HomeMy WebLinkAboutBROOKWOOD BLK 4 LT 801( - 17Z. o7 FHA Form 2573 Form Approved Rev. Jul), 1958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8 .... " ...... ' HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEINAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. Anoho~a~e~ A.taska Cecil Dauphlnee 8&79 MORTGAGOR OR SPONSOR PROPERTY ADDRESS ~290 1/2 ~4~tght n ,,~.&.r..nee Construction Lot 8 Block 4 B=ookwood Subd. (Anchorage) SUBDIVISION NAME BLOCK NO. LOT NO. Brookwood Subdivision # 8 TOT'AL NUMBER: Can attic or other area be made into BASEMENT J~ New installation additional bedrooms? LIVING UNITS BEDROOMS BATHS (If Yes, how many~,) WATER SUPPLY BY: SYSTEM DESIGNED FOR [~ Public system~JxJ Community system--bJ Individual ,o. oF BO,MS. OARSAaE O,SeOSAL SEWAGE DISPOSAL BY: [---1 Public system [--J Community system [] Individual 3 ['--] Yes .[~No PART II.--lO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH - ~ ~___~ ...... ~-~-k--~ _ ~- ..~. ~ ..... ....... r-- ' ~- :"- ~'- -' "~ ~ r- ~ ..... - , ~ , ~- -- --~ ~---~- __ ~- ~- ~_ ..J_ __ .~_L_ ~---~- -- ~___ It is the opinion of the [--] State N County ~ ~Local Department of Health that this individual water-supply system ~--[~[~ N is not satisfactory asa domestic water supply for the subject property. It is the opinion of the [~ State [--I County 1 Department of Health that this individual sewage-disposal sys- an h proper maintenance: be expected to function satisfactorily, and ["-] Cannot be expected to function satisfactorily is not likely to create an insanitary condition [::?~ / SIGNATURE / / ,: / Z TITLE NOTE: The health aut~arity//~ould complete the appropriate opinion statement above and affix date, signature and 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 tho health authority. PART III.~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 ~] Acceptable [~ Not Acceptable Sewage disposal be considered ['-] Acceptable [-'] Not Acceptable. DATE SIGNATURE ~ CHIEF ARCHITECT -'-J 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, SI¢ONDARY TR[ATMENT consists of [] Tile disposal field. gallons. Capacity inlet compartment, feet. Liquid depth, 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, Distance from: Well,_ Inspection mode by: [] State. [] Cesspool. Number of compartments feet. feet; nearest lot line at [] front, [] side, [] rear, feet. Liquid capacity, .gallons. Lining material [] Seepage pits. Other gallons. feet. Date of inspection 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. ..feet. square feet. inches. inches. Depth of filter material over tile, feet. feet. Depth, feet. Lining material feet; building foundation,_ feet; nearest lot line at [] front, [] side, [] rear, [] County. [] Local Health Authority. Inspected by , 19__ (TITLE) 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 cast iron sewer, feet; tile sewer, seepage pit, feet; cesspool, Well construction: 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. 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__ feet; nearest lot line at [] front, [] side, [] rear, feet; septic tank, .feet; disposal field, .feet; other sources of possible pollution, feet. Depth of casing, gallons per minute. gallons per minute. (TITLE) feet; .feet. ,19 ~, u. s. GOVERNMENT PRINTING OFFICE: 1957 O-F--4ZT038 GAAB-HD-I GP'~ATER ANCHORAGE AREA BOROI'GH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL L qUlD CAPACITY I GALLONS. MATERIAL ~I~,~../V, ~ NUMBER OF COMPARTMENTS INSIDE LENGTH 7'~1~ INSIDE WIDTH ~' DEPTHLIQUID 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 NUMBER OF LINES 7 ABSORPT,ON AREA DEPTH: TOP OF TILE TO FINISH GRADE , FOUNDATION NEAREST LOT LINE .DISTANCE BETWEEN LINES ..,,~L,~./~ TRENCH WIDTH SQ. FT. LENGTH OF EACH LINE. --/ DEPTH OF FILTER MATERIAL BENEATH TILLS' TOTAL LENGTH.,..../ ~ OF LINES ..~/~--~, , IN. TOTAL EFFECTIVE IN. ABOVE TILE lc~-./j ~' WELL: LOT LINE TYPE DEPTH NEAREST SEWER LINE DISTANCE FROM BUILDING FOUNDATION. SEPTIC SEEPAGE , TANK / ~ ~ , SYSTEM WATER · SAMPLE ., NEAREST OTHER , CESSPOOL , SOURCES~ DISTANCES: DIAGRAM OF SYSTEM DATE APPROVED HEALTH- AUTH'~OR'JTY - GAAB-H D-2 GREATEI. ANCHORAGE AREA HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 __OROUGH 279-2511 Case No. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT ~f"~,~, RESIDENCE ADDRESS LEGAL DESCRIPTION ~'., SEEPAGE PIT. APPLICATION TO INSTALL: SEPTIC TANK ,DRAIN FIELD TO SERVE THE FOLLOWING FACILITY ~ ~ ~ FINANCED THROUGH F/~- TO BE INSTALLED BY ~ PERCOLATION TEST RESULTS /~¢/,fl/, ANTICIPATED DATE OF COMPLETION ~ff-___r'C'~ BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT LOCATION OF INSTALLATION THIS IS TO SERVE AS · SEPTIC TANK SIZE ,~, ./.~~ PERMIT TO INSTALL A ~ ~; AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ ~ TYPE ,,'~&,4~,4/~:~EEPAGE AREA ~"~ "~' ! TYPE DIAGRAM OF SYSTEM / ' ~i;'t~ 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. APPLI CANTS SIGNATU RE .~,~:~~.~",:~'~ DATE ~ · ,.__ ~,,~ TELEPHONE: 2'72-411,4 ALASKA GEOLOGICAL CONSULTANTS ENGINEERING GEOLOGY ~' MINING ~r GEOPHYBICB 'l~GROUNDWATER ~ PETROI. IrUM 222.7 .q. PENARD ROAD ANCHORAGE. ALASKA 99§03 April 14, 1969 Dauphinee Construction Co. 4290~ Wright Anchorage, Alaska Attention: Mr. Cecil Dauphinee Re: Percola~io. Test, Lot 8, Block 4, Brookwood S.bdivisit,n Gentlemen: This letter is to certify that a percolation test has been conducted on the above-mentioned property. The test was performed in an eight-inch diameter, twelve-inch deep test pit in the bottom of the proposed absorption field. Location of the test pit, the log of the test pit and percolation data are shown on the attached sheet. This test was made in accordance with the Greater Anchorage Area Borough Health Department specifications as prescribed in Appendix B of the National Plumbing Code, 1962 Revision.. Very truly yours, BGP:js ALASKA GEOLOGICAL CONSULTANTS Bruce G. Purcell' Attach. BY ....................... ....... DATE ..................... '~,H K,D. BY .................DATE ..................... SHEET NO ................... OF .................. dOl~, NO ...................... © "co