HomeMy WebLinkAboutLAKESIDE TERRACE LT 11
~ Gr~.TER ANCHORAGE AREA BORO 'iH
,' HEALTH DEPARTMENT
· ' 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
,, INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS ' PHONE.
~,.~,':~'~'~,<
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WE[[
LIQUID CAPACIIY
MATERIAL
GALLONS. INSIDE LENGTH
NUMBER OF
COMPA RTM ENTS
INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
_OR WIDTH ~:'
DISTANCE FROM WELL.
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
,LENGTH ~:_~'~ ,DEPTH
BU,LD,NG EOUNDAT,ON
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
FOUNDATION
. NEAREST LOT LINE
TOTAL LENGTH
, OF LINES
DISTANCE BETWEEN LINES
TRENCH WIDTH
IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
WELL: TYPE L!,/J,~,I~. ,DEPTH.
NEAREST
LOT LINE SEWER LINE
DISTANCE FROM
, BUILDING FOUNDATIO~,I.
SEPTIC SEEPAGE
TANK , SYSTEM
- WATER
· SAMPLE.
· CESSPOOL
., NEAREST
OTHER
, SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
APPROVED
GAAB-HD-2 ~
GREATEI~ ANCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
L ~)ROUGH C~No. /F~
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ('~r-)~.~'~ ~ ~ ~'~ ? CZ°~/~4~%/~
RESIDENCE ADDRESS ,~¢¢L,~.
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
F,N^NCED T.ROUGH ~
PERCOLATION TEST RESULTS ¢~' ~"
MAILING ADDRESS ~0,~ '~¢'F NE
LOCATION OF INSTALLATION
, SEEPAGE PIT
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
DRAIN FIELD , OTHER
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS /Y~/~b~), ~-'¢?~b/L¢'X~';;) ,PERMIT TO INSTALL~¢~ ~~-~¢,~,4,~*- ~.e~-~-
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ ~,.O-e.~,¢~/
, SEPTIC TANK SIZE ~ TYPE ~ SEEPACE AREA o~;;~ ~ 'TYPE
DIAGRAM OF SYSTEU
I' certify that I am famitiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
Phone:
Phone:
4. Location:
Type of facility to be inspected
Well Data:
A. Type (~ ¢~&~
C. Construction
7. Sewage Disposal System:
B. Depth
No. of bedrooms
D. Bacterial Analysis
Se
C. Septic Tank: 1. Size -/5~-~ 2. Manufacturer
D. Seepage Pit: 1. Absorption Area ~%' 2. Material
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank ~/¢o~ , Absorption area
Nearest lot line ¢;)~;f , Other contamination
B. Foundation to septic tank 1~¢
C. Absorption area to nearest lot line
Sewer Lines
, Absorption area
EQ-034 (1/74) Page 1 of two pages
'GREATER ANCHORAGE ARE/~ BOROUGH
Department of Environmental Quality
2330 "C" St., Anchorage, Alaska 99503 274-4561
REQUEST FOR "APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
· 1. Type of Inspection: · CMRO VA FHA CONV
2. Name of Buyer: ~. ~~
~ Address:
Mailing
4. Name of Lending Institution:
Mailing Address: ~~ ~ ~ Phone ~- ~/
5. Name of Realtor or Agent:
Mailing Address :~9~00
6. Legal Description:
· ~ Location:
7 .Type of Facility to be inspected:
8. Hater Supply
Type of Supply: Public Utility
No. Bdrms, o~_
Individual
If individual, hum'bar of dwellings presently served
' Individual
(on-site)
If. Individual, depth of well
Sewage Disposal' System
Type .of S~stem: Public Utility
I'f Individual, date of installation
,,P~§e 2 of two pages - Request for Approval of Individual v~er & Water Facilities
Legal Description
Approved ,,,~ (~ ~/&~' Disapproved Date
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279,~8686
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAl, SEWER & WATER FACILITIES
FOR
Approval Requested By: _ ~~/-~6~
PhoNe,
Pro oerty Owner:
Legal Description:
Location:
Type of.Facility to be I~spected:
Number of Bedrooms: <~
A. Type B. Depth .,~
Co Construction D, Bacterial Analysis
Co Septic Tan~: i. Size 2, ~anu~acturer
D, Seepage Pit: 1. Size 2, ~aterial
E. Disposal Field: Total Length of Lines
Distances:
A. Well To:
Septic Tank
, Nearest Lot line
Foundation to S~otic Tank
, Absorption Area , Sewer Ltnes
, Other Contamination
"~ AbSorption Area
C. Absorption Area to Nearest Lot Line
Rawest for Approval of 1. Avidual Sewer & Water Fe¢ilitl6
Pa.c~ Two
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borough, Department of Environmental Quality
D'~AGRAM OF SYSTEM
lT--
I certify that the information contained in this request for approval to be a:true
and accurate representet~.on of the subject sewer and water facilities located at:
~NA Fo~m'25)'3
Rev. July 1958
U.S. DEPARTMENT OF HOUSING ANO URBAN DEVELOPMENT
FEDERAL HOUSING ADMINISTRATION
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
Form A~proved $
Budget Bureau No. 63-R296.8
PART I.--TO BE COMPLETED BY FHA
INSURING OFFICE
MORTGAGOR OR SPONSOR
MORTGAGEE
SERIAL NO.
PROPERTY ADDRESS
BLOCK NO. LOT NO.
SUBDIVISION NAME
TOTAL NUMBER:
BASEMENT
Yes [~ No
[] New installation
Can attic or other area be made Into
additional bedreoms?
(If Yes, how many~)
WATER SUPPLY BY: . SYSTEM DESIGNED FOR
[] Public system [] Community system [] Individnal No. o, ,us,~s. o^,^oE D,s,os^t
SEWAGE DISPOSAL BY:
[] Public system [] Community system [] Individual a [] Yes [] No
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
tem with proper maintenance:
]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
)ATE
JSIGNATURE J TITLE
NOTE: The health authority should complete the appropriate opinion statement above and affix date, signature and title in the
spaces provided.
Use of the above grid for Health Department Inspector's sketch as well as use of the back of this form is at the option of the
health 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
HEALTH AUTHORITY APPROVAL
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