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Home My WebLink AboutSPENARD ACRES Block A Lot 10A FHA Form 2573 Form Approved Rev. July 1958 FEDERAL HOUSING ADMINISTRATION Budgel Bureau Ho. 63-R296,8 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.MTO BE COMPLETED BY FHA iNSURING OFFICE MORTGAGEE SERIAL NO. First National Bank of Anchorage Federal Hous_i_n_~ Administration Box 720, Anchorage, Alaska 60-008753 MORTGAGOR OR SPONSOR PROPERTY ADDRESS Robert K. Schnell 1310 - 39th SUBDIVISION NAME BLOCK NO. LOT NO. Spenard Acres Subdivision ..... 10-A ] Can attic er other oreo be made Into TOTAL NUMBERJ BASEMENT New installation additional bedrooms? LIVING UNITS BBDROOMS BATHS ............ (if Yes, how mony~) 1 3 i [~] Yes ['--1 No []Yes ['~] No WATER SUPPLY BY: SYSTEM DESIGNED FOR [] Public system~[__l Community system~[.~ Individual NO, OF BDRMS. OARBAGI~ DISPOSAL SEWAGE DISPOSAL BY: U Public system [] Community system .. [] Individual 3 [--] Yes ~ No PART II.---TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [~]'State [--} County [-'-] Local Department of Health that this individual water-supply system [-'-~s [--] 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: [~/C"-aan be expected to function satisfactorily, and [--] Cannot he expected to function satisfactorily is not likely to create an insanitary condition DATE SIGNATURE TITLE NOTE: The health authority should complete the appropriote opinion statement above and affix date, signature and title in the spaces provided, Use of the above grid for Health Deportment 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 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 [-7] Acceptable [~] Not Acceptable. DATE SIGNATURE [] CHIEF ARCHITECT -] DEPUTY FOR CHIEF i:.RCHITECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FaA Form 2573 Rev. July 1958 REPORT OF INSPECTION~INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of [] Septic tank. x3~,Cesspool. r Septic Tank: Distance from ~vell,__.feet. Material Total liquid capacity, gallons. Capacity inlet compartment, Inside length, feet. Inside width, feet. Liquid depth, Cesspool: Distance from: \V/ell, / ~ / .) %o feet; foundation,. Inside diame, t~,/='~ .x. I (o feet. Depth,~feet. Liquid capacity, ~7 & O O gallons. ,~CONDARY TREATMENT consists of [] Tile disposal field. [] Seepage pits. Other Tile Disposal Field: Distance from: \Veil,. Total length of tile lines,. Trench width Length of each line, Number of compartments feet. ~ :-54' feeti nearest iot line at [] front, J~,side, [] rear, Lining material gallons. feet. feet. square feet. inches. inches. feet; foundation, feet; nearest lot line at [] front,'J~side, [] rear, feet. Number of lines, Distance between liues, inches. Total effective absorption area in bottom of trenches, feet. Depth, top of tile to finish grade, Type of filter material: [] Gravel. [] Broken stone. Other. Depth of filter material beneath tile,~ inches. Depth of filter material over tile, Seepage Plt~: Number of pits . Outside diameter, feet. Depth,. Distance from: Well, feet; building foundation,.__ Incpoctlon mede b¥~ [] State. Date of inspection feet. Lining material feet; nearest lot line at [] front, J~ side, [] rear, /2.~ feet. Inspected by (..,~.{ ( ti ~ /'. ../. ~ '-:i' - ' (TITL.) REPORT OF INSPECTION~INDIVIDUAL WATER-SUPPLY SYSTEM Individual wells ~Z[.are [] are not customary in neighborhood. )~ O' ~ 'O Give most recent record of failure of \veils in immediate vicinity to furnish adequate supply of water Properties in neighborhood ~ff, are [~ are not being developed xvith both individual water-supply and sewage-di~osal systems. Lot size: / .5 WT) feet wide,./ ~ l~ ' ., ~ feet deep. Dwe hag set back from front property line, ,.- ,-) feet. Individual water supply from:~Drilled well. ~ Driven well. ~ Dug well. ~ Bored well. Distance of well from: Building foundation, ~ ~ .feet; nearest lot line at ~ front, ~side, E] rear, ~/ feet, cast iron sewer, 7'~ feet; tile sewer, '~ ~ feet; septic tank, ~ .... feet; disposal field,. ~'~ feet; seepage pit, ~ ...... .feet; cesspool, / ~ ~ feet; other sources of possible pollution, ~ feet. Well constructlom~ Diameter, [,~ inches. Totaldepth, /q~ feet. Type of casing, '"e ~ feet. Approximate depth to pumping level of water in well. / ~ f~t. Approximate yield, . gallons per minute. Sealed watertight to 4~pth of /l/(~ feet. Exterior space around casing sealed with: ~ Cement grout. ~ htddled clay. ~Ordina~ backfill. Well cover: D ~ncrete. ~ XVood. ~Metal. Openings ,n well cover watemght: ~Yes. ~ No. ~/?} ,5 ,'.:V/,t. ~. ~}, 1~, ,amp= ~ Shallow well. ~Deep well. Len~h of drop pipe, O ~cated in: ~Basement. ~ Pumproom off basement. ~ Pumphouse above ground. ~ ~mp pit. ~mproom pro' perly &ained: ~ Yes. ~ No. ~mp mounting wate~ight: ~Yes. ~ No. Type of storage:*~Pressure. ~ Graviw. Capacity, ~ ~ ' gallons. / Has bacteriological examinatJon of water been made? ~Yes. =No. If answer is "yes," give date Quali~ of water ~is ~ is not satisfa~ory for human consumption. Installation ~doe' s ~ does not comply with approved exhibits, if any. Inspection made by: ~ State. ~ County. :~ocal Health Authori~. / Date of inspection . (~'(-- '..~?~' /,~ '/ // / ",/" // A /.) ?t o / ? ADH-HSE-6-FI (f) 10-55 - 5M " INDIVIDUAL WATER SUPPLY '' 3outhcentraI Regional :~() ALASKA DEPARTMENT OF HEALTH ' OFFICE D~ Section of Sanitation and Engineering ACTION ON REQUEST FOR BACTERIOLOGICAL WATER ANALYSIS Your recent request for an analysis of a sample from the Indlvidual Private Water Supply se,.ing~ll kOt. h. Ave~ue was received 11/I/60 and examination has been completed. Records in this office indicate this Individual Private Water Supply to be of_ %~'~"Satisfactory~Questionable__.UnsaBsfactory sanitary status. Analysis shows this SAMPLE to be )~ .Satisfactory. Questionable Unsatiefactory. If aU "Unsatisfactory" or "QueMionable" status f~ indicated above, you should ta~e immediate aclion as recommended below. 1. Boil m' chemically treat yom' water supply to protect your family Jrom wafer-borne diseases as outlined iu en- closed leaflet, "Drink It Pure." 2. Improve your spring ~ flee bulletin HSE-G-2 3. hnprove your cistern ~ See bulletin HSE-6-3 4. Improve your dug well ~-See bulletin 5. hnprove your driven well --- See bulletin 8. Improve your drilled well~ See bulletin 7. Relocate yom' well to c~ safe location in relation~hip to your sewage disposal syMem -- See bulletin HSE-15 8. Bottle broken in transit, please send new sample. 9. Sample too long in trausit: sample should not be ever 48 hours old at examination to indicate reliable results. Pleaoe send new sample. 10. Contact your nearest ~ Local Health Department or ~ Alaska tfealth Depca'tment, Sanitation office for bulletins, consultation, and assistance. 1L This is a surface water source and subject to pollution b~ man aud animals. An approved water supply ~ource SANITARIAN'S REMARKS / ~ ?.~. ADH--HSE41-FI (e) This Form Must Out Completely. Be Filled q .... N~ k.'.'~ t>AM[I.E TO: I:: ,,~:tory, 945 Sixth Ave. ' Moudco,, T~lesda)', Wednesday ~D~U~ WATER SUPPLY ~IASKA DF~~ OF S~tion of SanCtion ~d Eng~eer~g Requ~t for Ba~eriological Analys~ Sheet for Sample Collection ........... ........... Water sample collected by ........ ,~...,. .~..S...~........~....~.-, ........ ~..-.-......-...-.....-" ~' ...... ~ ......... .?...Y...~ .... (Name of person collecting sample) (Time) Water sample collected from ~_~en tap; [] Bathroom tap; [] Basement tap; [] othe (list) ......................... ............ ...... .-.-.-.-....... .............................................. Address premise where:source is located . / 3/.../. ........... (.~...~... : . ..~..:..~/~O. ~...~.V~4~.~'-'... ~ .......................... (Mr.) Mall report to ~.~i~a) ...................................................................................................................................................... (Name) (Box No. or street address) (City) Please place an "X" in the box before items which best describe your water supply: SOURCE: Well -- [] Dug, [] Driven, [~D~lled, [] Bored [] Spring, [] Cistern, [] Other (list) ............................................................................................................... [] Creek, [] River, [] Lake, [] Pond .................................................................................................................. DUG WELL OR CISTERN CONSTRUCTION: Walls- [] Wood, [] Concrete, [] M~tal, [] Tile, [] Brick or Concrete Block Top -- [] Wood, [] Concrete, [] Metal, [] Open Top LOCATION: [] In basement, [] Basement offset, [] Under house, [] In yard Other ..................................................................................................................................................................................... DISTANCE TO: Building sewer or other drainage pipe .............. feet, Septic t~nk .............. feet, Tile field .............. feet, Seepage pit .............. feet, Cesspool .............. feet, Privy ..............feet. Other possible sources of contamination (list) ............................................................................................................................................. MATERIAL: Building sewer -- [] Cast iron, [] Wood, [] Tile, [] Fibre pipe, [] Asbestos cement Joint material -- TyPe .................................................. ~ .................................................................................................... GENERAL INFORMATION: Does water become muddy or discolored? [] yes, [] no When? .... , ................ ~ ................................................................................................................................. Diameter of well ...................................................... depth .......................................................... feet Weli casing material ........................................ diameter .................... depth .................................. Length of drop pipe .......................................................................................... : .................................... Water depth from bottom ............................................................................................................ feet Pump location: [] In well, [] Offset in basement, [] In basement [] In utility room, [] On top of well [] Other (list) ........................................................................................................ PURPOSE OF EXAMINATION: Illness suspected? [] yes, ~.~-r~V' 'New sero'ce of supply? [~yff~, [] no Repairs to existing system? [] yes, ~ PLEASE DRAW A SKETCH IN THE SPACE BELOW, THIS SKETCH SHOULD SHOW LOCATION OF HOUSE, WATI~ffR SUPPLY SOURCE, SEPTIC TANK, SEWER, DRAIN LINES OR OTHER SOURCES OF POLLUTION AND DISTANCES BETWEEN WATER SUPPLY SOURCE AND ANY OF ABOVE FACILITIES, MUST BE S~JBMITTEO IN CONTAINERS PR'0VIDED nY THE ALASKA DEPARTMENT OF HEALTH DIRECTIONS FOR COLLECTING SAMPLES OF WATEI% FOR BACTERIOLOGICAL EXAMINATION Read Carefully and Follow Instructions Exactly DQ NOT COLLECT SAMPLES FROM FIRE, HYDRANTS, · YARD ItYDRANTS, DRINKING FOrSN~AINS 'OR SI~,A/{ OUTLETS WHICH ARE DIFFICULT TO D IS I N F E C T PROPERLY " Bear in mind that water analysis dials with materials pressn~t 'in'~{~ry min'u~, quantities. The least carelessness in collecting and handling may give rise to results which are misleading. Arrangements should be made co have water samples reach the laboratory as quickly as possible. After 48 hours the significance of the bactoriologlca[ analysis is impaired. For obvious reasons the laboratory prefers to receive samples in the early part of the week, but is willing to accept samples at any time. In collecting samples from TAPS or PUMPS proceed as follows: (a) Thoroughly flush tap or pump by allowing water to run freely for five minutes. (b) Shut off water and flame the outlet with torch or burning paper. The flame should not be merely passed over the outlet, but should be applied until fixture shows indication of being hot, Flame should be directed against inside edge. (c) Open fixture so that a small stream flows, (d) Remove bottle from marling tube. Hold bottle by the lower half in one hand and with the other remove the screw cap with the fingers, leaving paper protecting cover in place. Fill the bottle to the shoulder, Replace cap with paper cover, screwing firmly into place but do not apply pressure which will split cap., (e) Pack bottle carefu~ in mailing tube enclosing' this completed information sheet, being sure that a simple sketch is included. In collecting samples from STREAMS and RESERVOIRS proceed as fotl6ws: (a) Remove cap and hold bottle as described under (d) above. - , (b) Collect sample by holding bottle in a slanting position and sweeping it below the surface in such a manner that water that has been in contact with the hand is not introduced into the bottle. Avoid collecting surface scum and bottom sediment. SAMPLES MUST"~BE SUBMITTED IN CONTAINERS P~OVIDED BY THE ALASKA DEPARTMENT OF ~EALTH