HomeMy WebLinkAboutCREEKSIDE PARK #2 LT 19I
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~E~TER ANO~OrCaGE AREA BOROIX~
I-~EALTH DEPAR'I) ~NT
327 EAGLE STREET
ANCHORAGE, AIASKA 99S01
279-2511
T FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
FOR ,
x$ ~-t~T OIZT
1. Approval Requested By /l~Z~. ~
Phone ~ ~- ~//,~ ,
2. Property O~ner
3. Legal Description
T~e of Facility to be Inspected
Phone
Number of Bedrooms "~ ~df w~'~
Well Data: .~~,
A. Type
B. Depth
C. Size
D. Construction
E. Bacterial Analysis
6, Sewage Disposal System:
Septic Tank (If homemade, show diagram on back)
1 Size
2. Age ~ ~. -
3. Manufacturer
4. Installer
Water Facilities
Approval Request flor Se
Page T~o
Seepage Pit
1. Size
2. Lining
C. _Disposal Field
1. Number of Lines
2. Total Length
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. CO~qENTS:
DATE: . . ~ DATE:
APPROVAL VALID FOR ONE YEAR FROrl DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT
EDl170
FHA Form ~5~3 ' ' '~---~q~ ' ' --
Rev. July 1958 FEDERAL HOUSING ADMINISTRATION ~ -- ~' Farm Approved
Budget Bureau No. 63-R296,1
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
INSURING OFFICE MORTGAGEE SERIAL NO.
MORTGAGOR OR SPONSOR ~ ~ ~ PROPERTY ADDRESS ~ ~ ~
~ Can ~ic ~ o~er a~a be made Into
TOTAL NUMBER: BASEMENT ~w ~fiSC~]]~C~O~ ad~ol b~moms?
LIVING UNITS BEDROOMS BATHS
(lf Yes, how
: z z ~ ~$o ~v~ ~$o
WA~R SUPPLY BY: SYS~M ~SIGNED FOR
~ ~blic system ~ ~uni~ system ~ Individual No. OF BDRMS. GARAGE DISPOSAL
~WAGE DIS~SAL BY:
~ ~blic system ~ ~mmunity system ~Individual ~ ~ Yes ~ No
PART fl.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTME~ INSPE~OR'S SKETCH
I I I I I I I
I
III III
III III i ,
III III
Ill Ill ~ ~
[[1 [ii I
] [ [ I [[ ,
Iii Iii '
Ill Iii
III III i : :
'
111 III :
III III
III III, ~
III II1~
III Ill i
II I I I I : '
III III
III III ,
III III
Ell Ill
I1[ III ;
III I~1 i '
III III I i I J I ; I
~ i~ ~h~ opi.ion or ~ ~ S~ ~ Cou.. ~ ~o~a] ~pa,~m~n, o~ .~a~h ~h~ ~hi~ in~i~i~a~ ~a~-~pp~
~ is ~ is not satisfacto~ as a domestic water supply for the subject properw.
I~ i~ ~h~ opinio~ oC ~h~ I I S~ I I Coun,y ~ ~o~a~ *~pa~m~n~ o~ ~a~t~ ~a~ ~i~ i~ai~dua~ ~g~-di.o~a~ ~.-
tern with proper maintenance:
~ Can ~ exp<t~ to function satisfa~orily, and ~ ~nnot be expected to function satisfa~orily
is not likely to create ~ insanit~ condition
DATE SIGNATURE. / ~ TITLE
~ ' ' :'r:/~'7 -'
NOTE: T6e 6e.l~ .u~ori~oul~ ~omplete lhe .ppropriote opinion stolement obove on~ .~x dote, signotore ond title In the
~pa~es provided. /
Uie of the above grid for Health Department Inspector's sketch as well as .se ~f the bo~k of this form is at the option of the
he.l~
PART Ill.--FOR USI OF FHA OFFI(E
TO THI (ffill U~IWIlTll:
Individual water-supply system ~ considered ~ Acceptable ~ Not Acceptable
~wage dis~sM ~ considered ~ Acceptable ~ Not Acceptable.
DATE SIGNATURE
CHIEF ARCHffECT
DEPU~ FOR CHIEF
ARCHITECT
III III
Ill II1
I1[ I[I
III III
III III
III III
Ill Ill
III III
III III
III III
III III
III III
III III
III III
III III
111 III
III III
Ill Ill
III III
III III
III III
III III
III III
III III
III III
III III
III III
III I1~
III III
III III
III III
III II1
III III
III III
III III
[11 III
III III
III III
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2S73
Rev. July 19S8