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Home My WebLink AboutBROOKWOOD BLK 1 LT 6 GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGE, ALASKA'99501 Performed For,, fX)a~ .~ea$~ .............. Date Performed . .~ ~%~w , I~ct ..... Lefal Descrip~iOn: 5or' /~ BloCk~S~diviSi°n .~.o~_l~ ~o~d This Fo~m Repomts a: So~ls L~g ~ ; ;percolation Tess ........... Depth Feet Soil Characteristics Location Sketch Was G~ound Wate~ Encountered? If Yes. A! ~,a~ Depth Reading Date GPoss Time Net Time Depth To H20 Net Dmop ~rco~a{'i.-Oh- ~ate ~"/ Minute ............... ' ...... Proposed Installation: Seepage Pit Drain Field Depth Of Inlet Depth T° B°~tom Of Pit Or Trench ............. COMMENTS: 't~,C, .....(.~.:"l" ',;'~,,:,~/ ~.~,,~' ~Ui ~'o~l . ~o~_~'~ a:_ ~.~'~ ::g~:~',:~ ~::~ Test Performed By:. 8u~~ ~:.:~e-~'CO~- ' ' ' ~C'~3 Data Certified By: ~ ~.~ _ _ J GAAB-HD-I GR~:ATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 2,~)-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION ADDRESS LEGAL DESCRIPTION '~('~" ~ ~ / PHONE SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY l GALLONS. MATERIAL INSIDE LENGTH NUMBER OF / COMPARTMENTS INSIDE WIDTH 5/ LIQUID ,~..! __ DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE OUTSIDE DIAMETER OR WIDTH DISTANCE FROM WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH , DEPTH BUILDING FOUNDATION.__ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION , NEAREST LOT LINE TRENCH WIDTH ! TOTAL LENGTH/ ,~'~,,~ '/ OF LINES 'ir ',.~ ~ I~ DISTA~GE BETWEEN LINES l i · : '~ '~,- ¢ ~" I , ' SQ. FT. LENGTH OF EACH LINE )1 ] '7' DEPTH OF FILTER MATERIAL BENEATH TILE IN. TOTAL EFFECTIVE II b IN. ABOVE TILE__ WELL: LOT LINE TYPE I(~ jl~ DISTANCE FROM WATER . '-- ~ DEPTH BUILDING FOUNDATION SAMPLE NEAREST SEPTIC SEEPAGE SEWER LINE ~, TANK , SYSTEM , CESSPOOL NEAREST OTHER , SOURCES__ DISTANCES: f'.'.- J::-- .0; DIAGRAM OF SYSTEM ] D DATE APPROVED HEALTH AUTHORITY GAAB-H D-2 GREATEK ANCHORAGE AREA HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case N o. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY ~0~ &a..~_., MA,L,N~ ADDRESS .'¢ 7~ 5'" ~ ~~_-. LOCATION OF INSTALLATION LEGAL DESCRIPTION ,,~f-.,~ ~ ~/ ~~~d ,DRAIN FIELD ~ ,OTHER b"" , SEEPAGE PIT. FINANCED THROUGH ~,~TO BE INSTALLED BY P.~R.C.I~'A-T'}O~ TEST RESULTS ANTICIPATED DATE OF COMPLETION THIS IS TO SERVE AS DISTANCES: ~, PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ ~~ ~. r DIAGRAM OF SYSTEM I / '~ealth 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 7///~'/~ ¢ APPLICANTS Sl6NATURE ~S / '/ - GREATER ANCHORAGE AREA BOROUGH /. Department of Environmental Quality ( 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received ~"//~x~ Time of Inspection/Z~ ~ ~ Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Mailing Address: ~ /~~ ~ - ,.~/~ 2. Property Owner: Phone: Phone: Mailing Address: 3. Legal Description: ~ ~r ~// ~~~~ ~/~ 4. Location: ~z~L.~-z$~c4) ~/Qu.~)~'/~/~ ~ ~ ~~Y~ 5. Type of facility to be inspected ~~~~ No. of bedrooms 6. Well Data: B. Depth D. Bacterial Analysis C. Construction Sewage Disposal System:~~J. A. Installed B. Installer C. Septic Tank: D. Seepage Pit: 1. Size /~6t2~ 2. Manufacturer 1 Absorption Area~O' ~ S/ 2 Material E. Disposal Field: Total length of lines e Distances:~_~ , ~.0 A. Well to: Septic tank ~00~ ~ , Absorption area , Sewer Lines __, Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re~..~...,st for Approval of Individual . .er & Water Facilities Comments A pprove~/~zg//-Y¢ j~'/~roved r from da te s, ned Date ~ Approval Valid for one yea / 'g ~reater Anchorage Area Borough, Depart~nt of Environmental Quality DIAGRAM OF SYSTEM ¢ c · ~ I Z ., 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 and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) Form Approved FHA Form 2573 u.s. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Budgel 8ureou No. 63-R296.B Rev. July 1958 - FEDERAL HOUSING ADMINISTRATION · HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PARt I,--tO ~NSURING OFFICE MORTGAGEE SERIAL NO. Con ~c ~ o~er o~a ~e mmda i~ BASEMENT ~ Nc~ J~s~JJ~fio~ a~i~onal b~omlt LIVING UNITS IIDROOMS BATHS (If Yes, how martyr) WA~R SUPPLY BY~ SYSTEM DESIGNED FOR ~blic system ~ ~mmuni. system ~ Individual 'No. OF BDKMS, OAR.AOE'DISPOSAL SEWAGE DIS~SAL BY~ ~ ~blic system D ~mmunity system ~ Individual ~ Yes ~ No PART II.~TO ~ ~OMPL~TfD BY H~ALTH D~PARTM~NT HEARTH D~PART~T INSP~OR'$ $KETCH water-supply ~ is ~ is not satisfactory as a domestic water supply for the subject properW. It is the opinion of the ~ State ~ County ~ Local Department of Health that this individual sewage-disposal tern with proper maintenance: ~ Can ~ exp~ted to function satisfactorily, and ~ ~nnot be exacted to function satisfactorily is not likely to create an insanit~ condition NOTE: The he h au~url~ should, complete the opDro~rlate o~lnion statement above and a~x date, signature and title In the .paces 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 heal~ authority. PART Ill.--FOR USE OF FHA OFFICE TO THE CHIEF UN~RWRI~R: I have r~iewed the foregoing and the ~inent FHA Compliance Ins~ion Repo~, and recommend that the Individual water-supply system ~ considered ~ Acceptable ~ Not Acceptable ~wage dis~sal ~ considered ~ Accep~ble ~ Not Acceptable. 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