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HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 6 LT 5 E~A Farm 2573 Form Approved Rev. July 1958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.B HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.mTO BE COMPLETED BY FHA INSURING OFFICE MORTGAGOR OR SPONSOR J4od~n Iianm, MORTGAGEE PROPERTY ADDRESS SUBDIVISION NAME gstgXo Rlv~ TOTAL NUMBER: LIVING UNITS BEDROOMS BATHS BASEMENT [] Yes [~ No F'lt New installation WATER SUPPLY BY: [] Public system [-~ Community system SEWAGE DISPOSAL BY: [--] Public system FI Community system BLOCK NO.6 LOT NO.~ Can attic ar ether area be made Inte additional bedrooms? (If Yes, how mafly~) NO. SYSTEM DESIGNED FOR --]Individual OF BDRMS. GARBAGE DISPOSAL ~ Individual ~ [~] Yes ~ No PART fl.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the'*'-~l~l State [] County N Local Department of Health ~'] is [] is not satisfactory as a domestic water supply for the subject property. pply system It is the opinion of the [5~ State r-] County tern 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 / * SIGNATURE '' ~ r ' / TITLE, / ? NOTE: The health authority should complete the appropriate opinion statement above and afflx 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 III.mFOR 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 1 CHIEF ARCHITECT F'-I DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 Rev. July 1958 ~i{ Tank: Distance from well, Total liquid capacity, Inside length, Cesspool: Distance from: Well, REPORT OF INSPE¢71ON--INDIVIDUAL SEWAGE.DISPOSAL SYSTEM PRIMARY TREATMENT consists of ~Septlc tank. [] Cesspool. :, / if, t( ~-: feet. Material, --x. , ~ _ l*' ~Number of compartments 00 gallons. Capacity compartment,. ~-- inlet feet. Inside width, feet. Liquid depth, feet. / gallons. . feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. Inside diameter, feet. Depth,. feet. Liquid capacity, gallons. Lining material SECONDARY TREATMENT consists of [] Tile disposal field, ffSeepage pits. Other Distance from: Well,. feet; foundation, feet; nearest lot line at [] fmnt, [] 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., inches. Seepage Pits: Number of pits / . Outside diameter ~"Tt4'~feet. Depth,~feet. Liningmateria, Distance from: Well, -- feet; buiMin~ fo;n-dation, 2 ~ feet; nearest lot line at [] front, ]~si~e, V~ (ear,~feet. Insll~lon mode by: ~'/State. [] County. [] Local Health Authority. Date of inspection 5' //~'(~:~ 19 ~ / Inspected by, / REPORT OF INSPECTION-~'~Jl~IDI¥tD~A'L-WATi:R-SUPPLY SYSTEM Distance to nearest public water main, feet. Size of main, inches. Individual wells [] are [] ace 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 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. Distance of wall from: Building foundation cast iron sewer, feet; tile sewer, seepage pit, .feet; cesspool, Well 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. P~m~: [] Shallow well. [] Deep well. Length of drop pipe,, feet. Pump capacity, Located 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, feet; septic tank, feet; disposal field., feet; feet; other sources of possible pollution, feet. Depth of casing, .feet. gallons per minute. .gallons per minute. ,19 (TITLE) 10I. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested Mailing Address: ~~~ 2. Property Owner: ~y~(k~ Phone: Phone: Mailing Address: 3. Legal Description:~ ~ 4. Location: 5. Type of facility to be inspected 6. Well Data: A. Type C. Construction 7. Sewage Disposal System:~/,~- B. Installer A. Installed C. Septic Tank: D. Seepage Pit: Be 1. Size 1. Absorption Area E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line No. of bedrooms B. Depth D. Bacterial Analysis 2. Manufacturer , Sewer Lines , Absorption area , Other contamination 2. Material , Absorption area EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - ReqL ~or Approval of Individual Sc ~ Water Facilities Legal Description Comments Approved . / / Disapproved Date Approval .Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)