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HomeMy WebLinkAboutSUNSET HILLS BLK A LTS 1 & 2 Rev. July 1958 HEA[IH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART L--TO BE COMPLETED BY FHA Approved Budgel Bureau No. 63-R296.8 INSURING OFFICE MORTGAGEE SERIAL ~O. MORTGAGOR OR SPONSOR M., 0,,. Young PROPERTY ADDRESS SUBDIVISION NAME TOTAL NUMBERz I-lYes No ] New installation BLOCK NO. LOT NO. additional bedroomlT (If Yes, how man¥~,) WATER SUPPLY [] Public system [] Community system SEWAGE DISPOSAL BY: -'] Public system ]Community system [~, Individual ~_~] Individual ~o. SYSTEM DESIGNED. FOR PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT iNSPECTOR'S SKETCH 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 property. It is the opinion of the [] State [] County 1{~] 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 insanitary condition DATE 3ept. 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 AHD SEWAGE DISPOSAL SYSTEM ]CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2S73 Rev. July 1950 tq~.--~'~ (rill out in ~riplicate) . 2. ~am~_ of property[ owne~, _~-' ,. .d ooms in house Kater, Analysis: b. Detemgent Well data: ype~ ao T c. Casing Size proposed: Distance from well to closest existing or ~. Septic tan~__~©~ 4, Cesspool' 5. Property Line,, ,~ . 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn~ draina[e ditch~ etc. , ..... . a. Age of system .... b. Septic tank capacity in gallons. c. Name of septic tank manufactu~e'r 1. If "home made" show diagram on reverse si~e of this form. d.' Disposal field or seepage pit size and type ....... 1. Distance to property line ._, to house fouodation ~ e. Percol.atiort Te'st Xesults ....... ' by f. Percolation Test performed "' ' ~.~ Use 'the reverse .side of this form to show diaFram, Diagran[ should include 'the foil.owing ~nfo~mation: p~operty lines~.well location, house location, ~i,~c tank location, disposal area location~ location of percolation a~4 direction of ground slope, 9. The ~,F~,-,:~[~*{~,r~ on this form is true and correct to the best of my knowledge. ~iF'n-[~tu'~'e ~ Applicant SiFned TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL ~T'he above described sanitary facilities are hereby approved, ~subject.~to the. ........... ~611owin? con~ifions: Conditions: ~_ (7~-3.~ ~ The above described sanitary facilities are disapproved for the following Approval is valid for one year following the date of approval. CPJ:cw