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Home My WebLink AboutBOLING LT 1A GRE'~ER ANCHORAGE AREA BOROU~q HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM , ~' g/t[. '6: N.o MAILING LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY NUMBER OF MATERIAL ..,,.c '.~ ~,~_~-,_~T~/__~.. COMPARTMENTS INSIDE LENGTH / INSIDE WIDTH x.--~-- HQU~D DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER /"~"~ OR WIDTH NEAREST LOT LINE ~- &~ ~" TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) , LENGTH ~'~ , DEPTH ~ / BUILDING FOUNDATION~;~/) -~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL /~-- 0 FOUNDATION NEAREST LOT LINE,~- TOTAL LENGTH OF LINES NUMBER OF LINES / DISTANCE BETWEEN LINES -'/g//'~'~ TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA //' ~ ~ SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE ~ / DEPTH OF FILTER MATERIAL BENEATH TILE tN; ABOVE TILE ~' J/ WELL: _~.~,~,/_ ,~,~,,~r~...-~_ ,, TYPE ~.../~_.,~_~z<~ DEPTH /7~ / DISTANCE FROM , BUILDING FOUNDATION. ~ NEAREST SEPTIC ~ SEEPAGE /~f~ ~ LOT LINE ~' ~ ~' SEWER LINE ~ '~' , TANK ~ , SYSTEM WATER SAMPLE , C ESSPOO L/~/~,/J~J''' , NEAREST OTHER . / , SOURC ES~ DISTANCES: ~.: /m--c- / ( , £o DIAGRAM OF SYSTEM HEAL'IH AUTHORITY GRE"tER ANCHORAGE AREA BOROUO".I HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: LEGAL DESCRIPTION /~ ,~ ~:~/6~'/ ~'~ DISTANCE FROM WELL /~4 / LIQUID CAPACITY ~'~') GALLONS. MATERIAL 'J("~4~/=-Z~Z NUMBER OF / __ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS NEAREST LOT LINE TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE WELL: LOT LINE OUTSIDE DIAMETER WIDTH DISTANCE WELL 9~'' TOTAL EFFECTIVE AI~DRPTION AREA (WALL AREA) FOUNDATI(J~~l/ /- LENGTH DEPTH BUILDING FOUNDATION SQ. FT. J ~T TOTAL LENGTH , LOT LINE OF LINES , TRENCH WIDTH IN. TOTAL EFFECTIVE EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__ DISTANCE FROM"~/~ ! WATER ...... BUILDING FOUNDATION. ~,~' SEEPAGE q~--' / -- OTHER __ DIAGRAM OF SYSTEM DISTANCES: DATE HEALTH AUTHORITY GreaTer ANChorage Area BOrOUgh DEPARTMENT OF' ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 995'02 TELEPHONE 279-86~]6 SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT NAmE OF APPLiCaNT ~~ MAILING aDDRESS INSTALLATION LOCATION ~#JI/~. ~ 4//~ ~ ~4 · LEgal DESCRIPTION Ldt //~ ~ ~ INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT DRAIN FIELD OTHER COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. TANK SIZE ~'1~/~1"~'~'~'~'~' TYPE SEPTIC MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK SEEPAGE AREA SIZE TYPE DIAGRAM OF SYSTEM FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL DRAIN FIELD SEPTIC TANK ., SEEPAGE PIT TO NEarEST LOT line. WELL TO SEPTIC TANK~- DRAIN FIELD , DRAIN FIELD /ZO ~ SEEPAGE PIT ALSO CONSIDEr AREA WELLS. WATEr main TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT SEPTIC TANK, ., SEEPAGE PIT TO RIVER, LAKE, STREAM. DRAIN FIELD. CAST irON 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, LICENSED DESIGNER ] 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. ~1~_~ DATE ~ /:~, /¢// APPLICANT'S $1GNATURE ~ : ~~ Y 6--- 8--- 10--- 12'" Smith LandscapinE & Excavaatin ~:or Norman Bolin~ c { ', Gray sand silt mix with poorly Eraded sand Seams and with scattered Eravel More silty from 10' - Was GPound Wa'top i~;ncountePed.? Dar e 9e;,r.;;~h 02 .in.~.e't: J;e'",~,-, ~c. ~lc, tt:om Of Pit <.:r. 262 squ~~~e ~iF,~~.~i~~~i 'Test PerfO~d By; R. E. Carlisle Certified nY;National Testinm Services, Inc. Date ,', JATER ANCHOP~GE AREA BOROUGH !'~ALI~.I DEPARl%~NT 327 EAGLE STREET ~NCHORAGE, ALASKA 99501 279-2511 DATE TIblE: REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES FOR 1. Approval Requested By Address_.. ,~~ / 2. Property Owner ~~~. P~ne 4. T~e of Facility to be Inspected~~TREET: Numbe~ of Bedrooms. S. Well Data: B. Depth /~, / , D. Construction_ E. Bacterial Analysis_~c-,~f~,~,c~ 6. Sewage Disposal System: Septic Tank (If homemade, show diagram on back) 4. Installer Approval Request for Sewa~ Page Two Water Facilities Seepage Pit 2. Lining C .... Disposal Field 1. Number of Lines. 2. Total Length ReqUired Measurements A. Well to Septic Tank. B.. Well to Seepage Pit C. Well to Sewer Line D. Well to Property Line E. $~ell to Other Possible Contamination F. Foundation to Septic Tank G. Foundation to Seepage Pit H. Seepage Pit to Property Line~ 8. COMmeNTS: APPROVED DISAPPROVED: iiiii~1, DATE: I DATE SIGNED, GREATER ANCHORAGE AREA BOROUGH HEALTH DEPAR'INENT EDll70 . REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES '~, f~. _,~ (Fill out in Triplicate) ~. Nu~,:.~,~e~ms in house Bacterial ...... . Detergent . .. . c. Casing Size d. Distance from well to closest existing or proposed: 1.' Sewer line 2. Septic tank s~-~.~-~ / 0_~ .'.. (. 1 ~. cesspool:.. ~ . 5. Property Line 6. Other sources of poss~le contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. ' b. Septic tank capacity in Eallons, . . o. Name of septic tank manufactu~m ._ ::_... . 1. If "home made" show diagram on reverse side of this form. Disposal field or seepage pit size and type (<.~? 1. Distance to proper~y. ]/ne_~ ~, / /~ to house foundation ~j~7 r~. Pe~co~Latio~ 'Test ~e.$ults ~ Uf. Percolation Test performed by ......................... -_ , se the reverse .side of. this form to show diagram, Diagram should include .....~he following information: pmoperty lines; .well location' house location, ~p~c~c tank location, disposal area location, location of percolation test, a~.. direction of ground slope, 9, The ~for~ation on this form is true and correct to the best of my knowledge. ~ Siffnature of Applicant Date si-)?ned TQ BE .FILLED O?T BY HEALTH DEPAP. T!.IENT PERSONNEL above described sanitary facilities are hereby approved~ _subJe.¢~___~9__th~' Conditions: The above described sanitary facilities are disapproved for the following reasonst ........ : I I I I I , .~ , il j i ilI il il ,,,. , , i "..Appt-oval is valid for one year following the date of approval, ./ CPJ:cw FHA Formal 2~[~'3 u.s. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Form Approved Rev, July 1958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63.R0296 HEALTH AUTHORITY APPROVAL ~ (}IISI #111-011915-203 INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--tO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. A~e skIl $~te B~nk 111-011015-105 MORTGAGOR OR SPONSOR PROPERTY ADDRESS ~n D. 8nenn~m Abbott ~ RoIId SUBDIVISION NAME BL~CK NO. J LOT NO. BoUn9 6ubdtvtsion , Lot l~ Except the West lZO ~eer TOTAL NUMBER: Can attic or other area be made Into BASEMENT E:! New installation addl~onal bedrooms? LIVING UNITS BIIDROOMe' BATHS -- (if Yes, how manyf) l--lYes m.$o I--lYes r-Iso WATIR SUPPLY BY: SYSTEM DESIGNED FOR r-] public system r-'J Community system r-] Individual NO. OF BOSMS. SEWAGE DISPOSAL BY: .0 Public system 0 Community system J--] Individual J~] Yes O No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH ......... * : : -~-: -_~ .... ~__~_~_ ~ .... ~ ~ , ._..: .... ~ ~ .............. ~_..: - ~- .... ~-_------ ~. ........ It is the opinion of the J'"] State J--J County J~ Local Department of Health that this individual system [~]is J"-J is not satisfactory domestic water supply for the subject as a property. It is the opinion of the J--El State D County ~Z] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: IX] Can be expected to function satisfactorily, and [--'] Cannot be expected to function satisfactorily ~s not likely to create an insanitary condition NOTE: The h~alth/authorlty should, complete the appropriate opinion statement above and affix date, signature and title in tho spaces provided./ Use of the b~ve grid 'for Health Department Inspector's sketch as well as use of the back of this form is at tho 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 g Acceptable [~] Not Acceptable Sewage disposal be considered r"] Acceptable O Not Acceptable. DATE SIGNATURE J~J DEPUTY FOR CHIef HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2573 Rev. July 1958 g8 0- 688 Od9 --61 'a)nuFu ~ad SUOll~ · a~nu!Lu ~ad SUOlle~' 'plo!,( a~etu!xo~dd¥ 'laaj '3'u!se~ ,~o tpdac] ii'u!se~ jo ad~L 'laaj 'uopnllOd alq!ssod pl0y [esods!p '.leaJ [] 'ap!s [] '3uoJj [] Se aU!l ~oI lsa~eau :laaj 'q~dap l~O,L 'saq~u!' loodss;2 · llata paJo~ [] 'liar* ~ncI [] *lla~ ua^!JCl [] 'lpt, POilUQ [] :tuoaj ,<Iddns Ja~e.,~ II?np!^!pui "~u!l ,(saadoad suoaj tuoaj ~pl?q las Xu!lP~Cl 'daap l~aJ---- 'ap!,~ saa;I :az~s soq pul? ,(Iddns-aa~t* ll?np!^!pu! qloq ql!~ pdop^ap ~'u!aq sou ~al? [] a~l? [] pooq~oqqXpu u! sap~ado~d WIIISAS XlddrtS-IFIIY/~R 1VflOIAIONI--NOII:):IdSNI 40 LIIOd:lll --61 Aq pos:~lsuI ',~!~otpnV qsll?aH 1~Ol [] Jl?a~ [] 'ap!s [] 'suo~j [] si? au!l soI lsat,au :saaj -- 'saq2u! 'saq~u! tlO!~.)adsu! Jo ~sl?fd 'SUOlle~ ll?!Jasl?cu ~ufu!q 'SUOlll?~ ',(S!.~l?dl?~ pmbH 'sa.¥ 'tlsda(] 's;)aj 'JeaJ [] 'ap!s [] 'SUOJ.,I [] SI? aU!l soI SSOJl?atJ '.saaJ --'uo!lepunoj '.saaj 'saaj 'qsdap p!nb!q 'la?t 'qlp!a~ ap!suI 'sa.¥ 'luaLulJedtuo:) S;~lU! As!.~l?dl?:) 'SUOlle~ ssuatusJedtuo:) jo aaquinN · loodssaD [] 'JaSatue!p ap!suI '[la/X~ :tuoJj a:~u~s!cl :loodsse::) 'qs~uaI ap!sul ',ru!~ed~.) pmb!l ImO,L :"quo/alld~ 'qUeS ~pdaS [] jo sss!suo9/NIWJ. VI~IJ. AIIVWlild W"JISAS 1VSOdSIO':i~)V/V~:IS 1VI'IOIAIQNI~NOIl:)]dSNI JO ltlOd:lll ~uly 1~, lg?l Mr. Norman Boltng Box 4-421 Affchorsge, Alaska 99502 Sub~ect~ On-site sewer system, Lot 1~ Boling Sub. Dear Mr. Boltng, Reg~rding ~he septic tank size on our final inspection form dated July 8, 1971, please be advised we are changing our form to read 1000 gallons. Please accept our apology for %he error, Sincerely, Carrol Sue McCechnie Env&ronmental Control Officer st