Loading...
HomeMy WebLinkAboutEVANSON LT 8 $ ~a/~- I" =. Dm' ~ ~, / Form Approved FHA Form 2573 "~/ FEDERAL HOUSING ADMINISTRATION ~ Budget Bureau No. 63-R296.8 Rev. July 1958 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE ~ationa~ Bank of Alaska Box 600t Ano~oz'aget Aleaka SERIAL NO. Anchorage, ~leaka MORTGAGOR OR SPONSOR Le~da & ~etzger SUBDIVISION NAME ~vanmon 8ulxtiviele~ PROPERTY ADDRESS 430~ ~eedle Drive BLOCK NO. LOT~NO' TOTAL NUMBER: BATHS LIVING UNITS BEDROOMS ! 2 WATER SUPPLY BY: [~] Public system SEWAGE DISPOSAL BY: [~ Public system BASEMENT [] New installation ~1 Community system D Community system Individual Iii Individual Can attic or other area be mede into additional bedrooms? (If Yes, how many'~) NO, OF BDRMS. GARBAGE DISPOSAL 2 [] Yes ~1 No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT 'IEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [-'] State [--1 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 J-'] County []~ Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: [~Can be expected to function satisfactorily, and ['-1 Cannot be expected to function satisfactorily is not likely to create an insanitary condition DATE SIGNATURE J TITLE ~ A / NOTE: The health authority should complete the appropriat/~pinion statement above and a~ix date, signature and title in the - spaces provided. ' '' - / · Use of the above grid for Health Department Inspector'~ sketch as wel~,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 Report, and recommend that'the Individual water-supply system be considered [--] Acceptable [--] Not Ac~c.ep.tab~ Sewage disposal be considered [--1 Acceptable ~1 Not Acceptable~. DATE SIGNATURE CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT~I HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2573 Rev. July 19S8 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of~ Septic tank. [] Cesspool. ,.,,,.,.o,, 6_. t Distance from well, --feet.~lMateri_al, O~'~'C~V~, ~ Number of compartments iotal liquid capacity, '~r O ~]1_~ gallons. Capacity inlet compartment, ~ gallons. Inside length, P feet. Inside width, I Liquid depth feet. Cesspool: Distance from: Well, feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. Inside diameter, feet. Depth, feet. Liquid capacity, gallons. Lining material SECONDARY TREATMENT consists of [] Tile disposal field. [] Seepage pits. Other Tile Dlapoaal 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. Seepage Pits: Number of pits / Outside ~mm~r,~feet. Depth. Distance from: Well, '-- feet; building foundation~ ~,- Depth of filter material over tile, '~ feet. Lining material ~ {~-~'~ feet; nearest lot line at [] front, [] side,~rrear,~--.-feet. Inspection made by: [] State. [] County. a~] Local Health Authority.  Inspected by Date of inspection 19~.~ REPORT OF INSPECTION--INDIVIDUAL 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, 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. 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 .gallons per minute. ,19 (TITLE) .~eet.