HomeMy WebLinkAboutBROOKWOOD BLK 2 LT 10
GREATER ANCHORAGE AREA BOROUGH
DaDartment of Env~ronment~l. Quality
3500 Tudor Road, Anchoraqe, Alaska 99507 279,8686
DaLe Received
Time of Inspection
3.
4.
5.
'~EQU~'ST~;. · . _ FOP.~ APPROVAL OF
' D
IN .... IDJAL SEi~ER & WA/E,. F^CILITIES
, · ~ [ : .~ -..
~ - ~ ~ . ~_~ ~ ' ,/ .
Number of Bedrooms:
Sewege Disposal Systat:
c.~eptic Tank: 1.
Size /tt-~-~ 2. Manufacturer
D. Seepage Pit: 1. Size 2. Material
A. Well To~ Sentic T~nk , Absorption Area , Sewer Lines
, ?,Ice, rest Lot. ldne
· Other Contamination .
B. Fo,zndatiov. '~..'2. So:-tic T3nk ~ / '> Absorption Area
C. Absorotton Are~ to Heare~t Lot Line /0
Requ-~t for Approval of ~n 'idua! Sewer & ~ater Pmctltttes
Page' T~o
A.~rove . ~ Di,~agoroved
An?fora? Valid for One Y~ar Fz-om Date Siqned
Greate? Anchoraqe Are~ ~orouoh, Department, of ~nvironmenta] Quality
D?AGi~AM OF SYSTEM.
I certif" that the information contained in this request for approval to be a true
and accurst, reore~ent~ti~m of the ~biect sewer and w~ter f'actlities located
~ Form Approved
FHA Form 2573 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8
,ev.J.,y,gS8 HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.mTO BE COMPLETED BY FHA
INSURING OFFICE MORTGAGEE SERIAL NO.
MoRTGAGoR OR SPONSOR PROPERTY ADDRESS
SUBDIVISIO~~NAME
TOTAL NUMBERJ BASEMENT New installation additional bedrooms?
LIVING UNITS BEDROOMS BATHS ~ ~M (If Yes, how many,)
WATER SUPPLY BY:~ ~ SYSTEM DESIGNED FOR
SEWAGE DISPOSAL BY:
PART fl.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
~ -
It is the opinion of ~e ~ State ~ Coun~ ~ Local 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 be expected to function satisfactorily, and ~ Cannot be expected to function satisfactorily
is not likely to create an ins~ta~ condition
DATE ~ . SIGNATURV / TITLE
NOTE: The health authority should complete the appropriate opinion statement abov~a a~x date, signature
spaces provided,
Use of the above grid for Mealth Department Inspector's sketch as well as use of the back of this form is at the option of the
health authority.
PART III.~FOR USE.OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
I have reviewed the foregoing and the pe~inent FHA Compli~ce' In'pelion Repo~, and recommend that'the
Individual water-supply system be considered ~ Acceptable ~ Not Accep~ble
DATE SIGNATURE ~ CHIEF ARCHITECT
,f ~ DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2573
Rev. July 1958
61
· omu!m zod sUOIl~8
· o~nu!m aod SUOllg~?' 'plo!,{ oagtu!xoadd¥ qaaj'
'gu!ss~ jo q~doG q?u!s~ jo od,(L
'q:dap lnOI 7saqau!
:UOli~naisuo) IleM
'Ioodssa~ '.3aaj '~!d
'JaVas alp '.~aaj'
'uopgpunoj 3u!pl!n[l
· aaaj 'uo!mlIOd a. lq!ssod jo so,mos aaqao :aaa.;'
'plait l~Sods!p '.:laaj- '~tulrl ~!~das '.3aaj'
· '.~a: [] 'ap!s [] 'luoJj [] 1~ aU!l :oI 3sa,~au '.3aaj
· [[a/~ pa~ot~ [] '[[a~ ~n(~ [] '[p~ ua^!:(~ [] '[P~ P~iI!:~ [] :moo/qddns
'3aaj' "au![ LlJadoJd ~uoJj tuoJj >p6q ~s 3U!iTa~(i 'daap ~aaj' 'ap!~ 3aaj ':a~s 30'1
· sma;sAs 16sods!p-a:?6t~,as pu6 Xiddns-:a:6,~ 16np!^!pu! q;oq q:!~ padola^ap l?u!aq lou aa6 [] aJ* [] pooqJoqqfi~!ou u! sa.llJadoJd
Jal6,,a jo Alddns a:6nbop6 qs!mn.j o~ th!m)!^ a:6!pamm! u! Sllata jo aJnl!gJ jo p:oaaJ luaaaJ lsotu ah!O
'pooqsoqq~?!au u! th6tuolsn> lou aJ6 [] aJ6 [] Silata i6np!a!pui
· saqau! 'u!6cu jo az}s '3aaj 'u!6cu Jo36nx a!lqnd lsa~6au o3 a~ums!(l
WIISAS MIddflS-il:llV'/~ ~¥flCllAI(3NI--NOII:)BdSNI :10 lllOdlll
'saqau!
'saqau!
':aaj
-sUOll6:~
-:aq:O 'auo:s ua~lost:I []
'ap6:l~ qs!u[t m al}a jo dol 'qlda(I
'saq>uaJ1 jo Klolloq LI! 6aJl,' uo!ldJosq6 an!laaJja I61o. I, 'saqau!
'sau![ uaa~laq a~ums!~ 'saU!l jo JaqtunN '~aaj
".~aJ [] 'ap!s [] 'luoJj [] 16 aU!l loI lsaJ~au '.lOaj 'uo!16punoj '.laaj
I6!Ja~6m :?u!u!'I 'SUOll6fi' 'thpgd~> p!nb!"I 'laaj
'~6aJ [] 'ap!s [] '~umj [] ~6 au!i ~Ol ~sa~au ~aaj
· loaf ~ 'qldap p!nb!'I 'laaj
· 'luamlJ6dtuo> lalU! .41p6d6D 'suoll6fi~
sauamla6dcuo~ jo JaqtunN
· Iaa6:O [] :16!:m6m :a;l~ jo MX[
'aU!l qa6a jo
'qlpva qauaJi
'saU!l ai!l jo q~uaI ImoI
'iiaz,A :mojj ^auras!(I
:PI®Il Ios°dsl(3 ®111
r~' '? ~?/07/:' .,~