HomeMy WebLinkAboutBROOKWOOD BLK 3 LT 10
GAAB-HD-I
GP~ATER ANCHORAGE AREA BORC
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
. . ADDRESS 32.1"'10~EE_~NI PHONE
LOCAT,ON "~ff~aY~ $~. LEGAL DESCR.PT.ON Zr..'Z- ,'~ Z~"'.,C .~
SEPTIC TANK:
DISTANCE FROM WELL '-"-'-- MATERIAL C~.,'~--~"'"'/~-.~ NUMBER OF
COMPARTMENTS /
LIQUID CAPACITY /~'~ .GALLONS. INSIDE LENGTH ,INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS ~E DIAMETI~R ~~'~ , LENGTH ~-'"'"~TH
LINING M BUtLDING FOUNDATION__
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
FOUNDATION , NEAREST LOT LINE
DISTANCE BETWEEN LINES TRENCH WIDTH
~ so. FT. LENGTH GE EACH L,NE l&'
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH ~'~/1/'
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
DISTANCE FROM
LOT LINE SEWER LINE .,TANK , SYSTEM , CESSPOOL.
DIAGRAM OF SYSTEM
DISTANCES:
WATER
SAMPLE
NEAREST
OTHER
SOURCES__
DATE
APPROVED
%~"'~ HEALTH"AUTHORITY
GAAB-HD-2 Case N o.
GREATEi. ANCHORAGE AREA bOROUGH
flEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIBENCE ADBRESS
LEGAL BESCRIPTION
, DRAIN FIELD ~"~' , OTHER
APPLICATION TO INSTALL: SEPTIC TANK /~ SEEPAGE PIT
TO SERVE THE FOLLOWING FACILITY
FINANCEB THROUGH P~--/~ TO BE INSTALLER BY
BELOW TO BE FIllED O~T BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
· SEPTIC TANK SIZE
DISTANCES:
,fff/~, ~&Ot~- PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED_
/~ TYPE ~I~SEEPAGE AREA
DIAGRAM 0F SYSTEM
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.
FHA Far:m 2S73 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.
MORTGAGOR OR SPONSOR PROPERTY ADDRESS
SUBDIVISION NAME J BL~)CK NO. LOT NO.
Can attic or other ar~a be made into
TOTAL NUMBER: BASEMENT New installation additional bedrooms?
LIVING UNITS BEDROOMS BATHS
(If Yes, how martyr)
WATER SUPPLY BY: SYSTEM DESIGNED FOR
E] Public system [] Community system J--J Individual NO. Of BD.MS. GARSAGE'DISPOSAL
SEWAGE DISPOSAL BYI
~ Public system J~ Community system [] Individual '~. [] Yes J--J No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
~- ~--_ _ _~ --~ -~ _
----~ ~. ~---- -~- , ~ ' ._~_
& '
-~ -.~ , ~- .... ~-_ --~_ _
..... ~__.~ ~_-~_ _
....... ~-~-- ...... -~ ~- ~ ~ ~ ........
.... ~- -~ : ~ .... ~.
It is the opinion of the J~J State J--J County JX-J Local Department of Health that this individual, water-supply .system
JJ~J is [-'J is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the J--J State r-1 County ~ Local Department of Health that this individual sewage-disposal sys-
tern with proper maintenance:
h Can be expected to function satisfactorily, and Cannot be function
expected
to
satisfactorily
is not likely to create an insanitary condition
/ / ~ ,' '" "' nvironmental Health Sui~rvtsor
NOTE: The heolt~aut~lty should, complete the appropriate opinion statement above and affix dote, signature end 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 ['-1 Acceptable [-] Not Acceptable
Sewage disposal be considered D Acceptable O Not Acceptable.
DATE
SIGNATURE
~'l CHIEF ARCHITECT
["-1 DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATIR SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2573
Rev. July 1958