HomeMy WebLinkAboutT14N R2W SEC 11 LT 60 S2LOT
O GREAt',
.R ANCHORAGE AREA BORCCH
Department of EnvironmentBI QuBlity
3330 C Street
Anchorage, AIBsk~ ggs03
NAME
LOCATION
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL. ~
INSIDE LENGTH
! ~ ~ NUMBER OF
~'~ ~' MANUFACTURER z~~- J~L~ MATERIAL ~ COMPARTMENTS ,J ,.9~&~
INSIDE-~/IDTH F LIQUID DEPTH LIQUID CAPACITY t~ GALLONS.
DISTANCE FROM WELL /<~d) FOUNDATION
,/z/O~2 ~....~.~ c~-/-/'t,..~..'¢ , TOTAL LENGTH
NEARl~ST LOT LINE__ OF LINES
NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE
ABSORPTION AREA ~-'.~J--~"Lg*"'~]~--"SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE____IN. ABOVE TILE IN.
TYPE
CONSTRUCTION
BUILDING NEAREST
FOUNDATION__ LOT LINE __
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED.
NEAREST SEPTIC
SEWER LINE , TANK__
REMARKS
DEPTH
SEEPAGE
SYSTEM
DISTANCE FROM:
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY: ~ ~
SEWER LINE DEPTH:
PIPE MATERIAL: C ,~"'~
LOT SLOPE:
REMARKS:_ U~
DATE ~ APPROVED ~
¢ G.A.A.B.
· ,~ GREATER ANCHORAge Area borough ~.
· ~' ~ ~ DEPARTMENT OF ENVIRONMENTAL QUALITY
PERMIT
NO.
· /~[/{uIJll[J [lll))~~ 5330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
NAME
Of
APPLICANT
INSTALLATION OF: SEPTIC TANK ~(~. ' S~PAGE PIT (~ ~- ,(/,~D~.~N~FI~LD '" OTHER ~ ~ Tr'--~'~J~
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION·
· DRAIN FIELD
DRAIN FIELD
· SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
· SEEPAge PiT
, DRAIN FIELD
CAST lEON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP Of
EXCAVATION 5 FEET iNTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PiT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEl. BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
o.^.^.~. /
CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO· 2S-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE·
~)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
GENERAL INFORMATION
(a)
Application Date July 31, 1986
Legal Description (include lot, block, subdivision, section, township, range)
Lot 60A, Sec. 11, T14N R2W
Location (address or directions)
(b)
(c)
Applicant Name Charles Valencia Telephone: Home Business
Applicant Address S.R. BOX 20 VFW St. Eagle River, Alaska 99577
Applicant is (check one): Lending Institution BI; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution 1st Nat ' 1 Bank of Anchor. Telephone 694-2013
Address P.O. Box 770548 EagRe Ri¥¢r, AZaska 99577
{e) Real Estate Company and Agent N/A
Address
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family[] Multi-Family[]
Number of Bedrooms 5
Other
WATER SUPPLV
Individual Well [~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 {11~84)
ENGINEERING FIRM PROVID,..~ INSPECTIONS, TESTS, FILE SEARCH, b,.~ I'A AND INFORMATION ,
Aa certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations tn effect on
the date of this inspection.
EAGLE R!VER ENGINEEr!~ RFRWCES
EAGLE RIVER, AK 99577
H0. BOX 773294
694-5195
Telephone
Name of Firm
Address
Date
DHEP APPROVAL
Approved for -~
Approved ~ Disapproved
Terms of Conditional Appr(~val
\\
bedrooms by ~/~'~' /''~' *'"~ Date '~-- ~ ~-~'
Conditional _
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
EAGLE RIVER
· ENGIN. EERING SERVICES I,
P. O. Box 773294
EAGLE R~VER, ALASKA 99577
Phone 694-5195
To Susan Oswalt
MOA - DHHS
LETTER
Date July 31, 1986
Sub]ecthot 60 A Sec. ll T14N
R2W
~y client, MF? Charles ~al~cia ~oBld like his Health approval modi£ied
from ~ to 5 bedrooms due to having a 5 bedroom home appraisal. The
existing tan~ capacit~ is 1500 gallons and the seepage pit is adeqnate
for 5 bedroom capacity. The o~ig±nal septic permit is for 5 bedroom
use. ~he pre~ious application for 4 bedrooms.~as approved ~ith waiver
of ~ell to tank ditance to 65'.
[] Please reply [] No reply necessary Lou Butera ~ P. ~.
MUNICIPALITY OF ANCHORAGE (MOA)
(~FIF~I:i~,~THORITY APPROVAL (HAA)
HEALTH I~HECKLIST- FEBRUARY 1984
'~E NT. AI. PRO]'EC~ION 264-4720
LegalDescription: ~¢ (¢0/~ TIq/L] ~:u.J ,~c, lj
WELL DATA k,.
Well Classification ~Ci tla.'('~ · If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) ,/~/ Date Completed L/~ JC~l~,,~ ~.c~. I~t~ ~ Yield
Total Dep!h 7~(~ Cased to
Sm, tic water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
Depth of Grouting MiA
Pump Set At ~o-~-/-O~q~ ~¢t.~L~¢t
Sanitary Seal on Casing (Y/N) ~/
Depression Around Wellhead (Y/N) ¢kJ
; On Adjoining Lots -I- I00 '
; On Adjoining Lots -4- ! ~:)O '
To Nearest Edge of Absorption Field on Lot !
To Nearest Public Sewer Line ILI/A' To Nearest Public Sewer
f'd J/~ TO Nearest Sewer Service Line on Lot
~'~/~- ,~,'U~.,"' ~"'r~t'k~,c,or','ho ;Date ~//
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)
Depression over Tank (Y/N)
Size JOOf~'/-,~)O No. of Compartments '~'~
Air-tight Caps (Y/N) %// Foundation Cleanout (Y/N)
Date Last Pumped
V
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~¢ ~'1
To Property Line .J-/~..D ~
To Water Main/Service Line -~J~'~/ Course /(-//~
; for --
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~-0 / (.L,¢? ('0,~
To Disposal Field /fOr d,(.~F't)'~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11184)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed I~,o[~ ~,~17 .
Width of Field J/El ,~.t3
^;
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot ~_]/~
To Water Main/Service Line ~ {{"~;
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field / / /
Gravel Bed Thickness 62/3 ~/%0(x;~,
Standpipes Present (Y/N)
Date of Lest Adequacy Test
To Property Line -¢- (
To Existing or Abandoned System on
; On Adjoining Lots J~ ,'2,~ ¢
To Cutbank (if present)
,,u lA
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off' Level at
Vent (Y/N)
Pumping Oycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I havgchecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ."~'~/~ Date 7--91 ~¢~ *wi'th waiver of well to
MOA No. septic tank separation
distance.
Company '~7/,/~ '¢~-~
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
MUNICIPALITY OF ANCHORAGE
,"~ DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MO~,, t~N¥1RONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description: .~-o .~'eo, / /
WELL DATA
IfA, B, G, D E C¢^ppr~ed C(/N)
Date Completed ~,,~,/~,¢,~.,.~,,.., ere Z~g Yield ~ ~ ~~
Depth of Grouting ~/~
Pump Set At ~ ~
Sanitary Seal on C~sing (Y/N) ~
Depression Around Wellhead (Y/N)
Well Classification
Well Log Present (Y/N)
Total Depth ~-z./~, Cased to ~-/-/o !
Static Water Level ~' -~ /
Casing Height Above Ground ¢~> ",/..~ - ,"7 ~;
Electrica~ Wiring in Conduit (Y/N) .~V
Separation Distances from Well:
To Septic/Holding Tank On Lot ~'&-' /
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
; On Adjoining Lots ~/~'~ ~
/ ; On Adjoining Lots ~-"~ ~ /
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
:/
Standpipes (Y/N) / Air-tight Caps (Y/NJ
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N) '~.,-'~
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well -~-~5-- /
To Property Line ~/'~ /
To Water Main/Service Line ~z/~2
Course
Size /~ ~"~5'~'~u No. of Compartments ':~
?" Foundation Cleanout (Y/N)
Date Last Pumped//
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field '/~
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72 026(11184)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /2¢"~' ¢-~
Width of Field ~'..~1¢,.,-'.
Square Feet of Absorption Area
Depression over Field (Y/N)
Results ~)f Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ,/~ /
To Building Foundation ~¢',,'¢~'~"¢' ~6'-'
Lot
To Water Main/Service Line "~/" /
To Stream/Pond/Lake/or Major Drainage Course
Type of System Design
Length of Field
Depth of Field ///
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line ¢-/'d
To Existing or Abandoned System on
; On Adjoining Lots '~"
To Cutbank (if present)
To Driveway, Parking Area, or Vehicle Storage Area
Comments :' :'
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
~~--~-- Date -..- -/~"/'~'/~ *with wavier of well to septic
Signed
Company
Receipt No. '~
Date of Payment
Amount: $
MOA No.
Page 2 of 2
72-028 (11/841
EAGLE RIVER ENGINEERING SErf, VICES
EAGLE RIVER, AK 99577
P. 0. BOX 773294
694-5195
tank separation distance.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
i OF ON-SITE SEWER AND WATER FACILITY
? 264-4720
Application Date Ju~¢ 17, 1986
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 60A Sec 11, TlhN R2W
Location (address or directions)
~ St., 2nd cl~:i.ve a.f'l;er m~-;'lbo×es
(b) Applicant Name Charles Valencia Telephone: Home Business
Applicant Address S.R. ]30× 20 ~[7~T S'c. ~,,'agle R±ver~ A~La8ka
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution 1s_t Nat'l Bank of Anchorage
Address P.O. Box 770548 Eagle River~ Alaska
(e) Real Estat~ Company and Agent
Address
Telephone
99577
694-2019
Telephone
(f) Mailthe HAAtothe~ollowing address:
Pic~]p hy ang4nee~
TYPE OF RESIDENCE
Single-Family ~] Multi-Family []
Number of Bedrooms /~
Other
WATER SUPPLY
Individual Well'J~ Community[] Public[]
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 (11/84}
Page I of 2
5.', ENGI~IEERING FIR~/I PROVIDR~ .NSPECTIONS, TESTS, FILE SEARCH, D~...AND INFORMATION
' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all MunicipaJ and State codes, ordinances, and regulations in effect on
the date of this inspection,~witb, wavier of well to seDt±c tank distance.
lelephone
EA~LE ~iVER ENGiNEEi~,~G SEI~CES
FJ~G[-E RIVER. AK 99577
P. O, BOX 773294
694-5195
Name of Firm
Address
Date
DHEP APPROVAL ;
Approved fei ~'^~?edroomsby .~'~--~:~' '"'~'~"~ Date
Approved ~ t'~'~"- Disapproved Gonditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
Anchorage
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
July 18, 1986
Lou Butera, P.E.
Eagle River Engineering Services
P.O. Box 773294
Eagle River, Alaska 99577
Subject: T14N R1W Section 11 Lot 60A
Waiver Request, WR86-091
Dear Mr. Butera:
This department has granted your request for a waiver of the 100 foot
separation required between the septic tank and well on the subject
property. This distance has been waived to 65 feet in this case.
This waiver is valid for the existing septic system only. Any modifications
to the system will invalidate this waiver.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
EAGLE RIVER ?*~
', ENGINEERING SERVICES Ih,,.
P. O. Box 773294
,' EAGLE RIVER, ALASKA 99577
Phone 694-5195
To Steve Morris
MQA-DHHS
LETTER
Date July 10, 1986
Subject Lot 60A Sec. 11 ~i~N R2W
It is mM opinion that ~oth ~ptic tanks serMing ~is lot a~e function-
ing adequately and do not ha~e any major leakage. At the time. of
initial ~esting, both tanks were ~ull to the same !evil 8~d ~he seepage
pit contained liquid. Liquid ~as also heard falling into the seepage
pit ~hen ~ater ~as added to the second tank
[] Please reply ~_~ No reply necessary Lou Butera
EAGLE RIVER ENGINEERING SERVICES
Lou Butera P.E.
P.O. Box 773294
Eagle River, Alaska 99577
Telephone (907) 694-5195
June 26, 1986
Mr. Steve Morris
Civil Engineer, On-site Services
Municipality of Anchorage
P.O. Box 196660
Anchorage, AK 99519
REF: Lot 60A, T14N, R1W, Section 11
MUNICIPALITY OF ANCHORAQ~
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
J u N o 1988'
RECEIVED
Dear Mr. Morris:
On behalf of my client, Mr. Charles Valencia, I am submitting the
information necessary for your determination of a waiver of separation
distance, well to septic tank, to 65' for the above referenced lot.
The septic system absorption rate has been tested' and found
adequate for a 4 bedroom use. The septic tank was installed in 1976
with a permit allowing 50' separation distance and was inspected and
approved by the Municipality at that time, as per the inspection report
enclosed. Our field measurements confirm the tank cleanout to be at
74' from the well. There is no well log available for this well. The
casing is continuous to +40' with a static water level of 63' below the
top of the casing. The surface topography is such that any seepage
would be directed away from the well location toward the septic tank on
a 5% slope to the west. The subsurface soil is a GW-GP type with an
assumed perc. rating of 86. A water sample for coliform bacteria was
satisfactory. The area in question has a low population density.
If there are any questions or if additional information is
required please feel free to contact me at 694-5195.
Sincerely,
Lou Butera, P.E.
HAA application
1976 inspection report
1976 permit
Encl:
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
[] PUBLIC WATERSYSTEMI.D.# J J J t I J J
"~_..PR VATE WATER SYSTEM
Name_ EAGI~E RIVER ENGINEERICG SERV~e No.
EAGLE RIVER, AK 99577
Mailing A~dress P. 0. BOX 773294
694-5195
City State Zip Code
Mo. Day Year
SAMPLE TYPE:
,~-.Routine
[] CheCkwith labSampleref, no.(f°r routine sample )
[] Special Purpose
[] Treated Water
~ Untreated Water
TO BE. COMPLETED BY LABORATORY
Analysis shows this Water SAMP~-E to be:
/,~ Satisfactory
Unsatisfactory
[] Sampletoo long in transit; sample should
not be over 30 hours old at examination
to indisate reliable results. Please send
new sample via: special delivery mail.
Date Received
Time Received
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
SAMPLE
NO. LOCATION
~ I Lo/-~o~ S~. // ?/~J
4
5
Time Collected
Collected By
~'..7.~... . _ _
Lab Ref. No. Result*
13~ ¢~'// I
J FF~
J
J FFq
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter:. Direct Count
Verification: LTB
Final Membrane Filter Results
Reported By
TNTC = Too Numberous To Count
OB = Other Bacteria
C011formll00ml
BGB.
Date.
Time: _
Coilformll00ml
a.m.
INSPECT, ION R~EPORT ON-S.,ITE ,S~W,AGE DISPOSAL..SYSTE~M
SEPTIC T~K: Dist~ce f~om well~ ~ Mate~ialS~L ~u~e~of e~pa~tments ~...
· ~ - . . ~ .
Liguld ea~aci%y?o~ ~allons. Inside ienEth.~ ....... Inside wxdth: Lxquxd dep~h
SEEP~_SYSTEM: Seepage P~: Nu~e~ of pits~utside dla~em ,
width .... ~ len~h ....... , depth ~, l~n~nE material ,,, _. Dist~ee f~om
well ~ buildin~ f~da~ion__~_~ nearest lo~ line , To~al effective
~so~ption a~ea (wall a~a)_ s~. ft.
T~L~ ~N F~ZL~: ~is~an~ f~om ~e~/f:., fo~a~on ~., ,, n.a~s~ ~o~ ~i~e:O /.:
width~n. To~al effe~Yve ~so~pt~on a~ea~O sg. f~. LenEth of each
Depth: Top of tile to f~nlsh E~a~e.~/-: Depth of ftlte~ m~em~al beneath
~. .. ~i~ i'~
t~le,' ~/~ in. Above e.
(
cesspool ~ othen sounoes
DISTANCES:
D~AGRAM
APP~OVEb
SEWAGE DISPOSAL SYSTEM - APPLICATION ~ PRRMIT
Residence Address ~;-z~" /~J~, ~ Location of Installation
,Legal Desc~'iption, ~
Application to Install: Septic t~k~ , Seepage p~t~, D~ain field~ , ~he~ ~:=~
To Serve the Following Facility ~ ~ ~, ~
Financed Through, , ,, To be Installed by. ,, ~ ~, ~
Percolation Test Results ~ ~.~ ~ti~ipated Date of Completion
BELOW TO BE FILLED OUT BY HE~TH DEPART~NT
This ts to serve as~, /~~ ~ peP~it to i~stall a ~_~~ ~
, /
~,, ~s described below. Size of ~it to be se~ve(~
-~ . ~Dtic tank aize_/~ype~~ Seepage ~e~ , Type. ~;~
DIST~CES: - . D,IAGRAM 0F SYS~M
0,--
'health Authority
I cemtify that I am familiar 'with the requirements of Greater Anchorage Area Borough
Ordinance No. 28-68 and that the above described system is in accordallce with said code.
· '~ ~ HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
~NSURING OFFICE
MORTGAGOR OR SPONSOR
SUBDIVISION NAME
PART I.--TO BE COMPLETED BY FHA
~i~/'~Y~O~'~~ SERIAL NO. ~ ~'~'~O~z~
PROPERTY ADDRESS ~*~.O J-.~'~ ~,~J)~ J~'~'~"~
LOT NO.
TOTAL NUMBER~
WATER SUPPLY BY:
r--]Public system
SEWAGE DISPOSAL GY:
--']Public system
BASEMENT
[] New installation
'-]Community system
--]Community system
Can a~lc or other area be made Into
additional bedrooms?
(If Yes, how many'~)
[] Individual
[] Individual
SYSTEM DESIGNED FOR
E] Ye5 [~ No--
PART fl.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
'"'"' '"' '"'"'"' "'""
IIIlll,l,,,,,,,, ,,,,,, '" '"'""'""'""
Illllllll~llll I II IIII ~1111 IIIIIIIIllllll
Jl till Il I IJll IIIlllllllllll
IIIIII IJll iiiiiiij111]1111111
Illll[l]l Il[Iii ]Il[il Ill{ 4[
It is the opinion of the [] State [] County Department of Health that this individual water-supply system
[~s [] is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the [] State [] County L_~ Local Department
of
Health
that
this
individual
sewage-disposal
.~anith proper maintenance:
be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily
is not likely to create an insanitary condition
JDA,E~/ / [S.G.A.U.E ~ ,,~ ~// _ h/ / I''TLE ~ "'~ /
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.
] CHIEF ARCHITECT
I~] DEFUTY FOR CHIEF ARCHITECT
DATE
SIGNATURE
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 25~,
Rev, July 1958