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Home My WebLink AboutTELAQUANA 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 ~ .~ x~... -'~5/ / K ........ Au~ j~ 's~q~tlx~ poao~dd~ ql~ta lldtuo~ lou s~op ~ s~o~ uml~llmSUI 'uon&unsuo~ u~mnq ~oJ l~m~jsu~s ~6I ' / / ~ a~p aa~ ,,'saZ. s~ ~a~su~ JI 'oN ~ 'sa~ daputu uaaq ~a3~ jo uouumm~xa N~[~OlOUal~uq S~H 'ON ~ 'so~h~ :~q~!uo~ ~u~lunom dm~ 'oN ~ 'so~ :p*u~u~ XlJ*doJd momdm~ '*lnu}m ~*d SUOlle~ '/lpudu~ dm~M 'l*aj~'ad}d doJp jo qlSu*q 'llo~ do*U ~ 'II0~ ~OllUq~ ~dmnd 'oN ~ 's*~ :~p~m~m ~a~o> ipnx u~ s~u~uod0 '~*~ ~ 'pooA~ ~ '*~*~>u~ :~*~o~ · ll~uq ~.u[p~O~ '4q~ P*IPP~ ~ 'moJ8 ~u*m~D ~ :ql~ p*lU~S 8u~su> punmu o~uds ~o~Jo~x~ 'omu~m J*d s~.~'pi*~X *~um~xmdd~ '~**j~'lp~ u~ J***~ jo l*a*l ~u[dmnd m qld*p ~um[xoJddv 'laa) ~ 'uo~mllod alq[~sod jo sa~2nos Jaqlo '.laaj .~ 'loodssa~ ~loaj~'l~d haaj ~ 'pla~ l~sods]p llaaj~'~um ~pdas :loaj ~ 'Javas alu ~aaj 'laaj 0 ~ 'auas ~ 'ap~s~ 'luoJj ~ 1~ amI 1oi lsa~uau '.laaj O~ 'uo}lupunoj 2u~pl!n~ 'llata paJo~ ~ 'Ham gn~ 'ILO& uaa~0 ~ 'lp~ Pall]So 'loaj~'amI XlJ~oJd luoaj ~oaj ~0eq las gmllaaXG 'daap laaj~'ap[~ laaj~:az*s 's~alsXs lUS~ut~as puu /Iddns-Ja~ax NnpD~pu[ tpoq q)Dx padolaaap 2u[aq ~ou aJ~ ~ aJ~ p~q~tlg[au u} sa!~JadoJd 'pooq:oqqg!au u! t,.mmsn2 lou oJU [] aJ~] Sllaax I~np!a!puI W:IXSAS AlddflS-UtlVM lvflalAlaNI~NOI13:IdSNI dO 1UOd:tU lU!lalem gu!uH 'SUOllr3 'thpgdg> p]nbH 'laaj 'lOO&~aD [] W:IISAS IVSOdSIQ-]OV/~A:IS 1vnalAIQNI~NOIJ,:):IdSNI dO 1UOd::IU /\./ ~ 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