HomeMy WebLinkAbout1991 - water supply and sewage disposal system • ,� form Approv.d
s OMB No.2800-0085
VETERANS ADMINISTRATION/U.S. DEPARTMENT OF HUD/FHA OR VA CASE NO.
HOUSING AND URBAN DEVELOPMENT • 2 q
HEALTH AUTHORITY APPROVAL Fiuti/FHGORSvR Pd 41e
INDIVIDUAL WATER-SUPPLY AND SEWAGE-DISPOSAL SYSTEM
IMPORTANT—This form should be completed and Mod no required by existU'g law 38 U S.G. 1804 end 1810.
_ PART I — TO BE COMPLETED BY HUD/FHA OR VA
MORTGAGEE NAME AND ADDRESS(Include ZIP Code) MORTGAGOR OR SPONSOR
Metropolitan Financial Mortgage LEVY, David
6800 France Avenue South #200 • PROPERTY ADDRESS Edina, MN 55435 4505 W. Branch Road
Orono, MN
SUBDIVISION/LUT NO.
Lot 1, Block 1, Gray Lindgren
_ IS*HIVE A IS THIS A NEW CAN THE ATTIC OR OTHER AREA BE MADE INTO -
TOTAL NUMBER . _. BASEMENTS INSTALLATION? ADDITIONAL BEDROOMS?(II 'yea,"how mrnyfl
LIVING UNITS BEDROOMS BATHS
0 YES 0 NO 0 YES 0 NO 0 YES 0 NO
wnrl:n.$UPPLY BY: SYSTEM DESIGNED FOR
0 PUBLIC SYSTEM 0 COMMUNITY SYSTEM DI INDIVIDUAL NO OF BEDROOMS GARBAGE DISPOSAL
SEWAGE-DISPOSAL BY:
0 PUBLIC SYSTEM 0 COMMUNITY SYSTEM INDIVIDUAL 0 YES 0 NO
PART II --TO BE COMPLETED BY HEALTH DEPARTMENT OR COMPLIANCE INSPECTOR
INSI'ECl DRSSKETCH(TO REPORT AS-BUILT DEVIATIONS FROM APPROVED PLAN) _
1 , _._ N.q... .- --
eM.L I s'-3`4 c.4xa"s J
It Is the opinion of the 0 State 0 County WLocal Department of44eefth that thIs individual water-supply system'f(Is O Is not Satisfactory as a domestic water-suppl1
for the subject property. S /1,..7.7.7„ ..0..&-, L `
641.1u' ..-\+�...i--ej
It Is the opinion of the O State 0 County IfICLocal Department of+lentttrlfiat this Individual sewage-disposal system with proper maintenance)(Can be expected to
function satisfactorily,and Is not likely to create unsanitary conditions 0 Cannot be expected to function satisfactorily.Sl`t.477 -/NSP.t7-Ali
DATE 1 SIONA R TITLE
1'/' - �'/ i P NzA� oNt,3 6..,�c,,1i"
NOTE: The health authority should complete the appro)444.4,-
//—/ - 9/1
pinion statement above and affix dale,signature and title In the spaces provided.
NOTE: Use of the reverse side of this form Is at the option of the health authority.
PART III — FOR USE OF FIELD OFFICE
I have reviewed the foregoing and the pertinent Compliance Inspection Report and recommend that the Individual water-supply system be
considered 0 acceptable 0 not acceptable end that the sewage-disposal be considered 0 acceptable 0 no acceptable.
DATE SIGNATURE TITLE
0 HUD ARCHITECTURAL SECTION CHIEF OR DEPUTY CHIEF
0 VA CHIEF APPRAISAL SECTION OR DESIGNEE
VA rORM 26.6995.APR 1982 SUPERSEDES VA FORM 28.6995,OCT 1910.
M
FIUD FOA92519 WHICH WILL NOT BE USED
EFS 540 (11/06)
RECEIVED FROM 6989616
__—. ..--_`-___
84. 17. 1991 13:40
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