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Home My WebLink AboutWENTWORTH BLK 3 LT 10LoT DATE DATE DATE MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCNO~GE DEPARTMENT OF HEALTH 825 L Street Anchorage, Alaska 99503 ENVIEONMENTAL PROTECTION ~ ENVIBON~ENTALSANITATION DIVISION [~JkY ~ 0 ]gs~ Telephone PROPERTY RESIDENT (If different from above) PHONE PHONE MAILING ADD~ESS 4. ~EALTOR/AGE~T PHONE MAI L{ NG ADDR ESS E. LEGAL DESCRIPTION iTREET LOCATION TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four .Z" SINGLE FAMILY [] /Two [] Five [] MULTIPLE FAMILY [~ Three [] Six [] Other 7. WATER SUPPLY ,,,[~NDIVIDUAL* * WELL LOG. A well is required for all wells drilled ATTACH log [] COMMUNITY · since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ~"'~'~U B LI C UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [~ ONE E] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []HoldingTank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~'"~APPROV ED FOR '~ BEDROOMS [] CONDITIONAL APPROVAL (letter mus~a~company certificate) []DISAPPROVED DATE BY 72-010 (Rev, 6/79) ~-./JREATER /~NCHOR~GE AREA BOROUGH !~ALTH DEPART!~!ENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 279-2511 DATE RECEIVB~ INSPECT: T I _hiE: RHQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND ~VATER FACILITIES FOR Approval Requested By ~, ~.//j /97/ :/// /< 1~71 Phone Property Owner~i~2~, Legal Description Type of Pacility'to be Inspecte ,~4(f ' ./ - Number of Bedrooms S. ~ell Data: B. C. D. E. 6. Sewage Disposal System: A. Septic Tank (If homemade, show diagram on back) 1. Size 2. Age $, Manufacturer 4. Installer ~-~ -g~pproval Request for SeW~ ~ ~ater Facilities Page Two B. Seepage Pit 1. Size 2. Lining C Disposal Field 1. Number of Lines 2, Total Length Required Measurements A. B~ C. D, E. F. G. H. lqell to Septic Tank Nell to Seepage Pit //~_" Nell to Sewer Line /~ l~ell to Other Possible Contamination Foundation to Septic Tank ~' Foundation to Seepage Pit Seepage Pit to Property Line 8. COMMENTS: GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT EDll70 THE FIRST NATIONAL BANK OF ANCHORAGE P. O. BOX 720, ANGIIORAGE, ALASKA 99501 June 9, 1971 Mr. Lynn S. Coad Borough Health Department 3500 Tudor Road Anchorage, Alaska, 99502 Dear Mr. Coad: Re: 3200 E. 42nd Ave. Lots 10 & 11, Blk 3 WENTWORTH SUBD. We are enclosing forms for the individual sewer system for the subject property that needs to be completed by your department. We do have a bacteriological water analysis, however it is dated October 13, 1970. Please make another one if it is necessary. After completion, please return to my attention. If you do have any questions, do not hesitate to contact us. Very truly yours, (Mrs.) Betty Kelley Mortgage Loan Department bk Enclosures RECEIVED ',JUN ~ 0 1971 ~ July 27, 1971 FirSt liational Bank Box 720 Anchorage, Alaska 99510 Subject: Forest A. Fish, Property at Wentworth Subdivision. Lots l0 and 11, Block 3, Dear Slrs= An inspection of the lot revealed that the well was located in a pit and therefore subject to surface flooding and con- rumination. Before approval of the subject property can be given, the well needs to meet certain minimum specifications. For these specifications contact this office at 279-B6B6, extension 236. Public sewer will be available at the end of August or the first part of September. The subject property will then need to connect to the available Borough Sewer. If you have any questions regarding the a~ove, please do not hesitate to contact this office. S t ))ce re 1 y, Lynn S. Coad Environmental Specialist cc: FHA Forest Fish st i FI~A Form 2575 ',,~j U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT ~ Form Approved FEDERAL HOUSING ADMINISTRATION Budget Bureau No, 63-R0296 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.mTO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. Anchorage, Alaska First National Bank of Anchorage MORTGAGOR OR SPONSOR PROPERTY ADDRESS 3200 East 42nd Avenue FISH, Forest A. Lots 10 & 11, Blk 3, WENTWORTH SUBD SUBDIVISION NAME BLOCK NO. LOT NO. WENTWORTH SUBDIVISION 3 10 & ll TOTAL NUMBER: BASEMENT 2 FY es [] New installation WATER SUPPLY BY: [] Public system SEWAGE DISPOSAL BY; ]Public system '-]Community system [] Individual ]]Community system [] Individual SYSTEM DESIGNED FOR []Yes []No PART II.~TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH 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 tern with proper maintenance: [] Can be expected to function satisfactorily, and is not likely to create an insanitary condition U Local Department of Health that this individual sewage-disposal sys- [~] Cannot be expected to function satisfactorily DATE July J SIGNA?UEE J TITLE 27, 1971J' ~1 Environmental Specialist 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 [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. SIGNATURE JJ~l CHIEF ARCHITECT ] DEPUTY FOR CHIEF ARCHITECT DATE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2573 Rev. July 1958 'pla!a al~tu!xo,~ddV 'laaj 'tlldaP i~1o£ 'lla,~ pa~otl [] 'l[a*x gn(l [] 'lla~ ua^U(I [] '[la*~ pa[l!~(1 [] :moJ.I ~lddns Jal~,'* I~np!^!pul W:IISAS )~lddllS'll:llVM IvI~alAIONI~NOII:)3dSNI :10 1VOd:IV 'satpu! W:IJ. SAS IVSOdSIO':IOVAA3S 1vrIOIAIQNI~NOIJ.:)3dSNI :lO J, IJOd:lIJ FNA Form 2573 Rev. Ju~y 1958 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.~TO BE COMPLETED BY FHA INSURING OFFICE Anchorage, Alaska MORTGAGOR OR SPONSOR FISH, Forest A. SUBDIVISION NAME WENTWORTH SUBDIVISION MORTGAGEE First National Bank of Anchorage 2 4 2 es o [] Public system [] Community system SEWAGE DISPOSAl. BYz [] Public system SERIAL NO. RR~)1~ .~aD~E~S 42.d Avmnue Lots 10 & 11, Blk 3, WENTWORTH SUBD BLO NO. [] New installation addl0onol bedrooms? {If Yes, how rnony~) []Yes [~No [] Community system [] Individual [] Individual SYSTEM DESIGNED FOR NO. OF BDSMS, GARBAGE DISPOSAL PART II.~TO BE COMPLETED BY HEALTH DEPARTMENT ~EALTH 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 tern with proper maintenance: -']Can be expected to function satisfactorily, and is not likely to create an insanitary condition DATE [ SIGNATURE July 27, 19711 of Health that this individual sewage-disposal sys- [~] Cannot be expected to function satisfactorily TITLE ~ Environmental Specialist NOTE: The health authorU~should complete the appropriate opinion statement above and af~x date, signature ~ndtitle in the spaces provided. Uso of the above grid ~or Health Departmentlnspector's sketch as well as use of the back of this form is at the option ortho health authoNty. 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 [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. SIGNATURE ] CHIEF ARCHITECT ] DEPUTY FOR CHIEF ARCHITECT DATE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form Rev. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM Distance from well .... feet. Material, Number of compartments Total liquid capacity, ,gallons. Capacity inlet compartment,__ Inside length, .feet. Inside width, f~et. Liquid depth, feet. Distance from: Well, feet; foundation, feet; nearest kn line at [] front, [] side, [] rear, Inside diameter, feet. Depth,_ feet. Liquid capacity, gallons. Lining material SE¢ONOARY ?REAl'MEN? consists of [] Tile disposal field. [] Seepage pits. Other gallons. Distance from: Well, Total length of tile lines, Trench width Length of each line, 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 bottotn of trenches, .square feet. feet. Depth, top of tile to finish grade, inches. Type of filter material: [] Gravel. [] Broken stone. Other Depth of filter material beneath tile.~ inches. Depth of filter material over tile, inches. Insertion made b¥~ [] State. [] County. [] Local Health Authority. Inspected by 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 neighb0rhoud. 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 wide, feet deep. Dwelling set back from front property line,, feet. Individual water supply t¥om: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. Distance of well from: Building foundation, cast iron sewer, feet; tile sewer, seepage pit, feet; cesspool,. Well construcBon: Diameter, 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, la,cared 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. lnstalla6on [] does [] does not comply with approved exhibits, if any. Inspection made by: [] State. [] County. [] Lo~al Health Authority. Inspected by Date of inspection 19 .feet; nearest lot line at [] front, [] side, [] rear,_ feet; septic tank1. .feet; disposal field, feet; other sources or' possible pollution, ieeet. Depth of casing, .gallons per minute, gallons per minute. feet; feet. GPO 889-080 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE Anchorage, Alaska MORTGAGOR OR SPONSOR f'ISH, Forest A. ~UBDIVISION NAME MORTGAGEE First National Bank of Anchorage ERIAL NO. ors 10 & 11, Blk 3, ~/ENTWORTH SUBD BLOCK NO. LOT NO. WENTWORTH SUBDIVISION TOTAL NUMgER: BASEMENT [D es [] No 2 4 2 WA~II SUPPLY DY~ [] Public system [] Community system [] New installation 3 & 11 Can atllc or other area be made Into additional bedrooms? (If Yes, how many~) SYSTEM DESIGNED FOR ] ?dO, OF 8DRMS, GARBAGE DISPOSAL Individual [] Individual [] Yes [] No SEWAGE DISPOSAL BY: [] Public system --]Community system PART IL--TO BE COMPLETED BY HEALTH DEPARTMENT !ALTH 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 tern with proper maintenance: [] Can be expected to function satisfactorily, and is not likely to create an insanitary condition DATE J S,GNATUR~ JTme luly ~7, 197t j I Environmental Spe~__ NOTE: The health authority should complete the appropriate opinion statement above and affix date, signature and title Jn the spaces provided. Uso of the above grid 'for Health Department Inspector's sketch as well os use of the back of this fQrm Js at the option of the health authority. [] County [] Local Department of Health that this individual sewage-disposal sys- ~--] Cannot be expected to function satisfactorily 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 [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM ] CHIEF ARCHITECT ] DEPUTY FOR CHIEF ARCHITECT FHA Form Rev. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. [] Cesspool, Distance from well,_ feet. Material Number of compartments Total liquid capacity, gallons. Capacity inlet compartment, gallons. Inside length, feet. Inside width, l~eet. Liquid depth, feet. Distance from: Well. feet; foundation. ___feet; nearest lot line at [] front. [] side, [] rear, feet. Inside diameter, feet. Depth,_ feet. Liquid capacity gallons. Lining material SSCONDARY TREATMENT consists of [] Tile disposal Iield. [] Seepage pits. Other Dismnce ~om: W~I, Total length of tile lines, Trench width Length of each line, _ feet; foundation, _feet; nearest lot line at [] front. [] side, [] rear1 feet. _feet. Number of lines, Distance between lines, fbet. _inches. Total effective absorption area in bottom of trenches, square feet. feet Depth, top of tile to finish grade, inches. Type of lilter material: [] Gravel. [] Broken stone. Other Depth of filter material beneath tile,~_ inches. Depth of filter material over tile., inches. S~epage Plt~: Number of pits .... Outside diameter, tbet. Depth.. feet. Lining material Distance from: Well, __ feet; building foundation, feet; nearest lot line at [] front, [] side, [] rear, __ feet. Ins~'lon rn~d~ by: [] State. [] County. [] Local Health Authority. Inspected by. Date of inspe(tion 19 REPORT OF INSPECTION~INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main, feet. Size of main, inches. Individual wells [] are [] are not customary in neighbgrhood. Give most recent record of failure of wells in immediate v~cimty to furnish adequate supply of water Properties in neighborh(×~d [] are [] are not being developed with both individual water-supply and sewage-disposal systems. L.t s~ze: feet wide, feet deep. Dwelling set back from front property line., feet. Individual water supply i¥orn: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. Building foundation. seepage pit, f~et; cesspool, Diameter. inches. Total depth, Approximate depth to pumping level of water in well, Sealed watertight to depth of feet. feet; nearest lot line at [] front, [] side, [] rear, f~et; septic tank, feet; disposal field, feet; other sources of possible pollution, ~'eet. feet. Type of casing, feet. Approximate yield, Depth of casing, gallons per minute. 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. Inspection made by: [] State. [] County. [] Lo<al Health Authority. Inspected by Date of inspection 19 gallons per minute. ,19 feet; GPO 889'088 1. Sewer line ~. Cesspool' 5. Property Line /~, ~. 6. Other sources of p. osstble contamination, *.e., creeks, lak houses, barn, drainage ditch, etc. ~ .~_~ ,#~J/ S~a~ ~sposat system. ~6"~ a. Age of system ~?~ ~ ~ .~2 ~-,~.~- ~ ~- ;~ b. Septic tank capacity in gallons, ~/~/~ , c. Name of septic tank manufacturer , t~/M 1. If "home made" show diagram on reverse side of this form. Disposal field or seepale pit size and type / 1, Distance to'proper~cy, line ~W 'Zz- to house foundation e. Peroo3x%tian Te~"t ~results f. Percolation Test performed by ............ . ~ Use the revers~ .side o~ this form To s~ow diagram. Diagram should include .~he foilowing znformat~on: p~opePty l~nes;.w~ll locat~on, house location, '%t~pt£c tank location, disposa~ area location, location of percolation test, a~ direction of ground slope. 9. The ~formatlon on this form is true and correct ~o the best of my knowledge. Signature of Applicant Date $~gned TO BE FILLED OUT BY HEALTH DEPAET!.1ENT PERSONNEL above described sanitary facilities are hereby approved~ subje, c~ to the ~l~owin~ oon~ons: Conditions: The above described sanitary facilities are disspproved for the following '~ Ap~h~oval is valid for one year 'following the date Of approval.