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Home My WebLink AboutBROOKWOOD BLK 3 LT 11 ~ TO · State Veterans Adndn' "ration Loan Section SUBJECT Loan Approval Certificate Sewer and Water MIIIAO[ FROM Lot 11 Block 3 Brookwood Subdivision is approved as certified April 23, 1979. The con~nUnity water supply is periodically sampled by the State of Alaska to insure the community being served is drinking safe water. Rmmml.y SIGNED Redi~rme 4S 471 Poly Pak (50 sets) 4P471 SIGNED SEND PARTS 1 AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WITH REPLY DATE DETACH AND FILE FOR FOLLOW-UP DEPT. OF F:~ALTk & MUNICIPALITY O F ANCHORAGE ENV RONMENTAL ~'~ ~ E .... ~ DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION ~//~, ~ ~,~ - 825 L Strut - A~hora~, Alaska 99501 ~ I ~/J ENVIRONMENTAL ENGINEERING DIVISION : ~ ' T. lephon, 264-4720 " R ~ C ~ 1 V ~ D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete raqu.~ ,will not be proceed. Please allow ten (10) days fo~ processing. 1. PROP~RTYOWNER · , " ' PHONE " ..... ~1 G DHE 8 .... PHON~ 2, BUY~~ · · ~( ~ ~ ~ / MAILING ADDRESS ' ~' " ' ii i il i~ I I T1 I ' i m ir i i ri m i i i nlm i r I I 5. LEGAL/.. oT. ../DESC.,PT, u'l i~ EET, LOCATION 6. TYPE OF ~ESIDENCE NUMB~ OF B~DROOMS ..... SINGLE FAMILY [] MULTIPLE FAMILY '7. WATER SUPPI'Y I'-I INDIVIDUAL* ~ COMMUNITY [] PUBLIC UT/LITY 8. SEWAGE DISPOSAL SYSTEM ' [] INDIVI DUAL/ON-SITE** PUBLIC UTILITY [] One ~ Four [] Other , [] Two [] Five [] Three [] Six * ATTACH WELL LOG, A well log is required for al[wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available,) ** fi ..... I nd~wdual/on-s~te, gwe nsta tat on date , , If system is over two (2) years old an adequacy test is required by this Department NO?E: THE INSPECTION FEE MuST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) ................... TIME THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS TIME DATE RECEIVED TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE i-]PUBLIC UTILITY Connection Verified i'--ISeptic Tank or []Holding Tank Size: If Tank is homemade give dimensions: NUMBER OFBEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX [] OTHER 3ERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE I NSTA LLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line ' Septic/Holding Tank IAbsorption Area. ISewer Line INearest Lot Line 5. COMMENTS It~.""APPROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE LEGAL DESCRIPTION BY,~(~(Title) ~. II 72-010 (Rev, 3/78) Form Approved FHA Form ~573 u.s. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Budget 8ureou No. 63-R296.8 lev. 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. MORTGAGOR OR S~NSOR PROPER~ ADDRESS SUBDIVISION NAME ~ ..... ~CK ~NO' ] LOTtiNG. NUMB~ TOTAL Can ~c m o~er ama be made Into BASEMENT ~ ~eW Jfistal]atJofi a~lflonal b~moms? LIVING UNITS &eDROOM$ BATHS (If Yes, how WA~R SUPPLY BY: SYST~ DESIGNED FOR ~ Public system ~ ~mmuni, system ~ Individual .o. o, ,~,~. ~ ~blic ,y,tem ~ ~mmuni,y ,y~,em ~ Individual 2 ~ Ye, ~ No HEALTH DEPARTME~ INSPE~OR'S SKETCH , .... ~ - ...... N~ ..... _. .--. , ..... , - . ~ .- _~-- -- ~ ~-~ ~__ _ ,_ __ -q ~-~ ....... Z ....... ~-~ .... ~_.~- --.~ .... ~ ~ .... ..-~..-, .... .--. ~ --- .... .... _: , ~ ..... ~ ~-~ .......... opinion of the ~ State ~ Coun~ ~ ~cal Department of Health that this individual water-supply It the ~ is ~ is not satishctory as a domestic water supply for the subject proart. opinion of the ~ State ~ County ~ Local Department of .ealth that this individual sewage-disposal It the sys- tem with proper maintenance: ~ Can ~ expected ro function satisfactorily, and ~ ~nnot be exacted to function satisfa~orily is not likely to create an in~anit~ condition NOTE: The healt~/au~l~ should, complete the appropriate opinion statement above and a~x dote, signature ~nd rifle in the lpa~e~ 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 heal~ authority. PART III.~FOR USE OF FHA OFFICE TO THE CHIEF UN~RWRI~R= ] h3vc r~i~wed ~ foregoing and the ~inent FHA Compliance Ins~ion Repom and recommend that the Individual water-supply ~y~tem ~ considered ~ Acceptable ~ Not Acceptable ~wage dis~al ~ considered ~ Accep~ble ~ Not Acceptable. DATE SIGNATURE D CHIEF D DEPU~ FOR CHIEF ARCHITECT HIALTH AUTHORITY APPROVAL INDIVIDUAL WATIR SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2573 Rev. July 1958 GAAB-HD I GJ~'rATER ANCHORAGE AREA BORO HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: MAILING '~1~ ADDRESS ,~,Jl ,~)l~,~"(l~O,~.,/ PHONE. DISTANCE FROM WELL MATERIAL ~0~~-~ NUMBER OF / '--"-- COMPARTMENTS '"'~'~'~'~'~'~'~'rl/A~-~'~ll~/4"~ f/ii(4'//( (~ LIQUID LIQUID CAPACITY '7'~O GALLONS. INSIDE LENGTH INSIDE WIDTH __DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: LINING MAT, /,,,~'DU'TLDING FOUNDATION__ NEAREST LOT LINE__ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION , NEAREST LOT LINE NUMBER OF LINES ~' DISTANCE BETWEEN LINES ~' · TRENCH WIDTH ABSORPTION AREA /~O SQ. FT. LENGTH OF EACH LINE. /'~"/' DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LENGTH /~,,.,~ ~ OF LINES IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: LOT LINE TYPE DISTANCE FROM WATER SAMPLE CESSPOOL , NEAREST OTHER , SOURCES__ DISTANCES: DATE DIAGRAM OF SYSTEM APPROVED HEALTH AUTHORITY GAAB-H D-2 Case No. GREATE._ ANCHORAGE AREA OROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK ., SEEPAGE PIT ,DRAIN FIELD TO SERVE THE FOLLOWING FACILITY PERCOLATION TEST RESULTS/~7 ~~ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT ,OTHER. THIS IS TO SERVE AS ,~,~, M~;~O,~ , PERMIT TO INSTALL A BELOW. SIZE OF UNIT TO BE SERVED AS DESCRIBED .SEPTIC TANK SIZE ..'~5~-~ TYPE ~r/~2%EEPAGE AREA 4 DIAGRAM OF SYSTEM DISTANCES: / '-H;alth Au'thority-- 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. DATE APPLICANTS SIGNATU / _ RE,