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HomeMy WebLinkAboutLAMPERT #3 BLK 4 LT 3 FHA Form 2573 Form Approved Rev. July 195B FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.O HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL Anchora~,e_~ Alaska City Nation~l ~,nk of A~chorage ~ Can a~lc or other area be made Into TOTAL NUMBER~ BASEMENT ~C~ ~ns(~l~ofi additional bedrooms? ~ (If Yes, how many~) WAYER SUPPLY By: SYSTEM DESIGNED FOR ~ Public system ~ Communiw system ~ Individual uo. oF B~[MS, GA"BAO~ DISPOSAL SEWAGE DISPOSAL BY: HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the ~State ~ County ~ Local Department of Health that this individual water-supply system ~is ~ is not satisfactory as a domestic water supply for the subject property. It is the opinion of the ~ State ~ County ~ Lo~al Depirtment of Health that this individual sewage-disposal sys- tem with proper maintenance: ~] Can be expected to function satisfactorily, and ~.~ Cannot be expected to function satisfactorily is not likely to create~insanitary condition NOIE~ lhe health authority should complete the a~prop~ate oplnlon stutement ~bove ~nd affix date, signature and titlelnthe spaces provided. Use of the ~bove grid for Health Dep~rtment Inspector's sketch ~s well ~s use of the back of this form i~ ~ the option of the PIRT Ill,--FOR USE OF FHA TO THE CHIEF UN~RWRI~R: ~ h~ve ~ev~cwcd the (o~c~oin~ 8nd cbc pe~inen~ ~HA Comph~n~c h~s~on ~epo~, m~d ~ecommend tb~t'chc [ndividu~ ~ce~-suppiy system be considered ~ AccepmNe ~ Not A~ept~Ne ~e disuse] be considered ~ Accept~Ne Not DATE SIGNATURE ~ CHIEF ARCHITECT  DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2573 Rev. 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Sllaa~ jo aml!~J jo pJo0aJ 1uaaaJ ~sotu aa!rD 'pootl~Oqtlg!au u! ~utuo~sno lou oJu [] aJu {~ Slla~ lunp!a!puI 'saq~u! 'u!~tu jo az!$ '~aaj-- u!~tu aa~m ~}[qnd ~saJ~au 03 a~ums!G W:IJ, SAS AlddFIS=HIIV/V~ IVrIQIAIQNI--NOII~):IdSNI dO ltlOd::l~ '~aaj 'saq~u! 'saqou!- qaaj aJunbs '~aaj '6I uo!1>adsu! jo alu(I ,iq pal>adsuI 'Al!aoqlnV qlleaH IWO] ~ '~unoD ~ 'alms ~ :Aq epum uoll}edsuI '~uaa ~ 'ap}s ~ '3uosj ~ le auH ~oI lsa~uau :laaj --'uo~l~punoj ~u~punq tlaaj --'lla~ :moJj l~pa~ gtqu~ '~aaj 'q~da~ '~aaj ~a~am~p ap~smO · s~d jo a~nN 'al~) JaAo [~[JalUm 2all~ jo q~dao 'saqou~ 4'aU) q~uau~ le[Ja)um ~a31~ jo apm~ ,s[u~ m alp jo dm 'qldaG 'l~J' 'auH q>~a jo qlgu~ 'sa~ua~l jo ~olloq u, gaJu uopdJosqu a~D>ajja lulox 'sag>u[ 'sauH uaam~aq aoums~G 'saU}l jo aaqmnN '~aaj '~aJ ~ 'apes ~ 'moJj ~ ~ auH 1oI ~sa~uau :~aaj 'uop~punoj :~aaj 'q~p!~ qouaU. alp jo q~uaI lmO& "lla/.~. :tuoJj a>umsKI :pi,alt IOSOdSlC] ell/ JaqlO 's~!d afi'~daag [] 'plotj l~sods}p al}& [] jo s~s!suo~ LNlWLVllll lU!Ja~mu gu!u?l 'SUOllU~ '~h!=,d~o p!nbFI '~aaj "q~daG '~aaj 'Jua~ [] 'ap!s [] '~uoJj [] ~ auH ~oI ~sa~uau :~aaj uop~punoj :~aaj' '~oaj 'q)dap p!nb?l 'laaj "qap!m ap!sul '~aaj '~uatmaedtuoo ~alu! X)p~duD 'gUOllU~' sluaml:mdtuo> jo JaqtunN 'loodssaD [] '~um a!ldag [] jo s~s!suoo/N~WJ, V~llll lllVWIIId WI/SAS 'I~SOdSla-~gVA~iIS 11~flCII^IaNI~NOI.L:):IdSNI :10 0 L~ © © ADH-HSB-6.F1 ([) (4M) DATB ACTION ON INDIVIDUAL WATER SUPPLY ALASKA DEPARTMENT OF HEALTH Section of Sanitation and l~nglneering Z~b. No OFFIC'~ REQUEST FQRo BACTERIOLOGICAL WATER ANALYSIS Your recent request for an analysis of a sample from the Individual Private Water Supply serving2306 F,a~,fl.e __was receivea /4fl18/00 and examination has been completed. Mr. Fred~ico Acoeto 2607 Denali St. 5penard~ Ala eka Records in this office indicate this Individual Private Water Supply to be of ..- Satisfactory- Questionable Unsatisfactory sanitary stares. Analysis shows this SAMPLE to be : · Satisfactory.__ .Questionable .Unsatisfactory. If an ~'Unsatisfactory" or "Questionable" status 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 ofi%e for bulletins, consultation, and assistance. 11. This is a surface water source and subject to pollution by man and animals. An approved water supply $ottrce should be developed. 8ANITARIAN'S REMARKS Signatare ADH~HS~-6-FI I ~lo?his Form Must Be FilledI ut Completely. ~TAKE WATEB SAMPLE TO: Laboratory, 945 Sixth Ave. Monday, T~esday, Wednesday INDIVIDUAL WATER SUPPLY ALASKA DF~ARTMENT OP [i~.P~LTH Seefion of Sani[ation and F. ngineerlng J'-lJl~s~ l~ok on lJev~r~ o! Sheet for Sample Collection Instructions. Joint material TAKE WATER SAMPLE TO: Laboratory, 945 Sixth Ave. l$'Ionday, T~esday, Wed~esday Request for B enl I Analysis _act_rL.ogica_ Lab. No ............ h~.. ?.'..g-%~. .............. (Name of person collecting'sample) (Date) (Tt~e) Water sample collected from ~] Kl~hen tap; ~. Bathroom tap; ~ Basement tap; ~ ~ Other (l~t) ....................................... ,. ............. , ............................................................................. Add~ ~a~l~e ~a~a ~araa ~ ~a. .~2 .~St : ~ ~t ,..~[[~_./.,~:?L./.z,~ ........................................................ (Mr.) e~ / , ~ ,, , ~ , , , ~~ ~ ..... / ...... ~ ...... t~ ,". ~.., . / , ,/, M~fl report t~(-~-~ //~:b'~ ,.~(? ,:'[~ .: -~:', ........................ tC .............. : ........................................... : (Name) (Box No. or street address)_ (City) Please place an ':X" in the box before items which b~t describe your water supply: 80'URCE: Well ~ ~ Dug, ~ Drtven,~Drllled, ~ Bored ~ Spring, ~ Cistern, ~ Other (lis~) .............................................................................. : ............................ ~ Creek, ~ River, ~ Lake, ~ Pond ................................................................................................................. DUG WELL OR CISTERN CONS~UCTION: W~lls-- ~ Wood, ~ Concrete, ~etal, ~ ~le, ~ Brick or Concrete Block Top -- ~ Wood, LOCA~ON; ~ In basement, ~ Basement offset, ~ Under ~o~e, ~In ygrd Other .................................................................................................................................................................................... DISTANCE TO: Building ~ewer or other draingge pipe ....... :.<~..feeg, Septic tank .............. feet, Tile field .............. feet, Seepgge pit .............. feet, Cesspool .............. feet, Privy ..............feel Other p~slble sources of contamination (l~t) ................... : ................................................ i~TERI~: Building sewer ~ ~ Cast ~on, ~ Wood, ~ Tile, ~ ~bre pipe, [~ Asbestos cement Does wa~er become muddy or discolored? When? ................................................ ~ ................................................ '....~ ............................................. Diameter of well ................................................... P ......................................................... feet Well easing material ........................................ diameter .................... depth .................................. Length of drop pipe ............................................................................................................................... Water depth from bot~m ...............................................[. ............................................................ feet Pump location: ~ In well, ~j Offset in basement, ~ In basement ~ In utility r~m, ~ On top of well ~ Other (12t) ........................................................................................................ Oo you suspect illne~, fron~ this supply? ~ yes, ~ no PLEASE DRAW A SKETCH ~ ~E SPACE BELOW. THIS SK~CH SHOULD SHOW ~CATION OF HOUSE, WAT~ ~UPPLY SOURCE, SE~IC TANK, SE~R, DRAIN LI~S OR O~ SOURCES OF POLLU~ON ~D DIST~CES L1E~EN WAT~ SUPPLY SO.CE AND ~ OF ~OVE FAC~$. '"' SAMPLli~' ~[UST BE SUBMITTED IN CONTAINERS PROVIDED BY THE ALASKA DEFARTMENT OF HEP~TH -- 723 A os J. ,'Jbe-r,.~ ?hie£ FHA ~0'orln No, 2217 (Revised Dec. 1948) [] New installation. ~] Existing installation. Budgel nurcau No. C~%R29S.3. 60- .00!ff~7 FEDERAL HOUSING ADMINISTRATION REPORT OF INSPECTION INDIVIDUAL WATER-SUPPLY SYSTEM To Be Heoded in by FHA Office THE t,VRST NATIONAL BANK OF Property address .... (City) (Cmmty) /~(Sbtte) Total number: Living units __3, ___ Bedrooms ........ ~ ~a~hs ........ ~_ Basement: ~s ~ No. Sewage disposal by: ~ Public se~er. ~ Community system. ~ Individual system on site. Part I-a.--FOR USE OF INSPECTING OFFICIAL (Fill in below information applicable to subject installation) INSTRUCTIONS: If new installation, inspect for compliance with approved e×bibits and record any observed information not shown on, or which varies from, the approved exhibits. If existing installation, furnish as much of the information as may be available. Distance to nearest public warm' main, _ ......... feet. Size of main ............ inches. Individual wells ~ are ~ arc not customary in neighborhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of warm' Properties in neighborhood ~ are ~ are not being developed with both individual water-supply and sewage-disposal systems. Lot size: _~_~_~ ...... feet wide, _~.~_~ ~eet deep. Dwelling se~ back from front property line, _ __~? -~-~- feet. Individual wa~er supply from: ~ Drilled well. ~ Driven well. ~ Dug well. ~ Bored well. Distance of well from: /~ ................. feet, Building foundation, _ ........ ~ ...... feet; nearest lot line at ~ fl'on% ~ side, ~ rear, east iron sewer, _____~}~% ..... feet; tile sewer, _ ..... ~_ ~_ feet; septic tank, __~_~_~__ feet; disposal field, _ ............ feet; seepage pit, ~-~-~- feet; cesspool, _ ............... feet; other sources of possible pollution, ____~ ..... feet. Well construction: Diameter, __~ .... inches. Total depth, _~_-feet. Type of casing, _~:~-~---~ Depth of casing .... :~_ feet. Approximate depth to pumping level of warm' in xvell, _ ........ feet. Approximate yield ......... gallons per minute. Sealed watertight to depLh of __~-~-~- feet. Exterior space around casing sealed with: ~ Cement grout. ~ Puddled clay. ~Ordinary backfill. Well cove,': ~ Concre~e. ~ Wood. ~e¢~1. Openhtg~inwelleover,v~erUgh~ ~Yes, ~No. SOda.r/ Pump: ~ Blmllow svell, ~ Djmp well, ~m~h of dry. pip~, ........... f~¢, pump e~paei~; _.~ ...... ~1~ per minuCe, Pump room properly drained: ~ Yes. ~ No. Pump moun~ing watertight: ~ Yes. ~ No. Type of storage: ~ Pressure. ~ Gravity. Capacity, __d~__ gallons. ....... Has bacteriological examination of water been made? ffi Yes. D No. If answer is "yes," giv9 date ~rr' Quality of water ~ is D is not satisfactory for human consumption. Installation ~ does ~ does not comply with approved exhibits, ~f any. (signea) ._ ff~ ............ (Title) Part I-b.--See reverse side Part IL--FOR USE OF THE HEALTH DEPARTMENT OFFICIAL REVIEWING REPORT Based on the informatim~ reported hereon and other available information, it is the opiRion of the :J~ State [] County [] Local Department of Health that this system :~ is Uts not satisfactory as a domestic water supply for the subject property. (Signed) ..... --/~--~>- ~~ ...... ----¥. Date } 19 F~inee~lrt~ At ~ ~ ~ob, ~f ltea%%~ Juneau To THE C}IIEF UNDERWRITER: Part IlL--FOR USE OF F. II. A. OFFICE ' I have reviewed the foregoing and the pertinent FHA Complimtce htspection Rgport, and recommend that the individual water- supply system be considered [] acceptable [] not acceptable. Date ......................... , 19 .... 2217--Individual Water-Supply System (Sig.ed) ......... -(5 ©);~/A,,~)i~sc~/- ©-bep~-*¢ );*'-6/~i~fii;'ggt;;~7 Report of Inspection FHA Form No. 2218 (Revised June 1951) FEDERAL HOUSING ADMINISTRATION [] New installation. REPORT OF INSPECTION i~ Existing installation. INDIVIDUAL SEWAGE-DISPOSAL SYSTEM To Be Headed in by FHA Office THE FIRST NATIO~OJ~ BA~( OF AWU~I0iIAGE .ALASKA ~OE ~ELT~ (Insurlug o~ce) (~[ortgu~ee) (~ort~ugor or sponsor) Property address _..~0~ ......................... .~ ,~ AOE · ·, SK~ ........................ (Ozf~) ' (Oou~) ' ..................................................................... Wa~er supply by: ~ Public system. ~ Community system. ~ Individual system on site. Budget Bureau No. 63--1~297.4. ......... ................ (Serial namber) Part I-a.--FOR USE OF INSPECTING OFFICIAL (Fill in below information applicable to subject installation) INSTRUCTIONS: If new installation, inspect for compliance with approved exhibits and record any observed information not shown on, or which varies from, the approved exhibits. If existing installation, furnish as much of the information as may be available. PRIMARY TREATMENT consists of :~] Septic tank. [] Cesspool. Septic Tank: Distance from well,---~.~-.~;et. Material, _..-(..q~2.~ .~ff.~t~__./~... ............................ Number of compartments ..... ~__ Total liquid capacity, ....... .~__~.~.~ .................... gallons. Capacity inlet compartment ..................................... gallons. Inside length, ___~_.'. ...... feet. Inside width, ...~P...'-.~.~..._ fee~. Liquid depth, __...~J~__ ....... feet. Cesspool: Distance from: Well, ............... feet; foundation, ............... feet; nearest lot llne at [] front, .[] side, [] rear, ............... feet. Inside diametm', .......... feet. Del)th, .......... feet. Liquid capacity, ............ gallons. Lining lnaterlal ......................... SECONDARY TREATMENT consists of [] Distribution box and [] Tile disposal field. ~ Seepage pits. Other ........................... Tile Disposal Field: Distance from: Well ............. feet; foundation, ............. feet; nearest lot line at .~ front, [] side, [] rear, ............... feet. Total lengtix of tile lines, ..................... feet. Number of lines, ..................... Distance between lines, ................... feet. Total effective absorption area in bottom of trenches, ........................... square feet. Trench width ...................... inches. Length of each line ........................................ feet. Depth, top of tile to finish grade, ....................................... inches. Type of filter materiah [] Gravel. [] Broken stone. [] Cinders. Other Depth of filter material beneath tile, ........................ inches. Depth of filter ~naterial over tile, .............................. inches. Seepage Pits: ~4~Y~(~ <~ , --~'---- Number of pits --~._. Outside-glmme~ ..... 1~:2... fee~. Depth, feet, Lining material --.--~--e~._._. _~'._ .~..~Y'. .......... Distance from: Well, .zf'.g~...~J~...--_~_ feet; foundation, __/'.~._ ..... feet; nearest lot line at [] front,,~] side, Fq rear ...... ..~. ...... feet. If Existing Installation, give all the following additional information available: Distance to nearest: Public sewer, ................. feet. Community system, ............... feet. Approximate direction of surface drainage of lot, .................................... Approximate slope, ................. feet per 100 feet. Soil is: [] Loam. [] Sandy loam. [] Clay. :[] Sandy clay. [] Coarse sand or g]'avel. [] Hardpan. [] Rock. Other Nmnber of bathrooms, ............ Is there a basement? ;j~J Yes. [] No. Basement draias to Fixtures in basement: :[] Laundry tray. [] Toilet. [] Bathtub. [] Shower. :[] None. [] Floor drain. [] Sump pump. Laundry waste disposal: Direct to [] Sgepage pit. Other .................. Through sump pit to: :lq ~eptlc tank. [] Seepage pits. Is footing drain provided? [] Yes. ;[] No. Drains to: [] Surface. [] Dry well. [] Sump in basement. Other ...................... Downspouts or areaway drain to: .rq Surface discharge. [] Dry well. Other ..................................................................... Depth of house sewer below finish grade at foundation, _ ............... feet. Inspection nlade by: Iq State. Iq County. [q Local Health Authority. ~~_,~._..~_~ , .~. (Signed) ._. ,- .'_ Date P .......................... ............. Part I-b.--See reverse side Part IL--FOR USE OF THE HEALTH DEPARTMENT OFFICIAL REVIEWING REPORT Based on the information reported hereon and other available infonnation, it is the opinion of the:~]] State .[] Cotmty [] Local Department of Healti~ that this system with proper maintenance: :1~ can be, expected to function satisfactorily, and is [] cannot be expected to function satisfactorily. not likely to create an insanitary condition. .... ~ki:Lel', ~3ec. of Sanitation Date ....J~l.a. 2(..._Z. m ........................ 1~.~... ]~;r~- Lu~ar£ng .--At)~. _ J un~_~.~u..._ &l~ ~ ....... .... ~ ' (Title)- ~ ~ ~ ....... Part Ill.--FOR USE OF FHA OFFICE To THE CHIEF UNDERWaITER: I have reviewed the foregoing and the pertinent FI:IA Compliance Inspection Report, and recommend that the individual sewage-disposal systcnl be considered Iq acceptable [] not acceptable. Remarks: ..................................................................... .- ........................................................................... ])ate ...................................,19 ..... 2218~Individual Sewage-Disposal System Report of Inspection (lalvJ.:o ';.ttnoy¢ ,h'., i[e~X. San, i}nc]osed lxlumm :Find 'the st9')jee% ~..~HA forms. Th~ s ~)ropert;y' was oz':i.?~aa].]¥ spec'bed :i.a 19~6 as an e:xis'b:lnf~ :Installation. ~t 'b}-mt 'tim% 'bhe w~ter Was no'b apOFovod and we a~nz'oved the septic %ank GFs$,em on -Ll~o b".ais 'that %-ms exts'b~nr~. Tho tm'bet aftra'Oil' was Iai;er :installed corroc'b]O/~ and be:fore tho forrr,~ were comp[Lo, ed we.receiw~d worf) vis a lo~ml cesspool[ ~D.mDer and no aee~w~e 'bhrm~d> 'bhe bott, o~,~. A ne,;~ aeepaf~e ~!'h was '~n~balled w'hicb 'Fended thron~d~ t, he clay la!xer ~nto ~raval a~a:Ln. There are savera'] dS screpaneS..es ~,a this o:~stem~ however~ :Lb is recommended i'b be mmroved. (,./dc ........................................................ De~r Lt. Stein, Enclosed please find o eo~ of a ].otter sent to ~r, ~.~roso~ton on 26 Oetdoor 1956o The water suppl~ for the ~roper~[ in question is approved; ho.~ver~ we cannot process the Fh'A for~,~s /..:2217 and 2218 until bo'th the '~,~at~r supp~? and the sm?,,.~ge dis.oossl ~yate',n~4 are s?~, prove, d, If w~, m~y bo of assistant% please fermi fre~.; to ca1! upon yours, Cn!vfl.n ~fjnts~, Jr. i~e. fd, onal ~;tm.~.tar.~' Eng,.neet T>~op~a'Sy at Jot 3~ ~?,~k 4~ D~oe~.'b ~;ubd~'v:~s~.on. 2 am so~.~7 fox' ,recoVerS. n?: the fn~t~.l]~tion, a~ ~hin was ~::l:~ ~.~fi.~tln;: tn~t~:.ll.:i;ion .4t tho be~irom'q h~m,a ~.~ only .:,. 500 galtot~. 4674TH GROUND OB$7, RV'iR USO BUILDING, }02 MORRIS DURI~AM~ NORTE CAROLINA PUBLIO N,~,,~I,IH I~{$PECTOR 5 October 1955 Dear Mr~ ','lhiney: I am writin~ to Pind out from you wheth~,r or not tho water supply and sewage disposal .qystov~,~ on our house haw-, been inspected by you and meet with your approval at the present time~ ','/hen ! lof~l; Anohoraple last April~ I had received a condi-tional cor.}mittynent from FHA provided those two items were satisfactory. The hoo.~e is located on the corner of Firoweod Lane and Bannister ~tree't (Lot 5~ Block &~ Lampert ~3ubdiv-~ ision I would app~eciate very much h~arinr from you in thi~ m'.~tter as soon ae possible so 'that an FHA loan may be secured on this property~ Thanking you for your prompt attention~ I remain Very truly yours~ Ned R, ~4toin 1/Lt. ~ U$;tF.