HomeMy WebLinkAboutBROOKWOOD BLK 1 LT 1601 - I")l- 05"
FHA Form 2573
Rev, Juty 1958 FEDERAL HOUSING ADMINISTRATION Form Approved
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 SERIAL NO.
MORTGAGOR OR SPONSOR PROPERTY ADDRESS
SUBDIV,S,ON NAME ,LOC¥O. [LOT
Can attic or other area be made into
TOTAL NUMBER: BASEMENT ~ New installation
additional
bedrooms?
LIVING UNITS BEDROOMS BATHS
(If Yes, how rnany~)
WATER SUPPLY BY: SYSTEM DESIGNED FOR
~ Public system t~ Community system ] ] Individual NO. OF EURMS, OARBAOE D,SPOSAL
SEWAGE DISPOSAL BY:
~ Public system [-'] Community system [] Individual ~ [--] Yes [~ No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is ,~e opinion of the ["-] State [--1 County ~'~ocal Department of Health that this individual water-supply system
~s F"] is not satisfactory as a domestic water supply for subject property.
the
It is the opinion of the ["-] State ['-] County [~Le~al Department of Health that this individual sewage-disposal sys-
tem wit,h proper maintenance:
be function satisfactorily, and N Cannot be expected to function satisfactorily
expected
tO
is not likely to create an insanitary condition
DATE SIGNATURE ., ;- TITLE
"NOTE: The health authority sKuld camplate the appropriate aplnlon statement above and affix date, slgnafure 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 ['--I Acceptable [-] Not Acceptable
Sewage disposal be considered [~] Acceptable [-] 'Not Acceptable.
DATE SIGNATURE [---J CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
Rev. July 1958