HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 5 LT 13
)'~ ~, C- ~'~C~'REPORT ON-.~ITE SE. WAGE. DISPOSAL SYSTE~ .
/
L~al D~C~ pt ~ ~
'/ '~ ti ~ ~ ~'t~ .... ~ "~
SEPTIC TANK: Dist~ce from well Material ~ N~e~ of co~a~tment
Liquid capacity /~-~ > ~allons. Inside lenEth . Inside width .. .Liquid depth
SEEPAGE SYSTEM: Seepage Pit: Nu~e~ of pits ./ Outside dia~te~ .....
width , length. , depth , lining material
well , building foundation ........ , newest lot line..
absorption a~ea (wall area) sq. it,
TILE DRAIN FIELD: Distance from well , foundation .
· Distance from
Total effective
,, nearest lot line
Total lenBth of
width
Depth:
tile
WELL:
lot llne..~ (. , nearest sewer line .
cesspool !-3~' , other sources
DISTANCES:
Nuu~ber of lines Distance between lines T~ench
in. Total effective absorption a~ea
Top of tile to finish grade Depth of filter ma%erial beneath
.in. Abqve tile
, dist~ce ~om buildiu~ fo~dation~, nea~st
, septic tank , seepage system ,
DIAGRAM OF SYSTEM
APPROVE ~,, ,,:4' 0';/~' //,,.;,/~. .... ~
Health Authority
gev. July t958 ~ FEDERAL HOUSING ADMINISTRATION ~ Budget Bureau No. 63-R29&8
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
INSURING OFFICE MORTGAGEE SERIAL NO.
MORmAGOR OR S~ONSOR ~RO~ERTY ADDRESS
BLOCK NO5 -- lOT NO.
?O?AL
Can attic or other area be made into
BASEMENT
~--~ New installation additional bedrooms?
(If Yes, how mony~)
WATER SUPPLY BY:
SYSTEM DESIGNED FOR
[JPublic system ~[] Community system l~] Individual NO. OF BDRMS. O^RB^O~ D,SPOS^t
SEWAGE DISPOSAL BY:
['~ Public system [] Community system ][~] Individual :~ [] Yes ~-] No
PART II.--lO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
........... ~: _:;; _- _- _- _- _- _- _- __- __- _- __- __- __- __- _- _- _- _- _-
It is the opinion of the N State [--] County ~'1 Local Department of Health that this individual
water-supply
system
[X'] is M is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the [] State [] County [] Local Department of Health that this individual
sewage-disposal
tern 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 / TITLE
spaces provided. /
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.
DATE
SIGNATURE
[] CHIEF ARCHITECT
J ---] DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2573
Rev. July 1958