HomeMy WebLinkAboutSUNSET HILLS BLK C LT 14C
0
Y
471~.
Sold to
Jack Stump
DeArmoun Road
SUNSET DRILLING
Star Route 1t, Box 1727
Spenard, Alaska
1 80' drilled well
Certified well log
l' ~ 3' - Gravel.
3' - 36'
36' - 70'
70' - 79'
79' - 80'
Grey GlacialTill (Soft)
Grey G'lacial Till (IIard)
Brown Glacial Till (tIard)
tt20 in Blue G~:avel. 3 GPM
5' - 20 slot -, Johnson well
screen installed
Driller: PaulBergstedt
HEALTH AUTHORITY APPROVAL
INDIV, IDUA'L WATER SUPPI. Y AND SEWAGE DISPOSAL SYSTEM
PART I.---TO BE COMPLETED BY FItA
INSURING OFFICE MORTGAGEE SERIAL NO.
/moholmgo~ A~sk~ Fir~% }~atlon~ ~3m~ of ~nuho~n~ 60-~?~6
MORTGAGOR OR SPONSOR PROPERTY ADDRESS
S'~U~P, 3ack~,~ ~f, and ~u[h Y. An~rage~ Ala~
SUmWS~ON NA~E ~OC~ NO. /LOT NO.
TOTAL NUMIIER~
WA?ER SUPPLY
[] Public system
GATH$
BASEMENT [] New installation
[]Yes VINo
['~ Community system
additional bedrooms?
(If Yes, how
J-X~ Individual No F BDRM$. OARSAG~ OISPOSAL
rqYes
SEWAGE DISPOSAL
[--J'Public system [3 Community system EX-] Individual
PART II.wTO 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-snpply system
[~is [] is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the--[~State E? Cotxnty [] Local Department of Health that this individual sewage-disposal sys-
tem with proper maintenance:
~xCao be expected to functiou satisfactorily, and [] Cannot be expected to function satisfactorily
is not likely to create an insanitary condition .
D~~ ~ ~ : ~- TITLE
NOTE: The health authority should complete tho al~propriut~ opt ~ion statement above and affix date, signature and title in the
spaces provided.
U~e of the above grid for Health Dep(zrtment Inspector's sketch as woll us use of the bGck of this form Is at the option of the
health authority.
PART III.~IFOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER~
I have reviewed the foregoing and the pertinent F~. Compliance Inspe~ion Rep6rt, and recomtneud that'the
Individual water-supply system be considered [~ Acceptal,le [~ Not Acceptable
~wage dis~sal be considered ~ Acceptable ~ Not Acceptable.
DATE
" ' . ;JJ:~ ' j--] DEPUTY VOR CHIEF ~,C~IT~Cr
HEALTH AUTHORITY APPROVAr~''''' FHA Form ~573
INDIVIDUAL"WATER SUPPLY AND SEWAG~ DISPOSALSYSTEM aev. July 1958
· o:mu!ul ~d SUOllU~'
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· pooqJoqqg?u u! ~ummsn> ~ou o~u [] aJV/'~] Sllata lunpla!pul
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WI/SAS IYSOdSla-loYMlS IYtlUIAlaNI~NOU,:)tdSNI :10/llOdlitl
Lab. No, ~[33 ~3
INDIVIDUAL WATER SUPPLY
ALASKA D]]PARTMI~NT OF HBALTH Soubhoon%~,l Regional
wr~ Section of Sanitation and llngtneerlng
ACTION ON REQUEST FOR BACTERIOLOGICAL WATER ANALYSIS
Your recent request for an analysis of a sample
from the Individual Private Water Supply
servlngLOt~ ~ & ~lJ~l~ I/Ok, O~vas
Sunse~ Hi~s S~bd.
received 7/~/~
ex~inatiou has been completed.
Records in this office indicate this Individual Private Water Supply to be of~
Analysis shows this S~PLE to be ,' ,Satlsfacto~
1~,, Jack Stump
Box 2MZ, Star Rt. A
Sponard} Alaska
(,~_/~atis facto~7____Questionable.
_Questionable _Unsatisfactory.
Unsatisfactory
If an "Unsatisfactory" or "Questiouable'" status is indicated above, you should take immediate action as recommended belmv.
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 H~alth Departmenh Sanitation office for
bulletins, consultation, and assistance.
I1. 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_
Sig~mture
ADPI--HSEWrFI
-This Form Must Be Filled Please Look on Reverse'o!
()ut Completely. INDMDUAL WATER SUPPLY J Sheet for Sample Collection J
ALASKA DEPAltTMENT OF III~ALTH [ Instructions. /
-- Section of Sanitatlon'~md Engineering
Request for Bacteriological Analysis ;~ ' o ~,~ ~'
Lab. l~o ............ ~ ..%~.~..~ ...........
water sample coneets, by ............................ ~ ~ .......... ~.~ ........... ~%..~...C. .......
(Name o{~ person collecting sample) (Date) (Time)
Witter sample collected from ~J-Kitehen. l~ap; [] Bathroom tap; [] Basement tap;
I-] Other (list) ............................................................... ~'"~ /o //~ /~/~ /7 "i)"'"--/7"~'5"~/~: ............... i' .............................................
(Mr.)
Mall re or to .... ......... ......... ........... Jr:==',?
(~'~e) ..................... (Box No. or street adrift.ss) (01ty) ........
Please place ~n "X" In t~e box before Items whlc~ b~t describe your water supply:
~OUgCE: Well -- ~ Dug, ~ Driven, gDrllled, [] Bored
~ Spring, ~ Cistern, ~ Ot~er (list) ...............................................................................................................
~ ~reek, ~ ~lver, ~ Lgke, ~ Po~d .................................................................................................................
DUO WELL
Ot~ CISTE~ CONST~UCTIO~: Wglls ~ ~ Wood, ~ Concrete,~Metal, [~T1]e, ~ Brick or Concrete Block
Top ~ ~ Wood, ~ Concrete, ~Met~l, [~Open Top
LO~ATION: ~ In b~e~ent, [] B~se~ent offset, ~ Under ~o~e, ~-In ygrd
Other .....................................................................................................................................................................................
DIST~O~ TO: Building sewer or other drainage p~pe_ ...~..~..~eet, Septic ~nk ...~O...feet, Tile ~leld ..............
~ee~, 8eepgge plt ..~/~.....~eet, Cesspool .............. ~eet, Privy ..............~eet, OtNer p~stble sources
ot contamination (1Nt) .............................................................................................................................................
~l&: Building sewer --- ~Cast h'on, ~ Wood, ~ Tile, ~ Fibre pipe, ~ asbestos cement
$olnt mgterl~l ~~n,'~pe.. . . .................
~ENER~ I~Oi~TION: Does water bedome muddy or discolored? ~ ~es,~ no
WNen? ...................................... ~; .............................................................................................................
Well c~slng m~teylal ........................................ ~/ diameter .................... depth ..................................
Lengt~ ot drop p~pe ...............................................................................................................................
Wgter dept~ ~rom bot~m ............................................................................................................ ~ect
Pump lo~tlon: [] In well, ~ OI~e~ tn b~sement, ~ln ba~emeng
E~ In utility room, E~ On top ot well
~ Ot~er (l~t) ........................................................................................................
PURPOSE OF EXAMINATION: Illness suspected? ~ yes, ~'no New source o~ supply? ~ yes, ~ no
Repairs to existing system? ~ yes,~no
.................................. ....... .....................................................................................................
PLEASE DRAW A SKETGH ~ ~E SPAGE BELOW. ~IS SK~CH SHOULD SHOW I~CATION OF HOUSE, WA~
SUPPLY SOURCE, SEPTIC TANK, SE~, DRAIN LI~S OR OT~R SOURCES OF POLLU~ON ~ND DISTANCES
BEnigN WAT~ SUPPLY SOURCE AND ~ OF ~OVE FAC~.
SAMPLES MUST BE SUBMITTED IN CONTAINERS PROVIDED BY THE ALASKA DEPARTMENT OF HEALTH
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Sunset Hills Block C Lot 14 018-201-62
0.403
Forge Engineering
7/11/24
7/29/24 (One Stop)
N/A N/A
N/A
Benjamin Schiller, P.E.
(907) 522-7773