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Home My WebLink AboutEAGLE RIVER HEIGHTS BLK 6 LT 18 FHA Form 2573 Form &pproved Rev. July 19S8 FEDERAL HOUSING ADMINISTRATION Budget Bureo~ ~lo. 63-R296.8 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGOR OR SPONSOR MORTGAGEE SERIAL NO. J 11 I-ON] 2q'7-203 Ea~].e ~iver Hei~hts PROPERTYADDRESS W/S{de Co]v~].]~ ~t. ~Oq.5 Rive~ Road, Ea~le 9ive~, BLOCK NO6 LOTNO.]8 SUBDIVISION NAME TOTAL NUMBER: LIVING UNITS BEDROOMB ] 3 WATER SUPPLY BY: [~] Public system SEWAGE DISPOSAL BY: O Public system BASEMENT Yes [] No ] New installation Can attic or other area be made Into additional bedrooms? ~lf Yes, how many~) I-1 Yes [] Community system [] Individual [] Community system [] Individual No. SYSTEM DESIGNED FOR Of SDRM5~ GARBAGE DISPOSAL 3 []Yes PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT ~EALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State [] County M Local Department of Health that this individual water-supply system [] is ~1 is not satisfactory as a domestic water supply for the subject property. It is the opinion of the ~] State [~1 County tern with proper maintenance: ]~ Can be expected to function satisfactorily, and is not likely to create an insanitary condition O Local Department of Health that this individual sewage-disposal sys- --]Cannot be expected to function satisfactorily NOTE: The healtlJ authority should complete the appropriate op' 'on 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 ofthe back of this form is at the option ofthe health outhority. 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 r-] Acceptable [] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 Rjr. July 1958 REPORT OF INSPECTIONmlNDIVIDUAL SEWAGE-DISPOSAL SYSTEM Septic Tank: Distance from well,__ Total liquid capacity, Inside length, Cesspool: Distance from: Well, PRIMARY TREATMENT consists of l~'Septic tank. [] Cesspool. .feet. Material ~'~W__ e. ~ U~_.~"~= ,..5'-"-t~ (_.9 ~ ~"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, Inside diameter, feet. Depth,. feet. Liquid capacity, gallons. Lining material SECONDARY TREATMEHT consists of [] Tile disposal field, l~ Seepage pits. Other Tile Disposal Field: Distance ~om: Well, Total length of tile lines,. Trench width Length of each line 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 tilea inches. Depth of filter material over tile, inches. Number of pits I . Outside diameter. ~' t~ ~ feet. Depth, ~' ~) -- feet. Lining material Distance from: Well, __ feet; building foundation, 7-'7' feet; nearest lot line at [] front, [] side, ~ rear, --~ ~:-O feet. ,nspe.lon ma:® b~St3_ ~ Count.'~ Lo.I Health ~uthority.insp.ted by ~ /~ff--~ ~ ' Date of inspectio ,' {' f~ 19 (~ ~'~ . (TiTLltl REPORT OF INSPECTIONmlNDIVIDUAL WATER-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, seepage pit, Well construction: feet; tile sewer, feet; cesspool. .feet; nearest lot line at [] front, [] side, [] rear,, feet, feet; septic tank,. .feet; disposal field, feet; feet; other sources of possible pollution,, feet. 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 Depth of casing, gallons per minute. gallons per minute. ,19 FHA Form 2573 Form Approv~ed 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 INSURING OFFICE MORTGAGEE SERIAL NO. AllOhozl&,e~ A~BIUL ~l&%iem~. Bmk ~f l].ls~. MORTGAGOR OR SPONSOR PROPERTY ADDRESS ~ L. ~ell~ Chizkaleea St. SUBDIVISION NAME TOTAL NUMBER: BATHS LIVING UNITS BEDROOMS BASEMENT [] New installation BLOCK6NO. LOT NO. Con attic or other area be made Into additional bedrooms? (If Yes, how man¥~) l--lYes 51No WATER SUPPLY BY: [] Public system ~ Community system SEWAGE DISPOSAL BY: [--1 Public system [-'] Community system ~] Individual NO. ~SYSTEM DESIGNED FOR '--]Individual oF ORM$, GARBAGE DISPOSAL I-1 Yes PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State [--] County [] Local Department of Health that this individual water-supply system I--1 is [-] is not satis~ 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 sys- tem witJ~proper maintenance: [~be expected to satisfactorily, [] expected to satisfactorily function and Cannot be function is not likely to create an insanitary condition DATE SIGNAT~ E ' '/ ~') ~,~ ~C [LE ~, ~ ..... sp}c-N' O-72/ah~hea~u ~p--~-- -- authority should complete the appropriate opinion statement above and affix date, signature and title in 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 III.mFOR 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 N 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 t958 REPORT OF INSPECTION~INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. [] Cesspool. $~lg'lc Tank: Distance from well,__ Total liquid capacity, Inside length, Cesspool: Distance from: Well. Inside diameter, .feet. Material, ~oel (IlL seal.'?,f~O~) ;0(: gallons. Capadty inlet compartment,. .feet. Inside width~ feet. Liquid depth, feet; foundation, feet. Delxh, SECONDARY TREATMENT consists of [] Tile disposal field. [] Seepage pits. Other Tile Disposal Field: Distance from: Well, Total length of tile lines,. Trench width Length of each line Number of compartments gallons. ~feet. feet; nearest lot line at [] front, [] side, [] rear, feet. Liquid capacity, .gallons. Lining material Depth of filter material over tile, feet. Lining material .square feet. inches. feet; foundation, feet; nearest lot line at [] front, [] side, [] rear,. feet. Number of lines, Distance between lines, inches. Total effective absorption area in bottom of trenches feet. Depth, top of tile to finish grade, Type of filter material: [] Gravel. [] Broken stone. Other. Depth of filter material beneath tile,~ inches. ~page ~i~: Number of pits '1 Outside diameter, ~ feet. Depth,. Distance from: Well,_ Inspection made by: ~ State. lo~ cribbt~_ feet; building foundation, ~ feet; nearest lot line at [] front,~] side, [] rear, [] County. [] Local Health Authority. John R. ~uhn Inspected by. 19 ~3 ~a'tit~lmn inches. Date of inspection 7111'7/62 REPORT OF INSPECTION--INDIVIDUAL WATER-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. Distancn 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 opacity,. 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 per minute. gallons per minute. 19 (TITLE) J Hef~tn 2X9 ~w~t~ Avenu~ This letter is in r~pc~e to ym~r reciter f~r ~ approval ~ t~4- offAee ~f Feet pla~ for eo~tr~ting a d~elli~ ~it on ~t 18, ~X~ek 6 ~ the ~aaXe Review of o~tr .eilee lndicate~ that this i~ an e~L~%ing ~Abdivision with an existing se~i-private ~ater suppl~ and distribution aywtea and soil pereolatiou ~tieo aeeeptable for private ~ waste dispoaal ay~t~. ~n view of the above, I feel Ju~%ified the ~ that cc~liam~ ~ith al~cifie State criteria John R. Ku~n District ~utltarian