HomeMy WebLinkAboutLot 25
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
REQUEST FOR APPROVAL OF
INDIVI-DUAL SEWER AND WATER FACILITIES
FOR
LEGAL DESCRIPTION:
TYPE FACILITY TO BE
NUMBER OF BEDROOMS:
WELL DATA:
A. TYPE
~PPROVAL
REQUESTED
BY:
ADDRESS: /,)~ ~
B. DEPTH
C. SIZE
D. CONSTRUCTION
E.
BA~TF~AL ANALYSIS
SEWAGE DISPOSAL SYSTEM:
A. SEPTIC TANK (IF HOMEMADE,
1.
2. AGE
3. MANUFACTURER
4. INSTALLER
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
7. REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE
D. WELL TO PROPERTY LINE
E. WELl TO OTHER POSSIBLE CONTAMINATION
F. FOUNDATION TO SEPTIC TANK
G. FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
8. COM'MENTS:~
APPROVED: DISAPPROVED:
DATE: DATE:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY
FHA Form 2573
~ Form Approved
'"k,~==~ U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT ~ ~
FEDERAL HOUSING ADMINISTRATION ~? Budget Bureau No, 63.R0296
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
INSURING OFFICE
Anchorage, Alaska
MORTGAGOR OR SPONSOR
Newton, Donald T. & Serafima
SUBDIVISION NAME
Southwood Park S/D ~1
TOTAL NUMBER: / 1 BASEMENT
Ur'NO U~'rS 'DSOOMS J BArns r-q ~
Yes No
i ~ ii '
WA~R ~UPPLY BY:
[~J Public system
PART I.--TO BE COMPLETED BY FHA
MORTGAGEE SERIAL NO.
The First National Bank of Anch. LH 185 184
PROPERTY ADDRESS
2400 Rasberry Road, Anchorage, Alaska 99504
BLO~K NO. LOT25NO'
[] New installation
J--]Community system
SEWAGE DISPOSAL BY:
--1 Public system
[~J Community system
Can attic or other area be made Into
additional bedrooms?
(If Yes, how rnafly~)
~O. oF SYSTEM DESIGNED FOR
Individual
IBDRMS. GARBAGE DISPOSAL
Individual [] Yes [] No
PART Fl.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMEI~FF INSPECTOR'S SKETCH
It is the opinion of the [] State [] County J--J 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 J--] State J~J County
tern with proper maintenance:
[] Can be expected to function satisfactorily, and
is not likely to create an insanitary condition
'~ATE J SIGNATURE
]Local Department of Health that this individual sewage-disposal sys-
J-]Cannot be expected to function satisfactorily
JTITLE
NOTE: The health authority should, complete the appropriate opinion statement above and affix date, 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
FO THE CHIEF UHDERWRITER.'
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 J~J Not Acceptable.
DATE SIGNATURE
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAl SYSTEM
CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
FHA Form 2573
Rev. Jury 1958
REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PRIMARY TREATMENT consists of [] Septic tank. [] Cesspool.
S~ptic Tank:
Distance from well,__
Total liquid capacity,
Inside length,.
Distance from: Well,
Inside diameter,
feet. Material __
Number of compartments
gallons. Capacity inlet compartment,
feet. Inside width,, t~et. Liquid depth, feet.
gallons.
feet; foundation, __ feet; nearest lot line at [] front, [] side, [] rear,
feet. Depth,. feet. Liquid'capacity, .gallons. Lining material
SECONDARY TREATMENT consists of [] Tile disposal Iield. [] Seepage pits. Other
Tile'Disposal Field:
Distance from: Well,
Total length of tile lines,
Trench width
Length of each line,_
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,
Type of filter material: [] Gravel. [] 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 n~ade by: [] State.
__ feet.
feet.
.square feet.
inches.
Date of inspection
inches.
feet.
feet. Lining material
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.
lndivklual wells [] are [] are not customary in neighbgrhood.
Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water
Properties in neighborh~×~d [] 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.
D4stance of w~lI from:
Buikling foundation
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.
feet; nearest lot line at [] front, [] side, [] rear,
fleet; septic tank, feet; disposal field,
feet; other sources o£ possible pollution, iCeet,
feet. Type of casing,. Depth of casing,
feet. Approximate yield, gallons per minute.
Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill.
Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No.
Pumpt [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity,
Ia~cated 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. [] L(x-al Health Authority.
Inspected by
Date of inspection 19__
gallons per minute.
, 19
feet;
GPO 88g-0 88