HomeMy WebLinkAboutWILK LT 3A
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GE' ~TER ANCHORAGE AREA BOROt,.~?I
D~'(ARTMENT OF ENVIfl0NMENTAL QUALITY
3600 TUDOR flOAD ANCHOflAGE, ALASKA gg§07 27g-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ~. ~
ADDRESS. -'X'/
LEGAL DESCRIPTION
SEPTIC TANK:
D,STANCE PROM WELL
LIQUID CAPACITY /~--~ f~-~''')
MATERIAL
GALLONS. INSIDE LENGTH
NUMBER OF /
COMPARTMENTS
LIQUID
INSIDE WIDTH DEPTH
SEEPAGE SY-,S,.TEM: SEEPAGE PIT:
NUMBER OF PITS_ ~ OUTSIDE DIAMETER
LINING MAIERIAL_ ~
NEAREST LOT LINE.
OR WIDTH LENGTH , DEPTH
DISTANCE FROM WELL___
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WEL[ FOUNDATION
NUMBER OF LINES_
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
, NEAREST LOT LINE
TRENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTALLENGTH/'hfS' t
,OF LINES /"7'-C/ ,
IN. TOTAL EFFECTIVE
IN. ABOVE TILE __
WELL: TYPE C 4" ~''///~¥×~PTH
'qEAREST SEPTIC
LOT LINE SEWER LINE .TANK
DISTANCE FROM
, BUILDING FOUNDATION.
SEEPAGE
SYSTEM
WATER
SAMPLE
CESSPOOl
· NEAREST
OTHER
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPROVED
HEALTH AUTHORITY APPROVAL
I'NDIVID-U~-[ ~Ti~J~0'P"P[Y AND SEWAGE DISPOSAL SYSTEM
Budget Bureau No. 63-R296.8
INSURING OFFICE MORTGAGEE SERIAL NO.
~ N~tional ~ of Alaska ~ ~111-012307-203
~O~TO~ O~ S~NSO~ ~o~
~lter P. C~yc~oft 6251 Collins Way, Anchorage, lla~k~
SUBDIVtEION NAME
EASEMENT
[] New installation
'ubtic system [] Community system
J~] Community system
BY:
Public system
BLOCK NO, LOT NO.
Parcel A 3
[] Individual
[] Individual 4 [] Yes [] No
PART U.---TO DE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMEI~q' INSPECTOR'S SKETCH
It is the opinion Of the [] State [] County [] LOcal Department of Health: ~.hat this individual water-supply system
[] is [] is not Satisfactory as a domestic water supply for the subect proPerty. C.A.U.
[ It is the opinion of the [] State [] County [] Local Department of Health that this individual sewage-disposal sys-
tern with proper maintenance:
j [] ~ be expected to function satisfactorily, and J--] Cannot be expected to function satisfactorily
L is not likely to create an insanitary condition --
iPa¢~l provided,
J i have r~i~ ~e foregoing and the peffinent FHA C0mplimice lnS~Jon Repo~, and recommend that the
individual water-suPply system be Considered [] Acceptable [] Not Acceptable
Sewage disP°s~l be considered [] Acceptable [] Not Acceptable.
[SIGNATURE
E]CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITEC~
] .
AUTHORITY APPROVAL
FHA Form 2573
Rev. July 1958
GREATER ANCHORAG~ AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
1. APPROVAL REQUESTED BY:
ADDRESS: ~: ~//
PHONE:
2. PROPERTY OWNER: ~xP(.Ui?? ~_ PHONE.
/ /
NUMBER OF BEDROOMS:
WELL DATA: C, ~- ~-
A. TYPE ~ ~Va,m/~
B. DEPTH
C. SIZE
D. CONSTRUCTION
E. BACTERIAL ANALYSIS
6. SEWAGE DISPOSAL SYSTEM:
A o
SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON
1. SIZE /2<~o G~z-,
2. AGE 2~.~"~s
3. MANUFACTURER
BACK)
7~
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE
D. WELL TO PROPERTY LINE
E. WELL TO OTHER POSSIBLE
F. FOUNDATION TO SEPTIC TANK
G. FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
CONTAMINATION
8. COMMENTS:
APPROVED "-'¥~, DISAPPROVED:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT
OF ENVIRONMENTAL QUALITY