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HomeMy WebLinkAboutEVANSON LT 9 LOCATION SKETCH TEST HOLE LO~ APP. TOPO~. t'l~&OINe ]DATE eROU TIME NET TIME DEPTH TO HaO NET DROP '1 IiATURATE 0 '~-~.d /d/· ~ I' ~ " t,'.- · i " , ~:z~ " . · - ~ ..... .'---_ -~ ~ PERG~-ATION RATE I"/ FHA Form 2573 Fotrn Approved Rev. July 1958 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 ~NSURING OFFICE I MORTGAGEE SERIAL NO. MORTGAGOR OR SPONSOR~ ~ - PROPERTY ADDRESS SUBDIVISION NAME , ...ce" ~ BLOCK NO. J LOT NO. TOTAL NUMBER: ~ ~L .~ Can attic or other area be made into ~ i BASEMENT \ ~l New installation additional bedrooms? LIVING UNITS BEDROOMS ~~'lYems ---- X ~ "Il (If Yes, ho .... WATE.R,,~ .y BY: ' __ '~. SYSTEM DESIGNED FOR SEWAGE DISPOSAL BY: ~'/ ~.. ~ ~ ~ ~ ~. / P"ART II"-"TO BE ~.~PL"ED BY'~!~EALTH DEPARTME"T . ...................... =================================== i .................. ~-4AAAAA444444 --- .......................... ~ ...... i ........ ' .... ................................ It is the opinion of the [---] State [~ County N 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 T~ 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 ~s not likely to create an insanitary condition DATE SIGNATURE TITLE NOTE: The health authority should complete the approprmte op neon statement above and affix date, signature and title in the spaces provided. Use of 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 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 [] CHIEF ARCHITECT r DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2573 Rev. JuJy 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. ~' Cesspool. Septic Tank: Distance from well, feet. Material, Number of compartments Total liquid capacity, .gallons. Capacity inlet compartment, gallons. Inside length, feet. Inside width, ' feet. Liquid depth, feet Distance from: ,SVell, __ _ feet; foundation, ~ ~r ~ ~L'~ feet; nearest lot line at [] front, lltl side, [] rear, ~feet., Inside ' ~_~_a~:~ feet. Depth, {~'. fee:. Liquid capacity, gallons. Lining material SI¢ONDARY IREAIMINI consists of [] Tile disposal field. [] Seepage pits. Other Tile Disposal Field: Distance from: Well, Total length of tile lines, Trench width Length of each line, feet; foundation, feet; nearest lot line at [] front, [] side, [] rear,_ __ feet. feet. Number of lines, Distance between lines, feet. inches. Total effective absorption area in bottom of trenches square feet. feet. Depth, top of tile to finish grade,_ .inches. Type of filter material: [] Gravel. [] Broken stone. Other Depth of filter material beneath tile,~ inches, inches. Seepage Pits: Number of pits . Outside diameter,, feet. Depth, Distance from: Well, __ feet. Inspection made by: [] State. Depth of filter material over tile, .feet. Lining material Date of inspection feet; building foundation, __ feet; nearest lot line at [] front, [] side, [] rear,. [] County. [] Local Health Authority. Inspected by ~'°a:~'/l~/'~9 ~//~ ~/' d ~< , REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main, feet. Size of main, inches. Individual wells [] are [] are not customary in neighborhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate Supply of water Properties in neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems. Lot size? feet wide, feet deep. Dwelling set back from front property line, feet. Individual water supply from: [] Drilled well. [] Driven well. [] Dug, well. [] Bored well. Distance of well from: Building foundation cast iron sewer, feet; tile sewer, seepage pit, feet; cesspool, Well construction: Diameter, inches. Total depth;.~ feet. Type of casing, Approximate depth to pumping level of water in ~ell, feet. Approximate yield, Sealed watertight to depth of feet. Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. Pump: [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity, Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No. Type of storage: [] Pressure. [] Gravity. Capacity, gallons. Has bacteriological examination of water Ne. on made? [] Yes. [] No. If answer is "yes," give date Quality of water [] is [] is not satisfactory for human consumption. Installation [] does [] does not comply with approved exhibits,' if any. Inspection made by: [] State. [] County. [] Local Health:Authority. Inspected by Date of inspection 19 feet; nearest lot line at [] front, [] side, [] rear,, feet, feet; septic tank,. .feet; disposal field, feet; xeeet; other sources of possible pollution, feet. Depth of casing, gallons per minute. gallons per minute. feet. 19 (TITLB) Form 2573 Form Approved Rev. July ~9S8 ' 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 MORTGAGOR OR SPONSOR iUBDIVISION NAME TOTAL NUMBER: Anohoz afef, Alaska inoho rafo, Alaska BASEMENT r~ New installation Yes [] No BLOCK NO. LOT Can attic or other area bo made Into additional bedrooms? (If Yes, how rnany~.) WATER SUPPLY BY: N Public system ['~ Community system SEWAGE DISPOSAL BY: [] Public system [] Community system [~ Individual NO. 092 SYSTEM DESIGNED~FOR --]Individual eo~. O^.^GE Dt. OS^L [] Yes ['Z'1 No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [-~ State N County N 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 N County tem with proper maintenance: N Can be expected to function satisfactorily, and ~s not likely to create an insanitary condition ]Local Department of Health that this individual sewage-disposal sys- ~1 Cannot be expected to function satisfactorily DATE ....... ~!gNATURE TITLE NOTEt The health authority should complete the ap~oprlato opinion statement above and a~x date, signature and title in the spaces provided. . ~ 'e Use of the above grid for Health Department Inspector's~h as well as use of the back of this form is at the option of the health authority. ~ ~ ~ PART III.--FC~R,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. CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2573 Rev. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. [] Cesspool. Septic Tank: Distance from well,__.feet. Material Total liquid capacity, Inside length, .feet. Inside width, Cesspool: Distance from: Well, Inside diameter, gallons. Capacity inlet compartment, qg? Liquid depth, Number of compartments ~ .gallons. feet. feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. Depth, feet. Liquid capacity, _gallons. Lining material SECONDARY TREATMENT consists of [] Tile disposal field. [] Seepage pits. Other feet. feet. square feet. inches. Tile Diaposal Field: Distance from: Well, Total length of tile lines,. Trench width, Length of each line, inches. feet. Lining material __ feet; nearest lot line at [] front, [] side, [] rear,_ [] County. [] Local Health Authority. Inspected by 19.__ (TITLR) feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, .feet. Number of lines, Distance between lines, inches. Total effective absorption area in bottom of trenches .feet. Depth, top of tile to finish grade,_ Type of filter material: [] Gravel. [] Broken stone. Other. Depth of filter material beneath tile,~ inches. Depth of filter material over tile, Seepage Pits: Number of pits , Outside diameter, feet. Depth,. Distance from: Well, __ feet; building foundation,. Inspection made by: [] State. Date of inspection. REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main, __feet. Size of main, inches. Individual wells [] are [] are not customary in neighborhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems. Lot size: feet wide, feet deep. Dwelling set back from front property line,, feet. Individual water supply from: [] Drilled well. [] Driven well. [] Dug well. [] Bored well. Distance of well from: Building foundation, .cast iron sewer,, feet; tile sewer, seepage pit, .feet; cesspool,. Well construction: Diameter, inches. Total depth, .feet. Type of casing, Approximate depth to pumping level of water in well,, feet. Approximate yield, Sealed watertight to depth of feet. Exterior space around casing sealed with: [] Cement grout. [] Puddled clay, [] Ordinary backfill. Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. Pump: [] Shallow well. [] Deep well. Length of drop pipe, feet. Pump capacity, Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No. Type of storage: [] Pressure. [] Gravity. Capacity, .gallons. Has bacteriological examination of water been made? [] Yes. [] No. If answer is "yes," give date Quality of water [] is [] is not satisfactory for human consumption. Installation [] does [] does not comply with approved exhibits, if any. Inspection made by: [] State. [] County. [] Local Health Authority. Inspected by Date of inspection , 19__ .feet; nearest lot line at [] front, [] side, [] rear, feet; septic tank. feet; disposal field, feet; other sources of possible pollution, feet. Depth of casing, .gallons per minute. .gallons per minute. ,19 (TITLE) feet, feet;