HomeMy WebLinkAboutCOLEMAN Block 2 Lot 10
FHA Form 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
INSURING OFF~CE MORTGAGEE SERIAL NO.
MORTGAGOR OR SPONSOR PROPERTY ADDRESS
TOTAL
NUMBER:
Con attic or other area be made Into
BASEMENT
3~ New installation additional bedrooms?
LIVING UNITS BEDROOMS BATHS
~ (If Yes, bow manyi
X JJJ X [--1 Yes jJrJ No J--1 Yes JJ~No
WATER SUPPLY BY: SYSTEM DESIGNED FOR
[--1 Public system~J J Community system~l Individual ,o. OF BDRM$. GARBAGE DISPOSAL
SEWAGE DISPOSAL BY:
~-] Public system J--] Community system 1~ Individual a D Yes I1~ No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
~ -~ ~ ~ ......
~ ~- ~---~ ....
It is the opinion of the ]~State J--1 County [-] Local Department of Health that this individual water-supply system
Jis J--J is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the ~ State [-1 County J---J Local Department of Health that this individual sewage-disposal sys-
tem with proper maintenance:
Can be expected to function sat!.~factorily, and ~ " J~ Cannot be expected to function satisfactorily
is not likely to create an ins~5~ary condition' '
DATE ( SIGNA]'UR/ ./. ' :TITLE ~
NOTE: The health authority should complete the appro~rlate opinion statement ahoy 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 III.~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
Sewage disposal be considered ["-] Acceptable ~'] Not Acceptable.
DATE
SIGNATURE
J'~ CHIEF ARCHITECT
J '~ DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Farm 2573
Rev. July 1958
REPORT OF INSPECTION-~-INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PRIMARY TREATMENT consists of l~Septic tank.
Septic Tank:
Distance from well,..~feet.
Total liquid capacity,
Inside length, feet.
Cesspool:
Distance from: Well, .
Inside diameter,, feet.
[] Cesspool.
Material,
Inside width,
feet; foundation,
Depth,
.~_W ~_ai~,4,~.4)'r .~ H~//) Number of compartments /.,
gallons. Capacity inlet compartment,. .gallons
feet. Liquid depth, feet.
feet; nearest lot line at [] front, [] side, [] rear, feet.
feet. Liquid capacity, gallons. Lining material
SECONDARY TREATMENT consists of [] Tile disposal fieldl
Tile Disposal Field:
Distance from: Well,
Total length of tile lines,
Trench width.
Length of each line
Type of filter material: [] Gravel.
~Seepage pits. Other
feet; foundation, ' feet; nearest lot line at [] front, [] side, [] rear~
feet. Number of lines Distance between lines
inches. Total effective .ab$0rp~o'~n area in bottom of trenches
feet. Depth, top of tile to finish grade,
[] Broken stone. Other
t~et.
square feet.
inches.
Depth of filter material beneath tile,~ inches~ Depth of filter material over tile, inches.
Seepage Pits:
Number of pits /'. Outside diiai~r, g a~ feet. Depth, /~ feet. Lining material
Distance from: Well.. /t~_ feet; building foundation, ~R feet; nearest lot line at ~ front, ~ side, ~rear ~feet.,
Ins.ctiOn made by: ~ State. = Count. ~o~1 H~I~ Authorlw... ~ .L _'/~.--.~~'%~ .
Date of inspection 7/~,19~ - ,~2 ,~--- ~(TIT~)
REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM
Distance to nearest public water main, '-'-'- feet. Size of main,- inches.
Individual wells Rare [] 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 pare [] are not being developed with both individual water-supply and sewage-disposal systems.
Lot slze:~feet ~ri~e, /q,~"' feet deep. Dwelling set back from front property line, ~3 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; ~esspool,
Well construction:
Diameter, ~ inches. Total depth, e~'
Approximate depth to pumping level of water in well,.
Sealed watertight to depth of feet.
Exterior space around casing sealed with: [] Cement grout.
Well cover: [] Concrete. [] Wood.
Pamp: [] Shallow well. [~Deep well.
feet; nearest lot line at [] front, [II/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.
[] uddled clay. Ordina. backfill, qY.X
~[etal. Openings in well cover watertight:,J~es. [] No.
Length of drop pipe,.~--feet. Pump capacity,
.gallons per minute.
feet,
feet;
.feet.
Located in: ii, Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit.
. Pumproom ~rc~perly drained: [] Yes. [] No. Pump mounting watertight:~ Yes. [] No.
Type of storage: Of Pressure. [] Gravity. Capacity,__~gallons. l~'~
Has bacteriological ex~imlnation of water been made~ ~es. [] No. If answer is "yes," give date /~)~__J:
Quality of water ~is [] is not satisfactory'for human consumption. ~
Installation [] does g~' does not comply with approved exhibits, if any. ~ ~ ~
Inspection made by: a~ State. [] County. XLocal Health Authority. (~__.~,~.~/~~r.---~__~q~..
, Inspected by . . -
Date of inspection ~//q/ , 19..~,~ ~,,,~~
~ u. s. GOVERNMENT PRINTING OFFICE: 1957 O-F--42703E