HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 6 LT 7
FHA ~"orm 2573 Form Approved
~ev. 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
INSURING OFFICE MORTGAGEE SERIAL NO.
Anohormges Alaska ]Soueh ~OZ2s ~_~oragm, AXs~Im 60-00860~
MORTGAGOR OR SPONSOR PROPERTY ADDRESS
SUBDIVISION NAME BLOCK NO. LOT NO.
6 '7
TOTAL NUMBER.'
LIVING UNITS BEDROOMS
WATER SUPP'LY BY:
V-]Public system
BASEMENT
Fl]New installation
Con attic or other area be made Into
additional bedrooms?
(if Yes, how many?)
WlYes Pllmo
SYSTEM DESIGNED FOR
[~[ Community system [] Individual NO. OF BDgMS. O^RB^OE mSPOS^L
SEWAGE DISPOSAL BY:
[] Public system [] Community system [] Individual ~ FI Yes [] No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
4t
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the r-] 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 l]~ State [--] County r-] Local Department of Health that this individual sewage-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
NOTE, Tho heolth a.thority sho.ld compIet, the oppropriote opini-- stotemont '- date, sl.at.ro .nd ti"e,,' the
Use of the 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
Rev. July 1958
REPORT OF INSPECTION INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PRIMARY TREATMENT consists of~ Septic tank. [] Cesspool.
s.~,c To.k.- ::~ ~/
Distance from well, .feet. ~ateria~-~l [fl L ~,~ s~ Number of compartments
gallons. Capacity inlet compartment,.
feet. Inside width~ feet. Liquid depth, .feet.
Total liquid capacity,
Inside length,
Cesspool:
Distance from: Well,
Inside diameter,
/
gallons.
feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet.
feet. Depth,. feet. Liquid capacity, gallons. Lining material
SECONDARY TREATMEHT consists of [] Tile disposal field, a~Seepage pits. Other TIIo Disposal Field:
Distance from: Well. feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet.
Total length ot 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,~ inches. Depth of filter material over tile, inches.
Seepage Pits: / / / __
Number of pits J . ~,~tside diameter,~--feet. D_epth,.--~feet. Lining material ~---~ __
Distanee from: Well,_ __feet; building foundation, ~ feet; near~t lot lie at = front,~sid5, 0 r~,/~ f~t.
- ~ ~ ~ Insp~ted~.~ ~ · ~ _~ ~
Date of inspe~ion~, 19~ ~ (~) ~
REPORT OF INSPECTION--~ ATER-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,
feet; septic tank, feet; disposal field,, feet;
feet; other sources of possible pollution, feet.
Depth of casing, .feet.
.gallons per minute.
_gallons per minute.
19__
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