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Home My WebLink AboutSWISS AIRE LT 11OIq HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-251'1 NAME_ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION ~)/~ (--/-,/~/~' _ SEPTIC TANK: / DISTANCE FROM WELl 'Z~5~ L,ou,D c~.~,.~ /~ ~o.~. INSIDE LENGTH NUMBER OF / I DEPTH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL SEEPAGE PIT: OUTSIDE DIAMETER NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) O,W,DTH /~'.LENGT, /X~/.OEPT, D,BTANCE EROM WEL' --Z &~' , BUILDING FOUNDATION TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA .~ ~EARESTLOTL,NE_ DISTANCE BETWEENzbI~~~ TRENCH WIDTH SQ. FT E~NGTH OF EACH LINE TOTAL LENGTH , OF LINES N. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE. .DEPTH OF F LTER MATERIAL BENEATH TILE IN. ABOVE TILE__ WELL: TYPE~"/g"~I'~[J/~ J"~ DEPTH NEAREST/~ LOT LINE SEWER LINE DISTANCE FROM · BUILDING FOUNDATION. SEPTIC SEEPAGE . TANK , SYSTEM - "OTHER CESSPOOl . SOURCES D AGRAM OF SYSTEM GAAB-HD-2 GREATEL. ANCHORAGE AREA L OROUGH 0 HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No. ':~'~ SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT ~-~ 7 RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK MAILING ADDRESS PHONE .,SEEPAGE PIT />" ,DRAIN FIELD ,OTHER TO SERVETHE FOLLOWING FACILITY //- .~:?/~',4~ , /.~- J/3 -- ~~ EINA"DED THROUGH PW'~ . · T0 BE I"STALLED BY ~h~ / / ~ ~ ~ PFRROLATION TEST RESULTS ~ / .ANTICIPATED DATE OF COMPLE~ION ~ ~ THIS IS TO SERVE AS ~ , ,~f~..~ PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE Of: UNIT TO BE SERVED -Z~//- .~z~o . SEPTIC TANK SIZE TYPE ~ [y.~/~ -- ~ DIAGRAM OF DISTANCES: 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.~//////~ fAPPLICANTS SIGNATURE DATE / (// Legal Deserlptlon: Lot~...~lock This Form Reports a: Soils Log Depth ' ' s __ Feet Soil Characteristic 2 Was Ground Water Encountered? If Yes, At W~at Depths_ 327 EAGLE oTREET ANCHORAGE, ALASKA 99501 Location Sketch ;ross Time Net Time Depth To H20 Net Drop ~_1~. ,~ (? ~ O " , ~ '~, ., ._.~ ., ~ ~.3~'" .7~" ~,_ ~(,~ ~r? n~,1" .~-"_~ Frop~sed Install~:~ on: Seepage Pit Drain Field Depth Of ln!et~)eptb To Bottom Of P~t Or ]~ench COMMENTS: _/']L/~ /~J~'~F/~;,'~ ~ f; 6', ~:~~z- ~ /~- ~ ~/~ ,~?"~ ///'/~ (~' ~? .... ~/.~,~f tp~ _ _~_--___ ,, -----~ ......... Test Pemfom~d FHA Farm 2573 Budget Bureau No. 63-R296.B Rev. July 1958 IJ. S. DE PART.MENT OF HOUSING AJ~D URBAN D.EVELOPMENT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. MORTGAGOR OR SPONSOR PROPERTY ADDRESS SUBDIVISION NAME TOTAL HUMBER: LIVING UNITS BEDROOMS WATER SUPPLY BY: BASEMENT []Community system [] New installation RLOCK/O. LOT NO. Can c~tc or other area be madl Into additional bedrooms? SYSTEM DISIGNED FOR [~ Public system SEWAG1 DISPOSAL lyf E] Public system ]Community system PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH IIlll11111111111111111111l] llll :lllllllllllllillllllllllllllll~ iii[ II Jill IIIIIIII II I Jill lis II JJ I Il II I1~1 II~llllll IIIllllllll{ll IIII i i i i i i i i i i ~ i i,i I i i ~ I I I I I I I I I I I I ~ II I I iiiill,,i, ,,,, i ii Illll III II I,III I Illl I~ I ,i,, ,,,,,,[ ,i,, '"" "' IIIIIll I I, II I II ~1 Illll I I Illlllll IIIIIIIIIII hill Illlll i iI iiiii iii ii ii[ll l]lll ii I IIIIIIIJ I Illllll[llllllllllllllllllll'lll IIII It is the opinion of the [] State [] County ]~ Local Department of Health that this individual water-supply system J~]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 tern with proper maintenance: ~] Can be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily is not likely to create an insanitary condition ~ATE ' , SIGNATURE /~ -. ,~ / /: / I TITLE - spaces provided. Use of the above grid'for Health Department nspector's sketch as well os use ortho back of this form Is at the option ofthe 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 j.~ cHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2~te Rev. July 195S REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists nf [] Septic tank. [] Cesspool. Septic Tank~ Distance from ~vell, feet. Material, Total liquid capacity, Inside length, ft'et. Inside width. Ce~spooh Distance from: \v/ell,. feet; foundation. Inside diameter, feet. Depth,_ gallons. Capacity inlet compartment, .teet. Liquid depth, .gallons. feet, feet; nearest lot line at [] front, [] side, [] rear, feet. Liquid capacity, gallons. Lining material SECONDARY TREATMENT consists of [] Tile disposal field. [] Seepage pits. Other Til~ Disposal Field: Distance from: Well. Total length of tile lines, Trench width, lzngth of each line, Type of filter mater;ah [] Gravel. 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. Distance from: Well, feet; building foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. Insplcllon mode by: [] 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 custo~nar~ in neighborhood. Give most recent record of failure of wells in immediate vtcinity to furnish adequate supply of water Properties in neighborh~x3d [] 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: Buihling fi)undation cast iron sewer, feet; tile sewer, seepage pit, feet; cesspool. 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, \V/ell 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 feet; nearest lot line at [] front, [] side, [] rear, feet; septic tank, feet; disposal field, feet; other sources of possible pollution, .;Feet. Depth of casing, gallons per minute. gallons per minute. , 19 feet;