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Home My WebLink AboutT12N R3W SEC 15 LT 83 sGRE' "iR ANCHORAGE AREA B0'- Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 'IGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME-'~/~t0J~A-~' 'YL)EJ~/~A/N'-~-} MAILING ADDRESS ~-.A LOCATION <~. O/: ZO~fA~--- ~:' AE~/~O~LA~_/)LE'GAL DESCmPTION~COT SEPTIC TANK: DIST,~NCE pP~(D p c)~ ~_ j~ FROM WELL _ MANUFACTURER. 'P/Lc MATERIAL INSIDE LENGTH INSIDE WIDTH ~-- __ _LIQUID DEPTH CO~-I Ce ~_ cN-oUMMpBAEF~Tf~4FENTS- / _LIQUID CAPACITY. I C)OO _GALLONS, SEEPAGE PIT: NUMBER OF PITS [ DIAMETER '-- OR WIDTH 14 ' LENGTHJ~I,/ DEPTH I 4 / LIN'NB MA'[ERIAL L'OC~ _ CRIB SIZE; DIAMETER l-- ~ g "T ~l s /DIS'rANgE FROM: WELL ~E~&0P, BUILDING FOUNDATION(('z~ NEAREST LOT LINE ~'~ / TOTAL EFFECTIVE __ , ABSORPTION AREA (WALL AREA) ~ ~ SQ. FT, ADDITIONAL ABSORPTION WELL: TYPE _&>~P-.O PO S EZ_ CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION__ LOT LINE_ SEWER LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS · DEPTH DISTANCE FROM: SI--PTIC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: ~K~T~A ~'F ~X (_Ak) AT iFS rq PIPE MATERIAL: ~ ~ II' I ~ ~ LDT SLOPE: REMA R KS: ~:~ ~'~ DIAGRAM OF SYSTEM got UNL~ DATE ~L/ 7/ GREATER ANCIHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT ~/~/, ,7 ,l, ~)0 ..'.T^,-L^T,O. LOOA",o," OO"''/"4 '~-¢ ----¢O~'"' ~- .:'~¢4Z-- PHONE FINANCED THROUGH __~. ~_ /L~/O P/-/~/'K} ~ R* 'lO BE INSTALLED BY --, SOIl- TEST RESULTS e COMPLETION DATE ANTICIPATED L MINIMUM DIS'rANCE~, REQUIREMENT~ / SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK, /0~ / , SEEPAGE PIT ¢~ / ., DRAIN FIELD . GRAVEL BACI(FILL LICENSED DESIGNER [ CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE AI3OVE "One test is ~vorth a thousand opinious" Performed For__T-~DE~_~s ~-~eL~.~.~X/,~-Y Date Performed ~7~7] Leoal ~escri~tion: t. ot_~.~Block Subdivision ~ ~/2~3~_ This Form Re~orts Soils Loq ~~ _Percolation l'est ~eoth Feet Soil Characteristics Was Ground Water Encountered?_~_~_~ It Yes, At what Depth? Proposed Deoth of CnNPENTS: Test Performed Percolation Rate Minute -- Installation: SeeDa(~e Pit Drain Field Inlet Depth To Bottom Of Pit Or Trench Readinq_~ Date Gross Time Net Time Depth to H20 Ne~ Drop 4. 5. fi. GREATER ANCHORAGE AREA BOROUGH 3 "C" Department of Environmental Quality ~ .~)~/L 330 Street, Anchorage, Alaska !)9503 274-4561 Date Received .~; Time of Inspection Date of Inspection ~,~ REQUEST FOR APPROVAL OF UAL SEWER & WATER FACILITIES FOR Approval requested by: Mailing Address: Phone: Property Owner: ~Q~ Mailing Address: Type of facility to be inspected Well Data: A. Type [~ 30~A~. C. Construction Sewage Disposal System: ~.]- ~>~ B. 1. Size 1. Absorption Area Field: Total length of lines A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Distances: No. of bedrooms ~-~ B. Depth D. Bacterial Analysis Installer 2. Manufacturer 2. Material A. Well to: Septic tank ~m.~ , Absorption area _ Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line , Sewer Lines EQ-03.4'(1/74) Page 1 of two pages Page 2 of two pages - Re ~t for Approval of Individual Legal Description {~/~-~ . (~_~L~ c~Jo~,c~lq. /~ Water Facilities Approved .,. ( ,~/"~.~'~./ Disapproved Approval ,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Date /-~/~7~/~ Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED ~7/~/~/7/~/~? Date yd~_ ~- EQ-034 (1/74) HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.---TO BE COMPLETIED BY FHA INSURING OI:FICE MORTGAGEE ,SERIAL NO. Anchorage First National Bank of Anchorage 17693 Weismann, Thomas M. & Marion R. /9811 Carlson Road - Anchorage, Alaska 99507 ,SU BDIVI'SION NAME BLM Lot 83, 1 3 1 _~] Public system Sec. 15, T12N, R3W, S. M. BA,SEMENT ~JYes []No []Communi~ system SEWAGE DISPOSAL [~Public system ~_] Community system ] New installation ~LBLOCK NO. ILOT NO, Individual [] Individual SYSTEM DESIGNED FOR []Yes []No PART II.~TO BE COMPLETED BY HEALTH DIEPARTMENT HEALTH DEPARYMENY IN,SPECTOR'S SKETCH It is the opinion of the ID State [~] County E] 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 [] Connty ~ Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: ~ Can be expected to function satishctorily, and ~ Cannot be expected to function satishctorily is not likely to create an insanita~ condition DATE j SIGNATURE I TITLE i PART Ill.---FOR USE OF FHA OFFICE TO YHE CHII~ UNDERWRITER: I bave reviewed the foregoing and the pertinent FHA Compliance Inspection Repo~, and recommend that the Individual water-supply system ~ considered ~ Acceptable ~ Not Accepuble ~wage dis~sal ~ considered ~l Acceptable ~] Not Acceptable. I'IEALYH AUTHORITY APPROVAL II~IDIVIDUAL WAYIR SUPPLY AND SEWAGE DISPOSAL SYSTEM CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 Rev. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM Total liquid capacity. Inside length, .fcet. Inside width. Inside diameter, feet. Dcptfi, .gallons. Capacity inlet compartment, teet. Liquid depth, Number of compartments . gallons. feet. feet; nearest lot line at [] front, [] side. [] rear, feet. Liquid capacity, gallons. Lining material [] Seepage pits. Other 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 Depth of filter material beneath tile., --inches. Depth of filter material over tile, inches. _inches. REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main, feet. Size of mainl inches. Indivklual wells [] are [] are not customary in neighbgrhood. Give most recent record of failure of wells in immediate vic;rely to furnish adequate supply of water__ Properties in neighborilood [] are [] are not being developed with both individual water-supply and sewage-disposal systems. Lot size: feet wide. leer deep. Dwelling set back frmn front property line, feet. Individual water supply from: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. Building foundation seepage pit feet; tile sewer feet; cesspool,. feet; nearest lot line at [] front, [] side, [] rear, feet; septic tank,. .feet; disposal field,_ feet; other sources of possible pollution, feet. Diameter, inches. Total depth, feet Type of easing._ 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. ~omp: ~ Shallow well. ~'} Deep well. LengFh of drop pipe, -feet. Pump capacity, lalcated 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. [] L(x'al Health Authority. Inspected by __ Date of inspection , 19 Depth of casing. _gallons per minute. _gallons per minute. feet; feet. 19 GPO 889'088 C/6-1g20(a) Rev. 1973 INDIVIDUAL [~] NAME AL/ iDEPARTMENT OF HEALTH AND SOCIAL S" CES ,'~ ~. DIVISION OF PUBLIC IIEALTH L.b No INDIVIDUAL AND SEMI.PUBLIC =' BACTERIOLOGICAL: WATER ANALYSIS omcE ADDRESS SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO CITY ZiP CODE ADDRESS ~OF SOURCE [],/Safisfaclory [] UnsaRsfaclor¥ [] QuesBonable [] Sample too long hi transit; sample should not be over 48 hours old at:examlnation to indicate reliable results. Please send new sample. [~ Botlle broken Jr~ transit, please send ~lew sample. SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY '::' DATE COLLECTED L' TIME COLLECTED Well - ~] Dug [] Driven [] Drilled [] Bored SOURCE: [~ Spring [] Cistern [] Olher Dug Well or Cistern Construction: Top -- [] Wood [~ Concrete LOCA'FIONJ GENERAL: Does Water Become Muddy or Discolored? [] Yes [~ No PURPOSE OF EXAMINATION: Illness SuspeCted? [] Yes READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE AGAR ~ctose Brolh 1Otc 1Otc 1Bec 1Otc IOcc 1,0cc 1.0cc 06.1~o lb1 BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1973 Date Received / (' ,// (' ' Time Received /~m L~b. No. 4. 5. 6. GREATER ANCHORAGE AREA BOROUGH Department of £nvironmental Quality ~3330 "C" Street, Anchorage, Alaska g9503 274-4561 Date Received Time of Inspection. Date of Inspection .. REQUEST FOR APPROVAL OF INDIVIDUAL SE~IER & WATER FACILITIES FOR Approval requested by: ~ ,~.~. Mailing Address: /~~gc'~D to, :~} ~ Phone: Property Owner:. ~~ ~.~~. Phone: Legal Description: Zo~'~'a ~.~ i~ ~<2..~ A~ Type of facility to be ns d . . Data: C. Construction .~,~ Sewage Disposal System: A. Installed q?~? B. Installer C. Septic Tank: 1. Size 2. Manufacturer ? B. Depth ~ D. Bacterial Analysis D. Seepage Pit: 1. Absorption Area 2. Material Field: Total E. Disposal Distances: length of lines , Absorption area ~., ewer Lines , Other contamination , Absorption area A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re ~..~_~11~ Descri pti on t for Approval~of Individual ' · & Water Facilities Approved ~. ~,~_~,//¥~,~ . Disapproved Appr6qal,.Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental DIAGRAM OF SYSTEM Quality certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) ~6-1220(a) Rev. ]973 . Lab No .... DATE ALAS,. ~PARI'MENT OF HEALTH AND SOCIAL SB .... ~ DIVISION OF PUBLIC HEALTtl INDIVIDUAL AND SEMI.PUBLIC BACTERIOLOGICAL WATER ANALYSIS INDIVIDUAL [] SEMI-PUBLIC j~ CHLORINE RESIDUAL PPM REPORT RESULTS TO OFFICE Analysis shows this Water SAMPLE to be~ ~J Satisfactory [] UnsalJsfactory [] Questionable [] Sample too :long in transit; sample should not be over 48 hours old of examlnation to indlcate tellable results. Please send new sample. [] Botlle broken [n transit, please send n~w sample. SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY ,L , :, DATE COLLECTED ' , ; '~ TIME COLLECTED ' ,: '" LOCATION: Tilo Seepage Cass- Field Feet. Pit ...... Feet. Pool Other Possible Sources of Contamination __. MATERIAL: Building Sewer- [] Cast Iron ~] Wood [] Tile GENERAL: Does Waler Become Muddy or Discolored? When? [] Fibre [] Asbeslos Cement [] Yes [] No PURPOSE OF EXAMINATION: Ilhless Suspecled? [] Yes [] No ' 06-1220 [b) Rev. 1973 READ INSTRUCTIONS Lactose Brolh ON ~4 Uours REVERSE SIDE 2~ H .... 48 Hours BEFORE Locto,o Broil,, 24 hrs. COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD ouJ < .~ o