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Home My WebLink AboutGREGORY TR 5 PTN " Form Approved FHA ~'orn . .,73 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8 Rev. July 1958 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA NSURING OFFICE l MORTGAGEE SERIAL NO. / ~he ~'~',~t ~at4Ow, 1 BaM~: of ~rxe, ho):age MORTGAGOR OR SPONSOR LA~DAU~ Robo~'~ L, and BoOty Lo PROPERTY ADDRESS SUBDIVISION NAME TOTAL NUMBER: WATER SUPPLY BY: [] Public system BATHS BASEMENT ~]Ye~ ~No New installation ~_] Community system SEWAGE DISPOSAl. BY: ] Public system Community system Scan attic or other area be made into additional bedrooms? (if Yes, how nlony~) SYSTiM DESIGNED FOR g Individual NO. OF Og~S_. GARBAGE DISPOSAL Ind,v,dua, i [[2 Yes PART II.~TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State [] County F~ Local Department of Health that this individual water-supply system [~is ~ is not satisfactory as a domestic water supply for the subject propertv. it is the opinion of the [--] State L1 County tern with proper maintenance: ~1 Can be expected to function satisfactorily, and is not likely to create an insanitary condition [~ Local Department of Health that this individual sexvage-disposal sys- [~ Cannot be expected to function satisfactorily SIGNATURE TITLE c., NOTE: The heulth authority should,'~omplete the approprlut~'6~nlon statement above und c~ffix date, signature und title in the spaces provided. have reviewed the foregoing and the pertinent FHA Compliance Inspe~ioD Report, and recommend tbat'the Individual water-supply system be considered ~ Acceptable ~ Not Acceptable Sewage disposal be considered ~ Acceprabte ~ Not Acceptable. DATE SIGNATURE I ~, HEALT~'i AUTHORITY APPROVAL CI41EF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form 2573 Rev. July 1958 6~ Jalgta jo Alddns alenbapg qs}uJnj ol il[up}a almpatutut m $lp^X jo aanl!eJ jo pao>*~ lua>a~ lsotu at,~o · pooq~oqqg!au u[ Xagusmsn~ ~ot] aJu [] a~gJ~' stpta i~npDflJuI WIIS,L$ AlddnS'lJllVJ~ 1VflalAIGNI--NOII:)ldSNI :10 llJOdltl . · 9oT ~~~. D ,op:~. D ,:.o~j D ~ ~,. :o[ :~,~o~ ,.:~j ~,.o.:~p~oj ~ p~ ~q '.mj~ ,~ ~o,j ~ I~pa3um gu[u[u '3aaj~'q3dao '3aaj~'sa~am~p ap[s3nO '~s~d jo ~aqmfiN¢'~ :Slid eB~dees 'saq~u~ 'alp Jato [~Va~m ~a~lU jo q~daG 'saq~u} "alp q~auaq l~}Ja~m Jall9 jO q~daG 'Ja~0 'auols ua~o~fl ~ 'laamD ~ !le[Jal~m Jail,~ jo · saq>u~ 'apuag qsN¢ m a[}~ jo dm 'q~daG 'laaj ~ "au}[ ~ jo 'laaj aaenbs 'satpua~l jo molloq u} uaJ~ uo[ldJosqg aa?a~a [~1o~ 'saq~u~ ~ , 'qlp? q0uaJ~ ' ~aaj 'saul[ uaaa~aq a~ums!Q 's~u}l jo JaqmnN '~aaj "sau}I alp jo ~q~uaI lmO& · ~aaj '~uaJ ~ 'apes ~ 'mosj ~ ~u au~[ mI ~a~uau :laaj 'uopepunoj haaj 'ip~/:moJj a~ums!G ~aqlO 'sl~d ag~daa~ 'pla9 l~sods~p al~& ~ jo sls~suo> INtWiYt~I AUVGNO}tS leVme~ gu~u~ 'SUOl[g7 '&pude2 p}nb~ '~aaj 'q~daG ']aaj 'Ja~amu~p ap~suI ']o~j (JU*J ~ 'op~s ~ 'moJj ~ ~* aU~l ~oI ~saJuau '.:aaj 'uopepunoj '.~aaj 'It~ :moaj :lOodsse3 · 1aaj ~ 'q~dap p}nbFi '~aaj ,~ 'SUOlpgg 'ltlarx/~JedtlJOa ~OlU! ,tlp~duD 'SUOlle$ OLIO sluatu~Judtuo~ jo JaqmnN 'loods~o3 [] W:IISAS 1VSOdSla-loV,'~AaS 1vflalAIONI~NOI/:):IdSNI :10 ltlOdltl Typ~ Name ^~dress_ Bx, 1~47-E~ 8ta~ Rt. A, Spena~. Name of Manager RO~t,, I,. ~l~ Location ~" ~5, (~e,g~ ~ll~. Sir: An inspection of your plant has this day been made, and you are notified of the defects marked below with a cross (X) in column marked with (U). The defects noted should be corrected. Y Site 2. Building ~. Ventilation 7. ~en, Control ~2. ~o,e~ ~i,~ie~ 15. Hand-w~hing faciliti~ 14. ~uipm~t 16. Cl=nsing 17, Sterili~tion 18. Storage 2~. W~olesomenes~ ,of 22. Storage, Display 23, Personnel, Clea~ine~ 25. ~6. ~7. has review~ this bspection with me_ ADH-~HS~6-FI (e) ut ComPletely. IND~a~&~A~T~PPLY sh~t for S~ple conectlon A~S~ DEP~'~NT OF H~ ~t~otlons. Section o! Sanitation on~d Engineering ,~; ~<. ;~-:~- ~ ~.~,t~, for Bdcteriological Analysis .:,~~' 0 Water sample collected ' ' ~ = ~ ~y ............... ~.....~.~..../~~ ....................................... ~..-~.....~. .............. (Nam~ of person colle~ sample) (Date) iTlme) Wa~ec sample collected from [~ Kitchen tap; ~ Bathroom tap; ~ Basement tap; · ~ Other (lisB)~~ ~ ........................................................................... ~, ~~ ...... 2 ................ ~Q~~~--.~...T...-.~.. Please ~lace an "X' in ~he ~}e llems ~loh b~ desoribe your ~a~er supply: ~-'~~ S()U~C~: ~ell ~ ~ Dug, ~D~ven, ~DrlIled, ~ Bored ' [~ Spring, ~ Cistern, ~ O~her (lisD ............................................................................................................... ~ Creek, ~ River, ~ L~ke, ~ Pond .................................................................................................................. DUD ~L,L O~ D~STE~N CONSTRUCTION: ~aIls ~ ~ ~ood, ~ Concrete, ,~I, ~ '~le, ~ Brick or Concrete Bloc~ Top --. ~ ~ood, ~ Conm'e~e,~Me~l, ~Open Tog LOCAtiON': ~ In basemenL ~ Basemen~ offset, ~ ~nder ~o~e,'~ ~In yard O~her ..................................................................................................................................................................................... DZ~TANC~ TO: Building se~er or o~her drainage pipe .............. feel Sep~lo tank ,~..~...feeL Tile tleld .............. fee~, Seepage pi~/~.fee~, Cesspool .............. fee~, Privy .............. fee~. O~her p~slble ~our~es of oo~aminalion (i~D .............................................................................................................................................. ~T~I~,: Building se~er -- ~ O~s~ ~on, ~ ~oo~, ~ Tile, ~ Fibre ~t~e, ~ Asbestos oemen~ Join~ m~erlal ~ ~e ....................................... G~N~ ~NFO~ON: Does ~a~er become muddy or disoolored? E~ yes, ~ no ~heu? ....................................................................................................................................................... ............... ...... ........ ............... Benggh of drop pipe ............................................................................................................................ Wa~er 0ep~h from Bog~m -~ .......................................................................... fee[ Pump loeaglon: ~ In well, ~ Offseg tn basemeng, ~ In basemeng ~ In uglllg7 room, [~ On gop of well ID O~her (l~D ........................................................................................................ Do you 8u~peeg lllne~ Irom ~h~s sup~lT~ ~ 7os. ~ no ........... ................................................................................................................................................................ PLEASE DEAW A SKETCH ~ ~E SPACE BELOW. THIS StI..~TCH SHOULD SHOW I~CATION OF HOUSE, WATt~ SUPPLY SOURCE, SEPTIC TANK, ~E~R, DRAIN LI~S O1~ OT~R SOURCES OF POLLU~ON ~D DIST~CE8 BE'~I~N WAT~ SUPPLY S()UROE AND ~ OF ~OVE FAO~'I~. Lab. No. INDIVIDUA~L 5V, ATER SUPPLY ~ .... Southoentral Region~2k ALASKA DEPAF, TMENT OF HEALTH Section of Sanitation and Engineering REQUEST FOR BACTERIOLOGICAL \VATER ANALYSIS Your recent request for an analysis of a sample frmn the Individual Private Water Supply serving IX~.~ 5~ _O_X~gOl~r 811bd*__was received 5~t~9/59 __and examination has been completed. l~. Robert Lo I~ndau Box 1.5~7~tt, afar itt. a · c/~..Satisfactory -- _Questionable- Records in this office indicate this Individual Private XY?ater Supply to be of sanitary status. Analysis shows this SAMPLE to be !~/~' . Satisfactory- If an Unsat sfactory .Questiouable Unsatisfactory. .Unsatisfactury or "Questiouable" status is indicated above, you should take im~nediate action as recomtnended below. l. 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 Iocation in reladouship to your sewage disposal system-~-See bulletin HSE-15 8. Bottl~ brokeu in transit, please send new sample. 9. Sample too long in transitl 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 bulletius, 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.