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HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 20CL 'OC, Grr~, T£R ANCHORAGE AREA BORO!~.H HEALTH DEPARTMENT ~ 327 EAGLE ST. ANCHORAGE, ALASKA 99501 27¥-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCAT'O N SEPTIC TANK: DISTANCE FROM WELL ~ LIQUID CAPACITY '~ GALLONS. MAILING ADDRESS MATERIAL NUMBER OF COMPARTMENTS LIQUID INSIDE LENGTH. INSIDE WIDTH. DEPTH,__ SEEPAGE SYSTEM: ... SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE / OUTSIDE DIAMETER OR WIDTH /~- '~' ,LENGTH ~¢'~/' , DEPTH (- ¢,,~ (.,t? ~ T"~ DISTANCE FROM WELL (,~14~~ , BUILDING FOUNDATION TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL . FOUNDATION ., NEAREST LOT LINE NUMBER OF LINES /~WEEN LINES /.~--~F.~'gH WIDI~H DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEAIH TILE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE .IN. ABOVE TILE , WATER SAMPLE WELL: TYPE . BUILDING FOUNDATION TIC SEEPAGE LOT LINE ., SEWER LINE. ., TANK , SYSTEM . CESSPOOL DIAGRAM OF SYSTEM DISTANCES: NEAREST OTHER SOURCES DATE GREATEr~'A. NCHORAGE AREA ./",3ROUGH llEALTIt DEPARTMENT 327 Eagle St. Anchorage, Alaaka 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT .)~, _,~_,~o,_: ? ~, ~J~ ,~, RESIDENCE ADDRESS ~t~ ,~,~. ~, ~e~ LEGAL DESCRIPTION APPLICATION TO INSTALL: SE~IC TANK ~ ,SEEPAGE PIT TO SERVE THE FOLLOWING FACILITY /1/ /0~¢ ~ FINANCED THROUGH F~///~ ~TEST RESULTS ../-~'"~/~,',- L .t.,'~.,..,., MAILING ADDRESS J3ox I/ LOCATION OF INSTALLATION ~"",,~. /. PHONE NO.~ ?Y /' ,OTHER ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT ,AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~'/' SEPTIC TANK SIZE ~t' J TYPE c~ SEEPAGE AREA 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~~ BATE. APPLICANTS SIGNATURE APPLIr ,NT FILLS OUT UPPER HA. _..ONLY 15r,~ert¥ .Owner J-~T P ~t_/'-/,~___o~.~/"d....-- Phone Buye~ /j/g Address Zip Code Lending Institution F/'.~...~/" J/./~C~',.-5~"~5~ ~/~'lJ~. Phone 47.~1%u~,~,~ p~e,c.~tvo.~L~kl ~.~.'~T'e:4 Address A,l~.flr. t4(~C ~( ~t~ ZlpCode Realty Co. & Agent A/j/t~ Phone Address Zip Code Legal Description /._07" ~ ~ ~'/1~:~.~ .,~]~/4~-- V'J~-~'~r ~/~t'//-~./~[r"~ Type of Residence r'l Single Family /0 ~ Multiple Family No. of Bedrooms [] Other Water Supply [] Individual 1~ ~ ,~_.~_..~ ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ~. Community (~ Fl? wells drilled prior to that date, give well depth (attach log If available). [] Public Utility *, · Sewer Disposal ~. Individual Year Individual Installed: D Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Inspector Inspector Inspector Inspector Field Notes: ~ ~ (~ ' ~' MUNICIPAL~ OF ANCHO~GE ' Well to Tank Septic T~k Size SANITAI~¥ PUMPERS P.O. BOX 772226 EAGLE RIVER, AK 99577 694-2408 '1 t ~ e,lv-.~/(--., I i ~ I I I I i I I STATEMENT 'JK November 16~ 1983 Herb8rt P. 5chroeder 165B Eagle River Road Eagle River, AK 99577 Sub3ect: Lot 20L, ~aole River Valley Ranchettes Approval for the individual sewer and water tacilities cannot be Granted until the following items have been completed: The septic tank pumped with a receipt submitted to this department. PLease notify this Department for a reinspection when the noted discrepancies nave been corrected. If t~ere are any further questions, please call this office at 264-4720. Cory Willis, R.S. Acting Sewer & Water Program ~la~%ager C;{30/ej/E1 ~EQUEST FOR APPROVAL OF INDIVIDUAL SEWAG~ AND gAII;R FACILITIES (Fill out in T~iplicate) · of pet, son ~equesting app.-oval b. Decedent . data-' b. Dept~.,, c. Casing Size Distance from wall to closest existing o~ p~oposed: o 1. Sewer line . 2. Septic tank 3. Seepase A~ea .... . ~. C~sspool'__ 5. Pz'opel~c¥ Line, O~her soumces of possible contamination, i.e. s c~eeks, lakes. houses, barn, drainage ditch, etc. . Sewagu d.~'po~al system. a. s ta,. b. Septic tank capacity in Name of septic tank menufactul~T~. 1. If "home made*' show dia~am on reverse side of this ~or~. d.' Disposal field or seepagep_.i/~ size and - 1. '~lstance to pz~p~//ne to ~.ouse ~o~dati~ o,T/-//. e. Per?a~m?lc~ Te~ ~es,,~_~_m h_f. Percolation Test perfor=ed by ....... · Use the reverse.side of =his ~o~ ~o show d~ram. D~a~a~ should ~ncLude e f~ in~tion~ ~pe~ ~lne$~ .we~l ~oce~on, house ~ d~ct~on off ~und 9. ~e ~~ on ~s ~o~ Is ~ue ~d co=~cv ~o ~he best off ~ ~ow~edge. ~ $~.nature of ApPlicant Date Sided TO, BI/: FXkLED' Ot~, BY HE,A, LTH D£,P~RT?.fF.,NT [~e above described .sanits~y facilities are hereby approved, ,sub~ect ,to the The above described sanitary facilities are disapproved for the following '--~al 18 valid for ~e ye~ foll~in~ the ~e of app~val. .,- CPJ: cw FMA Formv2573 ' U. $. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT FEDERAL HOUSING ADMINISTRATIC~I HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM Sedget B~eov 14o. 63-R296.I 1?4SURING OFFICE Ancbo~&e; Al~,aJm MORTGAGOR C~ SPONSOR SUK)IVI$1ON NAM~ Eagle Etver ¥~11e]~ Panchetts 3~OTAL HUMBeRt J ~E~ ~ 10 b Yes ~ No WA~R SU~Y ~ ~blic system PART I.--TO BE COMPLETED BY FHA MORTGAGEE . . ' ~ . $ERIA,t.NO..,. ~... P~OPERTY AOORE$$ Con att~ ,m. other m'oa be, mode Into' [] New installation D Community system J~l Individual .o. o, ,m.~. OAt. O, %,.OSAL 10 ~ Yes o SIWAGE DISPOSAL IY: [] Public system [] Community system L--] Individual PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT I Il llllllllllllllllllllllllllllllll[lllllllllllllllllllllllllllil lllllllll I llllllllllllllllllllllllllllllllllllllllllllll I I lllllll lllll lllll llllllllll II llllllll lllllllllllllll I I I lllllllll llllllllll Il llllllll lllllllllllllll I I I I I I I Il I I Ill iilll I J ill I Sill I I I I I J Sill I I Ill I I llll lllllllllll llllllllllll lllllllllllllllllllllll llltlllltlliiill I I IIIIIlllllliillllllltlttltllllllllllllll ~l~ll I t t i i-i I I I I I I I I i I I I il i J I I i I I t i I i I I I i I I i I I t i i I I t I t I I t I i I I I I I II I I I I lilii ilill iilliilltl Iltlllltliltlll iltil il Illl IIII iillliiltl tliii I'i I il I i I I I t I1 i I I I I I t 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 I i I I I I I I I I II1111 I lllllllllllillllllllllllllllllllllllllllllllll I lllll lillllllllllll!lllll lllll lllll llllllllllll llllllll llllllllll lllll I I Ilttllltltlltlilllllllltlllllllltllllliillttlllllliltlttlltl U I I I I I t I II I IIII IIIII I I I II I II II i t I I II IIII II I ~ IIIitl I I IIII IIit111tlt1111111t1111t1111111111111 I I tl II I I ] I I I II II t I II I I II II I I I II I I I II I tl II IIitl II I II I tl t1.1 I I I I I IIItllllllllllllllllllllllllllllllllltlllltllltllllllltl IIIIIIIIIIII111 IIItlllllllJllllll 11111111111t111111 t1111 I1111 IIitl t IIII 111111111111tll I I I IIIII IIIII IIIII IIIIIIIIII tt111tltll II Itl It111 IIIIIIIIII Iltll I I I I I I t111 I I I II tl I II IIIII II tll I IIII II Itl I'1111 I I! II Ltllll I I Illllllllllltillllllllltllllltllllltlllllllllll · ! I tl Il III ttl II Il Ill II I II II I II Iltll It Il I I Itll I I I Il I I I II I I t II I I I tll II II Itl 11t II I II II I II II t I III I Iltl I I ttl I II II I I I II I Illll tlli I I IIitl Iltll IIIII IIIII IIIII I IIII II IIIII IIIll ! I I IIII IIIIIIIit111111 t1111 Ilttl I II11 IIit111111 II III I I I II I I Itl IIIIit I III III II II I II II I tl I I III tll Ilill II I II II II .11 I IIII I I I Ii REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM HIIMAIIY IlllATMIN~ consists of I--1 Septic tank. I-I Cesslx~ol. S4,p*k Tonk: Distance from well. feet. Material, Total liquid capacity, Inside length, fcet. Inside wldlh, Ce, eepoeh Dhunce fit)m: Well Inslde diarneter~ fe~t. Number of compartments, gallons. Capacity inlet compartment,, gallons. feet. Liquid depth, feet. feet; firdndation, feet; nearest lot line at [] front, [] side, [] rear, Depth. feet. Liquid'capacity, gallons. Lining material SECONDARY T~EATMI~fl' consists of ['] Ti~e disposal ficld. I-I Seepage pits. Othc~ ~ Ti~e Dilposal Fltl-i, Distance from: Well. Total IcnFh of tile lines, Trench width, Lcngth of each line feet: foundation, feet; nearest lot line at I'-I front. [] side, [] rear, feet. Number of lines, Distance between lines, _inches. Total effective absorption area in bottom of trenches, ~ . fi'ct. 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 p!ts ....... Outside diameter, feet. Del~h, Distance from: Well, fcc-t; building foundation, Stluare feet. inches. In~l~diM~ M by: [] State. Date of inspection inches. feet. Lining material feet; nearest lot line at f-I front, f=l side, [] rear. [] G)unty. [] Local Health Authority. Inspected by . 19 .. (~ITLJ) REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distame to nearcst public water main. feet. Size of main, inches. Individual wells I-I 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 neighbodlood [] are [] arc not being developed with both individual water-supply and sewage-disposal systems. l~)t size: feet wide, feet deep. Dwelling set back from front property llne, feet. Individual water supply from: [-] Drilled well. [] Driven well. I-I Dug well. [] Bored well. D4otMK® of well fromt Building fi~undation, ~-epage pit, WMI CM~S~JCt~On: feet; tile sewer. feet; cesspool, feet; nearest lot line at [] front, f-I side, f-I reit, feet; septic tank, feet; disposal field, feet; other sources of possible pollution, 'feet. Diameter .... inches. Toul depth, feet. Type of casing, Approximate delxh to pumping level of water in well, feet. Approximate yield, Sealed watertight to depth of. feet. Exterior sp~c¢ around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordioaty backfill. Well cover: [] Concrete. VI Wood. [] Metal. Openings in well cover watertight: VI Yes. [] No. ~mpt [] Shallow well. [] D~.p well. Length of drop pipe, .feet. Pump capacity, I~ated in: [] Basement. [] Pumproom off' basement. [] Pumphouse above ground. [] Pump pit, Pumproom properly drained: [] Yes. [] No. Pump mounting watenlght: [] Yes. [] No. Type of storage: [] Pressure. [] Gravity. Opacity, gallons. Has b~cteriological examination of water been made? [] Yes. f-I No. If answer is "yes," give chte Quality of water [] is [] is not satisfactory for human consumption. Installation [] does [] does not comply with approved exhibits, if anat. Inspection made by: f-I S~ate. VI County. [] Lo, al liealth Authority. Inspected by. Date of inspection ~ 19 Depth of casing, .gallons per minute. gallons per minute. feet; tlUl~W(3ih,, D. C~