HomeMy WebLinkAboutNEVILLA PARK LT 31O0 (0
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FHA Form 2573 Form Approved
Rev, July 1958 FEDERAL HOUSING ADMINISTRATION Budg0t 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
SUBDIVISION NAME BLOCK NO. LOT NO.
i'll;villa Pa~k ,qubd[vb~'~on 3~L
TOTAL NUMBER: BASEMENT~ New installation additional bedrooms?
uw.o um~s ~EOROO~S
...... (If Yes, how nlany~)
r--lYes
WATER SUPPLY BY: SYSTEM DESIGNED FOR
[] Public system ~ Community system [] Individual NO. o~ ~OR~S. O~eAO~
SEWAGE DISPOSAL BYE
~ Public system [~ CommuDity system [] hldividual [-~ Yes [] No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
22ZZZZZZZZZ:ZZ2222222::Z2222222222222ZZ222222222222222:222 2222222222
ZZZzZzZZzzZZzZZZZZZZ:-ZZZZZZZZZZZZZZ2ZZZZZZZZ- 222222222- 222222222: 22222
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 ~ Local Department of Health that this
individual
sewage-disposal
tern with proper maintenance:
~1 Can be expected to function satisfactorily, and r-1 Cannot be expected to fimction satisfactDrily
is not likely to create an insanitary condition
DATE SIGNATURE TITLE
: l;nviVonra,~ntal llealth l')iveeto~,
spaces provided.
health authority,
PART III.~FOR USE OF FHA OFFICE
TO ?HE 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 [--J Acceptable [] Not Acceptable.
DATE
SIGNATURE
[--] CHIEF ARCHITECT
] DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORI?Y APPROVAL FHA Form 2573
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM ue~. July 195B
2,
3,
q,
5,
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Tripllcate)
Name
person requestin~ approv=l__?% .~-f~
Na~e of p~ope~ty, owne~ ~~_
Numbe~ of ~ed~ooms in house , .~ ~.~
Water Analysis:
a. Bacterial
b. Detergent
Well data:
c, Casing Size
Distance from well to closest existing or proposed:
1. Sewer, line
2. Septic tank
3. Seepage Ar, aa
4. Cesspool'
5. Property Line
6. Other sources of possible contaminatlon~ i,e,: creeks~ lakes,
houses~ barn~ dralna~e diteh~ etc. .
Sewage disposal system.
a. Age of system..
b. Septic tank capacity in gallons
c. ~,[ame of septic tank manufaotu~e,r
1, If "home made" show diagram on reverse side of this form.
Disposal field om seepage pit size and type_._.~.~/~. , ~Y~,~
1. b~-~tance to propoint-! line__/~ to house t.~,mdation
Percolation. Test ~esults
f. Percolation Test performed by
Use the reverse,side of this form to show diagram. Diagram should include
-~he foilowing information: ~operty llnes~.well location, house location,
~6Utlc tank location, disposal area location, location of percolation test,
and dlmection of ground slope.
9. The h~fo-~,~atlon on this form is true and correct to the best of my knowledge.
Signature of AppliCant
~ BE F.ILLED OUT BY HEALTH DEPAP, T~.~ENT PERSONNEL
~he above described sanitary facilities are hereby approved, su~bject to the
~llowing conditions:
Conditions: /~?]_~a
The above described sanitaryfacllzt~es' ' ' are disapproved for the following
re asons:
Approval is valid for one year following the date of approval.
CPJ:cw
May 22, [968
Mr, Charles La Grant
812~ East Seoond Avenue
Anchorage, Alaska 9950~
Dear Hr. ~a Grant=
SUBJECT~ Sewage Disposal
Faoilities, 812~ g. Second
(East o£ 812~ E. 2nd)
The Greater An~torage Area Borou~ Health Department
·ade an inspection of the sewage disposal system for
yotm ne~ hon~ directly east oE 812~ East Second~ and
~ound the system to be adequate in terms o~ the size
of tbs home.
Sincerely,
DAVID R. L. I)U~CAN~ M. D.
~sdical Dlreittor
DBH/srr
BY:
San it arian