HomeMy WebLinkAboutTELAQUANA HEIGHTS LT 7A7
[ HA For~, 2573 FEDERAL NOUSING ADMINISTRATION Budget Bureau No, 63-R296.S
Rev. July ~9S$ .~.~
HEALTH AUTHORrrY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DIISPOSAL SYSTEM
INSURING OFFICE
Anchor age~ Alaska
M~AGOR OR SPONSOR
HEIGHTS SUBD.
NUMBERI
PAR'r I.~TO BE COMPLETED BY FHA
MORTGAGEE c~i ERIAL NO.
National Bank of Alaska :tn Author 60-0067~1
BASEMENT
PROPERTY ADDRESS
New installation
Chill,igan Driv% Anchorage, Alaska
BLOCK NO. J LOT NO.
- J 7
Can attic or other area be made Into
additional hedrooms?
{If Yes, how many?l
SYSTEM DESIGNED FOR
SUPPLY RYz
SEWAGE DISPOSAL RYI
~,uUic system EEl Community system [] Individual 3 [] Yes [] No
PART II.roTC) BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the [] State [] County [~ Lo0a~epartment o£ Health that this individual water-supply system
[] is [] is not satisfactory asa domestic water supp~ for the subject property.
It is the opinion of the [] State
tern with proper maintenance:
~JCan be expected to function satisfactorily, aod
is not likely to create an insanitary condition
[~] County [] Local DepartmeI!t of Health that this individual sewage-disposal sys-
[--I Cannot be expected to function satisfactorily
)ATE J~G~JA~U RE/L' /~ ~ ~' 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 Healtb Department lnspectorts sketch as well a~ use of the bach of this form is at the optlon 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 [] Acceptable [] Not Acceptable.
JDATE SIGNATURE
J[] CHIEF ARCHITECT
]DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FIIA Form 25~'3
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/\./
~ 5, ~L959
TO WHOM IT MAY CONCERN:
Concerning the well at L~t 7, Telaquana Neights~ the well is a 22
dug well, consisting of 1.5 ft; of 3 fb. diameter oonere~ eamings, three five feet
lengShs, sealed at the joi~ts and with a watertight concrete c~ver, 7 f~ ~l~w
grade.
At the t~e of ins~llation and p~pi~ there was fo~ feet of wa~r
in the well at the ~x~%m recovery.
I certify t~t this well will produce an adeq~ wa~ supp~ for
the intended use of this property,
The septic ~ is a 750 ~en steel ta~, '~rred con~iner,
faet%~ed in assonance with 0o~er~ial Standard 177..51, and t~ ~eepage pit
is an 8~ x 8~ x~~ log crib.
(6-58 10M)
INDIVIDUAL WATER SUPPLY
,5'~'~ ALASKA DEPARTMENT~ OF Hti!ALTH
aKrll -- ' SectiOn of Sanitation anti E~gineering
ACTION ON REQUEST
Youl: recent request for an analysis of a sample
from the Indivklnal Private Water Supply
serviug l~b ?t~ ~OlOguall~ }10:tg~3a}8
received 5/~59 and
examination has been completed.
Fa', J, L, 8te~
Box 2.1:55~ St.ar f~%, B
Spenarcl~ Alm;ska
Records in this office indicate this Individual Priva}:e Water Supply to be of z_.,5.7 __Satisfactory_ Questionable Unsatisfactory
sanitary status.
Analysis shnws this SAMPLE to be___~''~ Satisfactory Questionable .__~Unsatisfactory.
If an "Unsatisfactory" or "Questionable" status is indicated above, ynn should take immediate action as recmmnended below.
l. Boil or chem[cally treat your water supply to protect your family from water-borne diseases as outliucd in eu-
closed leaflet, "Drink It Pure."
2. lmprnve 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. hnprove 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 io transit; sample should not be over 48 hours old at exa,nination to indicate reliable results,
Please send new sample.
10. Contact your nearest [] I,ocaI Health Department or [] Alaska Health Department, Sanitation office for
bulletins, consultation, and assistaoce.
I 1. 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 /~':/5~
ADH--HSE-6-FI (e~
]iTh~s Form Must Be Fliled1
Out Completely,
INDIVIDUAL WATER SUPPLY
A~,ASKA DEPAI~TMENT OF HEALTH
Section of Sanitation and Engineering
Sheet fm Sa~aple Collection ]
Instt~lctlons. ~
Req.est for Bacteriological Analysis ~,i~,t),~}
-/ C~ pab. ~o .........................................
Water sample eel(coted Dy ........... ~.~. .......................................................................... ~......./-----.,~ ........................................
(Name of person collecting semple) (Date) {Time)
Water sample collected from [] Kitchen tap; ~ Bathroom tap; [] Basement tap;
[J Other (list)./~...f. ~'~ ................................................. ~7~ ~""2 .............................................../.-/~ -~ /~~ ~ ~-: .............................
addr~s precise where so,roe is lo~at~d .......... ~.--....~.':....._..../.. .......... .../.-..~.~...Z..:~...7.~..~.e.g. ......... :..-:.:.:..r'Z..:.~:...:...~:- ..........
=a~ roi, or[ t~ mlss~ .... ~.5.CC ......................... C./..~.~-:.Z.. ............. ~
(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, [] Drilled, [] Bored
[~ Spring, [2 Cistern. [] Other (list) ..............................................................................................................
[] Creek, [] River, [] Lake, [] Pond ..................................................................................................................
DUG WELL
OR CISTERN CONSTRUCTION: Walls- ~ Wood, ~ Concrete, [] ~etal, [] Tile, [] Brick or Concrete Block
Top --- [] Wood, ~ Concrete, [] ~etal, [] Open Top
LOCA~I~Olff: [] In basement, [-2 Basement offset, [] Under house, [] In yard
Other .............................................................................. :~ ............................................. :; ..................................................
DISTANCE TO: Building sewer or other drainage pipe.. ~..<..,..'..feet, Septic tank ...~..-.~.,.....feet~ Tile field ..............
feet, Seepage pit .............. feet, ~esspool .../.~...~... feet~ Privy .............. feet, Other possible sources
of contamination (list) .............................................................................................................................................
MATERIAL: Building sewer -- ~ Cast iron, [] Wood, ~ Tile, [] Fibre pipe, ~ Asbestos cement
~lolnt material -- Type ........... ..~...:ff.~27..~ ..........................................................................................................................
GENERAL INFOI~MATION: Does water become muddy or discolored? [_] yes, ~ no When? .......................................................................................................................................................
Diameter of well ............ .~..( ................................... depth .......................................................... feet
Well casing material.....~..~.ff...c..d~e...~..&,. ..... dlumete,'........~.. ......... depth ..................................
/
Length of drop pipe ............................./_~.. .............................................................................................
Water depth from bottom ............... ./.-/.~ ..................................... feet
Pump location: [] In well, [-j Offset in basement, [] In basement
[] In utility room, [] On top of well
[-1 Other (listl ......... ~5....~_~.C.g,.......(~.?...~.Y...~x......./.,.,~........C..~?..~....XT.....~f,...~..~ e.__
Do you suspect illness from this supply? [] yes,~ no
I~,emarks: ..................................................................................................: ......................................................................................................
.P[£~EAS?. D~AW A SKETCI~ ~ TH]~ SPACE BELOW, Ti~][S S~ETC[~I S[-[OULD SI*IOW ¥~OCATrON OF J[[OUS~I, WAT~
SUPPLY SOURCE, SEPTIC TANK, SEWER, DRAIN LINES OR OTHER SOURCE~'~ OF POLLUTION AND DISTAN(JF~
BETWF. EN WATER SUPPLY SOURCE AND ANY OF ABOVE FACILYI'IES,
SAMPISES MUST BE SUBMITTED IN CONTAINERS PROVIDED BY ~q~tE ALASKA DEPARTMEWE OF