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Home My WebLink AboutRAYMOND TEDROW BLK 3 LT 15 Efta Form 2573 Kev~ July 19S$ U. S. DEPART~AENT OF ItOUSING AND URBAN DEVELOPMENT FEDERAL HOUSING ADMINISTRATION HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM Form Approved Budget 8ureou No. 63-R296.8 PART I.~TO BE COMPLETED BY FHA INSURING OFFICE Anchorage, Alaska MORTGAGOR OR SPONSOR MORTGAGEE SERIAL NO. First National Bank of Anchorage 59010 000 1 HROPERTYADDRESS N Dawn Street, Eagle River, Alaska et 15, Block 3, RAYMOND TEDROW SUBDIVISION ZOBEL, Richard J. & Beverly A. SUBDIVISION NAME BLO~K NO. J LOT NO, RAYMOND TEDROW 15 TOTAL NUMBER, BASEMENT E"I New installation [~Yes [] No Can attic or ether area be made Into additional bedrooms? (If Yes, how rnanyf) WATER SUPPLY ~Y: [] Public system [] Community system [] Individual SEWAGE DISPOSAL BY~ [] Public system [] Community system [] Individual SYSTEM DESIGNED FOR NO. OF BORMS. GARBAGE DISPOSAL PART Ill.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the E] State E] 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 tem with proper maintenance: [X~ Can be expected to function satisfactorily, and is not likely to create an in/~anitary condition ~-A?E SlG N,~,t'U RE/ Nov. 1.6, 1970 J--'J County ~ Local Department of Health that this individual sewage-disposal sys- []Cannot be expected to function satisfactorily ITITLE Sanitarian SECONDARY TREATMENT consists of [] Tile disposal field. TiI~ Disposal Field: Distance from: Well, Total length of tile lines,. Trench width Length of each line [] Seepage pits. Other feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, __ feet. Number of lines, Distance between lines, inches. Total effective absorptkm area in bottom of trenches feet. Depth, top of tile to finish grade, Type of filter material: [] Gravel. [] Broken stone. Other Depth of filter material beneath tile,t inches. Seepaga PIt(J~ Number of pits____. Outside diameter, feet. Depth, Distance from: Well, feet; building foundation, Ins~'lon made by: [] State. feet. square feet. inches. Date of inspection Depth of filter material over tile, inches. .feet. Lining material feet; nearest lot line at [] front, [] side, [] rear, [] County. [] Local Health Authority. Inspected by- 19 (TITLe) REPORT OF INSPECTION~INDIVIDUAL WATER-SUPPLY SYSTEM Distante to nearest public water main, feet. Size of main, inches. Imlividual wells [] are [] are 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. [] [)riven well. [] Dug well. [] Bored well. Distance of well from: Building fl~undafion seepage pit,_ Well conlt ruction.. feet; tile sewer, feet; cesspool, feet; nearest lot line at [] front, [] side, [] rear, feet; septic tank, feet; disposal field, feet; other sources or' possible pollution, ~'eet. 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, la,cared in: [] Basement. [] Pumproom off basement. [] Pumpbouse 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. [] L(xal Health Authority. Inspected by Date of inspection 19 Depth of casing gallons per minute. gallons per minute. ,19 (TITLE) feet; HUI~Waah.~ D. C. REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES '/u (Fill out in Tmiplicate) R%~f~{~'~'~ g. Num~r.~f~ed~ooms in house ....... . ~-~. ~ ~,. 5. Wate~%3u%alys is: a. Bactemia~. b. Detergent . "'-' 6~ We]O data: c. Casing Size . Distance from well to closest existing or proposed: 1. Sewer line . 2. Septic tank 3, Seepage Area___._.__. Cesspool[ ....... . 5. Property Line 6. Other sources of possible 'contamination, i.e,, creeks, lakes, houses, bamn~ drainage ditch, etc. Sewa.g~ disposal system. .. ''' ?'., b. Septic tank capacity in gallons_ ~5 /,"~ i c. Name of septic tank manufactu~ 1. If "home made" show diagram on reverse side of tfiis fo~m. d.' Disposal field om seepag~e pit size and type__~ .-. 1. Distance to property, line ':'-z ..... :.,- to house foundation ' . Perc~la~io~ Temt Yesults f, Percolation Test performed by ............ ~ Use the reverse.side of this form to show diagram, Diagram should include ....~he following information: ~operty llnes~.well location, house location, '~xpt£e tank location, disposal area location, location of percolation tes~, a~. direction of ground slope. 9. The tmformat£on on this form is true and correct to the best of my knowledge. T.O_ BE~I-[~LLED OUT By. HEALTH DE~Ap. TUENT PERSOI.[NEL above described sanitary facilities ape hereby approved, subJec! :t~.:_t.~e_ [f61t, owin~ cpna~ions.i' Conditions: -,~ The above described sanitary facilities are disspproved for the following reasons: · Signa%ure of ~l:f.f;.e.~'a:/~; :.' ,."., ~Dat~ f~: ~'t..},~:;:../i:- ' ::--'-- ' '- Approval .is valid for one year following the date of approval. ..-- CPJ:cw