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HomeMy WebLinkAboutMCMAHON BLK 4 LT 8o E) o,/-t REQUEST FOR APPROVAL OF . INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) .ame .of person requestln, app.oval, , /~/~//,~. //~F I~/Y NumbeP of bedrooms in house Wate~ Analysis: a. Bacterial b. Detel~gent Well data: , Yld Dept C. Casing Size Distance from well to closest existing oF pmoposed: 1. Sewe~ line .. Septic tank [~.0! . Seepage Ar.e a_ . e Cesspool' . Propenty Line--I~-/ . Other sources of posstble contamination, i.e., creeks, lakes, houses~ baPn, drainaEe dltch~ etc, .. Sewage disposal system. a, Age of system /~ . b. Septic tank capacity in gallons /~S~ . c. Name of septic tank manufactu.mg.~ ,.~'..9-/~/~/~, . --' / 1. If "home made" show diagram on ~evemse side of this fo~m. 1. Distance to p~ope~ty llne ~t yO~ to house foundation _. · e, Percolation Test ra~ult~ f. Percolation Test performed ....... · Use the reverse.side of this form to show diagram. Diagram should include the following information: p~operty lines~.well location, house location, septic tank location, disposal amea location, location of percolation test, and direction of ground slope~ The Information on this [or~ is true and correct to the best of my knowledge. gignature o Appl'ca~t/~ . TO BE FILLED OUT BY HEALTH DEPARTMENT PERSONNEL T e above described sanitary facilities are hereby approved, s~ub~ject to the ........ ~'llowing con~fo~s: Conditions: _ ' The above described sanitary facilities are disapproved for the following reasonst Ap s va id 1 lng the date of approval. CPJ: cw ADHW LAB - 2W ALASKA DEPARTMENT OF HEALTH AND/.~WELFARE /-~/'%' DIVIS!O~N OF~PUBLIC HEAL1 BACTERIOLOGICAL WATER ANALYSIS OFFICE pUI~LIC []]]]] SEMI-PUBLIC J~J NAME INDIVIDUAL?[] -REPORT RESULTS TO DATE OF ~f .'[ / '? /!/~ ~? CITY ADDRESS OF SOL RCE DATE COLLECTED --' TIME COLLE~CTED ,' - /L · ' Sample Collected From {~ Kitchen Tap '~- Bathroom Tap [] Basement rap [] Other lust} Well- [] Dug [] Driven SOURCE: [] S~ring [] Cistern Dug Well or Cistern Construction: Walls- [] Wood [] Concrete Top- [] Wood [] Concrete ] Melal LOCATION: [] In Bosemem [] Basement Ogset [] In Yard [] Other Build]ng Sewer DISTANCE TO: or Olher Drainage Pipe /- "" Tile Seepage Cess- Field__Feet. Pit Feel. ~oo1__ Olher Possible [ Sources of Contamination MATERIAL: Building Sewer - [ Cast [] Wood Iron [] Plaslic Joint Material -- Type : GENERAL: Does Water Become Muddy or Discolored? _-E~]] Drilled [] Bored [] Other Brick or ~ Metal [] Tile [] Concrele [] Open Too [] Under House SeplJc Feet. Privy Feet. Asheslos [] Tile [] Fibre [] Cement [] Yes [] No When? . .. Basemem [] In Basemenl [] Room [] Of Well [] Olher PURPOSE OF EXAMINATION: Illness Suspected? [] Yes [] No READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Records in this office indicate this WATER SUPPLY to be of: [] Satisfactory [] Questionable [] Unsatisfactory Sanitary Status. Analysis shows this Water SAMPLE to be: [] Satisfactory [] Questionable [] Unsatisfactory. If an "Unsatisfactory" or "Questionable" status is indlcated above you should take immediate action as recommended below. 1. Notify consumers water is polluted. Boil or chemically treat thls water as outlined in the enclosed leaflet 2. Increase chlorination sufficiently' to meet recommended residual standards. Determine source of contamination and fake action necessary fo maintain a safe water supply at all times. 3 Check chlorination and other mechanical equipment. Make certaln it is iuncfionin9 properly. 4. If after checking equipmem a disinfecting residual is not obtained, please wire this office for emergency assistance or advisory services. 5. This is a surface water source and subject fo pollution by man and animals. An approved water supply source should be developed. 6. Improve your [] spring [] dug well [] driven well [] drilled well [] cistern. 7. Relocate your well to a sate location in relationship to your sewage disposal system. [] see enclosure 8..Sample too long in transit; sample should not be over 48 hours old at examinatlon to indicate reliable results, please send new sample. [] Bottle Broken in transit, please send new sample. 9 Contact your neares~ [] Local Health Department or [] Alaska Division of Public Health, sanltation office for bulletins, consultation and assistance. SANITARIAN'S REMARKS Date Received BACTERIOLOGICAL WATER ANALYSIS RECORD ,. ,: :," '~- -' · - , ~" Time Received -?.'." ~ :~ Lab. No. Lactose Broth ' . 24 hours 48 hours 48 hrs._ EMB Lac ose Broth, 24 hrs. _ Coliform Density. MF results This analysis indicates Coliform Organisms fo be: BGB .(Most probable No. per 100cc.) Date · Absent Present R~,QUES~ FOR APPROVAL OF INDIVIDU^L e~..~ o. A~E AND WATER FACILIIIES (['ill out in Triplicate) , .,-- ~ ......~ ~ , · , {~, , , ,, Number of bedrooms in house a. Bacterial b. Detergent Well data: a, Type~ b. Depth c. Casing Size de Distance from well to closest existing or proposed: 1. Sewer line ~:"~ ~ 2. Septic 3, Seepage Cesspool' 5. Property Line/~-'~ 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc.. ..... Sewage disposal system. a. Age of b. Septic tank eapa6ity in gallons c. Name of septic tank manufacturer /~'~ ~. /~/2~ ~ 1. If "home made" show f!iagram on reverse side of this form. d. Disposal field op seepage pit size and type if' / " 1, ~istance to property line ~'~ / ,,~ .-.. to house foundation e. Percolation Test results f. Percolation Test performed Use the reverse side of this form to show diagram. Diagram should include the following information: p?operty lines~.well location, house location~ septic tank location, disposal area location, location of percolation test~ and direction of ground slope. The information on this form is true and correct to the best of my knowledge. SignatUre 0£ Applicant/J D~e $ig6ed TO BE FILLED OUT BY HEALTH DEPART~.!ENT PERSONNEL - e above described sanitary faczl~t~es are hereby approved, subject to the ........... '~$'llowing conditions: The above described sanitary facilities are disapproved for the following reasons: . ~ -, "~:;' · ' 9 ~ ~ . .~ ., ': · Approval is valid for one yea~ followin~ the date of approval. CPJ:cw ?HA FORM 2054¢ SU!}D~VIS',ON SF. WAGE DISPOSAL P.~PORT PART t * To Be Completed By Federal Housing AdministrQtion - Yeterans Administration Forra Approved Budget Bureau No. 63-R$48.6 F. M. & Connie W. Lindse~ McMahon Subdivision No. of Acres [Proposed t~rpica! Max, No. Bedrooms[ Water Supply Source: Date PART !i - For Uso of Sponsor INSTRUCTIONS TO SPONSOR: This form is used where Sewage Disposal ia to be by means of Sepfiic Tanks with subsm'face absorption fields. Federal Housing Administration or Veterans Administration will furnish the form when applicable, des- ignating the Public Health Authority. Percolation tests and soil borings shall be made and tabulated in Tables I and II,' PaR II below, by a licensed Engineer or qualified Sanitarian. This report in duplicate, accompanied by ~he required top- ographic map, shall then be submitted for review and analysis to the following Health Department: (Name and Addressl INSTRUCTIONS TO ENGINEER OR SANITARIAN: i. A~ adequate number of tests shall be made (one per acre, or if sell conditions indicate, a greater number will be required) to show clearly the absorptive ability of the soil throughout the tract. (Use Table I) ?~ ~ach test hole shall be located by a key number on a topo- graphic map of the tract. 3. Soil borings shall be made (one every 5 acres, or if subsoil conditions indicate a greater number will be required) to show clearly the type of soil existing beneath the absorptinn area, Borings should extend to a poin~ at least 6 feet below the finish grade of proposed absorption trenches. (Use Table I1) PROCEDURE TO FOLLOW IN MAKING REQUIRED PERCOLATION TESTS: 1. Dig or bore the holes with horizontal dimensions of from4 to !2 inches and vertical sides to the depth of the bottom of the proposed absorption device. Holes can be bored with 4 inch di- ameter post-hole type auger. 2. Roughen or scratch the bottom and sides of the holes to pro- vide a natural surface. Remove all loose materials from the hole. Place about 2 inches of coarse sand or fine gravel in the hole to prevent bottom scouring. 3. Fill thehole with clear waterto a minimum depth of 12inches over the g~avel. By refilling, if necessary, or by supplying a su~plus reservoir of water (automatic siphon), keep water in hole for at least four hours, and preferably overnight. In sandy soils ie GW~ GP, 8¥I, or SP classified according to the " Unified Soils Classification System'~, the above saturation procedure is not nec,essary and the test can be made after the water from one fill- ing has seeped away. 4, Percolation rate measurements should be made on the day fol- lowing the saturation process, except in sandy soils. 5. If water remains in the test hole after oven/sbt saturation, ad- just lhe depth to 6 inches over the gravel. From aflxed reference point, measure the drop in water level at approximately 30-minute intervals over a 4 hour period. The drop which occurs during the final 30-minute period ia used to calculate tho percol~tinn rate. Note: The engineer should deterndixe if the water in the test hole is due to a high ground water condition or the permeability of the soil. Report ground water conditions on reverse of Form and soil types in Table Z 6. If no water remains i~ the hole after overnight saturation, add clear water to a depth of about six inches over the gravel. ~'rom a fixed reference point, measure the height of the water surface at approximately 30-minute intervals over a 4 hour period, a'efi21ing the hole to a depth of 6 inches when the percolation rate indicates the hole wiI1 run dry before the next ~eading is made. The ch-op which occurs during the final 30~minute period is used to calculate the percolation rate. Note: If a hole must be refilled to obtain a final 30-miffute reading, d'---~term~e from the previous reading the water level drop during that interval. Add water until the level above the bottom equals this figure plus one half inch. Continue, measure drop during the final 30-minute period. 7. In sandy soils, or other soils ia wlach the first six inches of water seeps away in less than 30 minutes, after the overnight sat- uration period, the time interval between measurements can be taken as 10 minutes and the test run over a period of one hour. The drop which occurs in the final 10 minute periodis used to calculate the percolation rate. Adequate TABLE l- PERCOLATION RATE(R~zCORD RATE iN MINUTES PER .,Cd) 2 I i ~2 I 3 I ! 4 14 t 17 Percolation 23 33 ' 30 J j_co Percolation Al i.,..'-,~ 6 FT,) 'fA~[.E Il o SUBSOIL DATA (GiVe. TO A D~PTH OF " NOTE: last line to record depth at each h01e. 1 foo't Jor~anic a[to~soil I [ j . 2 feet topsoil &Jcourse.,g~ave~l~ j I 6 feet ~ine g~avel & ~ "' . c0bbl~s . ~ ~ . Distance to ] I ~ O .... d ~/ato, , j j Description of soil by Unified Soil Classification system is preferred. When ground water is encountered, use Y~s~ Hole 7 Test Hole 8 FHA FORM 2084¢- VA FORM 26/1888 (Continued) Use this space to describe any known seasonal variations in ground water level. This lot is high and well drained. Ground water was not encountered in this test, however, it is known to be lower than 6 feet below ground surface. Seasonal variations should be'slight because of the excellent drainage from this lot. 1, ....o..? ' ..., - . .:?, ,~ (., ' // ' I' ~'~ :'""' ?!'~'? "",~ ,f ,. PAI:~T I11 - To Be Completed By HEALTH DEPARTMENT Date INSTRUCTIONS TO PUBLIC HEALTH AUTHORITY: This portion of the report is to be filled out by the PubLic Health Authority designated in Part II, Instructions to Sponsor. When completed, the Report, in duplicate, together with the accompanyiug topographic map shall be returned to the Federal Agency which issued it. We have examined the results of the Percolation Tests and other information developed in connection with this sub- division.~ is our opinion that the tract: [] Is suitable for the use of septic tank systems with subsurface absorption fields. [-] is not suitable for the use of septic tank systems with subsurface absorption fields. [] Is suitable for the use of septic tank systems if the following alternate method of effluent disposal is installed.