HomeMy WebLinkAboutSTATE MANOR LT 1Lo'T'
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dREATER gNCNO,~^GE AREA BOROUGH
Department of Envxronmen~al Qu*lity
3500 Tudor .,Road, Anchorage, Alaska 99507 279-8686
Date Received.~
Time of InsDec~zon /_,
REQUEST FOR APcROVAL OF
I~}IVlDUAL SE¢t?'.R & ',;lATER FACILITIES
FOR
Address:
2. Pro.er~y ~ner: _..
5. Type o¢ FacSl[~y ~o be I~spec[ed: ...... ~.~
~umber o¢ Bedrooms:~ ~__
Well Data:
A. Type Bo Dept.~__
C. Construction D. Bacterial Analysis
7. Sewage Disposal System:
A. Installed B. Installer
C. Septic Tank: 1. Size 2~ Manufacturer____
D. Seepage Pit: ].. Size 2. Material
Disposal Field: Total Length of Lines
8. Distances:
A. Well To: Septic Tank
Absorption Area
Sewer Lines
, Nearest Lot Line
Other Contamination
Bo Foundation to Septic Tank
' ;, Ab§orption Area
C. Absorption Area to Nearest Lot Line
Request for Approval of ~' ;v!dual sewer & Water Fac~l~tl~ ~
Pa'ge Two -
9. Comments:
Approved Pisa~oroved Date
Aporova~ Va~id for One Year From Oa%e
Greater Anchorage Area ~oroush, Department of ~nv~on~enta] Quality
DIAGRAM OF
· contazned in request for approval to be a true
I cerfzfy that the information '' this
and accurate representation of the subject sewer and water facilif~es located at:
Signed Date
~FMA Form 2573
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM __
INSURING OFFICE
Anchorage
MORTGAGOR OR SPONSOR
John V, Nolander
~imothy A. Lutmmn
SU~Vm~ON NAME
State 1.~nor S/D
TOTAL NUMBER~
1 2 !
WAIIR SUPPLY BY:
[] Public system
SEWAGE DISPOSAL
PART I.--TO BE CO~/IPLETED BY ~HA ~ . ,,.~--
~972
[? ~ORTGAG EE SERIf-NO.
Irst National Bank o[ Anchorage ~ 0111:015586
PROPERTY ADDRESS
344-1073 1866 Dare Avenue, Anchorage, Alaska
~ Individual ~o.~,
~ Individual.. D Yes ~ No
Yes [] No
[-"~ Community system
] Commt/nity system
r-[ Public system
PART II.~TO BE COMPLETED BY HEALTH
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the [] State [] County [] Local Department of Health that this individual water-supply system
[] is. [] is not ~tisfactory as a domestic water supply for the subject property, g0r~}IiiUB'l ty We] 1
It is the opinion of the [] State [] County ~ Local Department of Health that this individual sewage-disposal sys-
tem with proper maintenance: Publ i c Sewer
U Can be expected to function satisfactorily, and [] Canno~ be expected to function satisfactorily
is not likeTy to create insanitary condition
........ [£nvironment. ai SerVices- Super.
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 wlter-supply system be considered [] Acceptable [] Not Acceptable
Sewage dispOsal be considered [] Acceptable [] Not Acceptable.
I DATE j SIGNATURE
CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM