The URL can be used to link to this page

Home My WebLink AboutEAGLE RIVER HEIGHTS BLK 5 LT 16 r~HA. Form 2573 . , i Form Approved 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 INSURING OFFICE MORTGAGEE SERIAL NO. MORTGAGOR OR SPONSOR PROPERTY ADDRESS ~UBDIVISION NAME BLOCK NO. LOT NO. TOTAL NUMBER: J ~-~ BASEMENT LIVING UNITS SEDROOMS SATHS [l~ New installation Can attic or other area bo mode into additional bedrooms? (if Yes, how ma~y~) WATER SUPPLY BY: --]Public system SYSTEM DESIGNED FOR [~ CommuniW system [--] Individual No. OF SIDR~,S. GARBAGE DISPOS~,L SEWAGE DISPOSAL BY: [---] Public system [] Community system [i~ Individual ~ [~] Yes [-~ No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT tEALTH 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 satisfactory as a domestic water supply for the subject property. It is the opinion of the rLr~ State [] County tern with proper maintenance: []Can be expected to function satisfactorily, and is not likely to create an insanitary condition DATE --]Local Department of Health that this individual sewage-disposal sys- N Cannot be expected to function satisfactorily SIGNATURE TITLE .'" ~ ~. ,,-' .. .~ --,,,.- .' '.., Q r *!4 ..;~' ~.~-~ 5,,;-.~-,o:,~:~' ~ ~*',<~' NOTE: The health authority should complete the appropriate opinion statement abC~e and afflx date, signature and title in the spaces provided. Use of tho above grid for Health Department Inspector's sketch 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 water-supply system be considered [--] Acceptable [] Not Acceptable Sewage disposal be considered ['-] Acceptable [] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM _~ CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 R~v. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM ~l~'k Tank: Distance from well, Total liquid capacity, Inside length,. Cesspool: Distance from: Well, Inside diameter, PRIMARY TREATMENT consists of ~Septic tank. [] Cesspool. ~ feet. Material. ,~f~."'~55C.: ! i~_!l~"~ ~'i~ ~'.gT~ Number of compartments gallons. Capacity inlet compartment, feet. Inside width, feet. Liquid depth, feet. gallons. feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. feet. Depth,. feet. Liquid capacity, gallons. Lining material SECOHDARY TREATMENT consists of [] Tile disposal field. ~Seepage pits. Other Tile Disposal Field: Distance from: Well, feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. Total length of tile limes, feet. Number of line.% .... Distance between lint~, K, et. 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.~ inches. Depth of filter material over rile, inches. Seepage Pits: Number of pits Distance from: Well,. ~--' feet; building foundation, ~ ..~"- feet; nearest lot l~ine at [-] front, l~side, [~J'"l~'ar,-,m.,'ai--al~'--~=feet. Inspection made by: cate. [] County. [] Local Health Authority. Date of inspection .~ f'igg~ '~, / "~'~' 19_~ Inspected REPORT OF INSPECTION--~IYIDI/iE[L-~fATER-SUPPLY SYSTEM 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: Diameter, .inches. Total depth, .feet. Type of casing, Approximate depth to pumping level of water in well, feet. Approximate yield, Sealed watertight to depth of feet. Exterior space around 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 feet; nearest lot line at [] front, [] side, [] rear, feet; septic tank, feet; disposal field.. feet; other sources of possible pollution, feet. Depth of casing, .gallons pet minute. _gallons per minute. ~' U. S. GOVER#ME~4T PRLHTING OFFICE: 1957 O'F--4Z?038 ,19 N t lmfle ~.: 4--1 D~r ~fr. lbed~ It hss been b~mqM to our ettontie~ thet pd~le sewer is evdld~e to Lot 18, Bleak l, lhfle River ~dghts Subdivision. Aeeordbig to the Aflehm, q~ Code o~ Ordfnlnelo "lewefe l~lopoo~l PTeat~', Cheplin* 1S, AFtide 11.41, feettou ll,4l.tll: odd p~Muiees. You must eppl3r ~e? a ~ perudt f~om b penult orflem' br b M~o~Anehorefe, OSO0 EeotTudorB~d. lfyo~have myquestioos sbmflty, RECEIPT FOR CERTIFIED MAIL--30~ (plus postage) POSTMARK SENT TO OR DATE -~TREET AND NO. P.O., STATE AND ZIP CODE ~.. Show~hom and~livered ........... RETURN ~1~ With delivery to addressee only ............ 65¢ RECEIPT 2. Shows to whom, date and where delivered .. 35¢ S~RVICES With delivery to addressee only ............ 85¢ ~-~VER~EE ONLY ................................... : ............. : ~d~- ~EC~AL DELIVERY (ex, re tee rsqui red) .................................... , ..... PS Form 3800 NO INSURANCE COVERAGE PROVIDED-- Apr. ).971 NOT FOR INTERNATIONAL MAIL * o~o: ]0'A o - 4,eo-?u