HomeMy WebLinkAboutPLEASANT GROVE LT 6
FHA Form 2573 Form Approved
Re¥. July 1958 FEDERAL HOUSING ADMINISTRAtiON Budget Bureau No. 63-R296.8
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
INSURING OFFICE MORTGAGEE SERIAL NO.
Anchorag~q~ Alaska First National Bank of Anchorage ]. 1].1:008662-203
MORTGAGOR OR SPONSOR PROPERTY ADDRESS
Lowell D. Chappell & Waneta A. Chapgell L 3730 West 7gth Avenuet Anchorage, Alaska
SUBDIVISION NAME
Lot 6, B].ock 2, Pleasant Gz~ove S/D
TOTAL NUMBER;
LIVING UNITS BEDROOMS BATHS
1 3 1 1/2
BASEMENT . [] New installation
E Yes
E-~ Commnnity system
WATER SUPPLY BY:
--]Public system
I BLOCK2NO. LOT NO.
_ 6
Can altlc or other area be made Into
additional bedrooms?
(if Yes, how many~)
JSYSTEi DESIGNED FOR
m~ NO. OF BDRMS. OARBAOE DISPOSAL
Individual
~ Individual [--] Yes [] No
SEWAGE DISPOSAL BY:
--1 u lic system [--1 Community ys em
PART mi.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the ~J State [] County [] Local Department of Health that this individual water-supply system
['~] is [] is not satisfactory as a domestic ,vater supply for the subject property.
is the opinion of the [] State [] County ~ Local Department of Health that this individual
It
sewage-disposal
tem with proper maintenance:
~] Can be expected to function satisfactorily, and J"-] Cannot be expected to function satisfactorily
ts not likely to create an insauitary condition
TITLE
- "~' ,.1! ', ~ ~ t~ 1~ L/~. ,~,t Sanitarian
NOTE~ The health ~uthorlty ~¢oOId complete the appropri~te opinion statement ~bove and ~x date, signature ~nd title in the
OFFICE OF THE DIRECTOR
DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
fEDERAL HOUSING ADMINISTRATION
P. 0. Box ~80
Anchorage~ Alaska 99501
August 13~ 1969
First National Bank of Anchorage
P. O. Box 720
Anchorage~ Alaska
Re: FHA Case 111-008662-203
Gentlemen~
As requested in your letter of August 8~ 1969~ the condition regarding
the sewer connection on the above case is waived. However~ it will be
necessary that you submit Form 2~73 on the existing system.
Very t~uly yours~
Director
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate>
Name .of pepson ~equestJng approval
.. ... ..................................
4. Numbe~.-.of bedrooms in house
b, Detergent "
a. Type
b. Depth
c. Casing Size
Distance from well to closest existing or proposed:
1. Sewer line
2. Sept J c tank
3, Seepage Area
~, Cesspool'
5. Property Line
6. Other sources of possible contamination~ i.e., creeks, lakes~
houses, barn, drainage ditch, etc.
7. Sewage disposal system,
a. Age of system .
b. Septic tank capacity in gallons
c. Name of septic tank manufactu.m.e..m
de'
1. If "home made" show diagram on reverse side of this form.
Disposal field or seepage pit size and type
Distance
to
property line___~Q~to house foundation ,_.~)0'
Name of person requesting approval
Water..Analysis:
2.' Nan~ of pPoperty~owner
4. Numbew~..o~ ~edrooms in house
5,
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Pill out in Triplicate)
a. Bacterial
O.
bi Detergent '"
6. Well data:
a. Type
b. Depth
c. Casing Size
d, Distance from well to closest existing or proposed:
1. Sawer line
2. Septic tank
3, Seepage Area
~, Cesspool'
5. Property Line
6. Other sources of possible contamination, i.e., creeks, lakes,
houses~ barn~ drainage ditch, etc.
Sewage disposal system.
a. Age of system
b. Septic tank capacity in gallons
c. Name of septic tank manufacturer
1. If "home made" show diagram on reverse side of this form.
Disposal field or seepage pit size and type
Distance to property line ..... .~ .... to house foundation
Percol.atio¥~ Test 'r,esults
f. Percola~;ion Test performed by ...... ,
-~-, Use the reverse ,side of this f'orm to show diagram. Diagram should include
'~.I;he following information: p.ropepty lines~ .well location, house location,
p~i~t{c tank .location~ disposal area location, location of percolation test~
an: direction of ground slope.
9. The 5.~o~,~tlon on this form is true and correct to the best of my knowledge,
'$'igncture of Appl~{~ .............. Date Signed
TO BE FILLED OUT BY HEALTH DEPAP~TMENT PERSONNEL
~T~e above deserlbed sanitary facilities are hereby approved, subject to the
........... ~61!owin f cor~]~.t'~on s .......... ' .......
Conditions: :On_(__
The above described sanitamy facilities are dise. pproved for the following
reasons:
' Signat'ur'e Of "~--f,~fi'ei;~.'l.,. ......., :,. '¥"'m,.
Date ' ,' I,,~/ v~ .:.21
Approval is valid for one year following the date of approval.
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