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HomeMy WebLinkAboutLot 06, 07 FHA F.~m ~S73 Form Approved Rev. Ju!,~(]9~8~ FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8 HEALTH AUTHORITY APPROVAL i!/IND lDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM INSURING OFFICE PART I.--TO BE COMPLETED BY FHA e Firs~ National Bank of Anchorag 0,006623 Anchorage MORTGAGOR OR SPONSOR NOLENs Charles SUBDIVISION NAME PROPERTY ADDRESS ~ of ~ot 6, ~o% 7, Block 12 J Pleasant Valley Subdivision Subdivision :t .a i' 1 Yes []No WATER SUPPLY BY: --]Public system --]Community system [~] New installation additional bedrooms? (If Yes, how many?) No. SYSTEM DESIGNED FOR [] Individual SEWAGE DISPOSAL BY: '~' Public system --]Community system [~]Individual PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State [] County ~ Local Department of Health that this individu&l~ water-supply system [~is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of t~e [] State [] County tern with proper maintenance: [~ Can be ~xpected 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 NOTE: The he~th authority should complete the approp}iate op' ' statement above and affix date, signature and title in the spaces provided. Use of the above grid for Health Department InspectoWs sketch as well as use of the back of this farm is at the option of the health authorlty. PART III,~FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Insp~. ction Repo}t, and recommend that'the Individual water-supply system be considered [] Acceptable [] Not ~cceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM ] CHIEF ARCHITECT ] DEPUTY FOR CHIEF ARCHITECT REPORT OF INSPECTION~INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [~Septic tank. [] Cesspool. Septic Tank: Distance from well ~,~J ! , feet. Material, . Number of compartments / Total liquid capacit% ~ LQ gallons. Capacity inlet compartment, ~ O gallons. Inside length, ~ feet. Inside width, ~ feet. Liquid depth, '~-'- feet. ¢osspooh Distance from: W Inside diameter, feet. Depth, feet. Liquid capacity, . gallons. Lining material $S¢ONDA~:¥ 'rRSAIM[NT consists of [] Tile disposal field. [] Seepage pits. Other Tllo Disposal Flold: 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, incbes. Number of pits , .Outside diameter, 6.~,' feet. De~th,/~feet Lining material ~ '"'- Distance from: Well,~~ feet; building fou.dation,.~k~feet; nearest Io~ llne at ~ front, ~..~ide,~gar, /~ feet. In..,Hon m~8. by: =State. = CourtW. ~ Local Health Authori~. Date of inspection /~- ~ ~ ,19 ~ 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 wet, from, ' /~__/~/ Building foundation ...... feet; neares~e at [~fro~de,~ rear,7~ cast iron sewer,~feet; tile sewer,~fe~ septicgank -- fe~ ~sposal field, feet; seepage pit,~t; cesspool[ ' ~~ssible pollution,' f~t.. Diamete~Z4o~th,~fe.. ~peZfca~,~ /-_~' ~ta~g:' feet. Approximatff depth to pmping level of water in~well,~0~ate yield, ~all~ns per minute, Sealed watertight to depth of feet.//~/~ Exterior space around casing sealed with:~nt grouff ~uddled ~. ~ Ordina~ backfilh . Well cover: ~ ~ncrete. ~ Wood. ~ M~~II cover watertight: ~ Yes. ~ No. Pump= ~ Shallow well. ~ Deep well. Len~h of drop pipe, feet. ~mp capacity, gallons per minute. ~cated iff: ~ Basement. ~ ~mproom off basement. ~ Pumphouse above ground. ~ ~mp pit. ~mproom properly drained: ~ Yes, ~ No. ~mp mounting watenight: ~ Yes. ~ No. Type of storage: ~ Pressure. ~ Gravity. Capacity,~ gallons, Has bacteriological examination of water been made? ~Yes. ~ No. If answer is "yes," give date /~-- --119~ Quali~ of water ~ is ~ is not satisfa~ory for human consumption. InstallatiOn ~ does ~ does not comply with approved exhibits, if any. / ..... ~ / ~-~ lnsp~tion made by: ~ State. ~ County. ~ ~cal Health authority. -- Q-- ~ Date of inspection /~ ~ , 19~ 7 ADI{-FfSE-6-Fk (c) This Form Must Be Filled Out Completely. SEMIPUBLIC WATER SUPPLY ALASIL, A DEPARTMENT OF ~R~kLTH Section of Sanitation and Engineering Request for Bacteriological Analysis Please Look on Reverse of Sheet for Sample Collection Instructions. Lab. No ........................................... Sample collected by .~..,-~/...,.~.--.,.-~-~-.....~..~---.:-~:~ .......... Date .... (J ~:q...~.....~Tlme-..f-.--~--..t.--z~--..~7.-- .... Name and type of establishment using this water ......................................... ~-:~-~::: ................................................................... School, Cafe, Hospital, Camp, or Similar EstabMshment oeatlon of water ....... .................................................................. Report should be mailed to~:~...~...~..~.~.~(....l .~...:.'~.. .............. .ro'~fier, - ............................................................................. Name owner....~-~b,.K~l.~.~.......~...:...-~....o.J..e..~....~-.. ............Name Manager .................................................................................. Address .... _~....~....~%. ........ ..~..~...~. ........................................... Address .................................................................................. Please place an "X' in the box before items which best de~scribe the water supply sampled. Collection Point: [~ Kitchen tap, [] Bathroom tap, [] Basement tap, [] Utility Room tap, [] Other (list) Source: ~ Drilled Well, [] Driven Well, [] Dug Well, [] Bored Well, [] Spring, [] Cistern, Construction: Walls--[] Wood, [] Concrete, [] Metal, [] Tile, [] Brick or Concrete Block Top --[] Wood, [] Concrete, [] Metal, [] Open Top Depth of water in well .................... feet. Well Location: [] In Basement, [] Basement offset, [] Under building, [] In Yard, [] In Utility Building, Treatment: [] Yes, [] NO. If yes, give type of treatment: [] Chlorination, {~ Softening, [] Iron removal,. [] Other Cist) ........................................................................................ Pump Location: [] In well, [] Offset in basement, [] Utility room, [] On top of well cover, [] Other (list) Distance to Pollution: Any sewer or drain .................... feet Septic tank....~...0...0......feet Other source (list) ..................................................................................................................................... fee~ Type Sewer: [] Cast iron, [] Wood stave, [] Cement t,lle, ~ Other (list) ............................................................ General Information: Does water become muddy or disColored?~[~'Yes, [] No. If so, when.....$~..~..~.,~../~,~:,~. Is water suspected as ~ource of illness? [] Yes, B~] No. If yes, then describe illness ............. PLEASE DRAW A SKETCH IN THE SPACE BELOW. SKETCH SHOULD SHOW LOCATION OF HOUSE, WATER SUPPLY SOURCE, SEPTIC TANK, SEWER, DRAIN LINES OR OTHER SOURCES OF POLLUTION AND DISTANCES BETWEEN WATER SUPPLY AND ANY OF ABOVE FACELITIES. USE BACK SIDE IlO MORE SPACE NEEDED. SAMPLES MUST BE SUBMITTED IN CONTAINERS PROvIDE, D BY THE, ALASI~[A DEPARTMENT 0}' *HEAL'EH DIRECTIONS FOR COLLECTING SAMPLES OF WATER FOR BACTERIOLOGICAL EXAMINATION Read Carefully and Follow Instructions Exactly DO NOT COLLECT sAMPLES FROM FIRE HYDRANTS, YARD HYDRANTS. DRi~NKING FOUNTAINS OR SIMILAR OUTLETS WHICH ARE DIFFICULT TO D I S I N F E C T PROPERLY ~ Bear in mind that water analysis deals with materials present in very minute quantities. The least carelessness in collecting and handling may give rise to results which are misleading. Arrangements should be made to have water samples reach the laboratory as quickly as possible. After 48 hours the significance of the bacteriological analysis is impaired. For obvious reasons 'the laboratory prefers to receive samples in the early part of the week, but is willing to accept samples at ally time. In collecting samples from TAPS or PUMPS proceed as follows: (a) Thoroughly flush tap or pump by allowing water to run freely for five minutes. (b) Shut off water and flame the outlet with torch or braining paper. The flame should not be merely passed over the outlet, but should be applied until fixture shows indication of being hot. Flame should be directed against ir~side edge. (c) Open fixture so that a small stream flows. (d) Remove bottle from mailing tube. Hold bottle by the lower half in one hand and with the other remove the screw cap with the fingers, leaving paper protecting cover in place. F111 the bottle to the shoulder. Replace cap with paper cover, screwing firmly into place but do not apply pressure which will split cap. (e) Pack bottle carefully in mailing tube enclosing this completed information sheet, being sure that a simple sketch is included. In collecting samples from STRE/kMS and RESERVOIRS proceed as follows: (a) Remove cap and hold bottle as described under (d) above. (b) Collect sample by holding bottle in a slanting position and sweeping it below the surface in such a manner that water that has been in contact with the hand is not introduced into the bottle. Avoid collecting surface scum and bottom sediment. SAMPLE~ MUST BE SUBMITTED IN CONTAINERS PROVIDED BY THE ALASKA DEPAR~IENT OF HEALTH 25 September 1963 Mr. Charlee Ao Nolen Star Route B Box 3~.0 Pleasant Valley Subdivision Dear ~r. Nolen: Pleasant Valley St~bdivi~ion iadica~es no contamination a~ th~s t~me, how~ ever, our records do no~ ~dica~e that a chemical analysis has been sub# mi~ted, ~herefo~e, we canno~ de~ermine whether ~his supply tm or is not chemically potable. We have~ in the lest two year~, required that persons owning public wa~ez supplies submit a chentcal analysl~ report upon completion of the water fore, I must aa~e ~ha~ thio departmeat hms not approved ~his system formally, Stnce~ely~ DAVID R, L, DUNCAN, ll.D. ~diel Director ~ncl cC: Federal Donald Il. Penner, R.S. Out Completely. INDIVIDUAL WATER SUPPLY ALASKA DEPARTMENT OF HEALTH Section of Sanitation and Engineering Request for Bacteriological Analysis Please Look on Reverse Sheet for Sample Collection Instructions. Lab. No ........................................... (Name of person collecting sample) (Time) Water sample collected from [] Kitchen tap; [] Bathroom tap; ~ Basement tap; [] Other (list) ....................... : ................... Addres~ premise where source is l~cated ........ ..~-..D.?~."--~---~----~-------J~-~-~--'~'~'FL[''~'' ............ k~r'~' '~':""~'"'"'~""~:~"~F! e .... ~fl repo~ to (~) .............. ~-~.~ ........ (Box No. or street address) ....... ~(City) Please place ~n "X" i~he bOX before items which b~t describe your w~ter supply: SOURCE: Well ~ug, ~ Driven, ~ Drilled, ~ Bored (list) ............................................................................................................. ~ Spring, ~ Ciste~, ~ Other " ~ Creek, ~ ~iver, ~ L~ke, ~ Pond ................................................................................................ ~ ................. DUG ~LL OR C~TE~N CONS~UCTION: Walls ~ ~ Wood, ~ Concrete, ~ ~tal, ~ ~le, ~ Brick or ConCrete Block Top -- ~ Wood, ~ Concrete, ~ Metal, ~Open Top LOCA~ON: ~ In basement, ~ Basement/_ .~ ~°ffset' ~ Under ~o~e, ~ In yard ........ DIST~CE TO: Building sewer or other~ ~ --V~rainage pipe .............. fee~, Septic ~nk .............. feet, ~le field .............. feet, Seepage pit -: ...... ..feet, Ce~0ol .............. feet,~ ~ ~Privy .............. feet. Other ~sible sources of contamination (l~t)......J.~. .......... X-~-~-~.~-~---.-~-~--.--~--~-~.-~-~-:-----~--~-~"''~'''''':'''':'''::~:'''~'''''':~' ~: Building sewer ~ ~ Cast ~on, ~ Wood, ~ Tile, ~ ~bre pipe, ~ As~tos cement Joint material ~ ~pe ................................................................................................................................ : ...................... GE~R~ ~OB~ON: Does water become muddy or ~coloredZ ~ yes, ~ no When? .,.~.~-~-~ .............................................................................................................. Diameter Of well.......~..dE..Z~...Y~.~-A.......depth -.-:/-~ ..................................... feet Well casinE m~teM~l .............. ~./. ~ ~ 0~ame~er ~ ~. J~ ~ep~h..~..~ .... Lenggh of drop pipe ............................................................................................................................... Wa~er depgh from bo[~m ............................................................................................................ fec~ Pump location: ~ well, ~ Off~eg ~ basemeng, ~ In basemeng ~ ~ ugl~7 ~m, ~ On gop of well ~ O~h~r (l~ ........................................................................................................ PU~PO8~ O~ ~XAMI~ATION: Illness auspee~ed? ~ 7es, ~ no New aouree of ~upplT? ~ 7es, ~ no ~epmrs ~o exisgln~ sTs~em~ ~ yes, ~ no * PB~ DR~W A ~T¢~ ~ ~ 8P~ B~BO~. ~IB ~K~¢~ Laboratory, 527 Eask 4fl~ Avenue Monday, Tu~day, W~y ~ S~LES MUST BE SUB~T~ED ~ CONT~EES PRO~ED BY '1'~ ~AS~ DEP~T~NT OF DIRECTIONS FOR COLLECTING SAMPLES OF WATEI~ FOR BACTERIOLOGICAL EXAMINATION Read Carefully and Follow Instructions, E~xac~ly DO NOT COLLECT SAMPLES FROM FIRE HYDRANTS, YARD HYDRANTS, DRINKING: FOUNTAINS OR SIMILAR OUTLETS WHICH ARE DIFFICULT TO D I S I N F E C T PROPERLY Bear in mind that water analysis deals with materials present In very minute quantities. The least carelessness in collecting and handling may give rise to results which are misleading. Arrangements should be made to have water samples reach the laboratory as quickly as possible. After 48 hours the significance of the bacteriological analysis is impaired. For obvious reasons the laboratory prefers to receive samples in the early part of the week, but is willing to accept samples at any time. In collecting samples from TAPS or PUMPS proceed as follows: (al Thoroughly flush tap or pump by allowing water to run freely for five minutes. (b) Shut off water and flame the outlet with torch or burning paper. The flame should not be merely passed over the outlet, but should be applied until fixture shows indication of being hot. Flame should be directed against lrside edge. (c) Open fixture so that a small stream flows, (d) Remove bottle from mailing tube. Hold bottle by the lower half in one hand and with the other remove the screw cap with the fingers, leaving paper protecting cover in place. Fill the bottle to the shoulder. Replace cap with paper cover, screwing firmly into place but do not apply pressure which will split cap. (el Pack bottle carefully in mailing tube enclosing this completed information sheet, being sure that a simple sketch is included. In collecting samples from STREAM. S and RESERVOIRS proceed as follows: (al Remove cap and hold bottle as described under (d) above. (b) Collect sample by holding bottle in a slanting position and sweeping it below the surface in such a manner that water that has been in contact with the hand is not introduced into the bottle. Avoid collecting surface scum and bottom ~ediment, SAMPLES MUST BE SUBlv~'i~rI~D IN CONTAINERS PROVIDED BY THE ALASKA DEPARTMENT OF HEALTH