HomeMy WebLinkAboutWALTER G PIPPEL ADDITION BLK 9 LT 12,o
FHA F'orm 2573 ~/~ FEDERAL HOUSING ADMINISTRATION ~-~/ ~°rm AP~r°ved
P~ev. July i955 Budgel Bureau No. 63-R296.8
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.mTO BE COMPLETED BY FHA
INSURING OFFICE
Anahorage~
?ederal Ho~_m!n.~ Adminstration
SERIAL NO.
6O-008525
MORTGAGOR OR SPONSOR
Moder~ Homes, Inc.
SUBDIVISION NAME
Walter Plppol Addition
TOTAL NUMBER:
LIVING UNITS BEDROOMS BATIKS
BASEMENT
[] Yes [] No
PROPERTY ADDRESS
Milo 14, Glenn ttighwa~
BLOCK NO. LOT NO.
9 12
] New installation
Can attic or other area be made into
additional bedrooms?
(if Yes, how rnany~)
E--lYes l~No
1
WATER SUPPLY BY:
[] Public system [] Community system
,EWAGE DISPOSAL BY:
[] Public system [] Community system [] Individual
SYSTEM DESIGNED FOR
[~ Individual No. OF BDRM. GARBAGE DISPOSAL
PART II.~TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
IIIII IIIIIII Illlllll
II """i '"'"'"1""
IJllllll
· "'"'l ""'"'iii
iiiiI1"""'"' ',,,,'"1,,,,,,
I'l'''~ Il,,,,,,,
II I I I II III I I II IIII
Jllljj'"'"
,,,,,,I "Jill
IIII IIl""l "'lJ"l,,,
Ill IIII Jllll
II IIIII tllllJllllllJlll
i ii,,,,,,,i ,,,,,,,,
II I I III I II I I III
II I I II1~ I II ~1 III I
IIIIIIlI IIIIllll
IJll'" Ill ""
IIIJlll
"1,,,,, " '""11
I II
,,,,lllll,,,,,,~,ll,,,,,,,,
It is the opinion of the [] State [] County [] Local Department of Health that this individual water-supply syste~n
[] is [] is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the [] State [] County
tern with proper maintenance:
[] Can be expected to function satisfactorily, and
is not likely to create an insanitary condition
]Local Department of Health that this individual sewage-disposal sys-
~--~ Cannot be expected to function satisfactorily
DATE GNATURE
NOTEJ The health authority should 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 bock of this form is at the option of the
health authority.
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 water-supply system be considered [] Acceptable [] Not Acceptable
Sewage disposal be considered [] Acceptable [] Not Acceptable.
SIGNATURE
CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
DATE
H~LTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTE/~:
FHA Form 25?4
Rev. July 1958
REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
Distance from well, S0
Total liquid capacity, 900
[] Cesspool.
feet. Material, (]on~'O'['~O Number of compartments ~_ .
gallons. Capacity ivlo~ cm~?~?%~ -. gallons.
.teec Inside width, ~ ..... .feet. Liquid depth, ~' feet.
feet; foundation, feet; nearest lot line at [] front, [] side, [] rear,
feet. Depth,. feet. Liquid capacity, gallons. Lining material
SECONDARY TREATMENT consists of [] Tile disposal field.~ Seepage pits. Other
Tile Di~posul Fleldt
Distance from: Well,.
Total length of tile lines,
Trench width,
Length of each line,
feet,
feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet.
.feet. Number of lines, Distance between lines, feet.
inches. Total effective absorption area in bottom of trenches, square feet.
feet. Depth, top of tile to finish grade, inches.
Type of filter material: [] Gravel. [] Broken stone. Other.
Depth of filter material beneath tile,v inches. Depth of filter material over tile, inches.
Number of plt~. Outsidediameter,~[L~feet. Depth. ~1(~1 feet, Lining material
Distance from: Well, ~O feet; building foundation, ~ feet; nearest lot line at ~ front, ~ side,~ rear, P~ feet.
In*peeBon rondo by~ ~ State. ~ ~unW. ~ Lo~l Health Authority.
Inspired by ~00
Date of inspection I~ov~er l~ 1960 19 l(oF~&o~a~
REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM
DistRnce to nearest public water ma'n~ :~: ""~-- feet. Size of main, ~ ..... inches.
Individual we]ls~ are [] are not customa~ in neighborhood.
Give most recent record of failure of wells in immediate vicinity to fumlsh adequate supply of water ~ol,Ilq
Properties in neighborhood ~] are [] are not being developed with both individual water-supply and sewage-disposal systems.
Lot size: 'l.::~O feet wide: ]-~3.~ feet deep. Dwelling set back from front property line; 53~ feet.
Individual water supply from:~] Drilled well. [] Driven well, [] Dug well. [] Bored well.
Distance of well from~
Building foundation, q~ feet; nearest lot line at,~ front, [] side, [] rear, ~,~
feet; septic tank, ~O feet; disposal field, ~"~'~
feet; other sources of possible pollution,.1'101lO .feet.
cast ~ron sewer '0~Q~feet; tde sewer, 2P
seepage pit, ~.L~ -feet; cesspool,
Diameter, 6 inches. Total depth, ~3
Approximate depth to pumping level of water in well,
Sealed watertight to depth of ~3 feet.
fe~. Type of casing, ~3tool Depth of casing, 53
feet. Approximate yield, ']~ gallons per minute,
Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. 30[] 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,. =~-gallons per minute.
Located in:3~] Basement, [] Pumproom off basemenc [] Pumphouse above ground. [] Pump pit.
Pumproom properly drained: :~] Yes. [] No. Pump mounting watertight: ~ Yes. [] No.
Type of storage:~] Pressure. [] Gravity. Capacity, 1}~ gallons.
Has bacteriological examination of water been made? ~] Yes. [] No. If answer is "yes," give date J)O~3UI~OO;O ~?
Quality~of water [i~'is [] is not satisfactory for human consumption.
Installation'S] does [] does not comply witfi approved exhibits, if any.
Inspection made by.,~] State. [] County. [] Local Health Authority.
Inspected by ]31'qJ. O0 I}, Arlt~l~3
Date of inspection ~O'V'~r~0oI' 1/4, , i¢0 t~.e~51.om~ t3an:Lf, o,x,:t~
feet~
-feet;
feet.