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FHA F;rm 2573 Form Approved 1
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
Anchorage, Alaska ~ First National Benk of Anchorage ! 60-008419
/
Alan J. H~rri:~ i 1906 Dolly Varden - Anohorage
SUBDIVISION NAME ~NO. j LOT NO.
B~oo~oo~ S~bd~v~on
TOTAL NUMBER:
BATHS
LIVING UNITS J BEDROOMS
1J 3
WATER SUPPLY BY:
BASEMENT
New installation
Can attic or other area be made into
additional bedrooms?
(If Yes, how rnany.~)
r-] Public system [-~ Community system [--] Individual
f ~YSTiM DESIGNED FOR
· NO. OF _DAMS GARBAGE DISPOSAL
Individual n'] Yes [-~ No
SEWAGE DISPOSAL BY:
--J Public system
n-]Community system
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the r-] State [--] County r-] Local Department of Health that this individual water-supply system
[--1 is [~] is not satisfactory as a domestic water supply for the subject property.
~-~Jt~]' State ~'] County [~ Local Department of Health that this individual sewage-disposal sys-
It
is
the
opinion
of
the
tern with proper maintenance:
]Can be expected to function satisfactorily, and F-] Cannot be
expected
to
function
satisfactorily
is not likely to create an in, s~an, itary condition
DATE / / I SIGNATUR~ff, / 1 T,T E .,
/ ~/ NjTE~hehealth"uthor,t sho Id ' ' ' · ...... abo'¢fidaffi--~-date, signature and title ln the
/ : ' y u comp,ere the appropriate op nion statement
spaces provided. ~/
Use of the above grid for Health Departmem' 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
Sewage disposal be considered [--] Acceptable [~ Not Acceptable.
DATE SIGNATURE
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
FHA Form 2573
Rev. July 1958
3
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