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Home My WebLink AboutBURLWOOD 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.