HomeMy WebLinkAboutBROOKWOOD BLK 1 LT 18C)I -1'11-0'1
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Qumlit¥
3600 Tudo~ Road, Anchorage, Alaska 99507
e
3.
4.
5.
T1me of Ins~ection
D~te of ~ns~ect~on
R~QUBST FOR APPROVAL'QF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Type of Fact l~v ~o be
z/ - '~ .~; " .....
~uabe~
We~ Data z
Sewege Disposal Syst.m:
C. Septic Tank: 1.
D. Seepage Pit= 1. 1ze 2, Material ~..~
A. We].l Tos 5antic Tank , Absorption A~ea , Sewer ~nes
, Nearest Lot Line , Other Contamination .
B, Foundation to ~ ? "
,:~..ttc T~nk ~ AbSorption A~ea
C. AOsoro~ion Are~ to Nearest lot Line
Request for Approval of Individual S'ewer & Water Facilities
Page Two
9. Comments: ~~ ,a~,~ ~oX~ ~d ~?
m~ ~/,~ ~ - ,~, ,~0~ ~ ~ .......
Ap~rova~ V~lid ~or One Year From D~e
Greater Anchorage Are~ ~oroueh, DeFartment of Environment~l Quality
DIAGRAM OF SYSTE~
! certif7 that the info'rmation contained in this request for approval to be a true
and accurate representation of the m]biect sewer and water facilities located at,
Signed ~ Date..
202 E. FIREWEED
ABCT][C EXC. AVAT]I'~G
ANCHORAGE, ALASKA 99503
Jack "-"~ '~' --
&-L-.,.20Z t
NORMAN LAMgERT
Phone 272-773
9~' hrs. bee':cboe ~ 22,00
90 fro 4 in. drain tile
2 90° turns
I roll felt
Pump cesspool
40 ~c
6.5O
4o,cc
,3547.5 3
FHA F'&rm 25'~3 · Form Approved
Rev. July 1958 U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Budget Bureau No, 63-R296.8
FEDERAL HOUSING ADMINISTf~ATION
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTI:M
PART I.--TO BE COMPLETED BY FHA
'~NSURING OFFICE MORTGAGEE SERIAL NO.
TOTAL ~M~R~~ Can ~ ~ o~er a~a be made In~
LIVING UNITS IEDROOMS BATHS ~SEMENT I~ New installation a~lflonal b~oms?
WA~R SOPPY IY~ SYST~ DISIGNED
~blic system ~ ~mmuni, system ~ Individual No. oF SDRMS GARSAOE*DISPOSAL
SEWAGE DIS~SAL BY~
~ ~blic system ~ ~mmunity ~ystem ~ Individual a ~ Yes ~ No
PART fl,--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPE~OR'S SKETCH
- -~ ~ _~_ __ ~ ....
..... 2 ........ 2 ....
It is the opinion of ~e ~ State ~ Counw ~ ~al Department of Health that this individual water-supply .system
,~ is ~ is not satisfactory as a domestic water supply for the subject properS.
It is the opinion of the ~ State ~ County ~ Local Department of Health
that
this
individual
sewage-disposal
sys-
tem with proper maintenance:
.~ Can ~ exp<ted to function satisfactorily, and ~ ~nnot be exacted to function satisfactorily
is not likely to create an insanit~ condition
-- SIGNATURE
DATE
SIGNATURE
~ CHIEF ~RCHITECT
DEPU~ F~ CHIEF ARCHITECT
HIALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2573
Rev. July 1958