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HomeMy WebLinkAboutEVANSON LT 17E ~ : Form Approved FHA Form 2573 FEDERAL HOUSING ADMINISTRATION ' Budge: Bureau No. 63-R296.8 Rev. July 1958 ' ' HEALTH AUTHORITY APPROVAL INDIVIDUAL INATER SUPPLY AND'SEINAOE DISPOSAL SYSTEM INSURING OFFICE MORTGAGOR OR 'SPONSOR SUBDIVISION NAME PART I.--TO BE COMPLETED'BY FHA SERIAL NO. Ban~ o£ ll~lr~ in An~eraee PROPERTY ADDRESS ~ee~le D~ive, Anohe~age, Alag~ BLOCK NO. LOT NO. TOTAL NUMBER: LIVING UNITS BEDROOMS BATHS BASEMENT [~New installation Can attic or other area be made into additional bedrooms? (If Yes, how many~) WATER SUPPLY BY: NO. O~ SY:)JiM DESIGNED FOR [] Public system [] Community system [] Individual BDRM$. GARBAGE DISPOSAL SEWAGE DISPOSAL BY: [] Public system [] Community system [] Individual [~ Yes [] No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SK~ETCH It is the opinion of the ['-] State r-] County .[] Local Department o~f Health that this individual Watefvsupply system [] is [] is not satisfactory as a domestic water supply for the~'subject property. It is the opinion of the [] State [-] County tern 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 S IGNATURE~. T TLE . DATE 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 Inspect0r's sketch as well as use of the back of this form is at the option Of the health authority. PART Ill.--FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspectio~a Repo~, and recommend that'the Individual water-supply system be considered [--] Acceptable [] Not Acceptable Sewage disposal be considered [] AccePtable [-'] Noi")kcceP~able. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM ECHIEF ARCHITECT DEPUI~ FOR CHIEF ARCHITECT FHA Form Rev. July 1958 REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of,~ Septic tank. [] Cesspool. Tank: Distance from well, feet. Material, ~_ Number of compartments Total liquid capacity, f~ gallons. Capacity inlet compartment, /~O ~ Inside length; ~ feet. Inside width,. ~ feet. Liquid depth, feet. Cns~peeh Distance from: Well, Inside diameter, gallons. feet; foundation, feet; nearest lot line at [] front, [] side, [] rear, feet. feet. Depth,. .feet. Liquid capacity, .gallons. Lining material UCONDARY TREATMENT consists of [] Tile disposal field. ~Seepage pits. Other Tile Disposal Fields Distance from: Well, feet; foundation, feet; nearest lot line at [] front, [] side, [] rear,, feet. Total length of tile lines, .feet. Number of lines,. Distance between lines, .feet. Trench width, inches. Total effective absorption area in bottom of trenches .square feet. Length of each line, feet. Depth, top cc 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. Seepag. Pit., / _~ Number of pits Outside diameter, feet. Depth, feet. Lining material Distance from: Well, ~ feet; building foundation, a~'~~/_ feet; nearest lot line at [] front, l~side, [] rear,_.,~_~_feet. Inspection made by: l~,Local Health [] State. [] County. Authority. ~ ,,~ ~9~ Date of inspection 0 19~ 'a~r 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,. feet; nearest lot line at [] front, [] side, [] rear,. feet; septic tank, feet; disposal field, feet; other sources of possible pollution,, feet. Diameter, inches. Total depth, feet. Type of casing, Approximate depth to pumping level of water in well, .feet. Approximate yield, Sealed watertight to ~e4ath 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 Depth of casing, gallons per minute, gallons per minute. (TITLB) feet, feet; feet.