HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 6 LT 20.¢ jo 0oo
FHA Fo~m'2573 Form Approved
Rev. JuJy 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
Az~borage, llaRMa
MORTGAGOR OR SPONSOR
l~xlera Xo~es, Mo.
MORTGAGEE
j l,lJtalmJila Valle~ ham
PoGeh TO:l.2~ Atmho~ges Alaska
JPROPERTY ADDRESS
SERIAL NO.
~UBDIVISION NAME
TOTAL NUMBER:
LIVING UNITS 6EDROOMS
WATER SUPPLY BY:
-]Public system
BASEMENT
BATHS
x l--lYes g] o
] New installation
BLOCK NO. LOT NO.
6
Can attic or other area be made into
: additional bedrooms?
(if Yes, how many?)
ii Community system [--] Individual
SEWAGE DISPOSAL BY:
[--] Public system ~] Community system [] Individual
[--]Yes []No
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
[] is [--] is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the ~ State [] County
tern with proper maintenance:
~] Can be expected to function satisfactorily, and
is not likely to create an insanitary condition
[] Local Department of Health that this individual sewage-disposal sys-
--]Cannot be expected to function satisfactorily
DATE / I SIGNATUR'E I TITLE ·
NOTE: The health authority should complete the appropriate opinion statement ~roove 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 of the bock 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 1--] Not Acceptable.
DATE
SIGNATURE
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
] CHIEF ARCHITECT
']
DEPUTYFOR CHIEF ARCHITECT
FHA Form 257:
Rev. July 1958
REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
feet. Mar~,l~ .,t~. ~' /~ -- { ~! ~,,,,1~ S~'~ ~ Number of compartments
7C~"}~ gallons. Capacity inlet compartment, ~
feet. Inside width, feet. Liquid depth, _feet.
Distance from well,
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 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 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.
Number of pits I ' Outside diameter, et. ~Depth~ ~;~ feet. Lining material
Distance from: Well, ~ feet; building foundation,__~,~feet; nearest lot line at [] front,t, ~ side, ar. /~' feet.
inal~etlen made by: j~ State. [_] County. 1_] Local Health Authorlty'
~/ ~ Inspected b
Date of inspection ~ 30 ,19 /~
REPORT OF INSPECTION-~ttqI~/~'D~I~ W TER-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 fumlsh 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.
feet.
19
(TITLE)