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HomeMy WebLinkAboutSWISS AIRE LT 12 ',./ HEALTH DEPARTMENT '~../ 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ADDRESS - SEPTIC TANK: D STANCE FROM WE', / .MATERIAL ~?'~'~/TMCOMPARTMENTsNUMBER OF / ~/, ~ ,~)/gJ / LIQUID GALLONS. INSIDE LENGTH INSIDE WIDTH__DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL ,,' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH '~ ('"~) , DEPTH (~'('~ ,BUILDING FOUNDATION '4~'~/ ~/--~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA FOUNDATION. DISTANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE. DEPTH: TOP OF TILE TO FINISH GRADE , NEAREST LOT LINE TRENCH WIDTH TOTAL LENGTH , OF LINES IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: NEAREST LOT LINE . SEWER LINE SEPTIC ., TANK DISTANCE FROM BUILDING FOUNDATION SEEPAGE SYSTEM WATER iI~'/jij.,~I?7~LI~i SAMPLE ~'~/~'""~ ~'~'~ ~/NEAREST OTHER CESSPOOL SOURCES__ DATE DIAGRAM OF SYSTEM ?4/ APPROVED ~ HEALTH AUTHORIIY ~ SEWAGE DISPOSAL SYSTEM - APPLICATION g PERMIT Nam of Applicant ~'~F- /~C/~.. Mailing Add1~ess....~70.~. ~ Residence Add,ess ~ Location of Installation Application to Install: Septic t~k .... , Seepage plt_~ , D~aln f~eld~ ~he~ To Se~ve the Following Facility .[ ~ .... ~C0 n-- Financed Th~ou a ed by Percolation Test Results ~ticipa~ed Da~e of Complet~on~ ... BELOW TO BE FILLED OUT BY HEALTH DEPART~NT This is to serve as~ . , permit to install a ~ ~/~ ~ ~/~ as described Below. Size of ~it to be Se~ved~ __. ~D~ic tank size~ Type.~/J, Seepage ~e~ ~ Type~ DIST~CES: - D~AGRAM OF SYSTEM Health Authority I certify that I am familiar 'with the ~equirements of Greater Anchorage Ames Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. ",~.~ 327 EAGLE STREET ... ANCHORAGE, ALASKA 99501 ,Date Performed~ PerformedLegal Descrzptton:F?r Lof /~ Block .' Subdivisiu~u , ~fx//~l' ,"-///'~J This Form Repomts a: Soils Log, ~ , -Percolation Test Depth Feet S~ill, Characteristics, Was Ground Water Encountered? If Yes, At ~.at Depth 1_. j, /~/,.. i Location Sketch Gross Time Net Time Depth To H20 Net Drop .~ t ~? , ,~ ' - ~,-~- fro , , I ~0 , ,f,~ .. ~._ /O~ ~o ~' . ...... ~ ..... - /.~ .... ~ ,~ ~.s~ 1.3' Free)seal lnst'a!la~ion: Seepage Pit Drain Field 'n Of n~e* z ~ Denth To ~ottom' Of ~it Or Tr=nc'h ....... Test Fe~forf~d By:~~ . . ,, · Data Certified By:~-~-~_.¢¢/~.~ Date: . ~, ANCHORAGE, ALASKA 99501 Date Performed Performed For /~ff'o ,~>)r//~ . ~,., .,,, Legal Description: Lot~lock . S~d~v~s~on This Form Reports a: Sozls Lo~ Depth Feet Was Ground Water Encountered?_._~ If Yes, At W~at Depth ..... Location Sketch I 2© Reading :'a~e Gross Time Net Tim~ Depth To ~ Net Drop .... ......... ,$ ..[..._/~.4. i., o ...~n ~ ," ~ .... ' /r~ ~n ~Z ~'' i, ,~-" ...... ~... ~/0..,~ . Proposed Installation. Seepage Pit Drain Field Depth Of Inlet ~[/7~/m.o)/? Depth To Bottom Of Pit Or Trench Test Performed GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-BGB6 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAl, SEWER & WATER FACILITIES FOR 5. Type of Facility to be Inspected'__ Number of'Bedrooms: Well Date: C. Construction D, Bacterial Analysis 7. Sewage Disoosal System: C. Septic Tank: 1. Size g~ 2. Manufacturer/f, D. Seepage Pit: 1. Size/_~_~X~ 2. Material 5. Disposal Field; Total Length of Lines Distances: A. Well To: Septic Tank .3~O/.f~ , Absorption Area ,f~ ~ , Sewer Lines ~_~ , Nearest Lot I. ine__~ , Other Contamination ~.~ . Foundation to Septic Tank /~/ ~'> AbSorption Area .~z~/ / Absorption Area to Nearest Lot Line ~ · Request for A~QroW~l of Individual Sewer & Water Facilities % Pa~,~ Two ~ 9. Comments: Aporoved Disapproved Date Approval Valid for One Year From Date Siine~ Greater Anchorage Area Borough, Department of Environn~enta] Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true end accurate representation of the subiect sewer and water facilities located Signed Date DiVISiON OF PUBLIC HEALTH BACTERiOLOGiCAL WA' ER A;;A[¥$1S DATE ADDRESS SAMPLE COLLECTED Well [] D~g [] Driven [] [h'flle~ SOURCE: [] $~n9 [] ¢l~ern [] Other Building Sewer ~c OFF/CE -- 3, Check chlorincEon and other mechanical equipment. Make certain it is An approved water supply source should ~e deve oped. 6, ,~nprove your E spring [] dug well [] driven wel] ~ drilled well [] cistern , 7. Relocate your well to t~ safe location in relationship to your sewage disposal [] Bo~lle Broken in transit, please send new smuple, 9. Contact your nearest [] Local Health Department or [] /~daska SANITARIAN'S REMARKS DATE SA~iOLE COLLECTED BY DATE COLLECTED DIVISION OF PUBLIC HEALTH BACTERiOLOGiCAL WATER ANALYSIS ~ Iuymd [] Other Building Sewe~ D~STANCE TO: o~ Olher Dratna9e Pipe Ce~ OFFICE SANITARIAN'S REMARKS READ INSTRUCTIONS,. ON REVERSE SIDE~ BEFORE. COLLECTING, SAMPLE 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD AGAR HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGOR OR SPONSOR SUBDIVISION NAME MORTGAGEE ~ten~ Valley SERIAl. NO. PROPEBTY ADDRESS 8651 ,~iSS BLOCK NO. LOT NO. TOTAl. NUMBBR: BASEMENT LIVING U NI1'$BEDROOMS BAIHS Yes [~New installation additional bedrooms? (If Yes, how manyf) [] [] No X WATER SUPPLY BY~ SYSTEM DESIGNED FOR ~l Public system [] Community system [] Individual No. OF [] ~blic system ~ ~mmunity system ~ Individual ~ ~ Yes o PART IL--TO 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 [] State [] 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 an insanitary condition autho~y si~o~d complete the appropriate opinion statement above and affix date, signature and title in the NOTE: The health spaces provided, / z// - - Use of-fhb abbve grid ~0r Heblth Dbp~rtmbnt Inspb(l:O~'s ~ketch as well as use of the back of this form is at the option of the health authority. JbATE PART III.~FOR USE OF FHA OFFICE TO THE CHIEF UNI~RWRITER: 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. SIGNATURE ~F.~ CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. [] Cesspool. S~ptlc Tank: Distance from well,__feet. Materia],_ Total liquid capacity. Inside length, it'et. Inside width, Celspool: Inside diameter~ feet. Depth, gallons. Capacity inlet compartment,_ teet. LiquM depth, Number of compartments gallons. feet. feet; nearest lot line at [] front, [] side, [] rear, feet. Liquid capacity, galkms. Lining material SECONDARY TREATMENT consists of [] Tile disposal field. [] Seepage pits. Other Tile Disposal Eield: Distance from: Well, Total length of tile lines, Trench width Length of each line, Type of filter material: [] Gravel. feet; foundation, feet; nearest lot line at [] front, [] side, [] rear,, feet. feet. Number of lines, Distance between lines, feet. inches. Total effective absorptkm 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,_ _teet; building foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. In$~eHon rn~d~ 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. Indivkiual 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 neighborh~xod [] 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 l¥om: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. Distance of well from: Building fi~undation cast iron sewer, feet; tile sewer, seepage pit. feet; cesspool, feet; nearest lot line at [] Iront, [] side, [] rear, feet; septic tank,_ feet; disposal field, feet; other sources of possible pollution, ~eet. 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. Pum~: [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity, l~cated in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No. Type (if 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. [] Lotal Health Authority. Inspected by Date of inspection 19 Depth of casing .gallons per minute. gallons per minute. feet; feet. Si J c~',rr, ty, (,,. Hr. Albert i',.Ullins