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Home My WebLink AboutLAMPERT #4 BLK 2 LT 19A ADH;HSB-64; 1 (f) ., ~ (4/~) ~.~ Lab. No, 21~03 INDIVIDUAL WATER SUPPLY ALASKA DEPARTMENT OF HEALTH Southcentral llegional vAru Section of Sanitation and Engineering ovv~c~ ACTION ON REQUEST FOR BACTERIOLOGICAL WATER ANALYSIS Your recent request for an onalysis of a sampl~ from the Individual Private Water Supply serving 2/+02 l~lgra .was : received 2/9/60 and' examination has been completed. Records in this office indicate this Individual Private Water Supply to be of 3/ sanitary stams. .~ Analysis shows this SAMPLE to be. t~ .Satisfactory. Mr. Bertram Smith 1/+6 4th. ^venue Anchorage, /%laska Satisfactory Que. stionable .Questionable .Unsatisfactory. Unsatisfactory If an "Unsatisfactory" 1. or "Questionable" status is indicated above, you should take immediate action ,as recommended below. Boil or chemically treat your water supply to protect your family frotn 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 01d at examination to indicate reliable results. Please seud 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 man and animals. An approved water supply source should be developed. SANITARIAN'S REMARKS FHA Porto 257.3 Form Approved Rev. July 1958 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. Anahor~aggs Alaska ~ ~a~on~ Bank o~ ~la~ka ~n ~chorage ~oo77b0 MORTGAGOR OR SPONSOR PROPfRTY ADDRESS ~]~rtram ~s S~th~gn~r~[~b~j~) 2~.[()2 I~ra- Anchorage~ Alaska SUBDIVISION NAME ~LOCK NO. LO~ NO. ~er~ S~divis:Lon ~)~ 2 _ ~ Can a~Jc or other area bo made Into __ TOTAL NUMBER~ BA$EM~NT New installation additional bedrooms? (If Yes, how WATER SUPPLY BY: SYSTEM DESIG~E~ FOR ~ Public system ~ Community system ~ Individual .o. o~ ~. o~o~ SEWAGE DISPOSAL BY: ~ Public system [~ ~mmunity system ~ Individual 3 ~ Yes ~ No PART II. TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH ....... 2~ _t__~ ............. = ..................................... ............ I~~_~L2L .................................. ................. j ............ ~ ~i~;~ZZiZZiZiZiiiiii'/iiiiiiiiiCZZii ............................... -ZZ-iZZ-Z ..................... + ........... Z ~ZZZZZZZZiZZZZZZZZZZZiiiiZ .... ~L~" ~ ...... ZZZZZZZZZZZZZZZZZ'ZZZZZZZiZiZiZiZZZiZZZZZZiZZZZZZiZZZZ~ZiZZZZ~Z~iiiZiZZ~ ................................................... ~ ..... ~.__~_._~__~ ....... It is the opinion of the ~ State ~ County ~ Local Deparfn,ent of Health that this individual ,vater-supp:'.y system ~ is ~ is not satisfactory as a domestic water supply for the sub}ect properS. It is the opinion of the ~ State ~ County ~ Local Department of Health that this individual sewage-disposal tern with proper maintenance: ] Can be expected to functioa satishcrorily, and ~ Cannot be expected to function sadshctorily ~s not likely to create an ins~nita~ condition spaces provlded, PIRT III,--FOR USE OF Fit OFFICf TO 7HE CHIEF UNDfRWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, aud recommend that'the Individual water-supply system be considered ~ Acceptable ~ Not Acceptable Sewage disposal be considered ~ Acceptable ~ Not' Acc2ptable. SIGNATURE DEPUTY FOR CHIEF ARCHITECT HEALTH AUTIlORITY APPROVAL FHA Form 2573 INDIVII)UAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM R.v.J.b 19SS ~.~ salu~ jo Xlddns alunbapu qsluJnJ ol ,h!up!^ al~!patuua! u! Slla~a jo aanl~uJ jo paovaJ 'pooqzoqqg?u u[ ~molsn~ lou aJu ~ aJu ~Sllam lenpD}pui S , D ~o '~poqlng q~l~aH lU~O~ ~ %un~ ~ 'alulS ~ :~q epnm UOl&~suI 'aaaj~'a~aa~ ap.s ~ 3uo0 ~ ;~,OU]l. I [ a aa~au '.)aaj ~OO uon~punoj. ~utpltnq' ' 'aaaJ~'ll°~~ OO/ .'~o~j oau~sl~. ieua:u~ ~u~uq 'aaaj' ~ 'q~daG '~aaj ~'Jalamu~p apronO '-- s;~d jo saqmnN · saqou} "alp Jaao l~pa~m Jaqg jo qldaG 'saqou] 4'alp q~uauaq l~Ja~m ~aqg jo q~daG 2aqlo 'auo~s ua~o~ ~ 'laa~O ~ :lepale~ 'saq~u~ aps}2 qslu~ o; alp jo do; 'qidao 'aaaj' 'audi qaea jo q;Su~ · aaaj 'sauH uaa~aaq a~uu~s]G ' 'souH jo JaqmnN ':aaj' 'souH alp jo qagua ':aaj 'auaJ ~ '=pis ~ ':uoJj ~ a~ auH :oI :saa~au :aaaj' 'uop~punoj :aaaj 'lla~ :tuo~j Jaq)O 'slid ag~daag ~ 'p[ag l~sodqp al)& ~ jo sls[suo~ INIWlVt~/laVONO~ {u[:a~um auiu~ 'SUOll~ '~p~dua p}nb}~ 'aaaj 'qadaG 'a~j 'JgaJ ~ 'ap}s ~ 'luoJj ~ 1~ aU]l 1oI lsaJgaU :laaj 'uopepunoj 'laaj 'SU°llUg ~ i sluatulJ*dmoo jo JoqtunN / 'qldap p!nb}*I '~aaj 'auamla*dtuoa aalU[ X:puduD 'SUOll~' 'loodssaD [] 1J;}*l aLU I~! p Op!suI 'll0/X,, :tuoJj a~ums!G :lOOdSse2 'q~uaI op!sul ',hp~du> p!nb!l lU:O~L Wa/SAS lVSOdSlC]-~lOVM:lS ' vrlG]AIONI~NOIJ.33dSNI :lO J,~lOd::l~l TAKE WATER SAMPLE TO: Laboratory, 945 Sixth Ave, Monday, Tuesday, Wednesd y /// .... 'AJSASIKA .DEPAiCT1VIENT OF ItEAL'i*Ii Section of Sanitation and 1/.n~lneertng Please Look on Reverse cfi Sheet for Sample Collection Instructions. Request for Bacteriological Analysb Lab. No. ' / / Water sample collected by ' ~ .~/.~... ....................................... :....:.:,:: ................................................. .e.. .............. (Name of person collecting sample) (Date) {Thne) Water sampte collected from t~Kltehen tap; [] Bathroom tap; [] Basement tap; [] Other (list) ............. ~..~ ............. fh ..................... 9' .............................................................. ddress ,:e lse where soiree lo0a d ...... ................ (Mrs,) ' -' Marl report to (MIss) ................................ (Name) (Box No. or street address) ~ (City) Please place an "X' in the box before items which best describe your water supply: SO'Ui~CE: Well -- ~ Dug, [] Driven, [] Drilled, [] Bored [] Spring, [] Cistern, I-- Other (list) ................................................................................................................ [] Creek, [] River, [] Lake, [] Pond ............................................................................................................... DUG W~LL OR CISTERN CONSTRUCTION: Walls-- [] Wood, [] Concrete, ~fMetal, [] Tile, [] Brick or Concrete Block Top -- [] Wood, [] Concrete, ~ Metal, [] Open Top LOCATION: [~ In basement, I-] Basement offset, [] Under house, [] In yard Other DISTANCE TO: Building sewer or ot,he{>~rainage pipe .............. fee% Septic tank .~.-~.~.~...-...feet, Tile field feet, Seepage pit ../..! ....... ieet, Cesspool .............. feet, Privy .............. feet, Other possible sources of contamination (It.st) .......................................................................... 2 ................................................................... MATF2~IAL: Building sewer --~ Cast lron,,~Woo..~l~ Tile, [] Plbre pipe, [] Asbestos cement Joint material --. Type ............. ~.-z..~........-~.~ ................................................................................................. GENERAL INFORMATION: Does water become muddy or dlseolore~d [] yes, [] no When? ......................................... ~....7 ......... tameter of well . -~.-~ ~ ~ denth 5~.- , ' .................... >,~,~ ................ ,. ..........~ .............................................. Well casing material .......... ~2~¢..~-..' ......... diameter .........~ ...... depth ........... ..~......7~f.~ .... Length of drop pipe .................................... ./.~......~. .......................................................................... Water depth from bottom ................................ ../..:~2 ................................................... feet Pump location: [] In well, [] Offset in basement,~In basement [] In utility room, [] On top of well [] Other (list) ........................................................................................................ Do you suspect tllnes~ from this supply? [] yes,~l~ no :~emarks: ?£,EASE DRAW A SKETCII IN THE SPACE BELOW. THIS SKETCH SHOULD SHOW IX)CATION OF HOUSE, WATER SUPPLY SOURCE, SEPTIC TANK, SEWER, DRAIN LINES OR OTHER SOURCES OF POLLUTION AND DISTANCES /...E I'WEEN WATEr% SUPPLY SOURCE AND ANY OF ABOVE FACILITIES. SAMPLES MUST BE SUBMITTED IN CONTAINERS PROVIDED BY ~THE-ALASKA DEPARTMENT OF HEALTH