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HomeMy WebLinkAboutEVANSON LT 18 FHA ~rm 2573 Rev. July 1958 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FEDERAL HOUSING ADMINISTRATION Form Approved Budget Bureau No. 63-R296. PART I.--TO BE COMPLETED BY FHA INSURING OFFICE Federal Housin~ ~a~netration MORTGAGOR OR SPONSOR Donald N. Lewis MORTGAGEE Matanueka Valley Bank Anchorage: ~!nska PROPERTY ADDRESS 4310 l~eedle Drive SUBDIVISION NAME SERIAL NO. 60-008~39 BLOCK NO. ~vanson TOTAL NUMBER: WATER SUPPLY BY: [] Public system iEWAGE DISPOSAL BY: --]Public system BASEMENT ~] Community system ]Community system New installation 18 I Can attic or other area be ~G-ae lilly additional bedrooms? (if Yes, how I SYSTEM DESIGNED FOR r-1 Individual .o. o; SDR,~S. OAeSAOE DISPOSAL [] Individual 3 [] Yes [] No PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT tEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the ~] State ~] County '" [] Local Department of Health that this individu,aL~at:er-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [-~SSate [] County tem With proper maintenance: [~an be expected to function satisfactorily, and is 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 / SIGNATURE TITLE NOTE: The health authority should complete the appropriate opinion statement a and affix date, signature and title in the spaces provided. Use of the above grid for Health Department Inspect~r's sketch as well as use of the back of this form is at the option of the health authority. -'~ -~- -=-"~"~'~=~-- .... - '~-~,'FOI~(USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: ~ '*' '~ I have reviewed the foregoing and the pertinent FHA Compliance i'nsPection Report, and recommend that 'the Individual water-supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM ~V : ~ARCHITECT DEPUTY F~, . CHIEF ARCHITES~ -' ~ -;~ Form 2573 · /'.?! July 1958 REPORT OF INSPECTIONmlNDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of]~Septic tank. [] Cesspool. : Septic Tanks Distance from well,__feet, h~r, gj.~,. ' Number of compartments Total liquid capacity, ~. gallrons. Capacity inlet compartment, gallons. Inside length, .feet. Inside width, feet. Liquid depth, feet. Cosspooh Distance from'. Well, feet; foundation, feet; nearest lot line at [] front, [] side, [-I rear, feet. Inside diameter, feet. Depth, feet. Liquid capacity, gallons. Lining material SECONDARY 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 of rile to finish grade, inches. Type of filter material: [] Gravel..fl Broken stone. Other Depth of filter material beneath tile, inches. Depth of filter material over tile, inches. Se~paRe Pl~s~ Number of pits / Outside diameter,~et, th~ ~$a,,,- . Di~ feet. Lining material Distance from: Well, ~ feet; building foundation,~ feet; nearest lot lineatat flfl front, [] side, fl rear, ~ feet. Inaction made byt fl State. fl County. ~a, Local Health Authority. .: Date of inspection /O~, 19 60 Inspected by .._ ,* 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 kine, feet. Individual water supply from: [] Drilled well. fl Driven well. fl Dug well. [] Bored well. Distance of well from~ Building foundation cast iron sewer, feet; tile sewer, seepage pit,. feet; cesspool,. Well constructions feet; nearest lot line at [] front, fl side, [] rear,. feet; septic tank,. .feet; disposal field, feet; other sources of possible pollutio0,, feet. 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. fl Ordinary backfill. Well cover: fl Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. Pumps [] Shallow well. fl Deep well. Length of drop pipe,, feet. Pump capacity, Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above gtound, fl Pump pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. fl No. Type of storage: [] Pressure. fl Gravity. Capacity,. gallons. Has bacteriological examination of water been made? fl Yes. [] No. If answer is "yes," give date Quality of water fl is [] is not satisfactory for human consumption. Installation fl does fl does not comply with approved exhibits, if any. Inspection made by: fl State. [] County. [] Local Health Authority. Inspected by Date of inspection 19__ Depth of casing, .gallons per minute. gallons per minute. (TITLE) feet; feet. ~horaSo, Al&ah 9950~ ]OIVlO B,. L* DU#CJd~, a.D. GREATER ANCHORAGE AREA BOROUGH HEALTH. DEPARTMENT 217 E Street P.O. Box 968 Anchorage ~ Alaska 99501 PHONE 272-5467 ~i5 Augusl; ~1966 C. David Evanson Box 2153 Anchorage, Alaska SUBJECTs:Evanson Subdivision. Dear Mm. Evanson: Our files indicate that you have not submitted a water sample since January 19_m_1966 . You have been sent one bottle each month since your water supply was designated public or semi-public. It is a requirement of the Administrative Code, Title 7, Chapter 2, Subchapter 1, Secti~ 236, Item (b) that water samples be submitted for bacterial analysis. In order that your;water s9pp$.y remain in use as a public or semi-public facility, water samples must be sub- mitted to the Laboratory at 527 E. 4th Avenue at the rate of one each month. Please return all unused bottles to this office. If you have been complying with this regulation, please contact this office as our files indicate that you have not. Sincerely, DAVID R. L. DUNCAN, M.D. Medical Director CPJ/cw By ~lifford P. JUdklns Supervising Sanitarian LO Jury 1963 Svaneon SubdtvtJton Dear Tho pereotetton camCo'for Lots 3, 7, and 9, Evanson Subdivision, indicate that Chess tots wit! eottsfaeCorttY sustain the eonventiouat septic Conk end an 8 x 8 x 6 soupess pit surrounded by cwo feet of seed Srmle StaYer co tho top of the Cos ~rtbbtn$, DAVXDR. L. DOHCAH, M.D. ttndt~at DirectOr Sanitarian =ADAMS · CORTHELL · LEE CONSULTING ENGINEERS ~.0. No. 4987 June 25, 1963 Lewis and Metzger Box 4-441 4206 Needle Drive ~nchorage, Alaska PROJECT: Percolation Tests - Lots 3, 7, and 9, Evanson Subdivision Gentlemen: Percolation tests have been performed on the subject lots. logs and test data are shown on the attached sheets. Soils The percolation rates were determined to be: , ,,.T~p,~ ,Rate in MinUtes p.e,r' ~, Inch 7 5 .9 3 Ground water conditions, soils, and percolation rates as reported indicate the conditions existent at the specific time and locations the tests were performed. We cennot predict the conditions which may exist at any other time or at any other location. Very truly yours, ADAMS · CORT~,~ · LEE Appro red: Frank W. Winoe, P. E. GREATER ANCHORAGE HEALTH DISTRICT Donald A. Penner, R. S. F~: s~de Attoh. (3) Evanson Subdivision July 6, 1959 Hole #1 Hole Depth to bottom Hole #1 Time Readin~ 12:50 4 1/2" 12:56 10" 1:5:30 15 1/2" Time 1" - 15 1/2 - 1 29" Hole #2 Time Reading 12:44:30 10" 12:52:30 18" i:0B:00 24" I - 14 1/2 - 1 Plus D 14 Hole No. Time Meas. Time Meas. #3 1:32 4 1/2" 2:05 27 1/2" #4 1:40 7" 2:12 30" #5 1:52 4" 2:30 29" #6 2:05 5" 2:47 31" 23" Fall - 33 Min. 23" Fall - 32 Min. 25" Fall - 38 Min. 26" Fall - 42 Min. ADI-I-HSE-6-FI (c) This Form Must Be Filled Out Completely. Please Look on Rever~e of] [ Sheet for Sample Collection Instructions. · ,..~ ~ .~ ~ Request for Bacteriological Analysis Lab. No ........................................... SEMIPUBLIC WATER SUPPLY ALASKA DEPARTMENT OF ~RALTH Seotion of Sanitation and Engineering Source: Well or Cistern Construction: ....... '~ ...... *' .................. ~ ......... ~/---:'"; .... 77-----,'2 ...... ' '"' ................ ( ) and type of establishment using this water.....~/z~$:/[/.cz..c/ ......... J.~......~t~......: ................................................ Name , School, Ca' re. Hospital, Camp, or Similar Establishment Location of this water supply ..~ ~.~..~', ~3~ ~.,~_ _"d' / ~./..&..<:j~:.- ..fi./..', Street, Highway, Milepost, Town Report should ~ maileVo..,.:(~..~.~.~.~:.fl?~.',¥/¢:~c,L .~jev..mer, L~..~...../.2'.../.' .,~......~,~.:z~9,.&..../Z,~Zfi.~Z.~..~nager Name Owner...~.~...(~ .~..~.~..;~'_'~....~..~,~.~.z~.i..~L~.b' ..... Name Manager .................................................................................. Address ............................................ : ..................................... Address .................................................................................. Town .................................................................................. Town .................................................................................. Plea~se place an "X" In the box before Items which best describe the water supply sampled. Collection Point: [] K. jl4~hen tap, [] Bathroom tap, l~] Basement tap, [] U~tllty Room tap, [] Other [~Drllled V~tell, [] Driven Well, [] Dug Well, [] Bored Well, [] Sprlng, [] Cistern, [] Stream, [] lmke, [] River, [] Pond, [] OCher (list) ........................................................................ Walls ~ [] Wood, [] Concrete, [] Metal, [] Tile, [] Brick or Concrete Block Top --[] Wood, [] Concrete, [] Metal, [] Open Top Diameter .................... inches, Depth .................... feet; Drop pipe length .................... feet. 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 t~ype of treatment: [] Chlorination, [] Softening, [] Iron removal, [] Other (list) ................................................................................................................... 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../~.~ ........ feet Other source (list) ..................................................................................................................................... feet Type Sewer: [~J Cast iron, [] Wood stave, [] Cement tile, [] Other (list) ............................................................ General Information: Do?s water become muddy or discolored? [] Yes, ~No If so, £ Y..e:a.~.~....~/?.~..~/.~./. [%...6~.Z.~......~.~z Z'...~.... J&Z~ .p.. ~.~..-~(.. .......................................... ~ ....................... Is water suspected as source of illness? [] Yes, [] No. If yes, then describe Illness .................. PLEASE DRAW A SKETCH IN THE SPACE BELOW. SKETCH SHOULD SHOW LOCATION OF HOUSE, WA'I'~JR SUPPLY SOURCE, SEPTIC TANK, SEWER, DRAIN LINES OR OTHER SOURCES OF POLLUTION AND DISTANCES BE"I'W~.I~.hl WATER SUPPLY AND ANY OF ABOVE FACILITIES. USE BACK SIDE IF MORE SPACE NEEDED. Remarks: ....... ::':"':~/~'"'"['r,, ) ....... : ............~ ...... [..-:.~'k~.~o ....................................................................................................................... SAI~'LII$ MIJST BE SUllMITTED IN CONT.~,INERlfl PItOVIDI!ID BT' TH~ ALASKA DIzPARTMIENT OF IIF~ S~ $~ ~ Sec · *-'--:-* ' ~ for revie~ o£ ~he l~a~i~ al ~he p~opo~d 8~t-public rater supply. ~he ~ell l~a~t~vldMet the dts~ace protecti~ ~etutr~e for a ~-public ~a~er supply ~p~ a. any time aevaSe disposal problems ~lease ~ee! £x'.~e ~o call ~lncerely you~e, Calvin ~lneys J~,.