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Home My WebLink AboutEVANSON LT 13 FHA ~orm ')573 FEDERAL HOUSING ADMINISTRATION Rev~ July 175B HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM Budget Bureau No. 63-R296.8 PART I.mTO BE COMPLETED BY FHA INSURING OFFICE MORTGAGOR OR SPONSOR T~eviJ & ~z~e~ ~nc. ,UBDIVISION NAME ~nson TOTAL LIVING UNITS BEDROOMS WATER SUPPLY BY: [] Public system BATHS MORTGAGEE l~atanuska Valley Bank Anchorage ~ Alaska PROPERTY ADDRESS 4.302 ltee4",e Drive BASEMENT r~Yes ~ No New installation ~-1 Community system SEWAGE DISPOSAL BY: [] Public system [] Community system SERIAL NO. 60-008~38 BLOCK NO. LOT NO. Can attic or other area be made Into additional bedrooms? (If Yes, how many~) SYSTEM DESIGNED FOR [] Individual .o.~, BDSM$. $ASSAO[ DISPOSAL [] Individual [--1 Yes [] No PART fl.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH (See Attached Drawl. rig) It is the opinion of the [--J State r-J County r-] 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--'J County tern with proper maintenance: [] Can be expected to function satisfactorily, and is not likely to create an insanitary condition g Local Department of Health that this individual sewage-disposal sys- --]Cannot be expected to function satisfactorily ~. l~ 1960 RegienaX-sar~itaria~ 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'~ske~'c~ ~s weli as use of the back of this form is at the option of the health authority. '~ PART III.~FOR USE O-F~HA o~:ficE TO THE CHIEF UNDERWRITER: ! have reviewed the foregoing and the pertinent FHA Complian~e Inspe~n Report, and recommend that~the Individual water-supply system be considered [] Acceptable [] No Acceptable Sewage disposal be considered [] Acceptable J--] Not Acceptable. ~ ..... ~, DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM rCHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT .r~ FHA~Form 25~ Rev. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists* of ~ Septic tank. [] Cesspool. Septic Tank* Distance from well,' m feet. Material. ~3~eel T~ ~ Number of compartments 'l . Total liquid capacity, ~ gallons. Capacity inlet compartment,. ~ gallons. Inside length,, feet. Inside width, ~'¢eet. 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 file Disposal Fleld~ Distance from: Well, Total length of tile lines, Trench width, Length of each line, feet; foundation, feet; nearest lot line at [] front, [] side, I-]. rear, feet. feet. Number of lines, Distance between lines, feet. inches. Total effective absorption area in bottom of trenches, square feet. 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. Seepage Pits* Number of pits ~a . Outside diameter,~, 2feet. l~th, ~' feet. Lining material Distance from: Well, ~ ' ' · ~I~ __ feet; braiding foundat*on, feet; nearest lot line at [] front, [] side, [~ rear,. ~ feet. Inspection mode by* [] State. [] County. ~ Local Health Aut. hority. Inspected by Date of inspection 0~e ~ ., 19 ~ ~l~ 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 construcflom 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. Capadty, ·gallons. Has bacteriological examination of water been made? [] Yes. [] No. If answer is "yes," give date Quality of water UI 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 (TIT£~) .feet. 1 Form Approved FHA Form 2573 Rev. July !~958 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 MORTGAGEE J SERIAL NO. INSURING OFFICE MORTGAGOR OR SPONSOR SUBDIVISION NAME TOTAL NUMBER: BATHS PROPERTY ADDRESS BLOCKe~NO' LOT~. LIVING UNITS BEDROOMS WATER SUPPLY BY: --1 Public system BASEMENT [~Yes~o ri] New installation Can attic or other area be made into additional bedrooms? (If Yes, how many~') ~1 Community system SEWAGE DISPOSAL BY: - [] Public system [] Community system [] Individual NO. f ~YSTEM DESIGNED FOR -']Individual o DRUS. O^RBA~E D~SPOS^L I--lYes PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [--1 State ~1 County N 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 [-] County tem with proper maintenance: [~.Can be expected to function satisfactorily, and s not likely to create an insanitary condition g Local Department of Health that this individual sewage-disposal sys- --]Cannot be expected to function'~gatl§'factorily DATE / ~ J SIGNATURE~/' / NOTE: The health authority should complete the .pproprmt.e opmmn statement obov~ejffnd date, in spaces provided. Use of the above;~]rid for Health Department inspector's sketch a~e~vell as back ,r -~A~' ii'~---F~)~Si~0F- FHA OFFICE ~ -- .... L ~ TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Comp}iance Inspection Report, 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 E]CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form Rev. July 1958 Septic Tank~ Distance from well,.__ Total liquid capacity, Inside length,. ~- Cesspool* Distance from: Well, Inside diameter, REPORT OF INSPECTION--iNDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [~Septic tank. [] Cesspool. -"-~,A' :~' ~ ~ ~-~ ~ '~ f/~ ~ ~ gallons. Capacity inlet compartment, ' - ' ' feet. Inside width, °~' .feet. Liquid depth, ' .feet. gallons. feet; foundation, ._feet; nearest lot line at [] front, [] side, [] rear, feet. feet. Depth, feet. Liquid capacity, gallons. Lining material [] Tile disposal field, l~eepage pits. Other SECONDARY TREATMINT consists of Tile Disposal Flald~ 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. Seepage Pltm Number of pits' /,- ....... ~X~feet Dp', ~'/'~"~ feet Lm,ngmatenal ~0/~ Distance from: Well, vu.o.~...~ fe":~:'~;;i'ding foundation,' ~ ~ feet;-~eare~t 1o; lin: ~t [] fro~t, ~ side, [] rear, f6 feet. Date of inspection ~'"~'~'~ , 19 (~ C ' , REPORT OF INSPECTION--IHDIVIDUAL 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 weft froms Building foundation, cast iron sewer,. seepage pit, Weft conatructtom 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 yieki, 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. Pumps [] 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. feet, feet; 19