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HomeMy WebLinkAboutNEW MCRAE West 100' of Block 2 Lot 10 L FHA For'r~ 2573 \ ~,, '% ),/ Form Approved Rev. 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 INSURINO OFFICE MORTGAGEE SERIAL NO. ~tanuska Valley Bank Federal Housing Administration Anchorage, Alaska 60-008610 MORTGAGOR OR SPONSOR PROPERTY ADDRESS John Skurla SUBDIVISION NAME BLOCK NO. [ LOT No.West New McRae Addition, Spenard 2 ~00' of 10 TOTAL NUMBER: WATER SUPPLY BY: D Public system SEWAGE DISPOSAL BY: --]Public system BATHS BASEMENT Yes [--1 No [-~ New installation ---]Community system D Community system Individual ~-] Individual Can attic or other area be made into additional bedrooms? (If Yes, how many~) J SYST~E/~_ DESIGNE~D FOR NO. OF BDRMS. GARBAGE DISPOSAL D Yes J~-J No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the r-] State J~J County r-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 ~State J-'-] County [] Local Department of Health that this individual sew~ge-'disposal sys- tem with proper maintenance: ,.~Can be expected to function satisfactorily, and [-'] Cannot be expected to function satisfactorily is not likely to create an insanitary condition date, signature and title in the spaces provided Use of the above grid for Health Deportment Inspector's ~l~etch 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 TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the Individual wa~er-supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable ~1 Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM CHIEF ARCHITECT DEPUTY FOI~ CHIEF ARCHITECT FHA Form 2573 Rev. July 1958 Septic Tank: Distance from well, Total liquid capacity,~ Inside length, Cesspool: Distance from: Well, Inside diameter, REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of ~eptic tank. [] Cesspool. feet. Material ~7, ~ )'$;) e '~"~ ~* ,/ Doe ~tallons. Capacity inlet compartn~t, feet. Inside width,. '3r feet. Liquid depth, ~"~ feet. Number of compartments / gallons. .feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. feet. Depth,. .feet. Liquid capacity, _gallons. Lining material S~¢ONDARY TREATMENT consists of [] Tile disposal field. ~Seepage pits. Other r lilo Disposal Field: Distance from: Well, feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. Total length of tile lines,, feet. Number of lines, Distance between lines, feet. Trench width inches. Total effective absorption area in bottom of trenches square feet. Length of each line feet Depth, top of tile to finish grade, inches. Type of filter material: [] Gravel. [] Broken stone. Other. Depth of filter material beneath tile,~ iuches. Depth of filter material over tile, inches. Seepage Pits: ~ ~,~ ~ Number of pits /. Outaidediaiiie~r, ~ X~feet. D~pth~ feet. Lining material Distance from: Well feet; building foundation,~feet; nearest lot line at ~ front,~ide, ~ rear, ~ f~t. ,ns,,tlon made by, = State. = ~un~. ~Lo~l Health AuthoriW. ~ Date of inspection / O/ q/19 ~O ..~~~ Distance to nearest public water main, __ __ feet. Size of main, inches. Individual wells [] are [] are not customary in neighborhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood [] 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. Distance of well from~ Building foundation cast iron sewer, feet; tile sewer,. seepage pit, feet; cesspool, Well construction: feet; nearest lot line at [] front, [] side, [] tear, .feet; septic tank,. .feet; disposal field, feet; other sources of possible pollution, feet. Depth of casing, gallons per minute. 19 Diameter, inches. Total depth, .feet. Type of casing,. Approximate depth to pumping level of water in well, feet. Approximate yield, Sealed watertight to 4~pth of feet. Exterior space arouud casing sealed with: [] Cement grout. [] Puddled clay. [] 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, Located 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. [] Local Health Authority. Inspected by Date of inspection , 19 (TITLE) _gallons per minute. feet; feet.