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Home My WebLink AboutCAMPBELL HEIGHTS BLK 2 LT 9A GRrATER ANCHORAGE AREA BOROL!'~H f ~' HEALTH DEPARTMENT ' 327 EAL-LE ST. ANCHORAGE. ALASKA 99501 2/9-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME SEPTIC TANK: DISTANCE PROM WELI~'/~F/~.~- LIQUID CAPACITY /~'gt?lO GALLONS. COMPARTMENTS // / LIQUID ~ / INSIDE WIDTH ~'- DEPIH MATERIAL INSIDE LENGTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBEI~ OFjFITS~ ~ /~~ LINING ~t~k~ERIAI~ ~ DISTANCE FROM WELL ., BUILDING FOUNDATION NEAREST LOT LINE . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) .SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WEt~'~//~I[' //"'Z'~, FOUNDATION NUMBER OF LINES ~ DISTANCE BEIWEEN LINES ABBORPT,ON A.EA :3'10 DEPTH: TOP OF TILE TO FINISH GRADE · NEAREST LOT LINF TRENCH WIDTH SQ. FT. LENGTH OF EACH LINE / ~ ',,~o / '~ O DEPTH OF FILTER MATERIAL BENEATH TILE IOTAL LENGTH . OF LINES (/5~ IN. IOTAL EFFECTIVE ~1/ ~_// '~" IN. ABOVE TILE. NEAREST LOT LINE ~/~ , SEWER LINE SEPTIC TANK DISTANCE FROM WATER BUILDING FOUNDATION. ~,~- SAMPLE ~/.-~' , NEAREST SEEPAGE /.~ OTHER ~'~ ~ ~ , SYSTEM fit.-. CESSPOOL - , SOURCES DIAGRAM OF SYSTEM DISTANCES: GAAB-HD-2 GREATE¥ aNCHORAGE AREA ~'~)ROUGH IIEALTll DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case 5.EWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT v LEGAL DESCRI.PTION , OTHER TO SERVE THE FOLLOWING FACILITY ' /x."~C;U.'C~'(- /,,/~r~/..,~ . PERCO~TION TEST RESULTff/ ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT DISTANCES: AS DESCRIBED BELOW. SIZE OF · SEPTIC TANK SIZE/ OR T 0 BE SERVED I certify that I am familiar with the requh'emcnts of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above descry system is in accordance with said code. · · -'/- / -~ - APPLIf-"NT FILLS OUT UPPER HA,''''~ ONLY Phone Address Phone Lending Institution Address ZIp Code Phone Realty CO. & Agent L.ga, De,c,,pt~.. '"~lh;' ~ Lot cia C~,P.~GCLL .14T$ ~tl~ Of Multiple Family NO. of Bedrooms O Other Water Supply n Individual/ ,, ATTACH WELL LOG. A well log IS required for all wells drtt~ed elnce June 1975. ~ i~/'. For wells drilled prior lo that date, give well depth (attach log if available). COmmunity ~ Public Utility Sewer Disposal NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH REOUEST BEFORE P~OCESSING CAN SE INITIATED. Time Time Time Time Date Date Date Datec.~ '~")~ -~ _"~--, Inspector Inspector Inspector Inspector-,,. ,- Field Notes: I1 N~UNICIPAUTY OF ANCHORAGE E'EPT. OF H~ALTH FNVIRON"d2' NTAL PROTECTION ~AY 2 1983 RECEI.VED (,~) APPROVED ~EDROOMS 'CONOITION$ OF APPROVAL . . ( ) DISAPF~OVED ( ) CONDITIONAL APPROVAL* Soils Rating Date Sewer Installed Well To Absorption A~ea Well Log Received Well to Tank Septic Ta~k Size MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~ L Street - Andto~a~, Alarm 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTION~; Corn(flare ail parts o~ pqe 1. Ic.~.l~ete requ~t~ will n~t be pn~med. Please allow ten (10) days for proc~ing. 1. PROPERTY OWNER . I PHONE MAILING AODR ESS PROPERTY RESIDENT (If different from a~)ove)BUYER [ PHoNEPHONE ~1 LING ~DORE~ ~ L~DING~STITUT;~N ' . ~ -- . PHONE · R~LTO~AGENT MAILING ADORE~ 6. LEGAL DESCRIPTION ~l.eel LOCATION , ~. TYPE OF RESIDENCE [~/~S~NG LE FAMILY r-I MULTIPLE FAMILY 7. WATER~JJPfl. Y . 1~ INDIVIDUAL* ~ COMMUNITY ~ PUBLIC UTILITY [ SEWAGE DIEPO~;AL SYSTEM [~puBI VI DUAL/ON-SITE LIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five J~l Three [] Six [] Other · 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.) '·If individual/on-site, give installation date f4"~''~ If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 724)10(3178) . j~' THIS SIDE FOR OFFICIAL USE ONLY ;, DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE'r' )ATE DATE INSPEcToR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMB. ER OF BEDROOMS ~ SINGLE FAMILY r-I ONE ~,~HREE [] FIVE I--I OTHER MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMEER ~) ~,,~ ~.~ .- [] INDIVIDUAL DEPTH OF WELL [~ COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified~'-~4'~'~ LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMEER [] INDIVIDUA/[~fl~~ :~ATE INSTALLED r~'0BL,C U~L,TY' ,,,/,/..,~, : Con~nectior~erified ~ INSTALLER [~"ptic Tank o~"'T._lHoldi~'~'~g Tank give dimensions:Size:'~'~'~-~lf Tank is h°memade SOILS RATING ~//.,~ ~ TYPE OF TA~.~_.... _ ~ MANUFACTURER TOTAL A~I~RPTION AREA MATERIAL ~~ 5. COMMENTS ~APPROVED FOR ~'~ BEDROOMS I"'l CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED '''T'''''... 72-010 (Rev. 3/78) ,W~te_-..bar 1, 197~ ~d water approval, we will need to ~cw the location of t~hc wcll so that wa cmn lnmp~ct it to ~ne if it muotm lo¢al ~d ~tat~ h~alth ccCe~ for ~ro~or ¢onstructicno F~bcrt C, Pratt, % ~rty 4797 ~usino~s Park ~ou!evard ~I~ Wc~t L'orthorn Lights ~ouleva 99503 .' ~'..-~ Gt,.;~TER ANCHORAGE AREA .80ROU ..... OEPARTNENT OF ENVIRONNENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 I~EQUEST FOR APPROVAL OF FACILI[TIES INDIVIDUAL SENER AND HATER FOR DATE RECEIVED: INSPECT: TINE: 1. APPROVAL REQUESTED BY: ~J' ~.~/£ ~:~:~-"/'" ~'/Z/~>~,~> ~, ADDRESS: ~6',.~ ~, ~?~ .~~ ~/~/. ~ ' Z.PROPERTY OHNER: ~' /~' /)~/~~ PHONE: ~-/~Z~. 4. TYPE FACILITY TO BE ]NSPECTED:~STREET:~, NUNBER OF BEDROOHS: ~ ~ ' '~ . 5. HELL DATA: A. TYPE 8. DEPTH C. SIZE D. CONSTRUCTION E. BACTERIAL ANALYSTS '6. SEHAGE*D~SPOSAL SYSTEN: SEPTIC TANK (IF HONENADE, ~. HANUFACTURER ~/rF~~ 4. INSTALLER ~or~ 4)~//.~[~ ~ SHOH DIAGRAN ON BACK) e APPROVAL REQUF...? FOR SEt/ER & HATER FACILI,..~S PAGE THO B. SEEPAGE PIT I. SIZE ~. LINING C. DISPOSAL FIELD 1. NUMBER OF'LINES 2. TOTAL LENGTH REQUIRED MEASUREMENTS R. HELL TO SEPTIC TANK_ $. HELL TO SEEPAGE PIT, C. HELL TO SEHER LINE '-'"*' O. HELL TO PROPERTY LINE E. HELL TO OTHER POSSIBLE CONTAMINAT'ION F. FOUNDATION TO SEPTIC TANK G. FOUNDATION TO SEEPAGE PIT H. SEEPAGE PIT TO PROPERTY LINE 8. COMMENTS: DISAPPROVED: OA~E:.~_~~~ OATE: APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED. · GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALIl -INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM INSURING OFFICE PART I.tTO BE COMPLETED BY FHA SERIAL NO. 111-0119A5 MORTGAGEE Pirst Not_~i~l ~_~k of An~h0r_~Ee MORTGAGOR OR S~NSO' I ,ROP~RW *OORESS Caress /~:~, '67th Aveg~e 1 3 2 WATER SUPPLY BYs Public system S~WAGE DISPOSAL BY: [] Public system D Y~ [] No [] New installation [] Community system ]Community system Can attic m, ether orca be I~mde Into oddlltonal bedrooms? (if Yes, ~w m~) ~Yes DNo SYSTEM DESIGNED ~ ~dividual ~. oF i0e~. GAe~GI DISPOSAL Individual 3 ~ TM ~ No PART II.tTO 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 nor 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 [] Local Department of Health that this individual sewage-disposal sys- [] Cannot be expected to function satisfactorily ....... us Well os use of tho bock of thfl form fo at the opt/on of the~ TO THE PART III.~FOR USE OF FHA OFFICE I have reviewed the foregoing and the pertinenz FHA Compliance Inspection Report, and reCommend that'the Individual Water.supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. OEP~F ARCSITECT HEALTH AUTHORITY [] INDIVIDUAL W APPROVAL Date of inspection AL SYSTEM REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main, feet. Size of main, inches. Indivldual wells n ate ["] ate not customary in neighborhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighbochood n ate [] are no~ being developed with both individual water.supply and se~age-dispusal systems. Lot size: feet wide, feet deep. Dwelling set back from front property line~ feet. Individual water supply from: [] Drilled well. [] Driven well. [] Dug well. [] Bored well Distanc® of well froms Building foundation, feet; nearest lot line at [] front, [] side, [] rear. cast iron sewer feet; tile sewer, feet; septic tank. feet; disposal riel& seepage pit. .feet; cesspool, feet; other sources of possible pollution, feet. Diameter, inches. Total depth, feet. Type of casing Approximate depth to pumping level of water in well. feet. Approximate yield, S~aled watertight to depth of feet. 'Exterin~ space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well covet: [] Concrete. [] Wood. [] bietal, Openings in well cover watertight: [] Yes. [] No. P~mp~ [] Shallow well. [] Deep well. Length of drop pil~, feet. Pump capacity, .gallons per minute. Located in: [] Basement. [] Pumproom off basement, [] Pumphouse above ground. [] Pump pit. Pumproom properly drained: f-I 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 [] do~ not comply with approved exhibits, if any. lnspeetion made by: [] State. [] County. [] Local Health Authoi'ity. Inspected by Date of inspection . 19 ....... (TITLll Depth of casing. .gallons pot minute. ,19 feet. feet;