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HomeMy WebLinkAboutBROOKWOOD BLK 4 LT 6 7z-o' FHA Form 2573 Form Approved Rev. July 1958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8 ~' ~' HEALTH AUTHORITY APPROVAL INDIVIDUAL INATER SUPPLY AND SEINAOE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. MORTGAGOR OR SPONSOR PROPERTY ADDRESS SUBDIVISION~i~ii~iii~iij~i~NAME ~ J BLOCK~it NO. LOT NO.6 I TOTAL NUMBER: Can attic or other area be made into [~ New installation additional bedrooms? BASEMENT LIVING UNITS SEDROOMS BATHS (If Yes, how many~,) WATER SUPPLY BY: SYSTEM DESIGNED FOR [] Public system~t~ Community system~l I Individual No. OF BDRMS, GARBAGE DISPOSAL SEWAGE DISPOSAL BY: E~] Public system [---] Community system [] Individual ~J r-1 Yes [] No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH -- ...... :---: ...... ~-. - ..:_..:-. .~ ~. ~ .......... ..... .- ..... ....... ~---- -~- , 4- -~'~ ' "~ ....... ~.--__- _~--___ _ ~ ~- ..... ~ -~ ....... ....... ~_..., ......... ~-~, ~" .... :, .... ., ....... ~----r----~ -~ '~ E - ....... ,_ _~_.~ ..... -~ ~---- _~---~-.-~ ~- ..... ...... ~-----~-4 ' -- ~-,- ....... ~---- . ~.-- ,..,. ~--,,~.--,~~ ~- ............. . .... ,,. ' _~ ~- _~.~ . ..... ~ ..... ~ , -~-~---~ , ~_ ~ -- t i! . 7- ~ ...... ..... .. ~_-~. ~ ..... .~ It is the opinion of the D 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 [~1 State J--J County J~] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: 1~ Can be expected to function satisfactorily, and~ ' N Cannot be expected to function satisfactorily is not likely to create an insanitary condition DATE SIGNATURE r~ TITLE i - .Imm 2s lg70 / ', ;~ ~ ~. Sanitarian NOTE: The health/authority should complete the appropriate opinion statement above and affix date, signature and title in the spaces provided. Use of the abo~e grid for Health Department Inspector's sketch as well as use of the back of this form is at the option of the health autho~ity.~: ,'/ 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 N Acceptable [~ Not Acceptable Sewage disposal be considered [~ Acceptable [~ Not Acceptable. DATE SIGNATURE F-'I CHIEF ARCHITECT r"-'l DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2573 Rev. 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, SECONDARY TREATMENT consists of [] Tile disposal field. Tile Disposal Field: Distance from: Well, Total length of tile lines. Trench width Length of each line, Type of filter material: [] Gravel. gallons. Capacity inlet compartment, feet. Liquid depth, Number of compartments [] Cesspool. gallons. feet. feet. .feet. square feet. .inches. feet; nearest lot line at [] front, [] side, [] rear, feet. Liquid capacity, .gallons. Lining material [] Seepage pits. Other inches. 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 Depth of filter material beneath tile,~ inches. Depth of filter material over tile. Seepage Pits: Number of pits . Outside diameter, feet. Depth, Distance from: Well, __ feet; building foundation,_ Inspection made by: [] State. Date of inspection feet. Lining material feet; nearest lot line at [] front, [] side, [] rear, [] County. [] Local Health Authority. Inspected by. 19__ (TITLB) f~t. REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main,_ __ feet. Size of main, inches. Individual wells [] are [] are not customary in neighborhood. Give most recent record of failure of wells in immediate vicinity to 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. [] Bored well. Distance of well from: Building foundation, .feet; nearest lot line at [] front, [] side, [] rear, cast iron sewer, feet; tile sewer, seepage pit, feet; cesspool, Well construction: Diameter, inches. Total depth, Approximate depth to pumping level of water in well, Sealed watertight to depth of feet. Exterior space around casing sealed with: [] Cement grout. feet; septic tank, feet; disposal field, feet; other sources of possible pollution, feet. feet. Type of casing, Depth of casing, feet. Approximate yield, gallons per minute. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. Pump: [] 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. [] Local Health Authority. Inspected by Date of inspection , 19__ gallons per minute. (TITLB) feet, feet; ,feet. ~' U, S, GOVERNMENT PRINTIHG OFFICE: 1957 O-F--427038 GRI=ATER ANCHORAGE AREA BOROU~,H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /~ ~ ~ #CNCL"' LOCATION SEPTIC TANK: MAILING ADDRESS / LEGAL DESCRIPTION,/'-~'-~ ~JJ(, I,./ _t~,~O/('~.)O0~J ~ub'~ DISTANCE FROM WELL LIQUID CAPACITY /0~t~ 1"7D/ MATERIAL Cl~ ~ ~,./~ ~ ~ NUMBER OF COMPARTMENTS I GALLONS. INSIDE LENGTH g INSIDE WIDTH 3 ! DEPTHLIQUID SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH LENGTH , DEPTH DISTANCE FROM WELL BUILDING FOUNDATION__ 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 9¢'/ FOUNDATION .DISTANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH,,,..,. ~..,.~ , NEAREST LOT LINE OF LINES o~/ "~/"-'/ , TRENCH WIDTH IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE ,,gl IN. ABOVE TILE WELL: ~ O t~'I M t,) K) I '7'~ TYPE , DEPTH NEAREST LOT LINE SEWER LINE SEPTIC , TANK DISTANCE FROM BUILDING FOUNDATION SEEPAGE SYSTEM WATER SAMPLE CESSPOOL NEAREST OTHER , SOURCES__ DISTANCES: I DATE APPROVED GAAB-H D-2 GREATEL ANCHORAGE AREA ..OROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT Case N o. ,~ J ~::::)e''- RESIDENCE ADDRESS /~"~/ ~'~t~'~;/~ LEGAL DESCRIPTION 1 APPLICATION T0 INSTALL: SEPTIC TANK ~- .,SEEPAGE PIT , DRAIN FIELD TO SERVE THE FOLLOWING FACILITY .~_~4~4raa~. FINANCEBTHROUGH~~, ~~-~ ~, TO REINSTALLED BY ~~- PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION MAILING ADDRESS ~/6 ?/~j~,~ . PHONE No.PJ LOCATION OF INSTALLATION~r~K~ ~-z-'~d/L~'/. ~ _, OTHER BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS /~- 5'~/2-'/v~'' ~' , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ue4-F__ · SEPTIC TANK SIZE / OOO ~;,~.TYPE AREA DIAl RAM OF SYSTEM .TYPE DISTANCES: 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. DATE ~'//)..... / ~6~ APPLICANTS SIGNATU RE dREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGE. ALASKA~99501 CASE Le~al Deseriptlon: LOt ~___Block ~.__S0bdi. vision '~,oo~u~o~ This Form Reports a: Soz~.sLog i~ ~;'. ::perColation Depth Feet Location Sketch Was Ground Water Encountered? If Yes, At V/hat Depth .... Reading Date Gross Time Net Time Depth To H20~ Net Drop Fropt,sed Installation:' Seepage Pit ~' DPaln Field Dep:h Of Inlet Depth To Bottom Of' Ipit or Trenc~ ............... Test Pemfo~me~ By l.:_~e~c c O . . .