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Home My WebLink AboutSOUTHWOOD PARK #1 BLK 5 LT 44 GAAB-HD-I GDEATER ANCHORAGE AREA BORO'~H x . HEALTH DEPARTMENT 327 E.~GLE ST. ANCHORAGE, ALASKA 99501 279-251 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCAT,ON MAILING ~x~-~ ADDRESS LEGAL DESCRIPTION PHONE SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY GALLONS. $'A. / / MATERIAL -': C.~_ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH -- DEPTH__ SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAl NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER DISTANCE FROM WELL IOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ,LENGTH /~,DEPTH :~ BUILDING FOUNDATION /~.t ( £ ET. TILE DRAIN FIELD: DISTANCE FROM WELl. NUMBER OF LINES ABSORPTION AREA FOUNDATION. ., NEAREST LOT LINE DISTANCE BETWEEN LINES~ TRENCH WIDI~H SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TIL[~: IN. ABOVE TILE WELL: LOT LINE NEAREST SEWER LINE DISTANCE FROM WATER , BUILDING FOUNDATIOI'q. . SAMPLE , NEAREST SEPTIC SEEPAGE OTHER · TANK . SYSTEM , CESSPOOL , SOURCES DISTANCES: t CL-~ 8= 23' DATE DIAGRAM OF SYSTEM --_ : -. - ... .- ~ ~', : ,:,( :_ - : APPROVED GAAB-HD-2 GREATEL; ANCHORAGE AREA ~;OROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT RESIDENCE ADDRESS ?'J~;!~ ~.~Z,.~/g..? LOCATION OF INSTALLATION./~-.~T~?;//~_ LEGAL DESCRIPTION .--~ ~~ APPLICATION TO INSTALL: SEPTIC TANK ~SEEPAGE PiT ~ ..... , DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS /Od) ~ ! BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT TO BE INSTALLED BY '//.-/~-o~ ANT,~,PATED DATE OF COMPLEX,ON .?.-- ,' / ~ _~ ?. THIS IS TO SERVE AS %'v"~-~'~¢~ /~ ~?~-~ , PERMIT TO INSTALL A AS DESCRIBED BELOW· SIZE OF UNIT TO BE SERVED ~,/TYPE '~¢~ .SEEPAGE AREA ~'~)~/ TYPE · SEPTIC TANK SIZE ';7'J'~ ~' DIAGRAM OF SYSTEM DISTANCES: /~- ~, ~;;ith-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. HA Form 2573 !Rev. July 1958 U. S. DEPARTMENT OF HOUSING AND URBRN DEVELOPMENT Form Approved Budget Bureau No. 63-R296.8 FEDERAL HOUSING ADMINISTRATION · HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER ,SUPPLY AND ,SEWAGE DI,SPOSAL SY`STEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE MORTGAGOR OR SPONSOR PROPERTY ADDRESS SUBDIVISION NAME TOTAL NUMBERt BASEMENT ! 2 1 [~7] Public system SEWAGE DISPOSAL BYz [--] Yes ~ No New installation [--] Communiq~ system r-]Community system Can attic or other area be made Into additional bedrooms? (If Yes, how rnony~) [] Individnal ~ Individual SYSTEM DESIGNED FOR NO, OF I~DRMS. GARBAGE DISPOSAL 9 ['~ Yes N~qo ]Public system PART fl.--TO BE COMPLETED BY HEALTH DEPARTMENT 4EALTH 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 [] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: [] Can be expected to function satisfactorily, and N Cannot be expected to function satisfactorily is not likely to create an insanitary condition SIGNATURE I TITLE AUgust 7, 1969 J _ NOTE: The health authority should-complete the appropriate opinion statement above and affix date, signature ~nd title in the spaces provided. Usa of the above grid ~or Health Department Inspector's sketch as well as use of the back of this form is at the option of the health authority. 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 [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. · J DATE cHIEF ARCHITECT rSIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 Rev. July 1958 RIEPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMEFIT consists of [] Septic tank, [] Cesspool. Septic Tankt Distance from well,__ Total liquid capacity, lnskle length,_ Cesspool: Dist.ance from: Well, Inside diameter, feet. Material gallons. Capacity inlet compartment, feet. Inside width,, f~et. Liquid depth, feet. Number of compartments , gallons. feet; fouodatk~n feet; nearest lot line at [] front, [] side, [] rear, feet. Depth,. feet. Liquid'capacity, gallons. Lining material SECONDARY TREATI~tENT consists of [] Tile disposal field [] Seepage pits. Other feet; foundation, feet; nearest tot line at [] front, [] side, [] rear,. feet. Number of lines __ Distance between lines, inches. Total effective absorption area in bottom of trenches feet. Depth, top of tile to finish grade, Type of filter material: [] Gravel. [] Broken stone. Other Depth of filter material beneath tile., inches. Depth of filter material over tile, ~page Piti: Number of pits ..... Outside diameter, feet. Depth, Dismuce from: Well, feet; building foundation, Insp~lon mud* by: [] State. .feet. square fret. inches. Tile Disposal Field: Total length of tile lines, Trench width Length of each llne, inches. feet. .feet. Lining material feet; nearest lot line at [] front, [] side, [] rear, [] County. [] Local Health Authority. Inspected by 19.__ (TITLI~) Date of inspection _._ REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main, .feet. Size of main, inches. Imlividual wells [] 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 neighborh~x)d [] are [] are not being developed with both individual water-supply and sewage.disposal systems. Lot size: feet wide,____ feet deep. Dwelling set back from front property line,, feet. Individual water supply I¥om: [] Drilled well, [] Driven well. [] Dug well. [] Bored well. Distance of well from: Buihtiflg foundation, cast iron sewer,. seepage pit, Well construction: Diameter, feet; tile sewer, feet: cesspool, feet; nearest lot line at [] front, [] side, [] rear, feet; septic tank,, feet; disposal field, feet; other sources of possible pollution, ~Ceet. inches. Total depth, .feet. Type of casing Approximate depth to pumping level of water in well,_ feet. Approximate yield, Sealed watertight to depth of feet. Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Wood, [] Metal. Openings in well cover watertight: [] Yes. [] No. Pump: [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity, Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No. Type of storage: [] 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. Insp~tion made by: [] State, [] County. [] Local Health Authority. Inspected by Date of inspection 19.__ Depth of casing, gallons per minute. ___gallons per minute. (TITLE) feet, feet; h~ID-Wanh., D. Cl,