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Home My WebLink AboutLot 01 This Form M~st Be Filled Ou~ Completely. ~ % '? 'TAKE WATER ,SAMPLE TC)~ \"" Laboratory, 945 Sixth Ave, Monday, Tuesday, l, Vedneut~ INDIVIDUAL WATER SUPPLY A~LASKA DEPARTMENT OF ~.&LTH Please Look on Reverse oI Sheet for Sample Collection Instructions. Section of Sanitation ~nd ~:n~ineerlng Request for Bacteriological Analysts l-qtb '0 ..z... ' ........................................... (Name of person eoltectlng sample) (Thne) WaC, er sample colleetecl from [~ Kitchen tap; [] Bathroom tap; [] Basement tap; · ~ Other (list) ........................................................... -; .......... a ........................................................... AOlirgSS promise where ............................. w ................................ : ............................ .m.*. ........................................................... Mall report, to (Miss) ............ ~ ........ ~ / (mine) ..... /(Bo~;. or'street ~;;~J"~ ..... Please place an "X" In the box before items which b~g describe your water supply: 80'U}l,Olg: Well ~ ~ Dug, ~ Driven, ~ Drilled, ~ Bored [YJ Spring, ~ Cistern, ~ Other (list) ....................................................................................................... ~ Creek, ~ ~tver, ~ Lake, ~ Pond ............................................................................................................... D'UG WELL Og CISTERN CONST~UCTION: Walls~ ~ Wood, ~ Concrete, ~Metal, ~le, ~ Brlek or Concrete Block Top ~ ~ Wood, ~ Oonerete,~Metal, ~Open Top LOCATION': [~ In basement, ~ Basement offset, ~ Under ho~e,t~ ~ In yard Other ................................................................................................................................................................................... Dlo~ANO~, TO: Building sewer or other drainage pipe .............. feet, Septic tank .............. feet, Tile field .............. feet, Seepage plt ............ feet, Oesspool .............. feet, Privy ..............feet, Other possible sources -.. c.~..5 [.aim~:aiic<~ (Ji.~[.) ...................................................................................................................................... ii:iii :~' ~<,w~r --~ Cast iron, [) Wood, [YJ .TIle, [~] Fibre pipe, ~'~ Asbestos cement · Ioin~ material --- Type ............................................................................................................ ?Olt~TJ.{D~:,: Does wate'~: become muddy or discolored? [~] yes, ~ no Wi~en? .................................................................................................................................................... Diameter' of ' ' well .................................................. depth .......................................................... feet Weil easing material ...................................... diameter .................... depth .................................. .Le~lgq:h of drop ~)ipe ............... Water d,(:i~gh ~rom bottom .......................................................................................................... feet P~.nnp !oca;5on: L~ In well, [~j Offset in basement, ~In basement ~ In utility room, U~] On top oi well _ E] Other (linC) ....................................... ~~~ ......................... , ~-,. iil!~.c;5;i~ fz'om '~his supply? ~ yes, ~ no ~ -' ............. i '~I~ 8PAC3I [~[igLOW. 2.HIS 8t[tuTC}I ,.SHOULD SHOW LOCATION OF HOUSE, WA~ ~ ~ ~; ~i~i~'T'J(5' ',YA?(~K, BE'~g, /)gAIN LINES O~ O~i~lg SOUgOE80P POLBU~ON ~D ,:~ ...... ii ;?.:_.sj:gr~.,.,..r.[E/. IN COblTAltNERS PROVIDED BY TIlE ll,/l, gl[l DEPARTMENT OF HEALTH FHA ~orm 2573 Form Approved Rev/July 1958 FEDERAL HOUSING ADMINISTRATION Budget Buteou No. 63-R296.8 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGOR OR SPONSOR SUBDIVISION NAME 1st Addftion~ TOTAl. NUMBER; WATER SUPPLY BY: [] Public system MORTGAGEE SERIAL NO. J City Xat'I_onal -Bank of' Anchorage 60-C,07'0.~ PROPERTY ADDRESS 22nd Avenue & Eagle St., Anohorage, Alaska '~amg~.r'b SnbdivisJ.on #3 BASEMI~NT BATHS 2'~ g0~es [] No ['5,~ Community system BLOCK~, NO. LiT NO. [-~ New installation Can attic or other area be made ]nfo additional bedrooms? (If Yes, how rnony~) NO. SYSTEM DESIGNED FOR ['~ Individual OF BDRMS. GARBAGE DISPOSAI. [--] Individual 3 [---] Yes ~-] No SEWAGE DISPOSAL BY: [] Public system ['--] Cotnmunity system PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the ['-] State [~] County ["-~Locat Department of Health that this individual water-supply system _ ,[-'-~is [] is not satisfactory as a domestic water supply for the subject property. It is tbe opinion of the [--] State tern with proper maintenance: [~Can be expected to function satisfactorily, and is not likely to create an insanitary condition DATE SIGNA"(URE -. [] County [~Local Department of Health that this individual sewage-disposal sys- [~ Cannot be expected to function satisfactorily TITLE NOTE: The health authority should complete the appropriate opinion statement above and afflx date, signature and title in the spaces provided. Use of the above grid for Health Department Inspector's sketch as well as use of the back of this form is at the option of the health authority. PART III.~FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspectiou 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 ] CHIEF ARCHITECT r-'l DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 Rev. July 1958 po~a~dsuI 'll!~oqln¥ q~l~aH lU~O'I ~ '~luno3 [] 'alms [] :Xq op~ uog~*dsuI 'uondmnsuo~ u~mnq Joj X~o~ujsuus lou s~ ~ s~ ~ J*lU~ jo ~q~n~ ~' olsp aA~S .'soX,, s~ Ja~SUe JI 'oN ~ 'saA ~ dapem uaaq aale~ jo uo~ieu]mexa lU~8olo~lal>sq sell 'oN ~ 'saA ~:lq~ualu~ ~u}mnom dm~ 'oN ~ 'saA ~:Rau}esp Xl~adoJd mooJdmt~ 'l~d dm~ ~ 'punoJ~ aaoq* asnoqdmnd ~ 'luamasuq ~0 mooJdm~ ~ 'luamosu6 ~ :u~ pal*>~ · alnu~m Jad suolI~2~'Xlpudeo dmnd 'laaj' ~ 'ad~d dogp jo q~ua2 'lla~ daaG ~ 'llam ~olFtlg ~ *dmod 'oN ~ 'saA ~:~q~pJo~u~ Ja~oo IlO~ u[ sgu~uadO 'Ima~ ~ 'poo~ ~ 'a~aJ~u~ ~ :Ja~oo lla~ 'alnmm Jad SUOllUS~'pla~X al*m~xoJddV '~aaj~'IIamiu} ~u~ajo ~a~2u~dmnd m qldap alum~xoJddV 'laaj '~u~su~ jo qldoG ~ '~ms*~ jo odX~ 'laaj 'qldop [~lo& 'saq~u~'Jolamu~G '~j- 'uopnI[od olq~ssod jo s~Jnos a~q~o ~j' 'loodss~ '.~j- %~d o~d0~s '.laaj pla~ lusods~p '.laaj ~um vDdas haaj 'la~as oUi ~laaj ~ ~Ja~as uoJ~ ~s~ :moji IIO~ lo OaUDISlfl '11~ poJo~ ~ 'II~ En~ ~ 'II*~ uonlJ~ ~ 'i[*~ p*iuJ~:~oJj Xlddns =,~ lunpD~pui '~**J ~ ~ ~ :ouH ~*doJd :uoJj ~oJj ~uq ~*s ~UHl*~G 'do~p ~*aj ~ '*p}~ ~*oj' ~ :*~s ~o~ ~alu~ jo Alddns munbapu tls!ujrbt Ol th!U!~!A alu!patutu! u! SllOaX jo oJnl[uJ jo pJo~aJ lua>aJ :~sotu o~!rD WIISA$ Alddrl$-U31V~A 1VI1QIAlaNI--NOIJ. DldSNI :10 lllOdl~l 'saqvu! 'looJ oJ~nbs' '~oaj 'laaj 'suoii.5~ t~ ~ / /~"- '* '~F°tpnv qllUaH l~ ~ '~unoD ~ 'alms ~ :~q ep~m UOll~edsuI ~aJ ~ 'apes ~ '~uoJ~ ~ ~H wi ~saluau '.laaj 'uo}lupunoj ~u~pl}nq '.laaj 'lla~ :mosj a0ums]G :Slid eSnd~ 'o19 Jato F}Ja~um aa~l~ jo q~do~ 'saq>u~ i'alp q~uau~ lU~Ja~um Jml¢ jo tDdaG 2aq~0 'auras ua~oJ~ [] 'apeJg qs!ug o~ al!~ jo do~ 'qldaQ 'aaaj %a~gua-n jo tuolloq u! gaJu uo!ldJosqu aA!l>aJja lmoj~ 'saqgu! 'saU!l uaa/*~aq a>ums!(I ' 'sau!l jo .~aqtunN '~aaj -'auaa [] 'ap!s [] 'luoJJ [] ~ OU!I ~01 lsaJeau :~aaj 'uo!lgpunoj ADH.HSE-6-~I (f) (4M) Lab. No, 19879 INDIVIDUAL WATER SUPPLY Southeontral i{eglon~l ALASKA DEPARTMENT OF HEALTH ~ S~on~'Of Sanlmfion ~d ~n~rlng A~ION ON REQUEST FOR BA~TE~OLOGIC~ WATER ~YSIS Your recent request for an analysis of a sample from the Individual Private Water Supply serving ~'~ E, 23rd* was received 11/6/59 and examination has been completed. Records in this office indicate this Individual Private Water Supply to be of /,~ Satisfactory sanitary status. Analysis shows this SAMPLE to be ~/ Satisfactory Questionable t~. I~,VR. Stock o/o OityNational Bank Anchorage, Alaska Questionable Unsatisfactory Unsatisfactory. If an "Unsatisfactory" or "Questionable" status is indicated above, you should take inunediate action as recommended below. 1. Boil or chemically treat your water supply to protect your family from water-borne diseases as outlined in en- closed leaflet, "Drink It Pure." 2. Improve your spring--See bulletin HSF,-6-2 3. Improve your cistern--See bulletin HSE-6-3 4. Improve your dug well -- See bulletin HSE-6-4 5. Improve your driven well--See bulletin HSE-6-5 6. Improve your drilled well -- See bulletin HSE-6-6 7. Relocate your well to a safe location in relationship to your sewage disposal system- See bulletin HSE-15 8. Bottle broken in transit, please send new sample. 9. Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. 10. Contact your nearest [] Local Health Department or [] Alaska Health Department, Sanitation office for bulletins, consultation, and assistance. 11. This is a surface water source ~and subject to pollution by m0n and animals. An approved water supply source should be developed. RAYMOND R, STOCK I~IT¥ NATIONAL BANI~ 01: ANI~HOBAGE ~ovember 24, 1959 The ~reaterAnchorage Health District 217 E Street Anchorage, AlaSka Attn: Mrs. Sherrock ~entlemen: In reference to your request, enclosed please find the followin§ documents: 1. Well Log 2. Sewer Diagram If there are any other documents you desire to complete my FHA record, please contact me at your convenience. OUR DEP m B ITO R B ARE: BU LDI N G ALA~ KA I~cnn J~r~c¥ Drillin~ "Good Water Our Specialty" P, O, BOX 4.6:36 SPENARD, ALASKA 2~rc}, Ave, .,.:or o v% Ancho~!~e~ Alaska D~aF ~r. Ai~s~O= ott~Leial~ i~ ~o ~ve a la~e~a! a8~*~ {:o p~tect Chi initial i~Cmllar ~];d ~ ~e~ buC hoc 3l~pb Joe L. ~alker National Bank o~ AlaSka November ~, 1957 Federoj. Housin8 Ad~i_nistr~tion Po~t Office Box ?~3 Aue~hor~se, Be: ~E FHA Forms 2217 & 2218 BIERS, Wm. ~ots 1 ~ Lampert SuM. ~#~ (Fireweed Lane) Anchorage, Alaska Serial No. Gentlemen: Enclosed please find ~ Form~ 2217 and ¢=215 for the above mentioned property. The water supply and ~ewa~e dl8poeal systems meet with the minimum requirements of the Alaska Department of Health and with pro~rmaintenauce~ can be expected to function i~a ~ati~factory manner ~md not create au insa~Atary condition. This installation ia a~provedbythe Department, If we may be of further assistance regardin~ th~s ~roperty please feel free to contact us. Very truly yours, Amos J. Alter, Chief Sec. of Sanitation and Enginee~hg FOB:ip Encl: 2 Forms2217 and 2218 cc~: GAHD: Mr. Ereltz.: {lnchorage Be~io~al Office gni~tos~d pleaae ~'lnd aub.iect l;ltA Fotma 2217 & 2218. ~d~n requi~nts o~ ~he AI~ ~pa~e~Z o~ HeaZzh. Th~ wa~ee a~le ta~n ~ 13 ~ t~d to be natia~ae~o~y, It ta ~ecm~ded that this ~tit be ~ed, FEDERAL HOUSING ADMINISTRATION New insta]latlon, REPORT OF INSPECTION .U . stln iastanatio,. INDIVIDUAL SEWAGE-DISPOSAL SYSTEM To Be Headed in by FHA O~ce (Insuring ofli~) ...................................................................................... ~ ~t'~__.__~ ......... ~ ............. A~tH[OI~G'/; ALASKA ................................................... '..L.f~ .................................. (City) To~a] number: Livin~ units )~ ............. Bedrooms ...... ~. ..... Ba~hs .__~. .......... Basemen~: ~ Yes ~ No. Wa~er supply by: ~ Public system. ~ Co~mfi~y system. ~ Individual system on si~e. (Serial number) ........ Part I-a.--FOR USE OF INSPECTING OFFICIAL (Fill in below information applicable to subject installation) INSTRUCTIONS: If new gnstallatio~, inspect for compliance with approved exhibits and record any observed information not shown on, or which varies from, the approved exhibits. If existing instalh~tion~ furnish as much of the information as may be available. PRIMARY TREATMENT consists of¢~ Septic tank. [] Cesspool. Septic Tank: 70 + Distance from well~ feet. ~aterial, ._.~_ ....................................... Number of compm4men~ Total liquid capacity, --~-~-49-~ ..... : ................ gallons. Capacity inlet compartment, .................................... gallons. Inside length, _~&_~.nf._~. Inside width, ............... ~eeC. Liquid depth, ~g~_.~ ..... feet. Cesspool: ~.,-~-~.,~ Distance from: Well, .............. feet; foundation, ............... fee~; nearest lot line a~ ~ fron~, .~ side, ~ rear, ............... fee~. Inside diameter, .......... feet. Depth, .......... fee~. Liquid capacity, ............ gallons. Lining material ......................... SECONDARY TREATMENT consists of ~ Distribution box and ~ Tile disposal field..~ Seepage pits. Other ........................... Tile Disposal Field: Distance from: Well, ............ fee~; foundation, ............. fee~; neares~ lo~ line ae ~ ~ron~, ~ side, ~ rear~ ............... TotaI length of tile lines, .....................leek Number of lines, ..................... Distance between lines, ................... fee~. Total effective absorption area in bottom of ~renches, ........................... square feet. Trench width, ..................... inches. Length of each line, ~ ...................................... feet. Depth, top of tile ~o finish grade, .......................................inches. .: Type of filter materiah ~ Gravel. ~ Broken stone. ~ Cinders. Other '~epth of fitter material beneath tile, ........................ inches. Depth of filter material over tile, ................... inches. Seepage Pits: ........... Number of ri~s _..~._ Ou~side diameter, ~a--~-- fee~. ~eren, ..~ ....... fee~. Lining material ___ ~ ~s~ance from:. Well, .~_... feeh foundation, _~.~. ..... fee~; neares~ Io~ line a~ ~ fron~, ~ mdc, ~re~r, __.]...~._ feet. If Existing ~nstallation, give all the 2ollowing additional information available: Distance to nearest: Public sewer, ................ fee~. Community system, .......... A._. feet. Approximate direction of surface drainage of lot, .................................... Arpr0xima~e slope, ................. feet per 100 fee*. Soil is: ~ Loam. ~ Sandyloam..~ Clay. ~ Sandy clay. ~ Coarse saud or g$'avel. ~ ~ardp~ ~ Rock. Other ..................... Number o2 bathrooms, ............ Is there a basement? :~ Yes. :~ No. ~asemen~ drains to ................................................ Fixtures in basement: .~ Laundry tray. ~ Toilet ~ Bathtub. ~ Shower. ~ None. ~ Floor drain. ~ Sump pump. Laundry waste disposal: Direc~ to ~ Seepage pit. Other .................. Through sum~ pi~ to: ~ Septic tank. ~ Seepage ~its. Is footifig drain provided? ~ Yes. ;~ No. Drains to: '~ Surface. ~ Dry well. ~ Sump in basement. Other ..................... Downspouts or areaway drain to: .~ Surface discharge. ~ DW well. 0~her Depth o2 house sewer below finish grade at foundation, ................ fee~. Inspection made by: ~ State. ~ County. ~ Local Health Authority. Part I-b.--See reverse side Part II.---FOR USE OF THE HEALTH DEPARTMENT OFFICIAL REVIEWING REPORT Based on the information reported hereon and other available information, it is the opinion of the CJ State ,I~ Cmmty [] Local Department of Health that this system with proper maintenance: ~ ]~] can be expected to function satisfactorily, and is [] cannot be expected to function satisfactorily, not likely to create an insanitary condition. Remarks: DateNevembe~,__~5 ................... 195T.. - bec~, ._of.. $a~i_t~,~i;~__Eng~ne er~n~ ...... Part IlL--FOR USE OF FHA OFFICE · ~ To THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the individual sewage-disposal system be considered [] acceptable [] not acceptable. Remarks: ............................................................ ~ bnzef ztqel~veet. ~ l) eputy for Chief A~ehiteet. 2218--Individual Sewage-Disposal System ~ '~ ' Report of lmpection · (Revised Dee. !~18) ~ Ne~v installation. [] Existing installation. FEDERAL HOUSING ADMINISTRATION REPORT OF INSPECTION INDIVIDUAL WATER-StJPPLY SYSTEM To B~ Headed in by FH,~ Offic~ 60,,0054§3 . AgOHO2A~E ALA6~_A .... F~qST NATcL KCI~--OF-ANCHORAGE BIED~ 14m.--J,-and- Property address ..... IAYl'~ ~, ~ ~ BI,_~K 4~_ Lal~LRT_ S]JBD. _#4__(Fixe~eed_Lane) ......... ~HO_RAGE ............................ ALASY, A (City) (Cmmty) (State) Total number: Living units _1_ ~ Bedrooms ___~ .... Baths ....... ~__ Basement: [] Yes [] No. Sewage disposal by: [] Public se~er. [] Community system. ~] Individual system on site. Part I-a.--FOR USE OF INSPECTING OFFICIAL (Fill iii below iafm'mation applicable to subject installation) ~NSTRUCTIONS: If ?tglO i?t8t(lll~io?l, inspect for compliance with approved exhibits and record any observed information not shown on, m' which varies from, tlle approved exhibits. If existing installation, furnish as moch of the infm'mation as may be available. Distance to nearest public water main, ___~___ feet. Size of main, _~___ inches. Individual ~vells ~are ~ are not eu]tomary in neighborhood. Give most recent ~&ord of failm'e of ,, ells iu immediate vicinity to furnish adequate supply of ,valet ___~~]__~~,~/ Properties in neighborhood ~ are ~ are not being developed witl~ both individual water-supply and sewage-disposal systems. wqde, ¢' STO feet deep. Dwelling set back from front property line, -~-O- feet. Individual water supply from: ~Drilled well. ~ Driven well. ~ Dug well. ~ Bored well. Distance of well from: Building foundation, ~ ~ feet; nearest lot line at front, ~ side, ~ rear, ....... _~,~ ......... feet, seepage pit, _~cOL~---- feet; cesspool, ................. feet; oflmr sources of possible pollution ............... feet. Well construe~ionr ' Diameter ...... ~ ....inches. Totald~pen, g:~-,Zf~e. Type of casing, t~/ .... Deptb of casing, _/_~f)_ feet. Approximate depth to pumping level of water in well, _~__~__g __ feet. Approximate yield ..... g_$_:Ygallons per minute. Sealed watertigh~ to depth of .......... fdeL Exterior spacq around casing sealed with: ~Cement grout. ~ Puddled clay. ~ Ordinary backfill. Well Cover: ~ Concrete. ~ Wood. ~ Me~al. Openings in well cover watertight: ~ Yes. [] No. Pump: ~ Shallow well. ~Deep well. ~ngth of drop pipe, _~O_d_ feet. Pump capacity, =~%,~, gallons per minute. Located in: ~Basemefi~. ~ Pump room off basement. ~ Pump house above ground. ~ Pump pit. Pump room ~%perly drained: ~ Yes. ~ No. Pump mounting watertight: ~ Yes. ~ No. Type of storage: ~Pressure. ~ Gravity. Capacity,~_~__4- gallons. /~' //'~ Has bacteriological exS~inatioa of water been made? '~¥cs. ~ No. If answer is "yes," give date :~ Quality of wate~ is ~ is not satisfactory for human ~Snsumption. Installation ~doe~ ~ does not comply wltb approved exhibits, if any. Inspection m~(~ by: ~ State. ~ County. ~Local Health Authority. Part II.--FOR USE OF THE HEALTH DEPARTMENT OFFICIAL REVIEWING REPORT Based on the information reported hereon and other available infm'mation, it is the opinion of the ~ State [] County [] Local Department of Healtl~ that this system ~ is Iqis not satisfactory as a domestic water supply for thc subject property. Remarks (Title) To TnB CHIEF UNDEgWRITBRi Part [II.--FOR USE OF F. II. A. OFFICE I have reviewed the foregoing and the pert)neat FHA Compliance Inspection Report, and recommend that the individual water- supply system be considered [] acceptable [] not acceptable. Remarks: ...................................................................................................................... Date ....................... , 19 .... 2217--Individnal Water-Supply System (Signed) ............... ~' d)[~y' A ;~)[i~i: --~ ~)~i~-[t~-~-o-~'-~]def ,d-~:~t[if~&}]-- Report of Inspection