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HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 5 LT C 327 '~.R ANCHORAGE AREA BORe :~ HEALTH DEPARTMENT ST. ANCHORAGE, ALASKA 99501 ,~511 NAME UOCAT~ON INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM - MAILING ,~t"~OCl,~ ~.;-_i,i,~ ADDRESS ~. I~ I~ ~ I~PHONE~ SEPTIC TANK: D~STANCE EROM WELL O_~m /4~o LIQUID CAPACITY /<~ ~''~ GALLONS. G. NUMBER OF MATERIAL ~,/----- COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH __ SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER OR W,OT. /,.¢'r LENGTH /S r ~/' ~ , , DEPTH DISTANCE FROM WELL BUILDING FOUNDATION ~'~' !, TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELl NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TiLE TO FINISH GRADE FOUNDATION /,NEAREST LOT LINE DISTANCE B~S TRENCH WIDTH LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE WELL: TYPE~j/~/j~lj'~r~ JJ~I/lJl~/~DEPTH NEAREST LOT LINE ~ , SEWER LINE DISTANCE FROM WATER , BU LD NG FOUNDATION, O//~'' SAMPLE ~ , NEAREST SEPTIC SEEPAGE ,, OTHER , TANK ~' , SYSTEM ~ , CESSPOOl , SOURCES DISTANCES: DATE DIAGRAM OF SYSTEM ~I~EALTH AUTHORITY FHA Form 2573, U. S. OEPARTMENT OF HOUSING AND URBAN DEVELOPMENT FEDERAL HOUSING ADMINISTRATIOH HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND $EWAGE DISPO,SAL ,SYSTEM Farm Atl~'oved Budget Bureau Ne. 63-R296.S PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGC)~ OR SPONSOR WATER SUPPLY BY: Iii Public system SEWAGE DISPOSAL --I Community system Community system MORTGAGEE SERIAL NO. -[I~ROPERTY ADDRES$ '~ - K LOT NO. 15 [] New installation C(,~lm~a~c_..~?b:d~,~mla~a bo m~de Io~o (If Yes, ~w ~ Individual ~. o~ ~. oa~o~ ~ Individual ~ Y~ ~ No J~] Public system PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH 1, 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. ~ rUDl~ IL, l~J~ i I~K . , It is the opinion of the ~1 State [] County ~] Local Department of Health that this individGal sewage-&sposa~ sys- tem with proper maintenance: }~] Can be expected to function satisfactorily, and ~! Cannot be expected to function satisfactorily ts not likely to create an insanitary condition -~ATE ]SIGNATURE ITITLE , ~.~,/ // ~,../ NOT~ g~*~rJ~ should ~o~,e~h~-~l~nlon s.tement above and .~x date, signature and tiff. In *. ..~bo~[.d ,~.....,h O..ar,..., ,....c,.r · .k."h ...."., ... o, ,h. b..k o, ,hi. ,o.. ,, a, ,h. o.,I., o' ~. heal~ au~orlty. 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 N Not Acceptable Sewage disposal be considered [] Acceptable N Not Acceptable. DATE SIGNATURE NIALTH AUTHORITY APPROVAL INDIVIDUAL WATIR SUPPLY AND SEWAGE DISPOSAL SYSTEM E~ CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2S73 I~v. July 195~1 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. [] Cesspook f~l~k Tank: Distance from well,__.feet. Material Number of compartments , Total liquid capacity, gallons. Capacity inlet compartment, gallons. Inside length, feet. Inside width, feet. Liquid depth, feet. Distance from: Well, feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. Inside diameter, feet. Depth,. .feet. Liquid capacity, gallons. Lining material ~J~CONDAIIY TIIEATM~NT consists of [] Tile disposal field. [] Seepage pits. Other TII~ IgspoNI Field: Distance from: Well, feet; foundation, feet; nearest lot line at ['-I front, [] side, [] rear, feet. Total length of tile lines,_ feet. Number of lines Distance between lines, feet. Trench width, inches. Total effective absorption area in bottom of trenches, square feet. Length of each line .feet. Depth, top of tile to finish grade, inches. Type of filter material: [] Gravel. [] Broken stone. Other Depth of filter material beneath tile,, inches. Depth of filter material over tile, ~p~ge INt~: Number of pits .... Outside diameter, feet. Depth, Distance from: Well, __ feet; building foundation, Inspection made by: [] State. Date of inspection inches. feet. Lining material feet; nearest lot line at [] front, [] side, [] rear, [] Cx)unty. [] 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 custo:nary in neighborho~M. Give most recent re<etd of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood [] are [] are not being deveh)ped with both individual water-supply and sewage-disposal systems. Lot size: feet wide,, feet deep. Dwelling set hack from front property line,, feet. Individual water supply i¥om: [] Drilled well. [] [)riven well. [] Dug well. [] Bored well. EMstance of well from: Building foundation, cast iron sewer, feet; tile sewer, seepage pit, feet; cesspool,. W~ll construction: 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. Pump: [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity, [x)cated 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, I[-I rear, feet, feet; septic tank, feet; disposal field, feet; feet; other sources of possible pollution, ireet. Depth of casing, .gallons per minute. .gallons per minute. 19 (TITLE) feet. I-IUD-Wa~h., D. C.