HomeMy WebLinkAboutBROOKWOOD BLK 2 LT 5OIb- 181-30
ARCTIC ALASKA TESTINe LABORATORIES
1940 POST ROAD BOX 843
ANCHOR~ FAIRBAN KS
P~.RGOI.A. TION TEST DATA
TES~T HOLE NO
w.o.
TECHNICIAN.
LOCATION LOT~ BLOCK
FHA NU~ER ........ ·
CLIENT ~
~L CLA~ ~ ~IF~O ~CATI~ SKETCH
,~_T~ ~8~. ~E ~ APP.. _ TOP08.
REAMNO ~ TIME H,O
4
FROST
NET DROP
LEGEND
GRAVEL
8ANO
SILT
CLAY
ORGANIC
CONTENT
PEAT
WATER
TABLE
lOX e4~ OATE. ~
FAtI~IAN ~ 'rEGI, tNI~AN, ~
CLIENT ~l~c,,IAf //4~S.~ .... .'_ . -
L.~eEND
GRAVEL
SILT
CLAY
OReANIC
CONTENT
PEAT
WATER
TABLE
I FHA Form 2573 Form Approved
Rev. July 1958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8
HEALTH AUTHORITY iAPPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
INSURING OFFICE MORTGAGEE SERIAL NO.
Anchoeage, A~Laeke. l~ret Nat'l Bank of Anchorage 111-0Oh036-~[~)~
MORTGAGOR OR SPONSOR PROPERTY ADDRESS
Allan J, Ba~£, ~,~~h~&~,
SUBDIVISION NAME BLOCK NO. LOT NO.
Bz, oocheood 3/D
Con otti¢ or other areo be made into
__ TOTAL NUMBER: BASEMENT [-~ ~ew installation additional bedrooms?
,~wNo UN~TS BEDROOMS SATMS
(If Yes, how many~)
WATER SUPPLY BY: SYSTEM DESIGNED FOR
J--] Public system [~] _Community system ~] Individual
SEWAGE DISPOSAL BY:
[--'] Public system ~] Community system [~] Individual h ~ Yes [-'1 No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
~- ~- -~ ~- -~ __
___~-_~_~___~_~ _~_-_~_.
It is the opinion of the [~] State ~i County ['-'J Local Department of Health that this individual water-supply system
[--1 is [~ is not satisfactory as a domestic water supply for the subject property.
of the ~'~ State [-] County ~Local Department of Health that this individual sewage-disposal
It
is
the
opinion
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 "
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 [--] Not Acceptable
Sewage disposal be considered ~ Acceptable ['-] Not Acceptable.
DATE SIGNATURE [--'1 CHIEf: ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2573
Rev. Ju~y 1958
REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PRIMARY TREATMENT consists of [~geptic tank.
Septic Tank:
Distance from well, ?. .feet. Material.
Total liquid capaci~ / ",,:7,
Inside length, ?' feet. Inside width,
Cesspool:
Distance f?om: Well, ,. ? / '~' feet; foundation,
Inside diameter, feet. Depth,
SECONDARY TREATMENT consists of {~/Tile disposal field.
Tile Disposal Field:
Distance from: Well,
Total length of tile lines~
Trench width
Length of each line
[] Cesspool.
Number of compartments
gallons. Capacity inlet compartment, gallons.
.feet. Liquid depth, feet.
feet; nearest lot line at [] front, [] side, [] rear;
feet. Liquid capacity, .gallons. Lining material
[] Seepage pits. Other
feet.
feet; foundation · 7, > feet; nearest lot line at [] front, [~Side, [] rear,
fees. ~Nuu~ber of lines ~. r~ Distance between line~,
inches. Total effective absorption area in bottom of trenches,
feet. Depth,~ top of tile to finish grade,
Type of filter material: [] Gravel. [] Brokep/stone. Other .~ ', ~ '~"
Depth of filter material beneath tile,~ /" inches. Depth of filter material over tile.
Seepage Pits:
Number of pits . Outside diameter, feet. Depth, feet. Lining material
Distance from: Well,
Inspection made by: [] State.
feet.
feet.
square feet.
inches.
feet; building foundation,_ feet; nearest lot line at [] front, [] side, [] rear,.
[] County. [] Local Health Authority.
Inspected by
, 19
(TITLE)
inches.
feet.
Date of inspection
REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM
Distance to nearest public water main, __ __ feet. Size of main, inches.
Individual wells [] are [] are not customary in neighborhood.
Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water
Properties in neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems.
Lot size: feet wide, feet deep. Dwelling set back from fi'ont property line, feet.
Individual water supply from: [] Drilled well. [] Driven well. [] Dug well. [] Bored well.
Distance of well from:
Building foundation
cast iron sewer, .feet; tile sewer,
seepage pit, feet; cesspool,
Well construction:
Diameter, inches. Total depth,
.feet; nearest lot line at [] front, [] side, [] rear,
feet; septic tank,. .feet; disposal field,
feet; other sources of possible pollution, feet.
Approximate depth to pumping level of water in well,
Sealed watertight to depth of feet.
Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill.
Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No.
Pump: [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity,
Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit.
Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No.
Type of storage: [] Pressure. [] Gravity. Capacity, gallons.
Has bacteriological examination of water been made? [] Yes. [] No. If answer is "yes," give date
Quality of water [] is [] is not satisfactory for human consumption.
Installation [] does [] does not comply with approved exhibits, if any.
Inspection made by: [] State. [] County. [] Local Health Authority.
Inspected by
Date of inspection 19
feet. Type of casing, Depth of casing,
feet. Approximate yield, .gallons per minute.
.gallons per minute.
feet~
feet;
.feet.
19__
(TITLE)
'i~ U. S. GOVERNMENT PRINTING OFFICE : 1957 O-F--427038