HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 6 LT 21
GP"~TER ANCHORAGE AREA BOROI H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
1V.o 33
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ~D~'//.
ADDRESS ~- ~-~' ~'
LOCATION
SEPTIC TANK:
NUMBER OF
DISTANCE FROM WELL~'~;)~'' ~"/~"~ MATERIAL -~-,~'-~-? ~
COMP~RTMENTS
LIQUID CAPACITY ./~) GALLONS, INSIDE LENGTH ~ INSIDE WIDTH
LIQUID
__ DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
SEEPAGE PIT: ~ '.~/"~'
OUTSIDE DIAMETER
OR WIDTH ~'~, LENGTH /~' , DEPTH ~
DISTANCE FROM WELL C~-~,~ ~ BUILDING FOUNDATION -~' j'
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~-'~"~' .SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL ~ FOUNDATION , N~'~"~_ , OF LINES .,
WELL: TYPE~/~/7~/~~,/-~ ~) DEPTH j../' DISTANCE FROM ~ WATER ./~
= .,BUILDING FOUNDATION SAMPLE , NEAREST
LOT LINE J NEAREST , ~,-SEPTIC ~ SEEPAGE ~ ~'""'~OTHER
., SEWER LINE ~- ,TANK , SYSTEM , CESSPOOL , SOURCES__
DISTANCES:
DIAGRAM OF SYSTEM
HEALTH AUTHORI[Y
GAAB-HD-2
GREATEI--tNCHORAGE AREA'
HEALTH DEPARTMENT
327Ea~eSt. Anchor~e,A~ska99501
JROUGH
279-2511
Case N 0,/~ ,,.~L
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT .,1~. ~.~ o ¢ ,~, ~,_
RESIDENCE ADDRESS
. LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
J
~ , SEEPAGE PIT. ~ , DRAIN FIELD
TO .E INSTALLED .Y
/~O ff.f~,.,,-ANTICIPATED DATE O, COMPLETION
BELOWTO ,E FILLED OUT BY HEALTH DEPARTMENT
MAILING ADDRESS
PHONE
LOCATION OF INSTALLATION
, OTHER
DISTANCES:
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordnance No. 28-68 and that the
ab ovedes~ibed system is in accordance with said code. ¢ ~/~
OATE~)~ APPLICANTS SIGNATURE ~ ~~?
FHA Form 2373 form Approved
R,~ Jv~y f ~$S FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R29&B
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.mTO BE COMPLETED BY FHA
iNSURING OFFICE
MORTGAGEE
Alaska State Bank
An cho~age, Alaska
Associate Bldrs. j Box l_l, Eagle ~iver, Alaska
SUBO,V~S,ON NA~ I BLOCK NO.
Eagle River Heights I 6
SERIAL NO.
111-0~ ~ !!00-203
LOT NO,
WATER SUPPtY
~ Public system [--} Community system
SEWAGE DISPOSAL BY:
[~ Public system
--]Community system
Can attic or other area be made Into
additional bedrooms?
(If Yes. how martyr)
[] Individual
[] Individual
SYSTEM DESIGNED FOIl
--]Yes [-~ No
PART II.eTa BE COMPLETED BY HEALTH DEPARTMEHT
HEALTH DGPARTMENT INSPECTOR'S SKETCH
It is the opinion of the [~ State ['-] County Department of Health that this individual water-supply system
['-~s [~] is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the [--] State [--] County [~ocal Department of Health that this individual sewage-disposal sys-
tern with proper maintenance:
[~Can be expected to function satisfactorily, and [--'] Cannot be expected to function satisfactorily
is not likely to create an insanitary condition
NOTEs The health authority, sho61'd complete the appropriato opinion statement above and affix date, lignaturl and title In the
spaces provided.
Use of the above grid for Health Department Inspector's sketch as well as uN of the back of this form Is at the option of th~
health authority.
PART Ill.--FOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the
Individual water-supply system be considered [] Acceptable [] Not Acceptable
Sewage disposal be considered ~] Acceptable [~] Not Acceptable.
DAT~
SIGNATURE
HEALTH AUTHORITY APPROVAL
iNDIVIDUAL WATER SUPPLY AND SIMfA$! DISPOSAL SYSTIM
CHIEF ARCHITECT
DEPUTY FOR CrilEF ARCriffECT
FHA Form 2573