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Home My WebLink AboutWENTWORTH BLK 4 LT 8 PHONE 7808~ OR 24921 /r afferd Drillin ANCHORAGE, ALASKA DRILLERS LOG WEL~ 0~E~i i~~~ ~A~E ~ 0M~E~ED /~ //~ /~ LOCATION OF ~fELL(TOWNSHIP,RANGE AND SECTION,IF KNOWN OR DISTANCE TOTAL DEPTH OF DRILLED WELL ~FEET BOTTOM OF CASING AT C~ FEET FINISH(CHECK ONE)OPEN END(~SOREEN() DESCRIBE SCREENS OR PERFORATIONS.. WELL DEVELOPMENT(BAILED) OR (PUMPED) FOR ~ (~0QRS) (MINUTES) WITH STATIC WATER LEVEL REMARKS SIZE OF CASING PERFORATED( ) GALLONS PER(HOUR) (M~_INUT_E) FEET OF DRAWDOWN (~E__L~W) LAND SURFACE DESCRIPTION OF FOR}~TION(TYPE OF MATERIAL,HARD OR SOFT, WATER BE BEARING, COLOR ETC. ~HICKNESS DEPTH FROM TTO / ~ / / / / / / Form 2573 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]~t~j~?]t~ i~t :] ~ ~ ~ERIAL NO. MORTGAGOR OR SPONSOR ~,l,.qt~mrb I.fot'toZ' SUBDIVISION NAME WnntwOx~,h 8ubd'l.xd.~.on TOTAL NUMBER: J WATER SUPPLY BY: J--] Public system BASEMENT Yes [] No J~New installation I--J Community system PROPERTY ADDRESS Tudor P~,,~I.ot 8~Bl.oek l~I,!ont~h Subdn,, BLOCK~[NO' LO,NO. Can ~JJ ~ othe~ ama be made into additional bedroomsT DYe' No. SYSTEM DESIGhlED FOR [] Individual [] Yes [] No SEWAGE DISPOSAL RY: []'Public system ]Community system PART II.~TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH /..~j~.; t 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 subject 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 SIG~NATURE ../ ' 4 ' TITLE 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 conmdered [] Acceptable [~ Not :Aq.eptable. DATE HIALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAOE DISPOSAL SYSTEM Rev. July 1958 'uo!~dmnsuo2 u~mnq zoj ~zo:~js!~s ~ou s! [] s! [~ ~m~^x jo 'al!l saao le!Jallltu Jall[J jo qldaG[ 'saq~u! natpO 'auras ua~oJfl [] 'laamO [] :[e!aal~ttl Jalllj jo adk~ 'apm~ qs!mj m al!~ jo dol 'qldacI 'laaJ 'au}l tp~a jo ql2ua'I 'saqo3! · laaj aJunbs '~aJ qaaj' 'SUOllU~' sluatulJ*dtuoa jo aaqulnN WtlSIS 1V$OdSla-loV~AlS 1vflalAqaNI--NOIl:)3dSNI ~O 1~1Od31~ INDIVIDUAL WATER SUPPLY Section of Sanitation and Engineering Lab. No /,900 ACTION ON REQUEST FOR BACTERIOLOGICAL WATER ANALYSIS Your ~ecent request fo~ an analysis of a sample from the Individual Private Water Supply K~. tqm. ~. serving Tudor Road was Box 72~ Anehox'age, Alaska ~.eived 3/m/~0 ex~mination h~s been completed. Records in this o~ce indicate this Individual Private Water Supply to be of *~.$atisfactoq, Questionable Unsatisfactory sanit~ An~ysis shows this $~PLE to be t / Satisfacco~_ Questionable .Unsatishcto~. If an "Umatisfacto~" o~ "Questionable" status is indicated above, you should take ~ediate action ~ reco~ended below. L Boil or chemically treac your water supply to protec~ yo~ f~ily from wader-borne dishes closed leaflet, "DH~ It Pure." 2. ~prove your spring--S~ bulletin HSE-6-2 5. ~prove yo~ cistern--See b~etin HSE-6-5 4. Improve your dug well--See buHet~ HSE-6-4 3. ~prove you~ ~iven well--See bulletin 6. ~p~ove your &iHed well-- See bulletin HSE-6-6 ~. Relocate your well to a safe location in reladomhip to your sewage disposal system- 8. Bottle broken in transit ple~e send new s~ple. 9. S~ple ~oo long in ~ansit; s~ple should not be over 48 hours old at ex~ination to indicate ~eHable ~esults. Please send new s~ple. 10. Conmc~ your neares~ ~ Local Health Depar~ent or ~ Alaskg Health Depa~enq Sanitation o~ce ~or buUetin~, consultation, and ~sistance. /' ~ 11. This is a surface water source and subject to pollution by man and ansaN. Afi?appr6ved water supply so.ce should be developed. S~TA~'S ~S AD,PI--'tq, SE-6-FI (e) Out Completely. INDIVIDUAJ ATER SUPPLY Section o! Sanl~ and Engineer[ug Sheet for Sample Collection n.~ructions. Req.~ost for BacteriOlogical Analysis ~ / /% ] ~ L~b. NO ........................................... W,ter sample collected by....(...~:.:~'..~..'.~.L...~.~'.~.~../."!~:.~,..~:: ~.....~7::.~t..'7...~...~.?. ....... (Name of person collecting ~krptSle) (Date) (Time) Water sample collected from~ Kitchen tap; [] Bathroom t~; [] Basement tap; ,," [] Other (list)~ ............... , ......................................................................................................... Addr.s p emlse w.e o s ree .............. ........... ........................... : ................................................. ~n revor~ to~.~.~/,..~..~..,.~_..Z.q~..~.~... ........ (~ame) (Box No. or street ad,ess) (City) ~ease place an '~" in the box before i~ms whlc~ b~t d~c~be your water supply: SO,GE: Well -- ~ Dug, ~ Driven, ~ D~ed, ~ Bored ~ 8pr~g, ~ Olstc~, ~ Other (Ust).....~ ......................................................................................................... ~ Greek, ~ River, ~ Lake, ~ Pond ................................................................................................ : ................. DUG ~LL O~ G~TER~ GO~8~UCTIO~: Walls ~ ~ Wood, ~ Cone~te, ~ ~al, ~ ~le, ~ Brick or Concrete Block Top ~ ~ Wood, ~ Concrete, ~ ~etal, ~en Top LOCA~O~: ~ In basement, ~ Basement offsey, ~ Under ~o~e~ ~In yard Other ............................................................................................................. i .......................... .. ........................................... DIST~CE TO: Building sewer or o~her dralnage pipe._ .:.~eet, Septic ~nk ..~(~:.~eet, ~le fiel~ .............. ~eet, Seepage pig .....~:~eet, ~esspool .............. Ceet, Prl~ .............. ~eet. Ot~er p~slble so~ees o~ contam~ation (l~t) ................................. : ........ : .................................................................................................. ~R~: Building sewer ~ ~ Cast ~on, ~ Wood, ~ .Tile, ~ ~bre pipe, ~ Asbestos cement ~o~t material -- ~pe .......................................................................... ~ ................. ~ ............................ :......: ...................... OE~R~ ~OR~O~: Does w~er become muddy or discolored? ~ yes, ~ no ~en? ........................................ ~ ................................................................ :wi ...................................... Diameter o~ well. ............... ~..f .... depth ~ ~eet Well cas~g materi~l ........................................ diameter .................... depth .................................. Length o~ drop pipe ..................... ~...& ................................................................... : ................................ W~ter depth ~rom bot~m .......... : ......................................................................... ~ ....................... feet Pump lock,on: ~ ~ well, ~ O~se~ ~ ~sement, ~ In basement ~ ~ uttHty r~m, ~ On ~0p o~ well ~ Other (l~t) ........................................................................................................ Do you s~pect~/~rg~~.~ th~ supply? ~ yes, ~ no ...... ....................................................................................................... PLEASE D~AW A SKETGH ~ ~ ~PAOE BELOW. ~IS SK~CH SHOED SHOW ~CATIO~ OF HO~SE, 8~PLY SO,CE, SE~IC T~, SE~R, D~A~ L~S OR O~ ~OU~OE8 OF PO~U~O~ ~E~ WAT~ SUPPLY 80~OE ~D ~ OF ~OVE FAO~X2'~. SAMPLES MUST BE SUBMITTED IN CONTA1NE~gS PRD-~'IDEDB¥ THE ALASKA DEPARTMENT OF DIZtECTIONS FOR COLLECTING SAMPLES OF ~ FOR BACTI~IOLOGICAL EXAMInATiON Read Carefully and Foi, ~tructions Exactly DO NOT COTJ.P~IT SAMPLES FROM FIRF. HYDRANTS, YARD HYDRANTS, DRINKIXG FOUNTAIN,el OR SIiVI1LAtt OUTLETS WHICH ARE DIFFICULT TO D ~[ S I N F E C T PROPERLY Bear in mind that water analysis deals with nmterlals present in very minute quantities. The least carelessness in collecting and handling may give rlseto result~ which are misleading. Arrangements should be made to have water sa~Lples reach the laboratory as quickly as possible, After 48 hours the significance of the bacteriological anal~,sis 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 burn{rig paper. Tile flame should not be merely passed oyer 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 mailing tube. Hold bottle by the lower half in one hand and with the other remove the screw cap with the fingers, lea¥1ng 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 wilt split cap. (e) Pack bottle carefully 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 follows: (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 centact with the hand is not introduced into the bottle. Avoid collecting surface scum and bottom sediment. SAMPLES MUST BE SUBMITTED IN CONTAINERS PROVIDE,D BY THE ALASKA DEPARTMENT OF HEALTH