HomeMy WebLinkAboutCAMPUS HEIGHTS Block 4 Lot 5Ittk
CASE NUMBER S~-'~475
PETITION FOR
DATE RECEIVED
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
PLATTING OR PLANNING AND ZONING CASE REVIEW
oF Fmd Na]atka & Associates for Plat of Lot 5C Campus
Helghts Subdivision - a resubdtv of Lots 5A & 58, Campus
Hetghts subdtv located tn NE ]/4 Sec 33, T]3tt, R3~, SH Ai
COMMENT TO PLANNING BY
FOR MEETING OF
COMMENTS:
ENVIRONMENTAL SANITATION:
lC ¥ 1,NOI'AVAI LABLE
of . Cases
C SEWER Nefl"~VAILABLE TO SERVICE PETITION AREA,
ENVIRONMENTAL ENGINEERING:
rcc¢ivcd a petition from Jo-m Dic.~erhoff' to resubdivide
lots into one lot/Thc pcthion area is located
west of ~mpus St. . .~~~' ....... . · ,. < ·
' Approved' as submitted. . -.'
}~ETING ~JOL~%~ AT ll:S3 P,H.
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
I~$URING OFF'CE
· PART I.~TO BE COMPLETED BY FHA
~Q¥ Clark
SUBOIVI$1ON ~
,,.,.~u.., I ,,0,oo.s,.,,s []
Yes No
MORTGAGEE
SERIAL
[] New installation
Public system
[] Corvanunity system
SA'~VA G S DISPOSAL
Public system
]Community system
[] Individual
Y~ [] No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
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.
lc 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 insanitary condition
O¢:ober 1". 1961 /'~'d~,~/' ,~ 0 ~ ] Sanitarian
.o,,. -,. ~f'~...,o,*,~, .~..,d ..,..,....~..,,,.,..-...,,.,....-..-,.., .b.....~ ..,. ~......,---,,. --~ ..- .- ",-
~ PART III.~.FOR USE OF FHA OFFICE
TO THE CHiEf UND(RWRITIItx
I have ~eviewed t~e foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the
Indivldu~ water-supply s~srem be considered [] Acceptable [] Not Accep~ble
Sewage disposal be considered [] Acceptable [] Not Acceptable.
INDIVIDUAL WATER SUPPLY AND SEWAGS DISPOSAL SYSTEM
REPORT OF INSPECTIONtINDIVIDUAL WATER-SUPPLY SYSTEM
Individual wells f-I ate I-] are m~t customa~ in n¢ighborh~x~d.
Ptopertles in neighh~xh~x)d ["] are f-I are no~ being deveI.ped with bo(h individual water-supply and sewage.disposal systems.
Lot size' feet wide, feet deep. Dwelling s~ back from front property line feet.
Individual water supply from: ["[ Drilled well. I-I Driven well. [-] Dug well. 1-[ Bored well.
Building founda6on.
seepage pit.
Well ceast~l
,feet; cesspool,
feet; nearest I~ line at f-] front. I-I side, f-I rear,. .fees.
.feet; seJxic tank.. .feet; disposal field, feet;
feet; mh~t ~o~tces m' possible pollutiofl. ~'eet
Diameter, inches. Total delxh, feet Type o( casing..
Approximate del'~h to ~mping level of water in well f~. Approximate yield,
~al~ watertight to ~pth ~f f~.
F~t~ sp~ around casing ~aled ~ith: ~ ~ment grout. ~ ~led clay. ~ Ordi~
~ell cover: ~ ~r~e. ~ ~, ~ M~, ~nin&s in ~11 cover wat~ig~t: ~ Y~,
~ ~ Shallow ~[I. ~ ~p well. ~h of drop pi~.. fe~. ~mp capacity,
bgat~ in: ~ ~nt. ~ ~mpt~m off ba~ment. ~ ~mp~ a~ve ~nd. ~ ~mp pit.
~mpr~m pro.dy ~ain~: ~ Y~. ~ No. ~mp ~ntln~ watertight: ~ Yes. ~ No.
Ty~ (ff sc~agc: ~ ~ssure. ~ Gravi~. ~city, gall~s. -'
Has ~c~t~logkal examinat~ of water ~n ma~? ~ Y~. ~ No. If answer is "~," give
~ali~ ~ water ~ is ~ is ~ sati~a~o~ for hu~n c~sum~n.
In~allat~ ~ ~s ~ ~ not comply with approved ex~i~ts, if any.
Ins~t~ made by: ~ ~ale. ~ ~unty. ~ ~ Health Au~ority.
Ins~ed by
Date ~ in~i~ ,19
Depth of casing, feet.
.gallons pet minute.
.gallons per minute.
19
(Trna)
INDIVIDUAL SEWAGE AND %~ATER rAClLITIES [~ ~'l .,~. ~ .
(Fill out in Triplif~e) _ ~ ~ ~ ~
5. Wate~nalysls: ¢
b. DeterEent .
WeLl date:
b. gepth,
c. Casinf Size
de
Distance 'from well to closest exlst~ng or proposed:
1. Sewer l~ne TO ~
2. Septic tank.
3. Seepage Area
~. Cesspool~.
5. Property Line
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, ham, drainaEe ditch, etc. .
7. Sewage disposal system.
a. Age of system .
.
b. Septic tank capacity in gallons /20~ ,
c. }lame of septic tank manufacturer ~ ~
1, If "home made" show diaFram on reverse side of this~orm.
d.' Disposal field or seepage.pit size and type
- 1. 'Distance to property line ~'! to house foundation....~"'
.. Percalaticm.,Test ~-~e sults
f. Percolation Test performed by
Use the reverse.side of this form to show diaEram, Dia~ra~ should include
'the fol].~oun~ information: p~operty lineal.well location, house location,
~,t-{c tank location, disposal area location, location of percolation test,
a,~ direction of Fround slope.
9. Tke l,J~.,.m~.ion on this form is true and correct to the best of my knowledge.
Signature of Applicant
Date SiFned
T.O BE FILLED OUT BY HEALTH DEPART;~ENT PERSONNEL
above described sanitary facilities are hereby approved, sub~ect to the
~611owinF conditions:
Conditior.s:
The above described sanitary facilities are disapproved for the following
' Approval is valid for one year followin[ the date of approval.
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