HomeMy WebLinkAboutSUNNY SLOPES LT 34
GAAB-HD-I
GRr~TER ANCHORAGE AREA BOROI/~'-H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL O .~L~) MATERIA[
LIQUID CAPACITY ///)L/'~ ~")
ADDRESS
LEGAL DESCRIPTION
COMPARTMENTS
GALLONS. INSIDE LENGTH INSIDE WIDTH
PHONE.
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
OUTSIDE DIAMETER ORWIDTH ,x/~? ,LENGTH ~'~'~ ,DEPTH
--- ~-) C/~) BUILDING FOUNDATION
(W L,
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBER .OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
, FOUNDATION. NEAREST LOT LINE
DISTANCE BETWEEN LINES TRENCH WIDTH
SQ. FT. LENGTH OF EACH LiNE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
TYPE DEPTH
NIEAREST
LOT LINE . SEWER LINE
DISTANCE FROM ' WATER
· BUILDING FOUNDATION. · SAMPLE , NEAREST
SEPTIC SEEPAGE OTHER
· TANK , SYSTEM , CESSPOOl , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
'' H~ALT~T XUTHO~' v
DATE APPROVED
GAAB-HD-2
~
~r GREATEt~tNCHORAGE AREA '~gROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
_ . PHONE NO.~
RESIDENCE ADDRESS LOCATION OF INSTALLATION ~'~ -,-~-~ '-~'//o,~'~-,
/,,~-~V LEGAL OESCR,PT,ON p~u ¢5 u~, ~,., .% .. .,~ ,.'T.,v ~./?.~ ~-, ~.,~...
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH fL~'~,/~ ,,~
PERCOLATION TEST RESULTS
SEEPAGE PiT X ,DRAIN FIELD.
TO BE INSTALLEO BY '7--Z..-~
ANTICIPATED DATE OF COMPLETION
,OTHER
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS OESCR,BED BELOW. S,ZE OF UN,T TO ,E SERVEO -~ ZT,-~--~ .~
.SEPT,C TANKS'ZE /oo,,/,,AYPE ~/,,-/ SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
DISTANCES:
Health 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 code.
DATE APPLICANTS SIGNATURE
A~proval Requested
Address: Eagle River
GREATER ANcHoRAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received Da~ ~; IQT~
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
VA
Selective Realty
Single Family Dwellin§
2. Prooertv Owner: Frederick Hess
3. Legal Description: Lot 24, Sunny Slopes Subdivision
4. Location: Sunny Circle
5. Type of Facility to be Inspected:
Phone:
Phone:-
Three (3)
1. Size .lO00 Gals 2.
1. Size ]2x12x6 2.
B. Depth
D, 'Bacterial Analysis
Number of Bedrooms:
6. Wel] Data:
A. Type Community
C. Construction'
7. Sewage DisPosal System:
A. Installed ~ ]969
C. Septic Tank:
D. Seepage pit:
~o Disposal Field:
8. Distances:
A. Well
B. Installer Tuck Construction
Manufacturer
Material Log'
Total. Length of Lines
, Absorption Area
· Other Contamination
~> Absorption Area
Absorption Area to Nearest Lot Line
Septic Tank
, Nearest Lot Line
Foundation to Septic Tank
Sewer Lines
Page Two
9. Comments: Approval pending escrow funds f~r hook up to public sewer system
in spring of 1974.
Disapproved Date
.Aopro~_~. ~ova] Valid for ~Year From Da%e Signed
Greater Anchorage Area Borough, Department of ~nvironmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true
and accurate representation of the subject sewer and water facilities located at:
Signed Date
~NA Form 2573~
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART L--TO BE COMPLETED BY FHA
DUPLIC^TE
~NSURING OFFICE
MORTGAGEE
SERIAL NO.
MORTGAGOR OR SPONSOR
SUBDIVISION NAME
PROPERTY ADDRESS
BLOCK NO. LOT~rNO.
TOTAL NUMBERz
WATER SUPPLY BYz
[] Public system
SEWAGE DISPOSAL BY:
[] Public system
BASEMENT
J~] New installation
p Communiq, system
]Community system
Can attic or other ama be made Info
additional bedrooms?
(If Yes, how manyF)
[] Individual
SYSTEM DESIGNED~ FOR
I~ Yes [~] No
[] Individual
PART IL--TO BE COMPLETED BY HEALTH DEPARTMENT
tEALTH 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
--~ATE ISIGNATURE ,' ~ ,' r s JTITtE
j ,. ~ ..... ~ [, ~nviroi~nental Health Sularvisor
NOTE: The health authorl~should complete the appropriate opinion statement above and a~x date, signature and title In the
~paces provided.
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.
SIGNATURE
___] CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
DATE
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2573
Rev. July 1958
REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
TII~ D]$posul Field:
Distance from: Well,.
Total length of tile lines,~
Trench width1
Length of each line,
gallons. Capacity inlet compartment,
feet. Liqukl depth,
Number of compartments ,
gallons.
feet.
feet.
feet; nearest lot line at [] front, [] side, [] rear,
feet. Liquid capacity, gallons. Lining material
feet.
square feet.
inches.
inches.
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,_
Type of filter material: [] Gravel. [] Broken stone. Other
Depth of filter material beneath tile,, .inches. Depth of filter material over tile,
Number of pits .... Outside diameter, feet. Depth,
Distance from: Well, feet; building foundation,
.feet. Lining material
feet; nearest lot line at [] front, [] side, [] rear,
[] Local Health Authority.
Inspected by-
REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM
Distance to nearest public water main1 feet. Size of main, inches,
Indivkhml 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 neighborhood [] are [] are 99t being deveh)ped 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 fi'om: [] 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, J'eet.
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.
~ump: [] Shallow well. [] Deep well. Length of drop pipe,_ feet. Pump capacity,
Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground, [] Pamp 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 an~.
Inspection made by: [] State. [] County. [] Local Health Authority.
Inspected by
Date of inspection , 19
Depth of casing,
.gallons per minute.
.gallons per minute.
feet;
feet.
19__
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
INSURING OFFICE
MORTGAGOR OR SPONSOR
BLOCK NO. LO~O.
TOTAL NUMBER:
WATER SUPPLY BYz
[] Public system
BASEMENT
[--~ Yes [] No
[] New installation
[~ Community system
Can attic or other area be made Into
additional bedrooms?
(if Yes, how many~)
[] Individual '
g [] Yes o
SEWAGE DISPOSAL
[] Public system
]Community system
[] Individual
PART II.~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 sew~.ge-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
~ATE J SIGNATURE J TITLE
health
Use of the above grid ~or Health Department Inspector's sketch as well as use of the back of this form is at the option of the
heal~ authority.
PART III.~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.
SIGNATURE
]r__i CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
DATE
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
Distance feom: Well,
Total length of tile lines,
Trench width,_
Length of each fine
gallons. Capacity inlet compartment,
f~et. LiquM depth, feet.
Number of compartments
gallons.
feet; nearest lot line at [] front. [] side, [] rear,
feet. Liquid capacity, gallons. Lining material
Other
feet.
square feet.
inches.
Depth of filter material over tile,
· feet. Lining material
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,
Type of filter material: [] Gravel. [] Broken stone. Other
Depth of filter material beneath tile,r inches.
Seepage Plt~:
Number of pits .... Outside diameter,, feet. Depth,
Distance from: Well,
Insp~dlon made by: [] State.
feet; building foundation, feet; nearest lot line at [] front, [] side, [] rear,
[] County. [] Local Health Authority,
Inspected by-
19
REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM
Distance to nearest public water main,, feet, Size of main, inches.
Individual wells [] are [] are not customary in neighborhood.
(Jive most recent record of failure of wells in immediate vicinity to furnish adequate supply of water_
Properties in neighborh~x3d [] 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 from: [] Drilled well· [] Driven well. [] Dug well. [] Bored well.
D~stance of well from:
Buikling foundation,_
cast iron sewer, feet; tile sewer,
seepage pit, feet; cesspool,.
Well construction:
Diameter, inches. Total depth,
Approximate depth to pumping level of water in well,
Sealed watertight to depth of .feet.
feet; nearest lot line at [] front, [] side, [] rear,.
feet; septic tank,_ feet; disposal field,
feet; other sources of possible pollution, ~eeet.
Depth of casing,
gallons per minute.
feet. Type of casing,
feet. Approximate yield,
19
Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill.
Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No.
~ump: [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity,
Located in: [] Basement. [] Pumproom off basement. [] Pumpbouse 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
Qualiq, of water [] is [] is not satisfactory for human consumption.
Installation [] does [] does not comply with approved exhibits, if any.
Inspection made by: [] State. [] County. [] Local Health Authority.
Inspected by
Date of inspection , 19
feet;
gallons per minute.
feet.