HomeMy WebLinkAboutBROOKWOOD BLK 1 LT 9
GAAB-HD I
GI~,C. ATER ANCHORAGE AREA BOROI'GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION ~r' J/~ (~')-[~ ~/~,
SEPTIC TANK:
DISTAN C E F ROM W EL~/~ ~/~.. ~- ~'~.O
LIQUID CAPACITY I. ~ GALLONS.
MATERIAL ~) C./~.~-T'~ NUMBER OF (
COMPARTMENTS
)
INSIDE LENGTH , DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
"--'- OR WIDTH
.DISTANCE FROM W ELL~,/
NEAREST LOT LINE
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
/
LENGT. /"( ,DEPTH
, BU,LD,NO FOUNDAT,ON~
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE ~ROM WELL //~~ATION NEA~OTLINE ,OF LINES
ABSORPIIO ~ ~ ~__~~ SQ. FT. LEN~
IN. ABOVE TILE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
;TP .-~,,~o~,'~v *-,."~.s-..,c~,o,,,, w~,~-~,~.,d
WELL: TY ~.(C,(,...~::9 , DEPTH '- , BUILDING FOUNDATION V SAMPLE ~ NEAREST
NEAREST SEPTIC ~//.~.. SEEPAGE OTHER
LOT LINE V SEWER LINE ~ ., TANK SYSTEM ~/~- , CESSPOOL '"-' , SOURCES__
DIAGRAM OF SYSTEM
DISTANCES:
-~z~ ~a~'
DATE
APPROVED/' HEALTF( AUTHORITY
Form Approved
FHA Form 2573 u.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Budget Bureau No. 63-R296.8
Rev. July 1958 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.
An,~ora~e, Alaeka First ~e~eral Savings ~ ~ 111-~100~
MORTGAGOR OR S~NSOR PROPERTY ADDRESS ~t 9 Blk 1
Cecil ~uph~e Co~t. Rain~ow ~i~ ~cho~
SUBDIVISION NAME K~CK NO. jla, ~o.
Can ~c ~ o~er oma be made In~
TOTAL NUMBERz BASEMENT ~ ~ew ~fiSC~]~C~Gfi a~iflonal b~om~?
LIVING UNITS BEDROOMS BATHS
(If Yes, how manyf)
WA~ SUP~Y BY~ SYSTEM DESIGNED FOR
~ Public system ~ ~mmuni~ system ~ Individual .o. oFDORMS. GARBAGE*DISPOSAL
~k~WAGE DIS~SAL BYz
[~ ~blic system ~ ~mmunity system ~ Individual .: ~ Yes ~ No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPE~OR'S SKETCH
..... .... - -
........ ~ .... ~ ..... ~ ~ '
............. ~ ~ ~
....... ~ ........ ~- ---~ ~~ --- __
........ ............ .... -
..... ~ ~ ~ ....... ~ ........ ~ ......
:ZSZ~Z - ~ ' ~-' ~ ' ~ ......
~ ~ ~-- y .....
-- --- ~- --~ ~
.....
........ ~ ~ ....~ - .
, . ~ ~ ........ ~ ~--~- ---
~ ~ ~ ' ~_~___
~ .... ~ ~ .... ~ .---
...... ~ -~
--~-~
It is the opinion of the ~ State ~ Coun~ ~ L~al Department of Health that this individual water-supply system
C~NI~
~ ~s ~ ~s not satisfactory as a domestic ~ater supply For the sub)eot
It ~s the open,on o~ ~he ~ Stem ~ County ~ ~oca~ Depar~mem o~ ~eakh that th~s ind~v~dual se~a~e-d~sposa~ sys-
tem ~(h proper m~ntenance:
~ Can ~ exp~ted to function satisfactorily, and ~ ~nnot be exacted to function satisfactorily
is not likely to c~ate an insanit~ condifio~ ,
~ATE SIGNATURE / / / /-"' / TITLE
.... ' . <, ,/ ,-/. 9~ 5 .' / Enviro~ental l~alth ~rvisor
spaces provided. ~ /
UJJ at t~J J~ovJ J~ 'for Health DepQrfmeflt IflIpoctor'~ lkltJh ~1 well ~ uli of the ~ock of thil torm IJ Qt the option of the
PART,IIh--FOR USl OF FHA OFFICJ
TO tH! CHIIF UNKRWRI~R~
I have r~iewed the foregoing and the ~minent FHA Complialce Ins~aion Repom, and recommend that the
Individual water-supply system ~ considered ~ Acceptable ~ Not Acceptable
~wage dis~sal ~ considered ~ Acceptable ~ Not Acceptable.
DATE SIGNATURE ~ CHIEF ARCHITECT
~ DEPU~ FO~ CHIEF
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2573
Rev, July 1958