HomeMy WebLinkAboutBIRCHWOOD PARK BLK F LT 5OlO-Z'z -
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FklA Form 2573 ' ' /F~r,F rm Approved
Rev. July 1955 FEDERAL HOUSING ADMINISTRATION E~dget 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.
Anchorage, Alaska M~tanuska .,Valley Bank-Anoh. Br. 60-008~46
MORTGAGOR OR SPONSOR PROPERTY AODRESS
Modern Homes ................... Anohora_ge
SUBDIVISION NAME BLOC O. LOT NO.
Biroh~ood Park Subdivielon 5
Can attic or other area be made into
TOTAL NUMBER: BASEMENT New installation additional bedrooms?
LIVING UNITS BEDROOMS EATHE
(If Yes, how rnany~)
WATER SUPPLY BY: SYSTEM DESIGNED FOR
[] Public system~L_] Community system rR-] Individual NO. Or E..MS. G^RE^OE D,SVOSA~--
SEWAGE DISPOSAL BY:
[--']'Public system [] Community system ['X'] Individual 3 [--] Yes [-X1 No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
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ZZZZ_' Z_-ZZZZZZZ_' ZZZZZZZZZ_' ZZZZZZZZ_-~ZZZZZZZZZZZZZZZZZZZZ-ZZZ-ZZ-_-ZZ-_--_-
iZZZZ; Z_'qZZ-ZZZ-Z ZZZZZZZZZZ ZZZZZZZZZZZZZZZZZZZZZZ_-ZZ_ZZZXZZZ_-ZZZZZZ_-ZZ_-_-Z
Z-ZZ2 ZZZZZZZZZ~ZZZZZZZZZZZZZZZZZZZZZZZ-Z-Z-ZZZZZZ--ZZZZZZZZZZZZZZZZZZZ
ZZZZi ZZZZ_---ZZ~2222ZZZZZSZZZZZZZZZZZZZZZZT_ZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
It is the opinion of the [-~State Fl County r-] Local Department of Health that this individual
water-supply
system
[-~s [-7] is not satisfactory as a domestic water supply for the subiect property.
It is the opinion of the [--~State [] County [] Local Department of Health that this individual
sewage-disposal
tem with proper maintenance:
[~an be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily
is not likely to create an insanitary condition
DATE SIGNATURE !. TITLE
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 Ill.--FOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
I have reviewed the fbregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the
Individual water-supply system be considered r'] Acceptable r-] Not Acceptable
Sewage disposal be considered ~-] Acceptable [] Not Acceptable.
DATE
SIGNATURE
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
FHA Form 257
Rev. July 1958
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,ADH-HSE-6.FI (f) ~
Z0-5,~ - 5M Lab. No.
INDIVIDUAL WATER SUPPLY
~'~'; ALASKA DEPARTMENT OF HEALTH
OFFICE
Section of Sanitation and Engineering
ACTION ON REQUEST FOR B~CT'~RIOLOGICAL WATER ANALYSIS
Your recent request for an analysis of a sample
from the Individual Private Water Supply
serving, was
received L9~1/60 and
examination has been completed.
Satisfactory ~_ C~uesilonablo Unsatisfactory
Records in this office indicate this Individual Private Water Supply to be of
sanitary status.
Analysis shows this SAMPLE to be Satisfactory C~uesilonable Unsatisfactory.
Ii an "Unsatisfactory" or 'C~uesilonable' 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-$-2
$. Improve your cistern -- See bulletin HSE-$-3
4. Improve your dug weR-, See bulletin HSE.$-4
5. Improve your driven well ~ See bulletin HSE-$-5
$. Improve your drilled well- See bulletin
7. Relocate your well to a safe location in relationship to your sewage disposal system -- See bulletin
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 la a surfaco water source and subject to pollutio~ by ~ and animals. An approved water supply source
should b.~!evol~l~ed. J / ~ ! ....... ~k, ..... ;~--
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SANITARfAN'S
REMARKS
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