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Home My WebLink AboutT12N R3W SEC 27 LT 58 DEPA[ 825 "L" Street ON-SITE SEWAGE 44-~:, l 'be-A MUNICIPALI'fY OF ANCHORAGE BENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 9t, Anchorage, Alaska 99502, Telephone 264-4720 OSAL SYSTEM AND/OR WELL INSPECTIC)N REPORT DISTANCES O/~¢ E~?~ - ~ 'rD SEPTIC ABSORPTION _~o~ ~ ~ TANK FIELD WELL ~---~-'-~ LOT LINE /7 / /C.'~ / ~ ~ ~ -~,,~'~ [3 OTHER :~'-*~= ~¢' ~-- FT ...... ~ ~- ~ /~? ', cedll IhaJ ns echo LEGAL DESCRIPTION TANKS L~$EPTtC TYPE OF SYSTEM LI'FRENCH ~7~ BED b~ W. DRAIN °"9'"algm°e 0 "~'"'0 / '/~/-- ,olaIO,,pthlrom or,g,na, gmde FT E] PRIVATE ~ OTHER REMARKS: 72 013 (3/85) l::: [)"[ ]:) J:: J::( ]: I q. ZI.!5 [ :i )iii: (.'i, ~ ;: P! [ ]1 ~ N PERFORMED FOR: LEGAL DESCRIPT(ON: 1 2 3 4 5 6 7 8 10- 11 13- 14 15 16 17 18 19 20 Municipalily of Anchorage DEPARTMENT OF HEALTH & IdUMAN SERVI 825 "L" Street, Anchorage, Alaska SOILS LOG -- PERCOLATION Township, Range, SITE PLAN PERCOLATION RAT£ ~/?' 7~' (mi~lxle~inchl PERC HOLE DIAMETER r) . 'rE. ST RUN BETWEEN? / ~ AND ~ FT / .. ~,~ ~o,~,,=/~. ~,t I/IL, '~~s~ -~ - - ~ ~'- -~ ~ ' ?k ~ ...... NOTE: All Dimensions ~d Locations Must Be Field Verified Prior To Construction SEWER SYSTEM 'LOCATION PLAN (~. '~, '% , , %',',c ~'7 ........ .,~., :. . /~_~ ~ ~ /~. ...... "'"'~ GREAT}~R ANCHORAGE.AREA BOROUGH Depar. tme. nt of Envir, onmentalcf~u~lif..~ 3500 Tudor ~qoad, Anchorage, Alaska 99507 2'79=8686 Inspection Time of REquEsT AP ;RO',!AL OF INg'[\IIOUA[. BE~E~ & ~I~ATER FAO~I,IT~S FOP Number of ~ "' ' ' ~ C. Constr~c~' :-?~ D. Bacterial Analysis 7~ Sewage Dls,)osal System: C. Septic Tank:' ], :~i'ze 2 Manufacturer D, Seepage Pit: Disposal F~e]d: Tot:al !,enqth_ of Lines Ao Wel I To: bentac Tank Absorntton Area , Sewer Lines , Negrest Lot I.:lne , Other Con%aminati°n B, Fm:nda!:ion +'' ',]m-,l:~c Tank '~ Ab'fiorption Area .......... ~ ..... · l,]ea re Lot Line ' OFFICE HEALTH AUTHORITY APPROVAl. INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.~TO BE COMPLETED BY FHA Anchorage= ~O~TGAOOR OR SPONSOR Buyer: BUEGE, Henry G., Jr. S__eel~] er: __II~WRENC__E_~Jagk A,~33~46 SU$DIVISlON NAME Lot 58, Sec. TOT&L NUMJE~ 1 2 1 WATER SUPPLY [] Public system __ SEWAGE 0ISPOSA[ ~] F h~blic ,system 1 MORTOAO~E ISE~AL ~O. __ First National Bank of Anchora_gc . 27, T12N, R3W, Seward Mer. SASEMENT [] New installation ~] Community system ~LOC LOT NO. ~A NA .~_] Community system [] Individual Yes E] PART II,.--tO BE COMPLETED BY HIEALTH DEPARTMENT HEALTH DEPARTMENT iNSPECTOR'S SKETCH is [] is not ~ltisfactory as a domestic supply for the sub}ect property, It is the opinion of the [] State [] County ~]7[~cal Department of Health that this individual sewage.disposal sys- tem with proper maintenance: ~ be expected to function satisfactorily [~ Can be expected to function satisfactorily, and Cannot' is not likely to create an insanitary condition ipaco$ provided. PART III.---FOR USE OF FHA OFFICE I'o THE CHI~EF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the Individual wirer-supply system be considered [] Acceptable [] Not Acceptable ,%w~ge disposal be considered [] Acceptable [] Not Acceptable. [] CHIEFARCHIT~CT ~' ,ffEPUTYFO~CHIEFARCHJtECT FHA Fo~m 2S73 Hi~L?H AUTHORITY ApPIROVAL ~.~,. ),ay I~ss IHDIVIDUAI. WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM REPORT OF INSPECTIONmlNDIVIDUAL SEWAGE-DISPOSAL SYSTEM Type of tilter material: [] Gravel. Depth of hirer malerial beneath ~de,, gallons. leel. L~quid depth,__ _feet. (eec; foundation .... feet; nearest lot line at [] front, [] side, [] rear,__ fe~t. 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 inches. Depth of filter material over tile,..: inches. Depth feet. Lining material. feet; nearest lot line at [] front, [] side, [] rear, [] County [] Local Health Authority, Inspected by 19__ REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLy SYSTEM Individual wells [] art. [] are not customary in nelghbgrho~ d. Properties in neighhoeh~x~d [] are [] are not being developed with both individual water.supply and sewage-disposal systems. Lot s~e:_ -feet wide Indtvldual water supply fi'om: [] Dtdled well. .feet deep. Dwelling set back from frunt property line .... [] l)twen well. [] Dug well. [] Bored well. feet. __.feet; nearest Jot line at [] front, [] side, [] rear,__ feet; septic tank, feet; disposal field feet; other sources of possible pollution ~'e~t. Diameter1_ roches. Total depth.__ __feet Type of casing --_ Depth of casing,. Approximate depth to pumping level of water in well __ -fe~t. Approximate yield,__ .gallons per minute. 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 covet watertight: [] Yes, [] No. Pump: [] Shallow well. [] Deep well. Length of drop pipe feet. Pump capacity,__ .gallons per minute. Located in: [] Basement, [] Pumproom of 5 basement. [] Pumphouse abc,ye ground. [] Pump pit, Pumproom prol:~rly 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," gb(e 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 Hex[th Authority, Inspected by Date of inspection , 19__ .feet; feet, GPO 889-088 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.~TO BE COMPLETED BY FHA MORTGAGOR OR SPONSOR WATffll SUPPLY D Public system Community system SERIAL NO, BLOCK NO. LOT NO. Individual SIWAOI DISPOSAL llyt [~ Public system Community system {~ Individual Yes [] No PART Il.---tO BE COMPLETED BY HIEALTH 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 ~tisfactory as a domestic water supply for the subject property. It is the opinion of the [] State [] County tern with proper maintenance: [-2 Can be expected to function satisfactorily, and is not likeTy to create an insanitary condition [~ l.ocal Department of Health that this individual sewage.disposal sys- ~-] Cannot' he expected to function satisfactorily ~ATE J SIGNATURE !TITLE PA~tT III.~EOR USE OF FHA C)FFICE TO THE CHIEF UNI~IRWRITER: I have reviewed the foregoing and tile pertinent FHA Compliance Inspection Report, and recommend that the Individual writer-supply system be considered r-] Acceptable [--] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTIM ] CHIEF ARCHITECT REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM Distance from: Well, Total length of tile hnes. _ Trench width Length of each line Type of filter material: [] Gravel. feet; foundation feet; nearest lot line at [] front. [] side. [] rear.__ fe~t. --feet Number of lines .... Dis!ante between lines,__ _inches. Total effective absorpmm area in bottom of trenches, square feet. feet Depth, top of tile to finish grade,_ , inches, [] Broken stone Other. Depth ~ff filter malerial beneath tile.~__ inches. Depth of filter material over tile. · inches. Number of pits .... Outside diameter leer. Depth. feet. Lining material Distance from: Well ..... fee*; building foundatK}n __ feet; nearest Jot line at [] front, [] side, [] rear, fe~t. Insp~dlon made by: [] State [] County. [] Local Health Authority. Inspected by REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distante to nearest public water mare feet. Size of main, roches, ]ndividua{ wells [] are [] are nol tustolnary in nelghbgrhood. Give most recent record of failure of weirs in immediate vicinity to furnish adequate supply of water Properties in neighhorh~d [] are [] are not being developed with both individual waler-supply and sewage-disposal systems. Lot stze: feet wide ........ feet deep. Dwelling set back from front property line. feet. Indwidual water supply lrom: [] Drdled well [] [)riven well, [] Dug well. [] Bored well. Buildin.~ fi~undadon Diameter, inches. Total depth,_ Approximate depth m pumping level of water in well, Sealed watertight to depth of feet. teet; nearest lot line at [] froht. [] side. [] rear,_ J}et; septic tank feet; disposal field, feet; other sources of possible pollution, ~eet. feet Type of casing, Depth of casing, feet. Approximate yield .gallons per minute. 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. ~mp capacity, --gallons per minute, Located in: [] Basement. [] Pumproom off basement. [] Pumphouse ahove ground. [] Pump pil. 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," ewe date Quality of water [] is [] is not satisfactory for human consumption. Installation [] does [] does not comply with approved exhibits, if any, Insp~:tion made by: [] State. [] County. [] Lo<a] Health Authority, Inspected by __ Date of inspection 19 19 GP 0 889'088