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Home My WebLink AboutELMRICH VILLAS Block 2 Lot 6 Public Information INDIVIDU G N ILITIE$ ~. Uama .of p~son requesting approval ~/' W, ~~~ .... // 2. ~a~ of prop~y~own~ 5, Wate~ Analysis: 6. Well data: a. Type . c. Casing Size d. Distance from well to closest existing or proposed: 1. Eewer line . 2. SeptJ. c tank. /70' . ! 3. Seepage Area /7~ · Cesspool' 5. Property Line Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. Sewage disposal system. a. b. C, Age of system ,ame of septic tank manufactu,r~,.r 1. If "home made" show diagram on reverse side of this form. Disposal field or seepage pi~ size and type ,~& ~/~ .......... 1. Distance to property line to house foundation ...... . Percolation. Test ~sut, ts f. Percolation Test performed by . . Use the reverse.side of this form to show diagram. Diagram should include -The following information: ~operty llnes~.well location, house location, ~pt£c tank location, disposal area location, location of percolation test, a~d direction of ground slope. The l~foz~tion on this form is true ~nd correct to_the best of my knowledge. - '? ]0 BE FILLED OUT BY HEALTH DEPARTt~ENT PERSONNEL -mT~e above described sanitary facilities are hereby approved, subject to the .......... ~ll0wing conditions: ' The above described sanitary facilities are disappmoved for the following ~easons: ' Approval is valid for one year following the date of approval. CPJ: cw Rev. July 1958 U,S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT FEDERAL HOUSING ADMINISTRATION HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM Form Appeared Budget Bureau No. 63-R296.S INSURING OFFICE MORTGAGOR OR SPONSOR tlee T. ~,y],,,n,~ SUBOIVI$10N NAME TOTAL NUMBER: LIVING UNITS BEOROOMS WATER SUPPLY BY; [] Public system SEWAGE DISPOSAL BY; [~] Public system SATHS J BASEMENT --]Community system --}Community system PART fl.--TO BE COMPLETED BY HEALTH DEPARTMENT ] New installation additional bedrooms? (If Yes, how manyf) NYes []No ST-~in~ DESIGNED FOR ] Indivi&,al NO. Of CORMS. OAREue, GE DISPOSAL HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State r-] County ~ Local Department of Health that this individual water-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. PlJBI, IC It is the opinion of the [] State [] County [] 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 · ' Sanitarian NOTE; The h®ulth authorHy ;hould complole the appropriate o.~n/l:n statement above and affix date, .,.naturo and rifle ia the spaces provided. Use of the above grid 'for Health Department Inspector's sketch as well os use of the back of this form is at the option of the health authority. TO THE CHIEF UNDERWRITER: IDATE PART Ill.--FOR USE OF FHA OFFICE 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. SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATIR SUPPLY AND SEWAGE DISPOSAL SYSTEM I~1 CHIEF ARCHITECT ] DEPUTY FOR CHIEF ARCHITECT FHA Form 25~J Rev. July 1958 PART L--TO BE COMPLETED BY FHA MORTGAGEE SERIAL NO. Can ~e REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. [] Cesspool. Septic Tank: Distance from well,__feet. Material Total liquid capacity, Inside length, .feet. Inside width, Cesspool: Distance from: Well feet; foundation, __ Inside diameter, feet. Depth, SECONDARY TREATMENT consists of [] Tile disposal field. Tile Disposal Field: Distance from: Well, Total length of tile lines,. Trench width Length of each line Number of compartments gallons.Capacity inlet compartment, f~et. Liquid depth, feet. feet; nearest lot line at [] front, [] side, [] rear, feet. Liquid'capacity, .gallons. Lining material gallons. [] Seepage pits. Other feet. Lining material feet; nearest lot line at [] front, [] side, [] rear, [] Cnunty. [] Local Health Authority. Inspected by- 19 feet. square feet. inches. feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. Number of lines,· Distance between lines, inches. Tntal 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. Depth of filter material over tile, Seepage Pits: Number nf pits .... Outside diameter, feet. Depth, Distance from: Well, feet; building foundation, Inspection made by: [] State. inches. Date of inspection_ REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main,__ feet. Size of main, inches. Individual wells [] are [] are not custoenary 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 h'om: [] Drilled well, [] Driven well. [] Dug well. [] Bored well. Distance of well from: Building flmnda6on 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, ireet. Diameter, inches. Total depth, feet. Type of casing, Approximate depth to pumping level of water in well,, feet. Approaimate 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. P~mp: [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity, Located in: [-1 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. Inspeetion made by: [] State. [] County. [] Lw.'al Health Authority. Inspected by Date of inspection , 19__ Depth of casing, .gallons per minute. .gallons per minute. · 19 (TITLE) feet; feet. l-fl./~)-WaBh., D. C. 2, 3, q, 5, REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE ^ND WATER FACILITIES (Fill cut in Triplicate) l~ame of person requesting approval Number'of bedrooms in house Water Analysis: a. Bacterial Well data: . a. Type . b. Depth c. Casing Size Distance from well to closest existing or proposed: 1. Sewer, line Septic tank eepage Cesspool', .... 5. Property Line houses, bern, drainage ditch, etc. Sewage disposal system. a. C. Other sources of possible contamination, i.e., creeks, lakes, Age of Septic tank capacity in gallons. Name of septic tank manufactu~e.r ~._ ~ ~/~,,~,.,,~/.,~ ~.~,~-/~;4.~z . 1. If "home made" sho~ dla~ram on reverse side Disposal field or seepage pit size and type, e, Perco~ ati~m~ Test ~'e sults f. Percolation Test performed by Use the reverse side of this form to show diagram. Dia[ram should include ~he following information: ~opert¥ lines~.well location, house location, ~t~e tank location, disposal area location, location of percolation test, a~d direction of ground slope. 9. The l~formation on this form is true and correct to the best of my knowledge. SSgnature 'of Appli'Ca~t " ~ Date Signed TO BE PILLED OUT BY HEALTH DEPART~,~ENT PERSONNEL ~'T~e above described sanitary facilities are hereby epp~oved, subject to the ........... ~611owing cond~i~ons: ' ' Conditions: ~/~~ ,,- , The above described sanitary facilities are disapproved for the following reasons: Date Approval is valid for one year following the date of approval. CPJ: cw