Loading...
HomeMy WebLinkAboutMCMAHON BLK 1 LT 8 QGRF '" ER ANCHORAGE .AREA BCF' UGH Department ~3E0n~irs~eme;ntal Quality Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~;Z'~,I~ .~ i~'0/~1~ MAILING ADDRESS LOCATION /--~~ I~l¢)i ~-~¢-¢z/4c/~/A LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELt MANUFACTURER NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPAC ITY/~_.~ GALLONS. SEEPAGE NUMBER OF PITS LINING MATERIA[ BUILDING FOUNDATION DIAMETER __ OR WIDTH LENGTH CRIB SIZE: DIAMETER__DEPTH NEAREST LOT LINE DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED PI pE MAT E R IA L: ~)~'t¢,~,~,~ LOT SLOPE:~'~ REMARKS: Form No. EQ-031 GRI~'/-'~R ANCHORAGE AREA DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF AP"L,CANT '~'"'~' 'sto/'"ZT MA.L,.G ADD~BS Spa 'EGALDESCRIPT,ON Lot ~ lg0F-.l INSTALLATION OF: SEPTtC TANK/~:,~'~ ~/'' T'~ iud''' SEEPAGE PIT DRAIN FiELI~.bP'~' ~¢~ER ~o,~ ~ ~.~ ODs -/-W~o~, ~.,~ ~..,~ ,~ .o~ ~,~ ~,~.ou~ ~o,~ ~. DEPARTMENT Of ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. / ~¢ ~"~ ¢ MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ., DRAIN FIELD SEPTIC TANK t(~ SEEPAGE PIT WALE SEPTIC TANK ., SEEPAGE PIT TO NEAREST LOT LINE. WeLLTO SEPTICtANK DRAIN FIELD WATER MAIN TO SEPTIC TANK ., DRAIN FIELD SEEPAGE PIT : ALSO CONSIDER AREA WELLS. ., SEEPAGE PIT DRAIN FIELD SEPTIC TANK, , SEEPAGE PIT TO RIVER. LAKE, STREAM. .. DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST lEON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT PITTED WITH AIRTIGHT REMOVABLE CAPS. DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. DESCRIBED SYSTEM ES IN ACCORDANCE WITH SAID CODE. 0 70- Gr;~,~TER ANCHORAGE AREA BOROZ'~H HEALTH DEPARTMENT 327 EA~GLE ST. ANCHORAGE, ALASKA 99501 279-2511 N? INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM 667 LOCATION -~//6///~=~ SEPTIC TANK: MAILING ADDRESS LEOAL DESCRIPTION DISTANCE FROM WELL LIQUID CAPACITY 7'-~¢0 .GALLONS. MATERIAl INSIDE LENGTH NUMBER OF // COMPARTMENTS LIQUID .INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER LI NI N G,~T~RIA['~ ~ OR WIDTH DISTANCE FR~ , LENGTH BU~I~g.-PO U NDATIO N NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT, TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LIMES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION. ,-~2 / DISTANCE BETWEEN LINES ~ / SQ. FT. LENGTH OF EACH LINE . NEAREST LOT LINE .TRENCH WIDTH ) DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH._ ~ ~ OF LINES IN. TOTAL EFFECTIVE · IN. ABOVE TILE WELL, Typ E,/~.,///~/~) DEPTH I 0 q ~ LOT LINE Z~ /~/~ NEAREST SEPTIC · SEWER LINE ~ ,TANK DISTANCE FROM WATER , BUILDING FOUNDATION. ~*-'c~ / SAMPLE__ ,/~:~LP / SEEPAGE / · SYSTEM //] ('/ , CESSPOOL NEAREST OTHER SOURCES DISTANCES: DATE 40 f. DIAGRAM OF SYSTEM ~ : ;':' ~ ;It' : · ,i~. ! . .... : /,,/ 7/ T GREA;~'ER ANCHORAGE AREA BON,JUGH DEPARTMENT OF' ENVIRONMENTAl. QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAMe OF APPglCANT ~J]"&"~'"'¢"¢¢~'~ ~" //~'~ ~'~' MAILING ADDRESS INSTALLATION OF: SEPTIC TANK TYPE AND SIZE Of FACILITYTO BE SERVED COMPLETION DATE ANTICIPATED SEEPAGE PIT ~/ , DRAIN FIELD . OTHER /~/ FINAL INSPECTION; 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION SY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK'-~1 FOUNDATION TO SEEPAGE Pit //S' SEPTIC TANK TO SEEPAGE PiT WALL. /5' SEPTIC TANK ., SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK 50 DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, ~' , SEEPAGE PIT TO RIVER, LAKE, STREAM. DRAIN FIELD _, DRAIN FIELD SEEPAGE Pit ALSO CONSIDER AREA WELLS. J SEEPAGE PIT ., DRAIN FIELD ?~AST IRONINTO. lAND OUT OF SEPTIC TANK AND INTO CRIB crosSING GAP OF EXCAVATION 5 PEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit PITTED wITH AIRTIGHT REMOVABLE CAPB. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTN g:THORITY I CERTIFY THAT I AM FAMILIAR WITH THE REQuIReMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DATE APPLICANT'S SIGNATURE ~¢ ~ -~ Was Ground Water Encountered?_~O~ ....... '"~ + Depth if Yes, At ,~¢~,a~ Reading Net Drop 99501 large ~nough for a four (4) b~d~m~ R~/Iw MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~ ~ ~nn~ ~ Telephone: (home) Mailing Address ~o~ Z/~ /~J~ Io~, ~/~ ~/0 (c) Lending Institution ~¢¢~ ~0'~¢~ Mailing Address ~o~ Dcn~(/ ~/, (d) Real Estate Company and Agent ~6¢/~ ~[ Telephone ~ ¢ - { 888 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Telephone Business ~ 7 ¢' - 5-/,5"0 Pe /zr ,.7'~ rr~ (e) Mail the HAA to the following address: (or check here I~', if hold for pick up.) LiSt contact person and day phone number below: TYPE OF RESIDENCE Number of bedrooms __ Single-Family [] WATER'SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site [] Public [] C~mmunity [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88} Page 1 of 2 5.. ENGII~IEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, ~ verify that my investigation of th is Health Authority Approval shews that the on-site water supply and/or wastewater disposal system is safe, funct ona end adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm i~'~-~,,~ 7'~d.A/~ ~'cc~/ .~/',/~'~' Telephone ~ ~'.5--/::T,~z-.5~ Address {~.~'.~0 ~c~o, .~'/. ) /~-~¢_../lof'c~,, ,~c ~2,~-(&' Date ,,./"-~ fy % (~) ~ Engineer's Seal 6. DHHS APPROVAL Approved for ~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Date -~/~ Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Mu n ici pality of Anchorage is not responsible for errors or om issions in the professional engineer's work. 72-025 (Rev. 7/88)Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: £~ A. WELL DATA Well Classification Well Log Present (Y/N) NO Date Completed Depth'Og'l ~' ~,/w i,~s~. Total Cased to v~, Depth of Grouting Static Water Level Casing Height Above Grq~u. nd .. t3~ Electrical Wiring in Cqp'~tuit (Y/N) Y'~'~ If A, B, C, D.E.C. Approved (Y/N) N .~. Yield ~ ~'.o",~'~,m ,*~',~' ~'(~-/~0 Pump Set At u Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: ~¢'-/r,, ¢,o. o~ law To Septic/Holding Tank on Lot ~?,' ;~ ~¢7~ ~4~ ; On Adjoining Lots ~ / To Nearest Edge of Absorption Field on Lot ~ loc' ; On Adjoining Lots To Nearest Public Sewer Line ~o~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~ ~¢~ Water Sample Collected by FLATTo~ T6c~. ~¢c~ ; Date WaterSampleTest Results ~c ~v . o coh~r~ /foc~ ~ F Comments E¢~f¢~O~ ~i~e~¢ ~¢~¢~ ~e ~/[ Date Installed e/7~ Size ~2~o No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ~/~ / ~/7 ;for Temporary Holding Tank Permit (Y/N) Standpipes (Y/N) ¥E'5 Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) To Disposal Field M.T SEPARATION DISTANCES F~IOM SEPTIC/HOLDING TANK: To Water-Supply Well ~¢ ' _:~-o,~ C.C~, ,~4 t'¢71 ;~-~'~I'¢T'O Building Foundation 1 To Property Line ~ '75' To Water Main/Service Line ~ ~5'~ To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~1/7or ?~ R q/7,C 22~' ~/SPat* P~e~ ~ype of System Design B~O Length of Field Width of Field Jo¢ Depth of Field ~ Gravel Bed Thickness ~2' Square Feet of Absortion Area E~o*~ te~ ~a Statndpipes Present (Y/N) Depression over Field (Y/N) No Date of Last Adequacy Test Results of Last Adequacy Test ~¢~f~ ~6~o*~ ~ ~¢ ~ b¢~Z, SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ ~oo To Property Line ~ ~'~ Feo~ fl,T, To Building Foundation ~2 ~¢,~ H.~. To Existing or Abandoned System on Lot N,~ ; On Adjoining Lots ~ To Water Main/Service Line ~ ~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course > To Driveway, Parking Area, or Vehicle Storage Area ~ ~¢ ~ Comments LIFT STATION N,/~. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to al~ MOA and HAA g~del~rl~e~.effect on the date of this inspection. Signed ~' ."" ~ c Company ~{~F~p ~"~c~f ~ ~ ~ ¢'"~"0"'"'" .... "'~"':"~'¢ Engineer's Seal MOANo. ~ -Oz~ ' Receipt No. ~ ~ ~ 0 7 _ ~ Receipt No. Date of Payment 7 --¢ ~ Waiver Fee: Amount: $ / ~ O¢ ¢~ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. %~iect¢.d, .!U!! ?3 9(, '? !4:35 hrs. ~eceivad JUlt L.'5 90 9 !'h30 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ~liA~'/8[S ~[-'0R? F/',¢,~P[2 for ~'ork 0crier ~ ?5027 ~ate ~e?ort ?tinted: JU~ 28 90 9 Ordered ~y : T~D Ch~,~H:~ ~s~ ~: ¢.~ o~ ~.:a~ S~.oi rD: Ma(rix: At !ovabte !'!g= [,[one [~e(ected ~ See Sample ~emrks .~--~--' ' ~' DATE RECEIVED · INSPECTION APPOINTMENTS DATE DATE ~ p~'/ DATE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION)EPT. OF HEALI~ & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTtO~ ENVIRONMENTAL SANITATION DIVISION SEP ~ 6 1980 Telephone 264-4720 REQUEST FOR APPROVAL~OF INDIVIDUAL WATER AND SE~~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please atlow ten (10) days for processing. 1. PROPERTY OWNE~ F ED · PHONE PROPERTY RESIDENT (If differep[ from above) , PHONE 2. BUYER MAILING ADDRESS ~ MAI LING ADDR ES~rX 5. LEGAL DESCRIPTION 'TREET LO i[E ./.z/ 6. TYPE OF RESIDENCE [~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS F-I One I~ F6ur [] Two [] Five [] Three [] Six [] Other 7. WATER S~JPPLY [] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LOG. Awell log is required for all wells drilled since June 1975. For wells drill.ed prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY ~YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79} ~_~.~ ~ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FiVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITYconnection Verified INSTALLER~~~ (._O--~/ ~.L~S'I, []Septic Tank or []Holding Tank Size: .~..~(C~© If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL ' ' L Absorption Area to nearest Lot Line 5, COMMENTS E~PPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79) ALASKA I~FIUIROFImeFITAL COF1TROL SeRUICI~$, Inc. ~nclineerin§ 8 ~nuJronmental Studies MUNICIPALITY OE ANCHORAGE DEPT. OF HEALTH & ENV RoNMENTAL pRoTECTION SEP 2, .,3, '1980 RECEIVED i3AS~EH:'~ LY,::'O¢',! "Fi-.HE '??;'~' DA't!'FN '¥'!..i~E !i; Y .?/ i;:: hl :).1!;; ACftiSF:'TF-'d~:L.;E I::' (:) F;'. ~'."~ 1220 LUcsl 251h Aucnu¢ · Anchora§e, Alaska 99503 · (907) 276-1361 APPROVAL REQUESTED A~R~SS: ~ £./: 2, PHOPJE: ~~ il ~.~ER OF ~EDROOt,IS: ~ E. ~ERIAL S~'I~E ~IS~SAL SYST~I: UEPARTFF-NTsOF ~']VIROFff~[,~ ~IW ~ T~R Ro~ ' ~'.:~G~, [~s~ ~7 REQUEST FOR APPROVAL OF IF~IVIDUAL SB'~ A'~ ~:~ATER FAC]LITI~S FOR / APPROVAL ~"-'~H'--'~Y FOP, .~!: :~:R ~ '.,'~Y"'D ,,:- ,-,~.,-°'~ "- ,,: c,, FACILITIES PAG~ 'l~ D N, O~d:PAG~: PIT 2, LI:;I:G ~ C, DISPOSAL 9 TOT~ LEN~ ['~UIR~ ~SUR~IED~S A, I~ELL TO SEPTIC B,' IE~ TO SEEPAGE C, ~IELL TO ~ '~ ~, I'E~ TO PROPER~ 'F nng,',,~., ? CO;.T~ '.I I: ;ATIO,. :?ELL TO OTis. uR ~ FOUh:DATIO!i TO SEPTIC TA~.:I,' ../ · FOUDDATIO[-i TO SEEPAGE ~ [~ (--3 __ SEEPAGE PIT TO PROPERTY LINE" AREA BOROUGH DEPAR~',FF OF B',~IRO~'FrAL ~UALI'I~' 'i7! FHA For~573 Form Approved Rev. July 1958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.$ HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE Anchorge, Alaska MORTGAGEE SERIAL NO. First National Bank of Anchorage FHA 12358 MORTGAGOR OR SPONSOR Dennison & Hood Const. Co. SUBDIVISION NAME PROPERTY ADDRESS NHN Huffman Road R Anchorage,Alaska BL.~CK NO. LOT N80. McMahon TOTAL NUMBER: LIVINGUNITS BEDROOMS 1 2 BATHS BASEMENT [-~Yes [] No New installation WATER SUPPLY BY: [] Public system [] Community system SEWAGE DISPOSAL BY: [] Public system [] Community system Can attic or other area bo made Into additional bedrooms? (If Yes, how many?) ~¥es [--1~o NO. SYST.EM DESIGNED FOR ~'] Individual GE BDRMS. GARBAGE DISPOSAL ~-~ Individual [] Yes [~ No PART II.MTO BE COMPLETED BY HEALTH DEPARTMENT tEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the ~] State N 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 [--] County ~ Local Department of Health that this individual sewage-disposal sys- tern with proper maintenance: MCan be expected to function satisfactorily, and · is not likely to create an insanitary condition [-~ Cannot be expected to function satisfactorily DATE SIGNATURE TITLE Sanitarian NOTE: The health authority should complete the appropriate opinion statement above and affix 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 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. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM CHIEI: ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 Rev. July 1958 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURINO OFFICE Ancborge, Alaska MORTGAGEE ~irst ~ational Eanl~ of Ancho~.:a~ SERIAL NO. !E~A 1235S MORTGAGOR OR SPONSOR D~nn±son{x ~ i:~ood Conat. Co. SUBDIVISION NAME JPROPERTY ADDRESS I(H ~;.? Huff~an ~oad ~, Anchorage ~Alaska BL~CK NO, LOT NO. TOTAL NUMBER: LIVING UNITS BEDROOMS 1 2 BATHS BASEMENT [-~Yes [~ No [-~ New installation WATER SUPPLY BY: [] Public system [] Community system SEWAGE DISPOSAL BY: [] Public system [] Community system Can all'it or other area be made into additional bedrooms? (If Yes, how many~.) NO. SYSTEM DESIGNED FOR [~ Individual o, BDRM$,, GARBAGE DISPOSAL [] Individual [] Yes [] No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [~ State [~ County [~ Local Department of Health that this individual water-supply system g is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [] State [] County tem 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 TITLE NOTE: The health authority should complete the appropriate opinion statement above and affix 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 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 ~1 Not Acceptable Sewage disposal be considered ['~ Acceptable [~ Not Acceptable. DATE J ~j~__] CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 25~'3 Rev. July 1958 [:FHA ~rorm 2573 Form Approve~ tRev.*July 195B FEDERAL HOUSING ADMINISTRATION x, Budget Bureau No. 63-R296.B HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE - - Anchor~e, Alaska MORTGAGOR OR SPONSOR Dennison & Hood Const. Co. SUBDIVISION NAME TOTAL NUMBER: BASEMENT MYes nNo MORTGAGEE SERIAL NO. First NattonaI Bank of Anchora~.e _?HA 1235g PROPERTY ADDRESS i<II N Huffman ?oad ,, Anchorage,Alaska New installation BLOCK NO. LOT NO '1 Can attic or other area bo made into additional bedrooms? (If Yes. how rnony~) ¥es l--lSo WAI~R SUPPLY BY: [] Public system [] Comrnunity system BY: [] Public system [] Community system [] Individual ~o. SYSTEM DESIGNED FOR ~---] Individual o~ BDRMS. GARBAGE DISPOSAl. j[]Yes []No PART II.~TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is th~ 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. It:is the opinion of the [] State. ~ County [] Local Department of Health that this individual sewage-disposal sys- tem with Proper maintenance: -'-]Can be expected to ~urJction satisfactorily, and [-7] Cannot be expected to function satisfactorily is not likely to create an insaniyary condition DATE TITLE NOTE: The health authority should complete the appropriate opinion statement above and a~ix date, signature and title in the spages provided. Use of the above grid for Health Department Inspector's sketch os well as use of the back of this form is at the option of the health O uthorlt~/. : , 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. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM ] CHIEF ARCHITECT ['~ DEPUD' FOR CHIEF ARCHI~ FHA Form 2573 RIY. July 1958