HomeMy WebLinkAboutEVANSON LT 3
LOCATION LOT --?
FHA NUMBER
CLIENT L~t5 ~' ~f~T~E~&~.
A.RCTIC ALASKA TESTING LABORATORIES
BOX 12:66 BOX 84:5
ANCHORAGE FAIRBAN KS
PERCOLATION TEST DATA
BLOCK , SUBDIVISION
SATURATE 0
NET TIME
TEST HOLE LOG
~RCOLATION RATE I"/ ~ MIN.
~EMARKS J. SOIL CLASS -VISUAL- UNIFIED
TEST HOLE NO.
w.o. No. ~?~__7___'
DATE, ~ -
TECHNICIAN.
LOCATION SKETCH
· I '
APP. TOPOG
FROST
DEPTH TO
NET DROP
3
LEGEND
GRAVEL
SAND
pZ',JSlLT
CLAY
PEAT
~ WATER
TABLE
HEALTtt AUTHO <, fY APPROVAL
F [i IVIDUAL 5gPPLY Ai tD SEWAGE DISPOS&L
PART L~TO B~ COMPLETED BY FHA
NSURINC~ O1'; ~'~ MORTGA~:; E
MORTG GaR OR SPONSOR PROPERTY ADDRESS
SERIAl. NO.
BLOCK N().
LOT
TOTAL NUMBER:] BASEMENT j ~ New insta]lation
LIVING UNITS BEDROOMS , BAIHS
~ J--] Yes No
Can attic or other area be made into
additional bedrooms?
(if Yes, how many~)
WATER SUPPLY BY:
[] Public system
~ Public system ~ Comlnunity system ~ Individual
PART II.--lO BE CO$PLETED BY HEAtlH DEPARTMENT
HE ,LTH ~PARTMENT INSPECTOR*S SKETCH
te opinion of the ~ State ~ County ~ Local Department of Health that this individual water-supply system
~ i~ ~ is not satisfactory as a dmnestic ,vater supply for the subject property.
Jt is the opinion of the ~ State N County ~ Local I)epartment of Health that this il {' '] ' sewage-disposal sys-
tem with proper maintenance:
~Can be expected to function satisfactorily, and ~ Cannot be expected to function satisfactorily
"ts not likely to create an insanitary condition
DA~'E ' ] SIGNATURE
NOTE: The health authority 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 Js at the option of the
health authority.
PART III.~FOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and reco[nmend that'the
Individual water-supply system be considered [~ Acceptable [--] Not Acceptable
Sewage disposal be considered ~] Acceptable [] Not Acceptable.
DATE
SIGNATURE
CHIEF ARCHITECT
DEPUTY EOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL FHA Form 2573
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM R~. J,ly 1958
REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PRIMARY TREATMENT consists of [] Septic tank. '[~ Cesspool.
Septic Tank:
l)istance from well, _ .feet. Material Number of compartments
Total liquid capacity, galhms. Capacity inlet compartment, __gallons.
Inside length, feet. Inside wldtb, feet. Liqukl depth, feet.
1)istance irp~: kVell ..... feet; foundation, ~_ ( k'et; nearest h,t line at ~ Imnt, ~ side, ~ rear, '* .~ r_ fc~t./
lnsklc dia~,_ ' -. feet. 1)eptb, _ 5 fee L~qtud capacity ..... gallons. Lmmg material _ /_ - .
SECONDARY TREATMENT consists of ~ Tile disposal field. ~ Seepage pits. Otber
Tile Disposal Field:
l)istamc thmu Well, ~ ~et; ~bundation, . feet; nearest lot line at ~ front, ~ side, ~ rear, .fret.
Total lengd~ ot tile lines, fbet. Number of lines, . Distance between lines,. .feet.
l~ngth ot each line .... feet. 1)cpth, top of tile to finish grade, _inches.
Type of biter materiah ~ Gravel. ~ Broken stone. Other___
Dclxb of tilter material heneatb tile,~ .inches. I)epth of tilter material over tile ....... inches.
Seepage Pits:
Number of pits . Outsklc diameter,, feet. l)cpth, _ feet. Lining material _ .
Distance f?om: Well, _~lbct; building foundation, feet; nearest lo~ne a},~ front, ~ side, ~$ear,. feet.
Inspection made by: ~ State. ~J County. ~] Local Health At thor t
Y'
:5z ./ -'. lnsp~tedby_ - .~ ~ r , ~
REPORT OF INSPECTION INDIVIDUAL WATER-SUPPLY SYSTEM
Distance to nearest public water main, _ feet. Size of main,_ inches.
[ndivkhial wells [] arc [] are not customary in neigbl)ortlood.
Give tnost recent record of failure of wells in immediate vicinity to thrnish adequate supply of water
Properties in neighborh(~)d ~ are ~ are not being developed with both individual water-supply and sewage-disposal systems.
Lot size: _ -feet wide, feet deep. l)welling set back from front property linc,. .feet.
Individual water supply from: [] Drilled well. ~ Driven well. ~ 1)ug well. ~ Bored well.
Distance of well from:
Building fl)u mlation,
cast iron sewer,
seepage pit,
Well construction:
fbet; nearest lot line at [] front, [] side, [] rear ........... feet,
feet; tile sewer,_ feet; septic tank,__ ....... feet; disposal field,_ . feet;
feet; cesspool .... feet; otber sources of possible pollution ........... feet.
Diameter, _ inches. Total deptb ...... {~:ct. Type of casing, Depth of casing ...... fret.
Apl~roximate depth to pumping level of water in well, _ feet. Approximate yield, . _gallons per minute.
Sealed watcrtigbt 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.
Pum~= [] Shalk)w well. [] 1)eep xvell. Length of drop pipe .... tbet. Pump capacity, .gallons per minute,
lx)cated in: ~ Basement. ~ l~umproom off hasement. ~ Pmnpbot~sc above ground. ~ Pump pit.
Pumproom properly drained: ~ Yes. ~ No. hm~p mounting watertight: ~ Yes. ~ No.
Type ~f storage: ~ Pressure. [7] Gravity. Capac ty,. gallons.
Has bacteriological examinatkm of water been made? ~ Yes. ~ No. If answer is "yes," give date ........ 19 _
Quality of water [ ] is ~ is not satisfitctory fi)r human consmnption.
Installation [ ] docs ~ does not comply with approved exhibits, if any.
Insl~e(ticm made by: ~ State. ~ County. ~ Local Health Authority.
Inspected by .....
Date of inspectiou ~ _, 19