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Home My WebLink AboutSUNNY SLOPES LT 58 Case No.'~,~ ~ GREATEF ANCHORAGE AREA ,?'OROUGH 'x.~: HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICAN/~"g~'J RESIDENCE ADDRE(ffB/~t.~ t. /'~"~.~ LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS MAILING ADDRESS ~ '76'? ~,,,.~ ~ LOCATION OF INSTALLATION ~ SEEPAGE PiT 7 ,DRAIN FIELD PHONE ,OTHER TO BE INSTALLED BY__ ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS ® ?¢:~ ,....~./.~_.,.~Z2~' PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE,,~.~'~'~,.,,~ TYPE sEEPAGE AREA. _TYPE ~ DIAGRAM OF SYSTEM DISTANCES: t certify tha am amiiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above des~bed system is in accordance with said code. 2. 3, 5, REQUEST FOR AP?ROYAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fii1 out in Triplicate) · of person requesting approval ~_~ Wate~ Analysis: a, Bacte~,is_l b. Detergent, "' Well data: a. Type__ b. Depth c. Casing Size Distance from well to closest existing or proposed: 1. Sewer line 2. Septic tank 3. Seepage Area Cesspool' 5. Property Line Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. Sewage disposal system. a. Age of system .... b. Septic tank capacity in gallons. c. Name of septic tank manufactum~m 1. If "home made" show diagram on reverse side of this form. Disposal field or seepage pit size and type, 1. Distance to property line ~'< to house ~undatzon f · Percolatlo~.Te'st'~esttlts f. Percolation Test performed by Use the reverse.side of this form to show diagram. Diagram should include '~he foilowing info~matlon: ~operty lines~.well location~ house location, ~ptic tank location~ disposal area location, location of percolation test, m~ direction of ground slope. The ~£o~e~on on this form is true and cormect to the best of my knowledge. 'Signature 'of Appl'icant Da~e Signed \ ~e above described sanitary facilities are hereby approved, subject to the ........... ~61!owing Conditions: The above described sanitary ac~lltles are disapproved for the following reasons: CPJ: cw HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM INSURING OFFICE MORTGAGOR OR SPONSOR PART I.--TO BE COMPLETED BY FHA MORTGAGEE SERIAL NO. PROPERTY ADDRESS SUBDIVISION NAME TOTAL NUMgER: WATER SUPPLY BY: -~ Public system SEWAGE DISPOSAL BY: '--]Public system ! .AtHS 1 BASEMENT 2j [~ Yes [] No []Community system ] Community system [] New installation BLOCK NO. LOT NO. additional bedrooms? {If Yes, how many~I I--1 Yes [] No ]Individual [] Individual SYSTEM DESIGNED FOR []Yes ~No 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 [5~ Local Department of Health that this individual sewage-disposal sys- j' tern with proper maintenance: [~Can be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily is not likely to create an insfin{tary condition NOTE: Tho health authority should complete the appropriate opinion statement above and affix date, signature and title in the spaces provided. Use of the above grid for Health Department lnspector~s sketch as well as use of the back of this form is at the option of the health 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. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 Rev, Ju~y 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. [] Cesspool. Septic Tank~ Distance from well, feet. Material, Total liquid capacity, Inside length,, feet. Inside width,. Cesspooh Distance from: Well, Inside diameter,_ gallons. Capacity inlet compartment, feet. Liquid depth, feet. feet; foundation, feet. Depth, SECONDARY TREATMENT consists of [] Tile disposal field. Tile Disposal Field: Distance from: Well,_ Total length of tile lines, Trench width~ hength of each line, Type of filter material: [] Gravel. Number of compartments .gallons. feet; nearest lot line at [] front, [] side, [] rear, feet. Liquid capacity, .gallons. Lining material [] Seepage pits. Other feet. 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, [] Broken stone, Other feet. square feet, .inches. Depth of filter material over tile, .feet. Lfifing material feet; nearest lot line at [] front, [] side, [] rear, inches. Depth of filter material beneath tile.~ inches, Seepage Pits: Number of pits , Outside dia~neter, feet. Depth, Distance from: Well, feet; building foundation, Inspection rondo by: [] State. [] Count),. [] Local Health Authority. Inspected by- Date of inspection , 19 REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water tnain, feet. Size of main, inches, Individual wells [] are [] are not customary itl neighborhood. 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. individnal water supply from: [] 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 constructlom 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. Pum~: [] Shallow well. [] Deep well. Length of drop pipe, --feet, Pump capacity, hocated 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. [] Local 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. feet; feet. 19__