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ARCT :~ ALASKA TESTING LN~ORATORIE,:
Ig40 POST RO4D BOX 845
ANCHOR&~E FAIRBA N K8
PERCOLATION TEST DATA
TEST HOLE NO. ~
w.o. NO. ~ ~T
DATE._. ~1/% I,L~'---
LOCATION LOT ~ BLOCK-- ~-- _ ~U~OIViSlON .'~'~/J,a,i.'l,~oo D
FHA NU~K~ ~_ . . .
CLIENT AL~ N~J~.
T,EST SE LO~
LOCATION SKETCH
APP. TOPOG.
D~II'H TO NIO
~.4DINe
:~ 0
I
3
4
ECHNICIAN. ~
FROST
NET DROP
LEGEND
GRAVEL
SAND
SILT
CLAY
ORGANIC
CONTENT
PEAT
WATER
TABLE
lO
II
I PERC~.&T,KIS# ll~TE 1'/ ......
FHA For;:~ 2573 Form Approved
Rev. July 1958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8 1
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
INSURING OFFICE MORTGAGEE SERIAL NO.
MORTOAOOR OR SPONSOR , PROPERTY ADDRESS
Aven~e
SUBDIVISION NAME ~t~ ~) ~'--- BLOCK NO. F LOT NO.
B~okwood
TOTAL NUMBER: Can a~ic or ot~r area be made
BASEMENT ~ ~ ~S~J~JO~ additional bedrooms?
LIVING UNITS BEDROOM5 BATHS
..................... {If Yes, how many~)
WA~R SUPPLY BY, SYSTEM DESIGNED FOR
~ Public system ~ Community system ~ Individual No. oF ~oRM$. GARBAGE
SEWAGE DISPOSAL BY:
D
PART II.~TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
..... ~ ~ ~ ~ ,
, ~.~ ~ ~
~--~ ~ .....
It is the opin~o~ o~ the ~ Sc~te ~ Coun~ ~ ~oc~l Dop~rtme~ oF Health th~t th~s ~dJv~du~l w~te~-suppl~
of the ~ State ~ County ~ Local Department of Health that this individual
It
is
the
opinion
sewage-disposal
tem with proper maintenance:
~ Can be expected to function satisfactorily, and ~ Cannot be expected to function satisfactorily
is not likely to create an insanitary condition
DATE SIGNATURE TITLE
NOTE: The health authority should comDlet~ th~ appropriate opinion statement above and a~x date, signature and title in the
Use of the above grid for Health Deportment Inspector's sketch as well as use of the back of this form is at the option of the
he~ .h authority.
PART Ill.--FOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
~ h~ve reviewed t~e fo~e~oin~ ~nd ~e pe~inent FHA Comp]i~nc~ ~nspe~ion ~epom ~nd recommend t~t
~w~e dis~sM ~e considered ~ Ac~epc~5~e ~ ~o~
DATE
SIGNATURE
~ CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2573
Rev. July 1958
£ST HOL£
ARCTIC ALASKA TESTINB LABORATORIES W.O. NO, ~
1940 ~ST ~ ~X a4a DATE.~~
AN~ORA~ FAIRBANKS TECHNICIAN.
LOCATION lOT ~ BLOCK-
FHA NUMBER
CLIENT ,~_L.~../q~r ///FI~,~I~ .....
~OIL CL~$ -VISUAL -UNIFIED
READING
I
$
4
t'
II
IO
tl
P~:RCC~A'nOfl
PERCOLATI0.N TES,,T DATA
SUBDIVISION 2'4~,P~ t4(oo L-' ....
LOCATION SKETCH
APP. TOPOG.
NET TIME DEPTH TO N~O
FROST
NET DROP
LEGEND
GRAVEL
SAND
CLAY
CONTENT
PEAT
_~ WATER
TABLE