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HomeMy WebLinkAboutEVANSON LT 10 ,, II -q FHA Form 2573 Form Approved Rev. July 1958 FEDERAL HOUSING ADMINISTRATION Budge: 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 National Bank of Alaska Federal Housing Administratio Anchorage~ Alaska MORTGAGOR OR SPONSOR Lewis & ~etzger~ Inc. SUBDIVISION NAME Evanson PROPERTY ADDRESS 4206 Needle Drive TOTAL NUMBER: LIVING UN]TS BEDROOMS i 4 BATHS 2 BASEMENT AYes J~ No ] New installation SERIAL NO. 60-008425 BLOCK NO. LOT'JO NO. Can attic or other area be made into additional bedrooms? [ (If Yes, how many~) --]Yes No WATER SUPPLY BY: J~ Public system [] Community system [] Individual SEWAGE DISPOSAL BY: [] Public system [] Community system [] Individual SYST~EM~ DESIGNE~D FOR J '] Yes r-~ No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH (See Attaehed Drawing) It is the opinion of the N State [--] County N Local Department of Health that this individual water-supply system ~] is N is not satisfactory as a domestic water supply for the subject property. It is the opinion of the ['~ State [--] County tem with proper maintenance: ~-] Can be expected to function satisfactorily, and is not likely to create an insanitary condition [] Local Department of Health that this individual sewage-disposal sys- [~ Cannot be expected to function satisfactorily DATE J SIGNATURE TITLE 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 Deportment Inspector's sketch, las well as use of the back of this form is at the option of the ;. health authority. PART Ill.--FOR?SE qF 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 N Acceptable [-~ Not Acceptable Sewage disposal be considered ~1 Acceptable ['--] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 ~v July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [l~Septic tank. [] Cesspool. S~ptic Tank: Distance from well, ~ feet. Total liquid capacity, ~ Inside length,, feet. Coaipooh Distance from: Well, Inside diameter, feet. Material. ~a~i~l Uel,~e I~,~'~ Number of compartments gallons. Capacity inlet compartment,. ~ Inside width, feet. Liquid depth, .feet. gallons. 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 Tile Disposal Fioldt 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. Depth of filter material over tile, inches. Seepage Plts~ Number ofpits.__~.-. Outside diameter,~t3i~1~ feet. Depth, *Si feet. Lining material Distance from: Well, ,,.mm, feet; building foundation~ feet; nearest lot line at [] front, [] side, ~ rear,. ~0 .feet. Inspadlon made by: [] State. [] County. ~] Local Health Authority. Inspected by- ~i, Date of inspection 0~t~l~ la0 , 19. ~ S~I~.~ REPORT OF INSP'ECTION~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 fi~rnish 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 wall from~ Building foundation, cast iron sewer,, feet; tile sewer, seepage pit, .feet; cesspool,. Weft conatru¢flon: Diameter, inches. Total depth, .feet. Type of casing,. Approximate depth to pumping level of water in well,, feet. Approximate yield, Sealed watertight to ~pth 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. Pumps [] 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. (TITLB) feet; .feet.