HomeMy WebLinkAboutHANSON ACRES #1 BLK 2 LT 14
"' ~ I~ulVIDUAL SEWAGE AND WATER FACILITIES
· (Fill out in Triplicate) .~...
Distance from well to closest existing or proposed:
1. gew~.r llne
2. Septic tank
3, Seepage Area
4. Cesspool'
5. Property Line
6. Other sourc9s of possible contamination, i.e., creeks, lakes,
houses, barn, drainage dltch~ etc.
Sewage disposal system.
a. Age of system
b. Septic tank capacity in gallons
c. Name of septic tank manufactu~m_
1. If "home made" show diagram on reverse Side of this form.
d.' Disposal field or seepage pit size and type. ~!~.~7 ~)~_~[~_.(7
1. Dist~nce~ to propew~cy lln=_ to house foundation
f, Percolation Test performed by
Diagram should include
Use the reverse .side of this form to show diagram.
'~.-.t. he foJ_lo.,,ing ~nformation: p?operty lines~ .well location, house location,
~o-I~c tank location, disposal area location, location of percolation test,
aud direction of ground slope,
The ~n-~*~..;on On this form is true and correct to the best of my knowledge.
Signature of App'l'icant Date Signed
TO BE FILLED OUT BY HEALTH DEP^RT~.~ENT PEgSONNEL
......... ~owing'j'he above cond~iions:described sanitapy facilities are hereby approved, .subject to the
Conditions:
The above described sanitary facilities are disapproved for the following
re aso~ls ~
Signature of ~fe.i;~¢;
Approval.is valid for one year following the date of approval.
CPJ:cw
HEALTH AUTHORIITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
INSURING OFFICE
Anchora~e ~ Alaska
MORTGAGEE
National Bank of Alaska
Box 600~ ~_~ncho~e Alaska
SERIAL NO.
].11-010/~8/~
MORTGAGOR OR SPONSOR
Rosey L. Du~r
SUBDIVISION NAME
PROPERTY ADDRESS
5~60 Denali S%ree%~ Ancho~age~ Alaska
BLOCK NO.2 LOT ~+NO'
Ha~SO~ AC~OS
TOTAL NUMBER:
LIVING UNITS BEDROOMS
1 2
BATHS
BASEMENT
[~Yes ~ No
] New installation
Can attic or other area be made Into
addltlonal bedrooms?
~lf Yes, how mony~)
WATER SUPPLY BY:
[] Public system [] Community system [] Individual
SEWAGE DISPOSAL BY:
[] Public system [] Community system [] Individual
SYSTEM DESIGNED FOR
NO. OF BDRMS. GARBAGE DISPOSAL
VlYes
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the [~ State N 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
tem 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
DATE
JSIGNATURE I TITLE
NOTE: The 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 Inspector'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
CHIEF ARCHITECT
] DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL FHA Form
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM R~¥. J~l~ I~se