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Home My WebLink AboutLAMPERT #3 FIRST ADDITION BLK 5 LT 11 002 ,70! FHA F< [m 2573 Form Approved Rev. Ju!~ '195" FEDERAL HOUSING ADMINISTRATION Budget Bureau No, 63-R296.8 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. 60.006819 MORTGAGOR OR SPONSOR I,~'.Llt~m~ O, m'~ Doz~o~,v E. gt. ehele SUBDIVISION NAME Fi',~% Addl%ion %o $~t~t~? NO, 3 PROPERTY ADDRESS BLOCK NO. LOT NO. TOTAL NUMBER; BASEMENT J~¥es [] No New installation WATER SUPPLY BY: [] Public system [] Community system [] Individual Can attic or other area be made Into additional bedrooms? (If Yes, how rnany~) ~ ¥es [rl ~o NO. SYSTEM DESIGNED FOR ~ [--']Yes ['J["] No SEWAGE DISPOSAL BY: []'Public system Community system ,~P Individual PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT IHEALTH 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 aubject 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 [] Cannot be expected to function satisfactorily "iS-not likely to create an insanitary condition DATE / '~// I SIGNATURe../~-' /f' ..~ / .... / J TITLE ','"' '._/~ -'' (.'~-'" '1, ,J.~' , '- ' ' NOTE: The health authority should complete the appropriate opinion statement above and affix 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 Inspection Report, and recommend that'the Individual water-supply system be considered [] Acceptable [] Not Acceptable Sewa/~e disposal be considered [] Acceptable [-'] Not Acceptable. DATE SIGNATURE HEALTH AUTHORIT~ Ab)P~OVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM jCHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 Rev. July 1958 .~,F6I /5"~' ~:7/' uo!~oadsu! JO al~G · ~h!~otpnV q~lUaH lu>o'I ~ '.41unoD [] 'alms [] :Xq aputu uo!DadsuI · Xu~ j! 'sl!q!qxo po^o~dd, tll!t~ Xldmo> lou soop [] s~op'~ uo!:~uilmsuI 'uo!admnsuo~ umuntI ~oj X~o~oujs!~es lou s! ~' s! [] ~*:lu~ jo ~ .~a:~r~ jo 2[iddns a~enbapu qg!UJllj o} Al!U.ID!A all~!pattlttI[ u! SllanX jo aJnl!l~j jo pzo2aJ ~uaoaJ lsouJ a^!.D 'pooti~oqq:g!au u! ~utuolsn2 lou a~u [] aJu ~' sila~ Nnp!a!pui 'saq2u!~-'u!utu jo az}s '~aaj..~7~-'u!utu aa~m,~ 2!lqnd :~saz~au o~ aoums!G WtlS/S AlddflS'tltlVh~ IvrtGIAIQNI--NOII3ldSNI :JO llJOdltl 'laaj 'saq~u! 'saq0u! 'laaj a~unbs '~aaj '~aaj '~aaj' 'o19 ia^o le!aa~utu Ja~iU jo q~daG 'saq3u} Jatll0 apm~' qs[utj o~ al9 jo dm 'tpdao '~aaj %I!~ q~u*u~t I~!J*~;m ;*~ItJ jo ~pd*cI · *urns u*:~m[I [] 'p^u;D [] :lqJ*~em J*qtJ jo · U!l q>eo jo q~'U~l W:IISAS 1VSOdSla-lov/~A:lS 1vrtalAlaNI~NOIJ,:):ldSNI ;JO l~lOdltl ADH-I-[sE-6-F1 (f) (6-58 IOM) DATE ACTION ON INDIVIDUAL WATER SUPPLY DEPARTME .bkT OF HEALTH ALASKA Section of Sanitation and Engineering Southcentrsl Regional OFFICB REQUEST FOR BACTERIOLOGICAL WATER ANALYSIS Your recent reqnest for an analysis of a sample from the Individual Private Water Supply serving 21~Oj} Eo.~e .was received :m/5/59 examination has been completed. Mr. t'~m. O. Niehel~ 220~3 Eagle Street Anehorage~ fila~ka Records in this office indicate this Individual Private Water Supply to be of sanitary status. Analysis shows this SAMPLE to be___//'~ Satisfactory If an "Unsatisfactory" Questionable QueStionable. Unsatisfactory Unsatisfactory. or "Questionable" status is indicated above, ),uu should take immediate action as recommended below. 1. Boil cdr chemically treat your water supply to protect your family from water-borne diseases as outlined in en- closed leaflet, "Drink It Pure." 2. hnprove your spring--See bnlletin HSE-6-2 3. Improve your cistern--See bulletin HSE-6-3 4. Improve your dug well --See bulletin HSE-6-4 5. hnprove 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. iSample too long in transit; sample should not be over 48 honrs old at examination to indicate reliable results. Please send new sample. . 10. Contact your nearest [] Local Health Departmeut or [] Alaska Health Department, Sanitation offtce for bulletins, consultation, and assistance. 11. This is a surface water source and subject to pollutiou by man and animals, An approved water supply source should be developed. SANITARIAN'S REMARKS A D rl--l--J. S E-O- _h" 1 (e~ i -This Form Must Be Filled Out Completely. 'FAKE WA'IEI~ $?iMPLE TO': ~O/,...~])omtory, 945 Sixth Ave, Pleas~ Look on Reverse o1~ INDIVIDUAL WATER SUPPLY Sheet for Sample Collection] ALASKA DEPARTMENT OF HI~,ALTH InstrUctions. Section o! Sanitation and Engineering Request for Bactefwlogw~l Analysis z ', ' (Name of person collecting sample) / .{Date) (Tittle) WaC, er sample collected from [~ Kitchen ~ap; [] Bathroom ~ap; [] Base!~lon~ (Name) (Box No. or street a~re~s) Please place an "X" In ghe box before lgems which b~g describe your wa~er supply: $OURO~: Well ~ C] Dug, ~ Drlven,~Drllled,.. ~ Bored [~ 8prlng, ~ Clsgern, ~ O[her (lts~) .............................................................................................................. ~ Oreck, ~ ~iver, ~ Lake, ~ Pond ................................................................................................................ DUG WELL CE CISTlgN CO~8TItUOTION: Walls ~ ~ Wood, ~ Concre~e,~gal, ~ Tlle, ~ Brick or Concrege Block Top ~ ~ Wood, ~ Concrege, ~Megal, ~ Open Top LOCATION: ~ In basemen~, ~ Basamen~ offseg, ~ Under ~o~e, ~ In yard Ogher .................................................................................................................................................................................... DIBTANCE TO: Building sewer or o~her drainage pipe .............. feel 8e9~ic ~ank .............. feel, Tile field .............. feo~, 8eepage pig .............. feeg, 0esspool .............. feeg, Privy ..............feo~. O~her possible sources oi congamina~ion (1~) ........................................................................................... /~TE~I~,: Building sewer -- ~ Cas~ iron, ~ Wood, ~ Tile, ~ Fibre pipe, ~ Asbestos cemen~ ~oing material ~ ~pe ....................... GENE~ INFectiON: Does wager become muddy or discolored? [_~ yes, [~ no When? ...................... ...............~'"ri ........................................................................................................ Well easing material ........................................ dlameger .................... dep[h .................................. Length of drop pipe .................................. ~-: ....................... ~ ........................................................ Wa~er depth from begum .......... ~~.~.....~~ .............................. fee~ Pump location: ~ ~ well, ~j Offseg in basemenC,~ I~a~emeng ~ O~her (1~) ......................................................................................................... Oo you suspecg illne~ from ~his supply? ~ yes, ~ no /gemarks; ..... ~ .................................................................................................................................................................................................... PLEASE D~AW g SKETCH ~ 2~E SPAOE BELOW~ Tills 8KCOtt $HOULD SHOW ~O~TION OF HOUSE, WA~R SUPPLY 8OUNCE, SEPTIC TANK, SE~R, DEAIN LI~80~ O~E~ SOURCES OF POLLU~ON ~D DISTICHS .3L~VEEN WAI~I SUPPLY ~O~CE ~D ~ OF ~OVE SAMPLES MUST BE SUBMITTir. D IN CONTAII~ERS PR~"~rlDED' By' THE ALASKA DEPARTMEN~F HEALTit[Z