The URL can be used to link to this page

Home My WebLink AboutBROOKWOOD BLK 4 LT 4016- TZ- t l - , Form Approved FHA Form 2573 u.s. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Budget 8ureou No. 63-R296.8 Rev. July 1951 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 ~ ~ Can ~c ~ o~ ama be rode In~ TOTAL NUMAR: ~SE~NT ~ew ~SCSJJGCJOn a~fl~al b~msl uw.o U.~TS .~DROO~S ,Ams (If Yes, how man~) WA~R SUPRY IY: SYSTEM DESIGNED FOR ~blic system ~ ~mmuni~ system ~ Individual ilWA~! ~II~IA[ IY: l~ ~blic system ~ ~mmunity system ~ Individual ~ ~ Yes ~ No PA~T II.--TO BE COMPLETED BY NEALTN HEALTH DEPA~TME~ I~$PE~OR'$ SKETCH ~ ~ ~___~ .......~ - . .... ~--~-~ ..... _ ---~- ~---~ ~ ~ ~-~-- 'ZZZ~ ........ , .... ~ ...... ~ ~ ~ ~--, ~ ~ ~~ ~'~ ~'~ --- --- ~ ~--- -~ - _.__ _~_ . _ .... : ~ - .... ... _ -~---- ~ .... ~ .............. ~._ _~ ~_ . , ~_ - ............. ..... , .... ~ ~ ~ -- ~ ----~ I ~, ........ ::::::::~ .... , .......~ , ~--~ .... . .__~ ..... ..... :__~ ~ ~ ~ ~--' ~ ~ .... . ..... ~'''' ....... .~ ~ .... ~'" ~_.'' ~ ' ~---:~ ~ ........ ~ .......... b--~... ~..m. ~ _~ .-- ..... lc is the opinion o~ ~e ~ Scare ~ Coun~ ~ ~al Department o~ Health tha~ this individual water-supply ~syscem ~ is ~ is no~ satisfactory as a domestic water supply ~or the subject proart. I, is the opinion of the ~ State ~ County ~ Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: Can ~ expired to function satisfactorily, and ~ ~nnot be exacted to function satisfactorily is not likely to create an insanit~ condition gTE I SIGNATURE I TITLE NOTE: The health outhori~/should complete the appropriate opinion statement above and a~x date, signature end title in the spaces provided. Use of the above grid 'for Health Department Inspector's sketch as well os use of the bock of this form is at the option of tho heol~ authority. PART Ill.--FOR USE OF FNA OFFICE TO THE CHIEF UN~RWRI~Rs I have r~iew~ the foregoing and the ~ninent FHA Compile)ce Ins~ion Report, and recommend that the Individual water-supply systcm ~ considered ~ Acceptable ~ Not Accep~ble ~wage dis~sal ~ considered ~ Accepoble ~ Not Acceptable. DATE SIGNATURE ~ CNffF A~CHIfECf DEPU~ F~ CHIEF ARCHITE~ qlALTH AUTHORITY APPROVAL FHA Form 2573, INDIVIDUAL .TlR SUPPLY AND SlWAG! DISPOSAL . .,TIM 8,,. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. Septic Tank: Distance from well,~.feet. Material Total liquid capacity, Inside length,_~ feet. Inside width, Cesspool: Distance from: Well, . feet; foundation, Inside diameter, feet. Depth, .~CONDARY TREAT~NT consists of [] Tile disposal tield. Number of compartments [] Cesspool. gallons. Capacity inlet compartment, feet. Liquid depth, .feet. feet; nearest lot line at [] front, [] side, [] rear, feet. Liquid'capacity, gallons. Lining material [] Seepage pits. Other. gallons. Tile Disposal Field: Distance from: Well, Total length of tile lines,. ~: Trench width Length of each line, ~ Type of filter material: [] Gravel. Depth of filter material 'beneath tile, Seepage Pits: Number of pits .... Outside diameter, feet. Distance from: Well, feet; building foundation, Inspection made by: [] State. feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. Number of lines Distance between lines inches. Total effective absorption area in bottom of trenches feet. Depth, top of tile to finish grade, [] Broken stone. Other inches. feet. square feet. inches. inches. Date of inspection Depth of filter material over tile. Depth,. feet. Lining material feet; nearest lot line at [] front, ~-I side, [] rear, [] County. [] Local Health Authority. Inspected by 19__ (TITL£) REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main __ __ feet. Size of main, inches. Individual wells [] are [] are not custotnary in neighborhood. Give most recent record of failure of wells in immediate vicinity m furnish adequate supply of water Properties in neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems. Lot size: feet wide .... feet deep. Dwelling set back from front property line, feet. Individual water supply from: [] Drilled well. [] Driven well. [] Dug well. [-l Bored well. Distanca of wall from: Building foundation cast iron sewer seepage pit, Well conltr~ctlon: feet; tile sewer, feet; cesspool, .feet; nearest lot line at [] front, [] side, [] rear,. f~et; septic tank,, feet; disposal field, feet; other sources of possible pollution, 'feet. Diameter, inches. Total depth, feet. Type of casing, APproximate depth to pumping level of water in well~ feet. Approximate yield, Sealed watertight to depth of feet. Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. P~mp: [] Shallow well. [] DeeP well. Length of drop pipe, feet. Pump capacity, Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No. Type of storage: [] Pressure. [] Gravity. Capacity, gallons. Has bacteriological examination of water been made? [] Yes. [] No. if answer is "yes," give date Quality of water [] is [] is not satisfactory for human consumption. Installation [] does [] does not comply with approved exhibits, if any. Inspection made by: [] State. [] County. [] Lot'al Health Authority. Inspected by Date of inspection 19 Depth of casing, .gallons per minute. gallons per minute. ( TITLE ) feet~ feet; feet. HUD.Wash., D. C. GAAB-HD-I GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION SEPTIC TANK: D~STANCE FROM WELl LIQUID CAPACITY / 200'+' MATERIAL A D D R E S ~/,'_,.,~.,,,,~,-- LEGAL OESCR,PTION Z¢ PHONE GALLONS. NUMBER OF COMPARTMENTS /9~ ~ ;~~,D WIDTH DEPTH__ 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 21~)0 ~ / FOUNDATION ABSORPTION AREA ~'l~'''~0 DEPTH: TOP OF TILE TO FINISH GRADE Z / / NEAREST LOT LINE DISTANCE BETWEEN LINES TRENCH WIDTH / SQ. FT. LENGTH OF EACH LINE ~'"'"~" DEPTH OF FILTER MATERIAL BENEATH TILE / / Z7 TOTAL LENGTH~//_ OF LINES F~:;~ IN. TOTAL EFFECTIVE 3`/ IN. ABOVE TILE WELL: TYPE ~/14/1'/~/L); ~ DEPTH I' NEAREST SEPTIC LOT LINE SEWER LINE ., TANK DISTANCE FROM WATER BUILDING FOUNDATION SAMPLE NEAREST SEEPAGE OTHER SYSTEM , CESSPOOL , SOURCES~ DISTANCES: ,~'.-').,~--. 2~, / ~'~>,~= I~' / DIAGRAM OF SYSTEM DATE APPROVED GAAB~H D-2 GREATE,, ANCHORAGE AREA HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 dOROUGH 279-2511 Case No. <~ SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT RESIDENCE ADDRESS ~.~ / ~ O~ LEGAL DESCRIPTION, APPLICATION TO INSTALL: SEPTIC TANK PERCOLATION TEST RESULTS MAILING ADDRESS~ /~O~C,~ PHONE NO~ ! O AT, , SEEPAGE PIT. ,DRAIN FIELD ~ ,OTHER TO BE INSTALLED BY A~T~¢,P^~EO ~ATE O~ COM~T~O~ BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT AS DESCRIBED BELOW· SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE 7 ~--,%~ TYPE ~SEEPAGE AREA ~-Z~ TYPE DIAGRAM OF SYSTEM DISTANCES: alth 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. DATE ~-"~///~f/ APPLICANTSSlGNATUN.' ~~A,~ )/~ )/~"~- ALASKA TE S T LA B 1940 Post Road Anchorage, Alaska Client ~-~/~/'zJ~? '¢ '"/~" '- ~ ./'"/"'~v ~,~ ,~ T. H. No. F~ NO-. ~/~ 7 Tech. ~cation, ~t ~ _ ,Block ~ Sheet... / of ~ '.__. 'WO No, Date_ g/W~c,v' f -/ z Depth Fee t PERCOLATION TEST DATA Soil class Visual - Unified Location c,k..tch Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation ?ate 1"/ 7,/ ;.,nnute.