Loading...
HomeMy WebLinkAboutEVANSON LT 6 r~HA F~;m 2573 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 J SERIAL NO. MORTGAGOR OR SPONSOR UBDIVISION NAME TOTAL NUMBER: BATHS LIVING UNITS BEDROOMS WATER SUPPLY BY: '-]Public system BASEMENT PROPERTY ADDRESS BLOCK NO. LOT NO. Can attic or other area be made Into additional bedrooms? (If Yes, how many~) [~ Community system [--~ New installation [] Individual NO. O~ SYSTEM DESIGNED FOR BDRMS. GARBAGE DISPOSAL [--]Yes [-~ No SEWAGE DISPOSAL BY: D Public system --]Community system [] Individual PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the ~] State [--] County ['7-] 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 thT~ State [~ County tern with proper maintenance: [7-] 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 / / J SIGNAT),JRE , TITLE i * NOTE: The health authority should complete the appropriate opinion statement abo~t~ and affix date, signature title in the spaces provided. '/ Use of the above grid for Health Department Inspector's sit. retch as ~vell as use "o~i the back of this form is at the option of the health authority. PART IIIJ' 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 N Not Acceptable Sewage disposal be considered [--] Acceptable [~ Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM [~1 CHIEF ARCHITECT ] DEPUTY FOR CHIEF ARCHITECT FHA Form 257,.~ Rev. July 1958 REPORT OF INSPECTIONmlNDIVIDUAL SEWAGE-DISPOSAL SYSTEM PR,MARY TR,ATM,NT co.s'sts of X Sep,c tank. [] Cesspool. l. e..c f Septic Tank: Distance from well, ~ feet. Material, Total liquid capacity, / tO ~ ~ Inside length, ~ feet. Inside width, Cesspool: Distance from: Well, feet; foundation, Inside diameter, feet. Depth, gallons. Capacity inlet compartment, feet. Liquid depth, - / Number of compartments / L gallons. feet, feet; nearest lot line at [] front, [] side, [] rear, feet. Liquid capacity, gallons. Lining material SECONDARY TREATMENT consists of [] Tile disposal field. ~Seepage pits. Other Tile Disposal Fioldl 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. SeepaR. Pits,/ ~ ~k/e~feet. 7 '~- %r~~ Number of p ts -- . e , f r. Lining mater al Distance'om:Well,.' feet; building foundation, ffp~h feet; nearest lot line at [] front, ~ side, ["] rear, '~feet. Inspection mado by: [] State. [] County. ~Local Health Authority. ////5~./A(./L.C.i~tL~ ..,~_. / .... Inspected by Date of inspection /~ 19 ~t/% l./~/,,.'*t it'l.,'r'..4],~.) ~r- ./"-~/ REPORT . u Cno.-- .mvmu t wm u- uuutv 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,, feet; tile sewer, seepage pit, feet; cesspool, Well construction: Diameter, inches. Total depth, Approximate depth to pumping level of water in well,. Sealed watertight to depth of feet. feet; nearest lot line at [] front, [] side, [] rear, feet; septic tank, feet; disposal field, .feet; other sources of possible pollution, feet. feet. Type of casing, Depth of casing, feet. Approximate yield, .gallons per minute. Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. Pumpl [] 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 .gallons per minute. ,19 (TITLE) .feet; .feet.