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Home My WebLink AboutBROOKWOOD BLK 2 LT 6 FHA Form 2573 Form Approved Rev. July 1958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.mTO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. Anchorage, Alaska First National Bank of Anchorage 60-007436 MORTGAGOI~ OR SPONSOR PROPERTY ADDRESS Allan J. Harris Anchorage, Alaska SUBD,V,S,ON NAME BLOCK NO. [LOT U~. l~O0~Od Subd~vi~:~on [] Can attic or other area be made into TOTAL NUMBER: BASEMENT ~Tew installation additional bedrooms? LIVING UNITS BEDROOMS BATHS (If Yes, how rnany~) WATER SUPPLY BY: SYSTEM DESIGNED FOR F-1 Public system F~ Community system J--1 Individual No. OF BDRM$, GARBAGE DISPOSAL SEWAGE DISPOSAL BY: Public system Community system Individual [5] Yes PART IL--TO BE COMPLETED BY HEALTH DEPARTMENT ,,.,...,,,.... .... --h..14.j.----. =.,./. ~ .-- ...... _- ..... g ...... 2___Z- -ZZi iZZ-_-Z u It is the opinion of the ~-] State [-'-} County [~ Local Department of Health that this individual water-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. It is the ()pinion of the ~ State r~ 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 DATE SIGJ~,~TU RE ~ TITLE NOTE: The health authority should complete the appropriate opinion statement e a d afflx date, signature and title iff 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 r-] Not Acceptable 'Sewage disposal be considered [--] Acceptable [~] Not Acceptable. DATE SIGNATURE [--'I CHIEF ARCHITECT CHIEF ARCHITECT DEPUTY FOR HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2573 Rev. July 1958 · alnu!tu Jad SUOlIe2 · alnu!m ~ad suoil~S 'Su~se2 jo qldacl · ~aaj 'uo!lnliod alq!ssod jo sa~Jnos ~aqlo '.laaj plait lesods!p '.laaj "~tum 9Ddas '.laaj 'aea~ [] 'ap!s [] 'luoJj [] ~ au!I loI lsaJeau loodssa~ '. 3aaj aid 'IIa/~ pa~o[t [] 'lla~ 2nG [] 'lla,~ ua^!JO [] 'lla~ PaiiVCI [] :tuoJj Xlddns Jale~ l*np!a!puI 'au!I Xl~adoJd ~uoJj tuoJj ~peq ~as ~U!lla~G 'daap ~aaj' 'ap!~ ~aaj :azq. s ~o~I · stualsXs Fsods!p-al~e~aas pus Xlddns4a~eax lenp!a!pu! q~oq qlVa padolaaap l~u!aq lou aJe [] a~e [] pooqJoqqS!au u! saDsadoJd aalem jo Xlddns alenbape qs[mnj al ~h!up!a al~!patutu! u[ Slia~ jo aJnl!~J jo pJo~a:~ luavaa lsotu aa!rD · pooqJoqqS!au u! /aemo2sn> sou az, [] aJe [] Slia/~ lenp!a!pul · saqvu! 'mmu jo az!s 'laaj- --'m~m sal~ax >!lqnd lsaa~au al a~ums!o WIISAS AlddI1S-IIIIV~A 1VflOIAlONI~NOI131dSNI t0 lllOdtll (WI&II) '~}~oqlnV qlleaH lmOq ~ '~unoD ~ 'al*iS ~ :lq epom uoD~sul · l~j~'lg~j ~ 'op~s~ 'l~oJj ~ le Cu~l ~oI lsoJeou '.~*oj~'uoDepunoJ Su[pI[nq '.~**j- 'lla~ :mo~j o>uns~G 'saq>u! · ~aaj aJ~nbs '~aaj 'laaj 'laaj ~aq~o smaua~edmo~ jo JaqtunN 'q~dap p!nb!q 'laaj 'luatu~edmo> lalU! X:q~edeD 'SUOll*l~ WIISAS ~YSOdSIG-tOYAA1S 1Yfl(IIAlaNI--NOII:)tdSNI t0 J. tiOd:ltl and water factl ..... ~, a% ~ Sinc~r~ly, _ ~-~,, -DE pA RTMENT~OF~HEA. CTH~ ~ENVJRONMENTA L PROTECTi 0N - 208.~est 13~ Av~ue ~aqe, A~a~ka 99501 3.-LENDING INSTITUTION MAILING ADDRESS ' ~ ~ - " ' ~ .... 645G ~% ~chpra~e, A~aaka 9950~ ~ · ~ REALTOR/AGENT ~' - ~. HONE ~t~ ~aIty/~~ ~1~ _ ~ 272-0571 ~uN~Aee~ss ' ' ' ......... 724- ~t 15~ AV~ Alaska 99502 I~ SING LE FAMILY One PLE FAMILY * ATTACH WELL LOG. A well log s required for a 1 wel s dr lied ~ince June-J975. For wells dril!ed prior tothat date. givewell [] PUBLIC UTI LITY, _ _ depth (attach log ifavailable.) _- t INDIVIDUAL/ON-SITE ' If ~ndlv,dual/on-slte, g~ve ,ns~allat,on date~. ]- [] ;:~J';~-' C UTI~'IT~ ' ' Ifsystem:,; isover two (2)years od an adeq~acy test is required I NOTE~ INSPECTION FEEMUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, THIS SIDE FOR OFFICIAL USE ONL DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE INSPECTOR INSPECTOR DATE NSPECTOR )IRECTIONS: 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] TWO [] FOUR [] FIVE [] SiX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUi~LIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or []Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED -INSTALLER SOl LS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area Sewer Line Absorption Area to nearest Lot Line 5. COMMENTS Lot Line [~. ~,,~PPROV ED FOR BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE LEGAL ~)ESCRIPTION BY (Title) 72-010 trey. 3/78) 172 163 ~k 171 ~(~l:--- 173 178 Creek Area Reference Map-P13 GREATER ANGHOPJ~GE AREA BOROUGH D.~.Da~tment Df Bnv1~onmeD~al Qu~lf~v 3500 Tu~o~ Roa~, ADcho~a,D~, Alaska 99507 Date Receive4 Time of Inspection REQ'.;E?,T FO;? APDROVAI. OF INDIVIDUAL SEtNE!R & WA~R FACILITIES FO~ _ __ , ,,, Address ~ Phone: Description: ~ ~ ,, , ~ ..... ~u~b~ of B~d~oom~_ ~ ..... Wel 1 D~te: A. Tvoe ~._ C. Construction ~5./U._ 7, Sewage Disposal 3vstom: 8. Deoth D. ~acterta! A'nalys:ls~¢/~,//~ff ~ 0.~-... A. Installed ~-/__0-~.~ .... a. Install. er C. Septic Tank: 1.. :Size 0','11 2. Manufacturer D. Seepage Pit.' !. Size 6;~/~ 2. Material ~. Dlsposal Fie]d: To%al. Lenqth of Lines Distances: A. Well To: Senttc Tank , Absorntion Area , Sewer Lines Lot line · Other Contamination Foundation to e · .:entu. c Tank ' ~. Ab',~orotton Area . AOsorotton Area to Nearest Lot Line Reque~-t for Approval of ~ndivfdua! Sewer & Water F~ctlitles Page Two 9. Comments, ~.~~ ~ _~ ~./?./ ~~/ Approv~ Valid for One Y, ar From Date S~gned Gre~ter Anchorage Area Borough, Department of P-nviron~.ental Quality DIAGRA~ OF SYSTE~ I certtf,l that the info'naatfon contained in this recmest for approwl to be a true and accurate representation of the ~ubiect sewer and w~ter facilities located at: May 2G, 1971 Veterans AdministratiOn P.O. Box 1399 Anchorage, Alaska 99501 SUBJECT: Sewage Dtsposal and Water Supply for Lot Block 2, Brookwood Subdivision; Ron Eggert, Owner Dear Sirs: Sewage Btsposal for the subject lot is by septic tank - soil absorption system which appears to be functioning satisfactory. . Water is supplied by one of the Brookwood Utilities' wells which is a water source approved by this Department. Sincerely, John R. Lee, R.S. Sanitarian rn ;REATER ANCHOR,AGE AREA BOROUGH I-!EALTH DEPARTb,!ENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 279-2511 REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES FOR 4, Type of Facility to be Inspected Number of Bedrooms Well Data: A. Type B. Depth C. Size D. Construction E. Bacterial Analysis 6. Sewage Disposal System: A. Septic Tank (If homemade, show diagram on back) 2. 3. 4. Manufacturer Installer Approval Request £or Se~ Page Two Water Facilities B. Seepage Pit 1. Size 2. Lining C D2sposal Field 1. Number o£ Lines., 2. Total Length, Required Measurements c. l D. E. }Vell to Other Possible Contamination F. Foundation to Septic Tank G. Foundation to Seepage Pit /_f' H. Seepage Pit to Property LineUP Well to Septic Tank Well to Seepage Pit Well to Sewer Line Well to Property Line 8. COUNTS: DISAPPROVED: DATE: APPROVAL VALID FOR ONE YEAR FRO~.I DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT EDllTO Form Approved FHA Farm ~1573 u.s. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Rev~ July 1958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63.R0296 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA ~NSURING OFFICE MORTGAGEE SERIAL NO. Ran Eggert 13~51 MORTGAGOR OR SPONSOR PROPERTY ADDRESS Matanuska Valley Bank 1922 Dolly Varden Street , NO. [ LOTTO. SUBDIVlSIONNAME Brookwood Subdivision TOTAL NUMBER: Can attic or other area be made into ~ New installation addl~onal bedrooms? BASEMENT LtVING UNITS BEDROOMS BATHS : s (If Yes, how manyf) 3 J--'J Yes J~] .No r---j Yes ~$o WA~R SUPPLY BY: SYSTEM DESIGNED FOR ~ Public system ~ ~mmuni~ systemIIIndividual ~ ~blic system ~ ~mmunity system ~ Individual ~ Yes ~ No PART fl.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPE~OR'S SKETCH ~ ~ t ................. It is the opinion of the ~ State ~ Coun~ ~ Local Department of Health that this individual water-supply system C0mmunity Water ~is ~ is not sads{actory as ~ domestic water supply subject properS. the I, is the opinion of the ~ State ~ County ~ Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: Can ~ expected to function satisfactorily, and ~ ~nnot be expected to function satisfactorily is not likely to create an insanita~ condition Aug. 2, lg71j,.{Sent°r Envt~0nmental Spectalt~ NO,Et The health authorl~ ,heuld. eemplete the appropriate opinion ,tatement above and a~x date, signature and title In the Ume ef the above g~d 'for Health Department In~peetor's ~ketch as ~mm ~, ~,~ o( the ~ae~ ~ thim form i~ at the option of the heal~ authority. mmm. mo usm om ommmcm I have r~iewed the foregoing and the ~inent FHA Complia)ce Ins~ion Repo~, and recommend that the Individual water-supply system ~ considered ~ Acceptable ~ Not Accep~ble ~wage dis~sal ~ considered ~ Acceptable ~ Not Acceptable. DATE SIGNATURE ~ CHIEF ARCHffECT DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2S73 ReVl July 1958