HomeMy WebLinkAboutBURLWOOD TERRACE BLK 2 LT 5
DATE RECEIVED
INSPECTION APPOINTMENTS
IME TIME TIME
DATE DATE DATE
...... lC ........ OF
DEPT. OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH &
LCTION
025 LStreet-Anchora~,Alaska99B01 :~PR 2 ! 1980
ENVIRONMENTAL SANITATION DIVISION
.e,e..o.e RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requesS will not be p~oce~ed. Please allow ten (10) days for processing.
PHONE
1. PROPERTY OWNER
MAI LING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
PHONE
3. LENDING INSTITUTION ~ PHONE
I
MAILING ADDRESS
PHONE
4. ~REALTOR/AGENT~z~ E~'
5. LEGAL DESCRIPTION
STREET LOCATION
.~/~-
6. TYPE OF RESIDENCE
y SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
j~ Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
fi~' PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72_o,o ,,.v. >,
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
E~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] ONE [] THREE
[] TWO [] FOUR
[] FIVE
[] SIX
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[~]Septic Tank or [] Holding Tank
Size: If Tank is homemade
give dimensions:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[] OTHER
Septic/Holding Tank
IAbsorption Area ISewer Line
INearest Lot Line
[~:~ROV ED FOR
DATE
~ CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~
72-O10 (Rev. 6/79)
(,ear ~r.
E :',vi ren~ nra! Sr, ecJal tst
st
cc: V?~ ~dmi~i$1ratio?
Gk_ATER ANCHORAGE AREA BOROUGh,
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
~S~EC~. ~'"'~
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACIL
ITIES '~ ~
FOR
~.
APPROVAL REQUESTED BY: ~/ ~~
PROPERTY OWNER: ¢ a~l~.. PHONE:
LEGAL DESCRIPTION: ~,'¢1~ ~ ~ ~' ~ ~'~ ~,~
NUMBER OF BEDROOMS: ~
o
WELL DATA:
A. TYPE~
B. DEPTH
C. SIZE ~,'/
E. BACTERIAL ANALYSIS~
SEWAGE DISPOSAL SYSTEM:
SEPTIC TANK
1. SIZE
2. AGE
(IF ~,OMEMADE, SHOW DIAGRAM ON BACK)
3. MANUFACTURER
4. INSTALLER
APPROVAL REQUES1 FOR SEWER & WATER FACILITIE~
PAGE TWO
B, SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
REQUIRED MEASUREMENTS
WELL TO SEPTIC TANK
WELL TO SEEPAGE PIT
WELL TO SEWER LINE
WELL TO PROPERTY LINE
WELL TO OTHER POSSIBLE CONTAMINATION
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEEPAGE PIT TO PROPERTY LINE
B.
C.
D.
E.
F.
G.
H.
8, COMMENTS
APPROVED: DISAPPROVED~
DATE: DATE: ~ ~i
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY
FHA Form 2573 Form Approved
Rev. July 19~;B FEDERAL HOUSING ADMINISTRATIOvr ~ Budget Bureau No. 63-R296.8
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
-iN~SURING OFFICE .................. J-MORTGAGEE ...... $~IAL NO.
/
MORTGAGOR OR SPONSOR 1 PROPERTY ADDRESS
TOTAL NUMBER:
LIVING UNITS BEDROOMS
BATHS .
BASEMENT
New installation
WATER SUPPLY BY:
r--] Public system [--] Community system
SEWAGE DISPOSAL BY:
~] Public system [--] Community system
Con attic or other area be made into
additional bedrooms?
(If Yes, how many.~)
NO. OF SYSTEM DESIGNEDmsPosAt
~] Individual BORMS. GARBAGE FOR
Individual ~ 1~ Yes [~] No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
PARTMENT INSPECTOR'S SKETCH
~e opinion of the [~ State [--] County .,1~] Local Department of Health that this individual water-supply system
F]is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the [~ State [--'1 County ..[]'__ Local Department of Health
that
this
individual
sewage-disposal
tem with proper maintenance:
'[~ Can be expected to function satisfactorily, and [--1 Cannot be expected to function satisfactorily
is not likely to create an insanitary condition
IDATE ] SIGNATURE TITLEist_ ~..?
////, ~,1(.. ,,,-. --.-- ,,e,__.~.,_..z~..'.5.__ ~.:Z.___..._?~' '
.o,E.. Th. h.o,,, o.,h~,,~,o.,d ,omp,.,. ,h.~pproprio,. op,.io.',a'.m.., obov. o.d n"'. da,.. ,i,.a,.r.a.d ,i,'. '. ,h.
spoce$ provided.
Use of the above grid far l'le~lth Dep~rtmenl Inspector's ~ketch as well as use of the k~k of this form is ~t the option of the
heulth uuthority.
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 Fl Acceptable [--] Not Acceptable
Sewage disposal be considered [--1 Acceptable [--1 Not Acceptable.
S~GN/k~URF..
CHIEF ARCHITECT
J'~ DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL FHA Form 2573
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM r~,¥. J,b, ~9s8
REPORT OF INSPECTIONmlNDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PRIMARY TREATMENT consists of iiI Septic tank.
Septic Tank:
Distance from well, --__~eet. Material
[] Cesspool.
Total liquid capacity, --~'
Inside length,~feet. Inside width,
Cesspool:
Distance from: Well, feet; foundation,
Inside diameter, feet. Depth,.
SECONDARY TREATMENT consists of [] Tile disposal field.
Number of compartments
gallons. Capacity inlet compartment,
feet. Liquid depth, .__~_~_Lfeet.
Tile Disposal Field:
Distance from: Well,
Total length of tile lines
Trench width
Length of each line,
Type of filter material: [] Gravel.
feet; nearest lot line at [] front, [] side, [] rear~
feet. Liquid capacity, gallons. Lining material
~ Seepage pits. Other
/
.gallons.
feet; foundation, feet; nearest lot line at [] front, [] side, [] rear,, feet.
feet. Number of lines Distance between lines feet.
inches. Total effective absorption area in bottom of trenches square feet.
feet. Depth, top of tile to finish grade, inches.
[] Broken stone. Other.
Depth of filter material beneath tile, inches. Depth of filter material over tile inches.
Number of pits / . Outsi~~,~_~_~feet. Depth, ~ ~eet
Di. stance from: Well,~feet; bujldir~ foun,dation,~feet' nearest lot line at [] front [] side, [iffrear, ~' feet.
In~c~nd ma~/b~.· ~ Stffte. ~o~nty. ~ Local Health Authority.
~'~/ _~l~/ Inspected by
Date of inspect'on ~ 9~
REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM
Distance to nearest public water main, ~feet. Size of main, ~ inches.
Individual wellsJ~ 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 not being developed with both individual water-supply and sewage-disposal systems.
Lot size:~feet ~v~de, /,,-.~--~3 feet deep. Dwelling set back from front property line,~feet.
Individual water supply from:al~ Drilled well. [] Driven well. [] Dug well. [] Bored well.
Distance of well from:
Building foundation, ~? feet; nearest lot line at [] front,~ side,e, [] rear, .~ ~ feet,
cast iron sewer,~feet; tile sewer, "'-- feet; septic tank,._~,_~.t~feet; disposal field, ---,--- feet;
seepage pit, ~'/'e~...>L"'~ feet; cesspool, -'-- feet; other sources of possible pollution, ~ feet.
Wall construction:
Diameter, ~ inches. Total depth,/~'--.~"~feet. Type of casing, ,.~ ~ / Depth of casing, /~.,i~,'~* feet.
Approximate depth to pumping level of water in well, -- feet. Approx~at~ y~e(d, .- gallons per minute.
Sealed watertight to depth of~'-'l'eet.
Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. j~] Ordinary backfill. ----~,~',O- '~'~'~ ~4t-'//~-///''~
Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight:a~ Yes. [] No.
Pump: [] Shallow well. J{] Deep well. Length of drop pipe, " feet. Pump capacity, _gallons per minute.
Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. ~ Pump pit.
Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No.
Type of storage: ji~ 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 any.
Inspection made by: [] State. [] County. [] Local Health Authority.
Inspected by
Date of inspection ~, 1~
(TITLe)
~, U. $. GOVERNMENT PRINTING OFFICE : Igs70-F--4ZT038
26 A~[~u'st 196~
Mr. Frank C. Fenderv
Box 51093
~ount~in View, Alaska
Lot 5, Block 2,
Burlwood Terrace
~ar !~r. Pendery:
I have the percolation test report f'ror: !.'ount~ine Ln'terpri-aes an¢! o~'~ the b~sis
of' this report will approve the st?,ndard septic tank and Io~ crib seep~'~e pit
installation.
The tank must be a 1,000 gallon tank for either ,'~ 1 or a 2 bedroom house, a
1250 gallon tank for a 3 bedroom house, and a 1500 i~llon t~nk for, ~ 4 Led-
room ho~e. The %o;j crib seepage pit must be 6' x 8~ x 6' surrounded by 3
feet thick backfill of loose ~ravel with not more than 5% fines.
Sincerely,
DAVID
!.~edical Director
CFS:cw
By
Charie~ F. Shocke~,, Ed. 'Dj ........
chief 'Sanitarian
HOME OFFICE
ZS~ EAST ~TH AVE.
ANCHORAGE. ALASKA .,
,,o,E mm. FA
P. O. BOX 721
0!
PE3-177~
Percolation Test
Test Location: Lot -~-' Block
Requested by:
Test Hole Log
d.
Test Hole Location
1st. Filling:
Bottom of hole filled with
to drain out.
2nd. Filling:
Bottom of hole filled with
Percolation Rate:
approximate slope
'--~' ~" of water and allowed
_'"z' ~,, of water and test run.
mtn./in.
Remarks:
These results are only the visual soil conditions and theoretical
percolation rate on this date for this test hole.