location Sketch
;ross Time Net Time Depth To H20 Net Drop
~_1~. ,~ (? ~ O " , ~ '~,
.,
._.~ ., ~ ~.3~'" .7~"
~,_ ~(,~ ~r? n~,1" .~-"_~
Frop~sed Install~:~ on: Seepage Pit Drain Field
Depth Of ln!et~)eptb To Bottom Of P~t Or ]~ench
COMMENTS: _/']L/~ /~J~'~F/~;,'~ ~ f; 6', ~:~~z- ~ /~- ~ ~/~ ,~?"~ ///'/~ (~' ~? ....
~/.~,~f tp~ _ _~_--___ ,, -----~ .........
Test Pemfom~d
FHA Farm 2573 Budget Bureau No. 63-R296.B
Rev. July 1958
IJ. S. DE PART.MENT OF HOUSING AJ~D URBAN D.EVELOPMENT
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
TOTAL HUMBER:
LIVING UNITS BEDROOMS
WATER SUPPLY BY:
BASEMENT
[]Community system
[] New installation
RLOCK/O. LOT NO.
Can c~tc or other area be madl Into
additional bedrooms?
SYSTEM DISIGNED FOR
[~ Public system
SEWAG1 DISPOSAL lyf
E] Public system
]Community system
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
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It is the opinion of the [] State [] County ]~ Local Department of Health that this individual water-supply system
J~]is [] is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the [] State [] County ~] Local Department of Health that this individual sewage-disposal
tern with proper maintenance:
~] Can be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily
is not likely to create an insanitary condition
~ATE ' , SIGNATURE /~ -. ,~ / /: / I TITLE
-
spaces provided.
Use of the above grid'for Health Department nspector's sketch as well os use ortho back of this form Is at the option ofthe
PART Ill.--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 [] Not Acceptable
Sewage disposal be considered [] Acceptable [] Not Acceptable.
DATE
SIGNATURE
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
j.~ cHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
FHA Form 2~te
Rev. July 195S
REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PRIMARY TREATMENT consists nf [] Septic tank. [] Cesspool.
Septic Tank~
Distance from ~vell, feet. Material,
Total liquid capacity,
Inside length, ft'et. Inside width.
Ce~spooh
Distance from: \v/ell,. feet; foundation.
Inside diameter, feet. Depth,_
gallons. Capacity inlet compartment,
.teet. Liquid depth,
.gallons.
feet,
feet; nearest lot line at [] front, [] side, [] rear,
feet. Liquid capacity, gallons. Lining material
SECONDARY TREATMENT consists of [] Tile disposal field. [] Seepage pits. Other
Til~ Disposal Field:
Distance from: Well.
Total length of tile lines,
Trench width,
lzngth of each line,
Type of filter mater;ah [] Gravel.
feet; foundation, feet; nearest lot line at [] front, [] side, [] rear,, feet.
feet. Number of lines, Distance between lines, feet.
inches. Total effective absorption area in bottom of trenches, square feet.
feet. Depth, top of tile to finish grade, ___inches.
[] Broken stone. Other
Depth of filter material beneath tile., inches. Depth of filter material over tile, inches.
Distance from: Well, feet; building foundation, feet; nearest lot line at [] front, [] side, [] rear, feet.
Insplcllon mode by: [] State. [] County. [] Local Health Authority.
Inspected by
REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM
Distance to nearest public water main, feet. Size of main, inches.
Imlividual wells [] are [] are not custo~nar~ in neighborhood.
Give most recent record of failure of wells in immediate vtcinity to furnish adequate supply of water
Properties in neighborh~x3d [] 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 t?om: [] Drilled well. [] Driven well. [] Dug well. [] Bored well.
Distance of well from:
Buihling fi)undation
cast iron sewer, feet; tile sewer,
seepage pit, feet; cesspool.
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,
\V/ell 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. [] Lo~al 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.
, 19
feet;