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HomeMy WebLinkAboutSUNNY SLOPES LT 34 GAAB-HD-I GRr~TER ANCHORAGE AREA BOROI/~'-H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL O .~L~) MATERIA[ LIQUID CAPACITY ///)L/'~ ~") ADDRESS LEGAL DESCRIPTION COMPARTMENTS GALLONS. INSIDE LENGTH INSIDE WIDTH PHONE. LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE OUTSIDE DIAMETER ORWIDTH ,x/~? ,LENGTH ~'~'~ ,DEPTH --- ~-) C/~) BUILDING FOUNDATION (W L, TILE DRAIN FIELD: DISTANCE FROM WELl NUMBER .OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE , FOUNDATION. NEAREST LOT LINE DISTANCE BETWEEN LINES TRENCH WIDTH SQ. FT. LENGTH OF EACH LiNE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__ TYPE DEPTH NIEAREST LOT LINE . SEWER LINE DISTANCE FROM ' WATER · BUILDING FOUNDATION. · SAMPLE , NEAREST SEPTIC SEEPAGE OTHER · TANK , SYSTEM , CESSPOOl , SOURCES DISTANCES: DIAGRAM OF SYSTEM '' H~ALT~T XUTHO~' v DATE APPROVED GAAB-HD-2 ~ ~r GREATEt~tNCHORAGE AREA '~gROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT _ . PHONE NO.~ RESIDENCE ADDRESS LOCATION OF INSTALLATION ~'~ -,-~-~ '-~'//o,~'~-, /,,~-~V LEGAL OESCR,PT,ON p~u ¢5 u~, ~,., .% .. .,~ ,.'T.,v ~./?.~ ~-, ~.,~... APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH fL~'~,/~ ,,~ PERCOLATION TEST RESULTS SEEPAGE PiT X ,DRAIN FIELD. TO BE INSTALLEO BY '7--Z..-~ ANTICIPATED DATE OF COMPLETION ,OTHER BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT AS OESCR,BED BELOW. S,ZE OF UN,T TO ,E SERVEO -~ ZT,-~--~ .~ .SEPT,C TANKS'ZE /oo,,/,,AYPE ~/,,-/ SEEPAGE AREA TYPE DIAGRAM OF SYSTEM DISTANCES: Health 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. DATE APPLICANTS SIGNATURE A~proval Requested Address: Eagle River GREATER ANcHoRAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received Da~ ~; IQT~ Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR VA Selective Realty Single Family Dwellin§ 2. Prooertv Owner: Frederick Hess 3. Legal Description: Lot 24, Sunny Slopes Subdivision 4. Location: Sunny Circle 5. Type of Facility to be Inspected: Phone: Phone:- Three (3) 1. Size .lO00 Gals 2. 1. Size ]2x12x6 2. B. Depth D, 'Bacterial Analysis Number of Bedrooms: 6. Wel] Data: A. Type Community C. Construction' 7. Sewage DisPosal System: A. Installed ~ ]969 C. Septic Tank: D. Seepage pit: ~o Disposal Field: 8. Distances: A. Well B. Installer Tuck Construction Manufacturer Material Log' Total. Length of Lines , Absorption Area · Other Contamination ~> Absorption Area Absorption Area to Nearest Lot Line Septic Tank , Nearest Lot Line Foundation to Septic Tank Sewer Lines Page Two 9. Comments: Approval pending escrow funds f~r hook up to public sewer system in spring of 1974. Disapproved Date .Aopro~_~. ~ova] Valid for ~Year From Da%e Signed Greater Anchorage Area Borough, Department of ~nvironmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities located at: Signed Date ~NA Form 2573~ HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART L--TO BE COMPLETED BY FHA DUPLIC^TE ~NSURING OFFICE MORTGAGEE SERIAL NO. MORTGAGOR OR SPONSOR SUBDIVISION NAME PROPERTY ADDRESS BLOCK NO. LOT~rNO. TOTAL NUMBERz WATER SUPPLY BYz [] Public system SEWAGE DISPOSAL BY: [] Public system BASEMENT J~] New installation p Communiq, system ]Community system Can attic or other ama be made Info additional bedrooms? (If Yes, how manyF) [] Individual SYSTEM DESIGNED~ FOR I~ Yes [~] No [] Individual PART IL--TO BE COMPLETED BY HEALTH DEPARTMENT tEALTH 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 [] Cannot be expected to function satisfactorily is not likely to create an insanitary condition --~ATE ISIGNATURE ,' ~ ,' r s JTITtE j ,. ~ ..... ~ [, ~nviroi~nental Health Sularvisor NOTE: The health authorl~should complete the appropriate opinion statement above and a~x date, signature and title In the ~paces provided. heal~ authority. 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 2573 Rev. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM TII~ D]$posul Field: Distance from: Well,. Total length of tile lines,~ Trench width1 Length of each line, gallons. Capacity inlet compartment, feet. Liqukl depth, Number of compartments , gallons. feet. feet. feet; nearest lot line at [] front, [] side, [] rear, feet. Liquid capacity, gallons. Lining material feet. square feet. inches. inches. Other feet; foundation, feet; nearest lot 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, Number of pits .... Outside diameter, feet. Depth, Distance from: Well, feet; building foundation, .feet. Lining material feet; nearest lot line at [] front, [] side, [] rear, [] Local Health Authority. Inspected by- REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main1 feet. Size of main, inches, Indivkhml 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 neighborhood [] are [] are 99t being deveh)ped 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 fi'om: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. Building foundation seepage pit, 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, J'eet. Diameter,_ inches. Total depth, __ feet. Type of easing, 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. ~ump: [] Shallow well. [] Deep well. Length of drop pipe,_ feet. Pump capacity, Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground, [] Pamp 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 an~. Inspection made by: [] State. [] County. [] Local Health Authority. Inspected by Date of inspection , 19 Depth of casing, .gallons per minute. .gallons per minute. feet; feet. 19__ HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGOR OR SPONSOR BLOCK NO. LO~O. TOTAL NUMBER: WATER SUPPLY BYz [] Public system BASEMENT [--~ Yes [] No [] New installation [~ Community system Can attic or other area be made Into additional bedrooms? (if Yes, how many~) [] Individual ' g [] Yes o SEWAGE DISPOSAL [] Public system ]Community system [] Individual 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 [] Local Department of Health that this individual sew~.ge-disposal sys- tem 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 J SIGNATURE J TITLE health Use 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 heal~ 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. SIGNATURE ]r__i CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT DATE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM Distance feom: Well, Total length of tile lines, Trench width,_ Length of each fine gallons. Capacity inlet compartment, f~et. LiquM depth, feet. Number of compartments gallons. feet; nearest lot line at [] front. [] side, [] rear, feet. Liquid capacity, gallons. Lining material Other feet. square feet. inches. Depth of filter material over tile, · feet. Lining material feet; foundation, feet; nearest lot 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,r inches. Seepage Plt~: Number of pits .... Outside diameter,, feet. Depth, Distance from: Well, Insp~dlon made by: [] State. feet; building foundation, feet; nearest lot line at [] front, [] side, [] rear, [] County. [] Local Health Authority, Inspected by- 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 neighborhood. (Jive most recent record of failure of wells in immediate vicinity 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 from: [] Drilled well· [] Driven well. [] Dug well. [] Bored well. D~stance of well from: Buikling foundation,_ cast iron sewer, feet; tile sewer, seepage pit, feet; cesspool,. Well construction: 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,. feet; septic tank,_ feet; disposal field, feet; other sources of possible pollution, ~eeet. Depth of casing, gallons per minute. feet. Type of casing, feet. Approximate yield, 19 Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. ~ump: [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity, Located in: [] Basement. [] Pumproom off basement. [] Pumpbouse 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 Qualiq, of water [] is [] is not satisfactory for human consumption. Installation [] does [] does not comply with approved exhibits, if any. Inspection made by: [] State. [] County. [] Local Health Authority. Inspected by Date of inspection , 19 feet; gallons per minute. feet.