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OAAB HD I
GP'~ATER ANCHORAGE AREA BORG(
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
'
LOCAT,ON ,
SEPTIC TANK:
PHONE
DISTANCE FROM WELl ~i'~ ~
LIQUID CAPACITY //~ ~') /) GALLONS.
~/ : NUMBER OF
MATERIAL -'~- ~- COMPARTMENTS
A +-
INSIDE LENGTH .INSIDE WIDTH
LIQUID
DEPTH__
SEEPAGE SYSTEM:
SEEPAGE PII:
NUMBER OF PITS / OUTSIDE DIAMETER__OR WIDTH //~-~ ,LENGTH {'~- , DEPTH
LINING MATERIAL L- ~-) ~ DISTANCE FROM WELL ~"~ ~'~ [
. , BUILDING FOUNDATION.__
/
NEAREST LOT LINE '~'-' ~/ TO?AL EFFECTIVE ABSORPTION AREA (WALL AREA) c~<~~'',~ C~'~)~' ~ SQ. FT.
TiLE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
FOUNDATION
.DISTANCE BETWEEN LINES.
SQ. FT. LENGTH OF EACH LINE.
DEPTH OF FILTER MATERIAL BENEATH TILE'
· NEAREST LOT LINE
TRENCH WIDTH
TOTAL LENGTH
· OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL: - ~/
TYPE· _, DEPTH.
NEAREST
LOT LINE . SEWER LINE
DISTANCE FROM WATER
., BUILDING FOUNDATION SAMPLE , NEAREST
SEPTIC SEEPAGE OTHER
TANK . SYSTEM . CESSPOOL , SOURCES__
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPROVED
HEALTH AUTHORIIY
~.a~-~,,-~ ~.~ GREATE[~ANCHORAGE AREA ~_~)ROUGH
~,' ' HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAMEO ^PPL.CAN !-.-//, A.L.NGAOD.ESS
RESIDENCE ADDRESS
APPLICATION TO INSTALL: SEPTIC TANK
F.NANCEO T.ROUG"
PERCOLATION TEST RESULTS
LEGAL DESCRIPTION
.~' ,SEEPAGE PIT .~' , DRAIN FIELD
LOCATION OF INSTALLATION ,~_~4~-/~ ~"/~r,,~, .~"',t.,~..~,
, OTHER
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SIZE nF_. UNIT TO BE SERVED ,~ ~e ~-~-~."-¢~/-
..SEPTIC TANK SIZE//0 o~]~¢/ TYPE ,._~.qL,~i .SEEPAGE AREA TYPE
Health Authority
DISTANCES:
DIAGRAM OF SYSTEM
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
FHA Form 2573
Rev. July 1958 ~
5~"~'~/ U.S. DEPARTM£NT OF HOUSING AND URBAN DEVELOPMENT FEDERAL HOUSING ADMINISTRATION
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
Form Approved
Budget Bureau No. 63-R296.B
PART L--TO BE COMPLETED BY FHA
INSURING OFFICE
MORTGAGOR OR SPONSOR
S-a~mv 81ope~ S/O :
~M~ORTGAGEE SERIAL NO.
pR~PlRTY ADDRESS
BLOCK NO. LOT
NO.
TOTAL NUMBER:
BASEMENT
[]Yes --lSo
.'~ New installation
Can attic or other area be made Into
additional bedrooms?
(If Yes, how many~)
WATER SUPPLY BY*
]~1 Public system
SEWAGE DISPOSAL
~'] Public system
~E] Community system
'-']Community system
[] Individual
[] Individual
SYSTEM DESIGNED FOR
•Yes
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the [] State [] County x~-1 Local Department of Health that this individual water-supply system
<U is [] is not satisfactory as a domestic water supply for the subject property.
IE is the opinion of the [] State [] County->::E~ Local Department of Health that this individual sewage-disposal sys-
tem with proper maintenance:
:Y~ Can be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily
is not likely to create an insanitary condition
DATE [SIGNATURE ,r , ]TITLE
L1/25/69 ' - ,-' 7 , iln.viroli~,ci~t;t1 '~u..tlt.' "~ui:;eyvisor
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 [] Not Acceptable
Sewage disposal be considered [] Acceptable [] Not Acceptable.
DATE
SIGNATURE
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
FHA Form