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Home My WebLink AboutBROOKWOOD BLK 1 LT 20 P-517OIG- 1'71-0 GAAB-HD- I GRr~TER ANCHORAGE AREA BOROL'~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION ADDRESS LEGAL DESCRIPTION /-"~/''' "~"('")f /~" / SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY NUMBER OF , MATERIAL Ci~) J~_..l~,, ~". 'r~ COMPARTMENTS GALLONS. INSIDE LENGTH .,,/i ~.." INSIDE WIDTH ~ '/'"J" I LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE OUTSIDE DIAMETER OR WIDTH DISTANCE FROM WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH , DEPTH BUILDING FOUNDATION__ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL. ,ANUMBER OF LkNES ~O 0 SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE NEAREST LOT LINE. TRENCH WIDTH TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE DEPTH OF FILTER MATERIAL BENEATH TILE WELL: C~'~ . TYPE DEPTH NEAREST SEPTIC LOT LINE SEWER LINE , TANK DISTANCE FROM WATER , BUILDING FOUNDATION SAMPLE NEAREST SEEPAGE OTHER SYSTEM , CESSPOOL SOURCES__ DISTANCES: DIAGRAM OF SYSTEM DATE APPROVED HEALTH AUTHORITY GAAB-HD-2 GREATE.. ANCHORAGE AREA ,OROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICAI~~ RESIDENCE AD D R ESS ~/.z-~'~?~ LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY MAILING ADDRESS.¢~'~,¢¢~° '~"~ PHONE NO. LOCAT, ON OF ,NSTALL^T, ON - SEEPAGE PIT ,DRAIN FIELD ~ ,OTHER FINANCED THROUGH /~'./'/-/</ - TO BE INSTALLED BY-.-'~'~ ~ PERCOLATION TEST RESULTS ~:::~¢:~ ~ ~'00A'/ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS ~..P,.,/C ~P/'¢/~/~ '~ PERMIT TO INSTALL A ~'~'~ZT'~ ,~'Y~')'~',,'~'~ AS DESCRIBED BELOW. SIZE OF UNITTO BESERVED ~ ,~~O~ SEPTIC TANK SIZE /O0~.TYPE ~~ SEEPAGE AREA ( F"" TYPE 0 DIAGRAM OF SYST~, DISTANCES: Hoalth Authodt¥ I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE ?/'(0 {///~' APPLICANTS SIGNATURE GREATER ANCHORAGE AREA BOROUGF, HEALTH DEPARTMENT ~ ~ E 327 EAGL S~REET ANCHORAGE~ ALASKA' 99501 CASE # J i ! I Location Sketch Reading Date [ Gross Time Net T~me Depth T Net Drop ercb'l'~z6h' "'~ate' l"'/ -'-~q'ini~v~_ ........ , ................. Installat~on: Seepage Pit Drain F.i. eld Depth Of Inle~ ... : ._ : ..... Dep%h To' B'otto~ 0'~' 'Pit Or COMMENTS · Form Approved FHA Form 2573~ u.s. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Budget Bureau No. 63-R296.S Bev. July 19Sa ~ ' FEDERAL HOUSING ADMINISTRATION HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.mTO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. MORTGAGOR OR S~R ..... PROPER. A6bR~SS ~t ~O ~k 1 TOTAL NUMBER; - Can ~c ~ o~er a~a be made Into :, ~SEMENT ~ New installation a~lflonal b~moms? UW~G U.~TS SeD.OOMS (If Yes, how mon~) I 'l Public system ~ ~mmuniW system ~ Individual .o. SEWAGE DIS~SAL ~ ~blic system ~ ~mmuaity system ~ Individual ~ ~ Yes ~ No PART II,--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTME~ INSPE~OR'S SKETCH ----~---~ ~ ~----~ ~ ~ ..... ~--~---- · , .... ._ ..... .... ..--~..--~..~ ..... . ~ ..... ~ -'~ ~ ~--~ ~ ...... ~ ~--~ ........... .. . .... ......... . ...... - . --~ ~ ......... ~ ~ ~ --- .... ~ .... ~-. - ......... ~-- - ~ -- It i~ the opinion of the ~ State ~ Coun~ ~ Local Department of Health that this individual water-supply .system ~ is ~ is not satishctory a~ a domestic water supply for the subject properS. It i~ the opinion of the ~ State ~ County ~ Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: Can ~ expired ro function sati~hctorily, and ~ ~nnot be exacted to function satisfactorily is not likely to create an in~anit~ condition ~paces provided. Use of the above g~d ~for Health Deportment Inspector's sketch as well os 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~RWRITER: I have reviewed the foregoing and the ~inent FHA Complim]ce Ins~ion Repo~, and recommend that the Individual water-supply system ~ considered ~ Acceptable ~ Not Accep~ble ~wage dis~sal ~ considered ~ Acceptable ~ Not Acceptable. D DEPU~ FOR CHIEF ARCHITECT HIALTH AUTHORITY APPROVAL INDIVIDUAL WATIR SUPPLY AND SEWAGE DISPOSAL SYSTIM FHA Form 2573 Rev. July 1958 FHA Form 257'3 ? U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Form Approved Rev. July 1958 ~ ~ Budget Bureau No. 63-R296.8 FEDERAL HOUSING ADMINISTRATION HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA iNSURING OFFICE MORTGAGEE SERIAL NO. Anchorage ~ Alaska MoRTGAGoR OR SPONSO, ~RO~ERT~ ADDRESS Cecil .0o Dauphtnee SUBDIVISION NAME [ BL6CK NO. l'OTNO. Bz, ookwood Subdivl~c~ 1 20 D Can attic or ot~er area be made Into TOTAL NUMBER: BASEMENT New installation additional bedrooms? LIVING UNITSBEDROOMS BATHS (If Yes, how manyf) F-lYes F-1$o UlYes IDSo WATER SUPPLY BY: SYSTEM DESIGNED FOR El Public system [~] Community system El Individual .o. oF SDR.$. GAREAOE'DISPOSAL SEWAGE DISPOSAL BY: ~E! Public system D Community system ~ Individual [-] Yes N No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH ~ _ .~l ...... ~ .......... _ ~ ~__ ~ ...... ~_ .......... ~ -- _ It is the opinion of the r'-J state__L-'] County . .~ Local Department of Health that this individual water-supply ~ is ['-1 is not satisfactory as a domestic water supply for the subject property. It is the opinion of the ~}1 State m County ~ Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: [] Can be expected to function satisfactorily, and [~ Cannot be expected to function satisfactorily is not likely to create an insanitary condition NOTE: The health authority should, complete the appropriate oplnlGn ~tatemant above and Gfflx date, signature and title in tho spaces provided. Use of the above grid 'for Health Department Inspector's sketch as well as use of the back of this form Js at tho 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 [--1 Acceptable El Not Acceptable Sewage disposal be considered D Acceptable D Not Acceptable. DATE SIGNATURE [~] CHIEF ~CHIT~CT U HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2S73 Rev. July 1958