HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 6 LT 25
FHA Form 2573 ' Form Af~proved
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.
$1~'km,, & 14~I~n Co.
JLmlboraffe, Ala.ka ADO - 5th Ave., AnohoraKe, Alaska ~-OOO555-203
MORTGAGOR OR SPONSOR PROPERTY ADDRESS
~. ~. ~ OoXvS~e st~,~t (~.~x~ ~ve~)
SUBDIVISION NAME BLOCKCO. LOT NO.
Ea~le ~iver Height~ 25
TOTAL NUMBER:
BASEMENT J-~ New installation
BATHS
LIVING UNITS BEDROOMS
[] Yes ['--] No
Can attic or ot~ner area be made into
additional bedrooms?
(If Yes, how rnany~)
WATER SUPPLY BY:
[] Public system ~ Community system [~ Individual
SEWAGE DISPOSAL BY:
[--] Public system ['-] Community system Iai] Individual
SYSTEM DESIGNED FOR
NO. OF BDRMS. GARBAGE DISPOSAL
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 [--~ate [] County [] Local Department of Health that this individual sewage-disposal sys-
tem with proper maintenance:
[~n be function and [-'-] Cannot be expected to function satisfactorily
expected
satisfactorily,
tO
is not likely to create an insanitary condition
////! TITLE (). ~1 ///
DA,E I' / IS'GNATURE / // ,0
NOTE: The health authjbrity should complete the appropriate opinion 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 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 Keport, 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 ARCHfTECT
DEPUTY FOR CHIEF ARCHITECT
FHA Form 2573
Rev. July 1958
REPORT OF INSPECTION INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PRIMARY TREATMENT consists of ~ Septic tank. [] Cesspool.
Septic Tank:
Distance from well,__.feet. Material,
Total liquid capacity, 1,000
Inside length, feet. Inside width,
Cesspool:
Distance from: Well,
Inside diameter,
gallons. Capacity inlet compartment,.
feet. Liquid depth,
Number of compartments
gallons.
feet; foundation, feet; nearest lot line at [] front, [] side, [] rear,
feet. Depth,. feet. Liquid capacity, gallons. Lining material
SECONDARY TREATMENT consists of [] Tile disposal field. [~ Seepage pits. Other
Tile DIspoaal Field:
Distance from: Well, feet; foundation, feet; nearest lot line at [] front, [] side, [] rear,
Total length of tile lines,, feet. Number of lines, Distance between lines,
Y~ Trench width .inches. Total effective absorption area in bottom of trenches
Length of each line .feet. Depth, top of tile to finish grade,
feet.
feet.
.square feet.
.inches.
Type of filter material: [] Gravel. [] Broken stone. Other.
Depth of filter material beneath tile, inches.
Seepage Pits:
Number of pits 1 Outside diameter, 8 feet. Depth,
Distance from: Well, __ feet; building foundation, 2~
Inspection mode by~E~ State. [] County.
Date of inspection
Depth of filter material over tile.
inches.
feet. Lining material ~.~,~-
feet; nearest lot line at [] front, [] side, [] rear.
[-] Local Health Authority. ~/~/ /
Ins~ted by ~ /' ,." . "~'~
(TITLe)
REPORT OF INSPECTIONwlNDIVIDUAL 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; septic tank,. -feet; disposal field,
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
(TITLE)
feet;
~r. S. G. ~eflin
219 East 6th Avenue
~ letter is
nary a~proval ~ this office of yoer plan~ for c~astructing
a d~e~ ~nit ca Lot 2%, Block 6 of the Eagle River
for p~-ivate ~ ~as~e disposal ~. ~n view of
above, ~ feel Jm~Afied in giving tentative approval of your
proposed c~tr~etic~ with the under~aading that cce~lianee
with s~ State criteria regarding septic tank size,
Ver~ truly
FRANCIS J. ~.twS, M.D.
Regional Health Officer
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