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FHA Form 2573 Form Approved
~ev. July 1958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8
HEALTH AUTHORITY APPROVAL
IHDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
INSURING OFFICE MORTGAGEE SERIAL NO.
Anchorage, Alaska l~r~t ~a~tl ~ of ~hor~ lll~hOlO-~3
MORTGAGOR OR SPONSOR PROPERTY ADDRESS
SUBDIVISION NAME BLOCK NO. LOT NO.
TOTAL NUMBER: Can a~ie or o~er area be made Jnt~
BASEMENT ~ N~w J~s~all3[Jo~ additional bedrooms?
uw~o u~s s~aoo~s ~.s
(If Yes, how many~)
WATER SUPPLY BY: SYSTEM DESIGNED FOR
~ Public system ~ Communi~ system ~ Individual NO. O~ BDRMS. GARBAGE DISPOSAl.
~ Public system ~ Community system g Individual ~ g Yes ~ No
PART ".--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
,
~-~ ~ ~ ~ .....
--'
,_ ,
'
It is the opinion of the~ ~ State ~ Court, ~ Local Department of Health that this individual
water-supply
system
~ is ~ is not satishctory as a domestic water supply Gr the subject properS.
It is the opinion of the ~ State ~ County ~ Local Department of Health that this individual sewage-disposal
sys-
tem with proper maintenance:
Can be expected to function satishctorily, and ~ Cannot be expected to hnction satishctorily
~s not likely to create an insanita~ condition
DATE SIGNATURE TITLE
NOTE: The health authority should complete the approgrlate opinion statement Gbove and a~x' date, signature and title in the
space~ provided.
Useof 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 fore~o[n~ ~nd ~he pe~[nenc FHA CompH~ce Inspe~{on ~epo~, ~nd ~ecommend ~h~t 'che
Individual w~ce~-supplF s~scem b~ considered ~ Acceptable ~ Noc
~wage dis~sal be considered ~ Acceptable ~ Not Acceptable.
DATE
SIGNATURE
~ CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2573
Rev. July 1958
'61
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FHA Form 2573 Form Approved
Rev. July '19.58 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 OFFICE MORTGAGEE SERIAL NO.
MORTGAGOR OR SPONSOR PROPERTY ADDRESS
TOTAL NUMBER: ~ Can afflc or other area be made into
tlV,.O U.ITS aEoeoo~s ~Ams ~Aj
installation
bedrooms?
(If Yes, how manyg)
WATER SUPPLY BY:~ SYSTEM DESIGNED FOR
~ Public system ~ Communiw system ~ Individual No. OF BDRMS. GARBAGE DISPOSAL
SEWAGE DISPOSAL BY:
~ Public system ~ ~mmunity system ~ Individual ~ ~ Yes ~ No
PART II.--lO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTORIS SKETCH (~ Atta~
2
~_~ ' ~ ...... ,
~--~ ....... ~___ M ' ~_~
It is the opinion of the ~ State ~ County ~ Local Department of Health that this individual
water-supply
system
~ is ~ is not satisfactory as a domestic water supply for the subject properS.
It is the opinion of the ~ State ~ County ~ Local Department of Health that this individual
sewage-disposal
sys-
tem with proper maintenance:
~ Can be expected to function satisfactorily, and ~ Cannot be expected to function satisfactorily
is not likely to create an insanita~ condition
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 Inspe.:tor'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 Inspe~ion Report, and recommend that 'the
Individual water-supply system be considered ~ Acceptable ~ Not Acceptable
Sewage disposal be considered ~ Acceptable ~ Not Acceptable.
DATE
SIGNATURE
~ C~IEF ARCHITECT
DEPUTY FOR CHIEF
HEALTH AUTHORITY APPROVAL FHA Form 2573
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM Rev. July 19SB