HomeMy WebLinkAboutBROOKWOOD BLK 3 LT 901 ,-17Z-Zo
Farm Approved
FHA Form 2573 u.s. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Budget Bureau No. 63-R296.8
Rev. July 1958 FEDERAL HOUSING ADMINISTRATION
.,' HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.~TO BE COMPLETED BY FHA
~NSURING OFFICE MORTGAGEE SERIAL NO.
Aricho~age, Al~ska
MORTGAGOR OR SPONSOR PROPERTY ADDRESS
Ce~i~ O. Da~phinee
SUBDIVISION NAME BLC~CK NO. I LOT NO.
B~ookwood Subdivision ~] g
TOTAL
NUMBERs
Can attic or other area bo made Into
[-~ New installation additional bedrooms?
BASEMENT
LIVING UNITS I~EDI~OOMS ~,ATHS
(if Yes, how manyf)
[--'}Yes DSo [--]Yes D No
WATER SUPPLY BY: SYSTEM DESIGNED FOR
-'] Public system ~ Community systemIIIndividual
%,S,OS^t
SEWAGE DISPOSAL BYt
,~ Public system O Community system [~ Individual [~] Yes [] No
PART IL--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the O 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 opinion of the [-] State O County ~ Local Department of Health that this individual sewage-disposal sys-
tem with proper maintenance:
~ Can be expected to function satisfactorily, and 1--] Cannot be expected to function satisfactorily
is not likely to create an insanitary condition
DATE [ SIGNATUR~r%~ ,~~~,,,,~ 1 TITLE
NOTE: The health authority should, complete the appropriate opinion statement above and affix date, signature and title in the
spaces provided.
Uso of tho above grid 'for Health Department Inspector's sketch as well as use of tho 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 O Acceptable [~] Not Acceptable
Sewage disposal be considered D Acceptable ["-1 Not Acceptable.
DATE SIGNATURE ~ CHIEF ARCHITECT
~ DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2573
Rev. July 1958
GAAB-HD-I
GREATER ANCHORAGE AREA BOROI'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
NAME
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
ADDRESS PHONE
LEGAL DESCRIPTION ~ ~"'~/ '~,3 ~1~0~,/~0~
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
GALLONS.
_MATERIAL ~--~/~C/~ '"J- ~-.,---
INSIDE LENGTH
NUMBER OF ~
COMPARTMENTS
INSIDE WIDTH ~.~ tL/--T ,c DEPTHLtQUID
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 ~;.,~1/~ ,,
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
DISTANCE BETWEEN LINES ! TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE ~q'fS~ ~"~
--~t "~ DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTHo d
, OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
TYPE ~..--~-.,~IP~ .. DEPTH
NEAREST
LOT LINE SEWER LINE
DISTANCE FROM WATER
BUILDING FOUNDATION . SAMPLE
SEPTIC SEEPAGE
, TANK , SYSTEM , CESSPOOL
NEAREST
OTHER
, SOURCES__
DISTANCES:
= I.c
DIAGRAM OF SYSTEM
DATE
APPROVED
~~EALTH AUTHORITY
GAAB-H D-2
GREATEI,. ANCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
OROUGH Case No. C~ -~ ~/
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICAN~
RESIDENCE ADDRESS ~';z~'~,~ ~z/...~_.~(.j~ .~_-E~-
LEGAL DESCRIPTION~"~ ~' /~---~,~' J~
APPLICATION TO INSTALL: SEPTIC TANK / ,SEEPAGE PIT.
TO SERVE THE FOLLOWING FACILITY ,~ ~-w'"~'-'~-
, DRAIN FIELD ~ , OTHER
FINANCED THROUGH ~ .,.A'/ ','/7'~
PERCOLATION TEST RESULTS
TO BE INSTALLED BY~/'~-~' ,~~-~<~
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SiZE OF UNIT TO BE SERVED
DIAGRAM OF ~~/~' ~1~ ~'
Health Authority
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.
/~0 /~ AP, LI CANTS SI G N ATU R ~.~-'~/~'~,~"'~"~-~~
DATE 7t [
Co plai art's Name:
Street Address:
Phone No. ,'~.,",/L/'-~/~.,~(..: BOX No.
NUISANCE COMPLAINT FORM
Name of Person Against Whom Complaint is Made: :¥:'"'.": ,-'.' ': '-' '.
Owner of Property Where Nuisance Exists:
~verre-w' s Address: ~' '~-' ~' Phone No.
I certify that such statement of facts is true to the best of my be-
lief and knowledge. I request that the foregoing matter be investi-
gated and that appropriate action thereafter be taken. I am willing
to testify to the facts stated in the foregoing complaint in court
if necessary.
Compl a i rant
REPORT OF ACTION TAKEN
Investigator:
Date Investigated
Action Taken:
1:?,~,,,,, :',,. '¢. .: . , :,....,,;' f/¢,, . ...... :- ":
DATE COMPLAINANT WAS CALLED REGARDING DISPOSITION OF cOMPLAINT~