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Home My WebLink AboutT12N R4W SEC 2 LT 12 GAAL HEALTH DEPARTMENT ~ 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM _.J SEPTIC TANK: MAILING LEGAL DESCRIPTION DISTANCE FROM WELL LIQUID CAPACITY '''~ ! L~'-~'~- ~. NUMBER OF MATERIAL COMPARTMENTS LIQUID GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH __ SEEPAGE SYSTEM: SEEPAGE PIT: LINING MATERIAL ~/"~' DISTANCE FROM WELL /"~,~ / BUILDING FOUNDATION t'/(~(~ /, NEAREST LOT LINE. ~ ~'" TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~'~'~, SQ. FT. TiLE DRAIN FIELD: DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILL IN. ABOVE TILE WELL: TYPE ~'~'~'( _, DEPTH '~) ~' DISTANCE FROM ~:>1 ' WATER · BUILDING FOUNDATION. SAMPLE , NEAREST '~._/ NEAREST /.~,~/ SEPTIC ~ ~ / SEEPAGE /~,~/' OTHER LOT LINE , SEWER LINE ., TANK . SYSTEM . CESSPOOL . SOURCES DISTANCES: DIAGRAM OF SYSTEM /: GREATEL. ANCHORAGE AREA HEALTH DEPARTMENT 327/Eagle S~. Anchorage, Alaska 99501 ~,~7~//_/L/~ 279-2511 qo ' ,/ / Case No. o777.- 7 7/,~ NAME OF APPLICANT ~'~'~ RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS SEEPAGE PIT LOCATION OF INSTALLATION ~'/"~, DRAIN FIELD , OTHER TO BE INSTALLED BY ~ ANTICIPATED GATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED .SEPTIC TANK SIZE ~ TYPE ~,-./.~¢z-,~SEEPAGE AREA ~ · ~ DIAGRAM OF SYSTEM DISTANCES: -lealth Authority 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 6ode. DATE ~~, 'TeAoadd~ oq %ouu~o qo~q~ ,uo!%on~suo~ sit{% ao~ ~oao~e uT %nd ~euoH o~edoo~ eq~ pu~ TTOa aq~ moa~ ~oo~ 08 ~o mn~!ulm e ~q ~nm ~uu~ u°II~ 0~/ ~ IIe~su~ o~ fd~ssooou oq IIT~ %t 'o~oq ~ooapoq om% ~Iddns aorta pu~ o~os OR% ~o uoT~oodsuI u~ apem ~T~uooo~ Oa~q ~uam~a~d°g q~TeOH q~noaog ~oa¥ o~aO/lOUV ao~eoaD aq~ ~o iouuosaod ~u~A~OS mo~X$ e~aO5 O8fl xoff ue~OTH ~aoqo~ 'a~ INDIVIDUAL SEWAGE AND ~[ATER FACIL , ', (Fill o~t i~ T~lpli~ate) /~z~[~ / p~ope~ty~owner ; ~~. ~ ~ P ~ ~/~ Number:o£ ~edrooms in house, Water Analysis: a, Bactemial b. Detergent Well data: a, Type ..... c. Casing Size ~" Distance from well to closest existing l. S wer llne ..... 2. Septic tank. 3, Seepage Area . ~. Cesspool' houses, barn~ drainage ditch: Sewage disposal system, a. Age of system b. Septic tank capacity in gallons Property Line Other sources of possible con{-gmination, i.e., creeks, lakes, c. Name of septic tank manufactu~m _. 1. If "home made" show diagram on reverse side of this form. d.' Disposal field or seepage pit size and type 1. Distance to property line to house foundation Perco]a~iork, Te~t~esults,, f. Percolation Test performed by Use the reverse side of this form to show diagram. Diagra~ should include · he following information: p~operty lines~.well location, house location, ~im*Jc tank location, disposal area location, location of percolation test, ~ direction of ground slope, 9. The ~or~at]on On this form is true and correct to the best of my knowledge. Signature of Applicant D~te Sign'e~' T._O BE FILLED OUT BY HEALTH DEPART!,~ENT PERSONNEL ~-~-T~e~,~. above, described sanitary facilities are hereby approved, subject to the r~llowlng conditions: ' Conditions: The above described sanitary f ' ' · aczl~tzes are disapproved for the following Signature of ~.f%fir~'i;~?l.q" ' ' : Date '~'~. Approval is valid fop one year following the date of approval, CPJ: cw FHA Form 2973 ~ HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART L--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO, ~ MORTGAGOR OR SPONSOR TOTAL NUMBERz BASEMENT WATER SUPPLY BY: [] Public system PROPERTY ADDRES$ [] New installation ]Community system BLOCK NO. tOT NO. Z,~ Can attic o~ other area be made Into additional bedrooms? (If Yes, haw martyr) []Yes ~No []Individual No. oF eD,~. GA~/AOE~IS'OSAL ~ Individual ~ ~ Yes ~ No SEWAGE DISPOSAL BY: ---]Public system [~Community system 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 tem with proper maintenance: r-~ Can be expected to function satisfactorily, and is not likely to create an insanitary condition [] Local Department of Health that this individual sewage-disposal sys- ]Cannot be expected to function satisfactorily J SIGNATURE I TITLE dune 17, 1969 ?~ /' "~ / " J Sanltal, ian j i./:(..~ .-, ,.,/ J. ' 7: !. ,': ~., ,- ~':.~_,, NOTE: The health authority should, complete the appropriate opinion statement above and aff)x date, signature and title In the spaces provided. Use of the above grid for Health Department Insp~ct6r's sketih ~s Wbll aS us~ of the back uf thls farm Is at abe option of the heal~ authority. 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 INDIVIDUAL , ~"~EALTH AUTHORITY APPROVAL ~ E'ER SUPPLY AND SEWAGE DISPOSAL ~ NEM ] CHIEF ARCHITECT I ] DEPUTY FOR CHIEF ARCHITECT FHA Form 2~_