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Home My WebLink AboutLAMPERT #3 BLK 4 LT 2 ~ Form Approved FHA Form 2573 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8 Rev. Ju~y 1958 / HEALTH AUTHORITY APPROVAL INDIVIDUAL WATI R SUPPLY AND SEWAGE DISPOSAL SYSTEM ': PART I.NTO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. .~meho;~a~% Ktm~!m ]:,'~at ~'~'~tiomO_ Bank o£ Aneho~'~ 60..007470 MORTGAGOR OR SPONSOR PROPERTY ADDRESS ,,. W. C;o.vner 23 &, ]~agle, Spmmrd~ Ar~oho~'agesAle First AddJ. t, to.vt 'bo :[~'m,.)ert Sut~Iiv:toJ. o~> #3]~ 2 ~ Can attic or other area be made Into TOTAL NUMBER: -- BASEMENT New insta~atiou additional bedrooms? .... (.If Yes, how many~) WATER SUPPLY BY: SYSTEM DESIGNED FOR I Ipublic system [--] Community system [] Individual ,o. or 6D,MS. o^,*^o~ D,s,o,^~t SEWAGE DISPOSAL BY: I~l Public system [] Community system [] Individual ['--] Yes [-"] No PART II.--lO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH I It is the opinion of the '1~ State [] County [] Local Department of Health that this individual water-supply system ~(1 is [--] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [~] State [] County [~] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: [] Can be expected to function satisfactorily, and r'-] Cannot be expected to function satigfactorily is not likely to create an insanitary condition DATE NOTE~ The heolth authority should complete the apprc~rlate .c~'nlon statement above and offix date. signature and title in tho spaces provided. Use of the above grid for Health Department Inspector's sketch as well as use of the bock 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 Inspection Report, and recommend that'the Individual water-supply system be considered [--] Acceptable [] Not Acceptable Sewage disposal be considered ["-] Acceptable [] Noi Accept-able. DATE SIGNATURE [] CHIEF ARCHITECT r -~ DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2573 Rev. July 1958 d i ADH-HSB-6-P1 (~) (4~) INDIVIDUAL' WATER SUPPLY 10594 8outheentral Re gional ALASKA DEPARTMENT OF HEALTH OPPICE :)Aam Section of Sanitation and Engineering ~ ACTION ON REQUEST FOR BACTERIOLOGICAL WATER ANALYSIS & '.-. Cleo &, Shirley pox k3~7 Spen~rd~ Alaska ':.' Sat.!sfactory Your recent request for an analysis of a sample from the Individual Private Water Supply servinF, g/W 0orner 23rd, was - & Eagle received 6fl8/60 and examination has been completed. Records in this ofl3.ce indicate this Individual Private Water Supply to be of Questionable Unsatisfactory sanitary' stams. Analysis shows this SAMPLE to be (,.'"~atisfactory. .Questionable Unsatisfacto~3,. If an]'Unsatisfactory" or "Questionable" stares is indicated above, you should take immediate 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 HSE-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 ottice for bulletins, consultation, and assistance. 11. Thi~ is a surface water source and subject to pollution by man and animals. An approved water supply source should be developed. SANITARIAN'S REMARKS ADH--HS]~I~I (el This Form Must Out Completely. Filled INDIVIDUAL WATER SUPPLY ALASKA DEP~HtTMI?~N~ OF Section of SanCtion ~nd Please ]Look on Reverse of Sheet for Sample Collection Instructions. Request for Bacteriological Analys~s Lab. No ........................................... Wo, ter ~ample eollecte~ by ............... ~.~..~. ....... ~: .................. ~...~ ...... ~... (Name of person collecting sample) (Date) ..... ('~lme) Wo, ter s~mple colleote~ ~rom ~Kltohen t~p; ~ Bathroom t~p; ~ B~sement tap; ~ omer 0~,~ ~......:-~-.~ ........ ~:, ............... ~. ........ ~ ....... '7"';.; ........ ~:~ ......... 7 ............... Add~ess premise where source ~ (Mr,) ., ~all r~or~ ~o -~ :~:' ~.:~ (~ame) (Box No. or 80~0~; Well ~ ~ Dug, ~ Drlgon,~DrllleO, ~ ~orefl ~ ~rln~, :~ ~ts~rn, ~ Ogler (lls~) ............................................................................................................... ~ ~ro~, ~ ~lwr, ~ La~, ~ Porto ........................................................................................ , ....... ~ ................. O~ ~I8~ ~0~8~0~: W~lls ~ ~ WooO, ~ ~on~r~, ~g~l, ~1~, ~ Brt2~ or ~on2rogo ~1o2~ · o~ ~ ~ Woo~, ~ ~on2rog~,~ M~g~l, ~ O~en ~o~ ~ ..................................................................................................................................................................................... DIS~N~ ~O: BuHOtng 82w~r or ogler Or~lnag~ ~1~ .............. ~g, ~12 ~an~ .............. ~, ~t1~ ~elfl .............. ~g, 8~pag~ o~ ~on~mlna~on (l~g) ......................................:.'. .................................................................................................... ~I~: Bu~Ifl~ng' s~w~r ~ 8oleg m~g~rlal ~ ~ ....................................................................................................................................................... ~ IN~O~O~: Do~s wager ~2om~ W~ ...................................... 7~:"Y% ............................................................. ~ .......................................... Dlam~or o~ w~ll .................. W~ll ~as~ng m~g~rlal ........................................ Otame~er .................... ~e~ .................................. ~ng~ o~ ~ro~ ~ ............................................................................................................................... W~or Pum~ lo2~glon: ~ ~ u~l~y r~m, ~ On ~o~ o~ well ~ o~nor (~ ........... ::.~.:~:~::<?..?.:::: ................................................................ P~RP08~ O~ ~XAMINA~ON: Illness sus~ee~e~ ~: yes, ~ no New 8ouree o~ 8u~l~ ~ ~es, ~ no ~8~ ..... ~ ............... ,~..~. ...... : ....................................................................................................................................... SAMPLES MUST BE SUBMITTED IN CONTAINERS PIt'OVIDED By THE ALASKA DEPARTMENT OF HEALTH