HomeMy WebLinkAboutBROOKWOOD BLK 1 LT 801 ,- 181-13
GAAB-HD-I
GDqATER ANCHORAGE AREA BORO'~GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY ~ ([~'~ GALLONS.
MATERIAL ,. COMPARTMENLS
L,OU,D
INSIDE LENGTH x INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
NEAREST LOT LINE ~L~)~
ORWIDTH /~// / '
' ,LENGTH /'~ , DEPTH
SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
,-"'"-'~, NEAREST LOT LINE OF LINES
NUMBE~..., /'"" DISTA~ / FF EC-IIVE
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE,T.(D FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
/-
WELL: TYP . _-,~, DEPTH. , BUILDING FOUNDATION, ~ SAMPLE _ , NEAREST
i/~)/'..~ NEAREST SEPTIC SEEPAGE .,,,.,-~. OTHER
LOT LINE _ , SEWER LINE ~' ,TANK ~ , SYSTEM ~-'" CESSPOOL , SOURCES__
DIAGRAM OF SYSTEM
I
DISTANCES:
= 4,"
DATE
HEALTH AUTHORITY
GREATER ANCHORAGE AREA BOROUGH
HEALTH DEPAkTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE
Le.g'al DescriptiOn: Lot~Blo~k
This Fcrm Reports a: Soxls Log
Depth
Feet
!
Soil Characteristics
Was Ground Water Encountered? __ :/~.~, ,~
Yes, At What Depth .......
Location Sketch
Reading Date Gross Time Net Time Depth .To H20 Net Drop
er¢ola-t£'o-n ~ate- -]."/ ................. ' .........
M ini]t~ ........
Froposed Installht-ion:- Seepage Pit / Drain Field
OepttrOf Inlet Depth' T0 Bo:~tom"O~it Or Trench- - ' · .....
d · ~ . ~ / - , '
~,: ~ ,L,~ ~/..~ .~ ~._ ~,? ~ ~ ~.~ ..... . ..............
Form Approved
FHA F°rm-2~-7~. U. S, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT BudGet B ..... No. 63-R296.B !
lev. July 19'58 FEDERAL HOUSING ADMINISTRATION
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
~NSURING OFFICE MORTGAGEE SERIAL NO.
MORTGAGOR OR SmNSOR PROPERTY ADDRESS
Cecil ~it~e Const ~eho~. aaah ~t 8
-- ' J LOT NO.
SUBDIVISION NAME ~OCK NO.
I
TOTAL
NUJJJ~I
C.n ~e ~ e~er ama be mode In~
BASEMENT
LIVING UNITS IEDIOOMS lATHS
(fl Yes, how manyf)
WA~R SUPPLY IY~ SYSTEM DESIGNED FOR
~j Public system ~ ~mmuni~ system ~ Individual
~ ~blic system ~ ~mmunity system ~ Individual ~ Yes ~ No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPE~OR'S SKETCH
~---~ '~ I
It is [he opinion o~ ~he ~ Sca[e ~ Coun~ ~ ~cal g~parcmen[ o~ Health [hac chis individual wa~e~-supply .syscem
~ is ~ is hoc s~ds~acco~y ~s a domestic water supply ~or che subjec[ p~o~r~.
o~ me ~ State ~ County ~ Local Depa~men~ or Heakh tha~ mis individual
is
o~J~Jon
sewage-disposal
sys-
cern wkh proper maintenance:
~ Can ~ expired [o Cuncdon saddac[orily, and ~ ~nno[ be exacted to Cuncdon satisfactorily
is no~ likely to c~eace an insank~ condition/
DATE SIGNATURE ..... / ./~ ~./ / -" / TITLE
NOTE: The heq~h auth~ should complete the appropriate o~nion statement above and a~x date, signature and title In the
spaces provided. ,'/ / /
Use of the above ~or Health Department Inspector's sketCh as well as use of the back of this form is at the option of the
heal~ authority.
PART Ill.--FOR USE OF FHA OFFICE
TO THE CHIEF UN~RWRI~R:
~wa~e dis~sal ~ ~oasMezed ~ Accep~ble ~ N~ Acceptable.
DATE SIGNATURE ~ CHIEF ARCHITECT
DEPU~ FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 257;3
Rev. July 1958