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HomeMy WebLinkAboutEVANSON LT 16 FHA Forn~ 2573 Form Approved 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 ~ORTGAGEE 1~ SERIAL NO. INSURING OFFICE MORTGAGOR OR SPONSOR & et, mg'er SUBDIVISION NAME ~on TOTAL NUMBER: LIVING UNITS BEDROOMS BATHS BASEMENT --]Yes [~] No PROPERTY ADDRESS An horqh -Jq New installation WATER SUPPLY BY: [] Public system [] Community system [] Individual SEWAGE DISPOSAL BY: [] Public system [] Community system [] Individual BLOCK NO. Li~ NO. Can attic or other area be made Into additional bedrooms? (If Yes, how many?) J SYSTEM DESIGNED FOR NO. OF BDRMS. GARBAGE DISPOSAL ~ I--lYes [~ No PART fl.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [-7] State [] County [] Local Department of~ealth 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 ["~Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: [~an be expected to function satisfactorily, and N Cannot be expected to function satisfactorily zs not likely to create an insanitary condition TITLE 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 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 Acceptable Sew~age disposal be considered ['-] Acceptable [] Not Acceptable. ] CHIEF ARCHITECT -I DEPUTY FOR CHIEF ARCHITECT DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 257,b Rev. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of~Septic tank. [] Cesspool. Septic Tank: Distance from well, Total liquid capacity, Inside length,. Ce~pooh Distance from: Well, Inside diameter, feet. Material: ~f-.ff-.~ Number of compartments ~ ,/~5'C2) gallons. Capacity inlet compartment, /g~L~ 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 SECONDARY TREATMENT consists of [] Tile disposal field. J~ Seepage pits. Other Tile Diapoaal Fields 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 Pita~ ~feet Depth e,~rea~ Number of pits ! Outside diameter, _.q'X . , 6 ' feet. Lining material Distance from: Well, ~" feet; building foundation, "._~'~g'.~'~---_ feet; nearest lot line at [] front, ~sid , .~t~feet, Inal~gtlon mad. by: [] Site. ? County. ~ Local Health Authority. ~ .~C_~.~,~/,,~ ~.~, Date of inspection ~/~ 6 ,19 ~' '~ Inspected by~7~gl~ ~~7~--~?---'''~_ .~.~ff~-~¢..~ - · ~ - - * (TITLe)' - 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 uoOpertiesin neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems, t size: feet. feat wide, Individual water supply from: [] Drilled well. Distance of well from: Building foundation cast iron sewer,_ .feet; tile sewer, seepage pit, feet; cesspool, Well conatrucflon: Diameter, inches. Total depth, feet deep. Dwelling set back from front property line,. [] Driven well. [] Dug well. [] Bored well. · feet; nearest lot line at [] front, [] side, [] rear, feet; septic tank,. .feet; disposal field, feet; other sources of possible pollution, feet. Approximate depth to pumping level of water in well,_ Sealed watertight to ~e, pth 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. 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. ~,pe 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 feet. Type of casing,. Depth of casing, feet. Approximate yield, .gallons per minute. gallons per minute. (TITLB) , 19 feet;