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Home My WebLink AboutTELAQUANA HEIGHTS LT 14 · Rev. July 1958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8 HEALTH AUTHORITY APPROVAL IIND VIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.---TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE ~ ,j~RIAL NO. NATIONAI, BANK OF ALASKA IN ANC IOR 60-006579 A~CHOt~AGE AIASKA P 0 BOX 600 - ANCH0~AGE --[ MORTGAGOR OR SPONSOR PROPERTY ADDRESS LOT 1~ Telequ~na lite, Subd., Anchorage Joim L. Stophl See o~ner at~ 1219 "I" St. ;USDiViS,ON~gi:~ANANAMEHEiGHTS . ' BLOCK NO. LO~.j~ O. OTAL NUMBER~ :L BASEMENT J--l o ] New installation additional bedrooms? (If Yes, how ma.y~) WATER SUPPLY BY: ---~'Public system [] Commnnity system [] Individual ~SYSTEM DESIGNED FOR ~ Individual .o. OF BDR~AS. OAReAOE DISPOSAL FlYeB PART II.--TO BE coMpLETED BY HEAl.TH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of [] State [] C [] Local Department of Health that this indiv [] is [] is not satisfactory as a domestic water supply for the subject property. water-supply system It is the opinion of the tern with proper maintenance: ~X~] Can be expected to function satisfactorily, and is not likely to create an insanitary condition [] State r-] County [~ Local DeparmleDt of Health that this individual sewage-disposal sys- L-~ Cannot be expected to function satisfactorily NOTE: The health authorDy should complete the approprlato opinion statement above and affix dater signature and title in tho spaces provided. Use of the above grid for Health Department Inspector's sketch as well as use of the back of this form Is at the option of the health authority. PART Ill.--FOR USE OF FHA OFF~CE TO THE CHIEF UNDr..RWRITER: I have reviewed the foregoiDg and the pertinent FHA Compliance Inspection Report, and recom~nend that'the Individual water-supply system be considered J-~ Acceptable [~] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. DATE SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM ] CHIEF ARCHITECT ] DEPUTY FOR CHIEP ARCHITECT FtlA Form 2S73 Rev, July 1958 p~adsuI · olinS [] :,{q aputu uop~*dsuI 'i.u~ j! 's~]q!tlx* pa*oxddu q~!,~ Xldmo~ ~ou saop ~ sgop ~ uo!l*limsuI 'uopdmnsuo~ u~mmI Joj ~o~js~l~s lou s! ~ s~ ~ J~l~ jo 'ON ~ 'Sax ~ :=tlg[na~uax gu]mnom dm~ 'oN ~ 'saA ~ :pou~p Xl~oJd mooJdm~ '~[d dm~ ~ 'punos$ *aoq~ osno~dmn8 ~ 'nuamasuq jjo moo~dm~ ~ 'lua~os~ ~:u[ 'alnu[~ aad SUOllUg ~ 'Alp~d~> dtu~ 'laoj~'admd doJp jo q~ua~ 'llO~ doaG ~ '11o~ t~OllUqS ~ ~dmnd · oN ~ 'saA ~ :lqgpsal~ta laAO3 Ila~ u[ s~u!uadO 'ima~ ~ '~oAk ~ 'a~aa>u~ ~:sa~o> ila~ · llg~aeq Meu[pJO ~ 'X~p palpp~M ~ 'inoJS auam*D ~:qwa paleas guise> punoJe a~*ds 'laaj~jo qldap o1 aqg}~a~g~ paleaS 'olnu]tu Jad *UOllU~- ~ 'plo~X a~m~xoaddv '~aaj~'lla~ u[ Jal~m jo la~*l ~u[d~nd ol ~ldap alum}xo~ddV :~*aj ~.' 'ppg I~so~p. haaj- O~ "~um mdas. :laaj ~ 'Javas al9 :~oaj~'Jamas um~ 'loaj O ~ '~ea~ ~ 'op~s M '~uoJj ~lg amI 1oI lsas~au tlaaj ~ ~e "uop~punoj gu[pi[nfl ']IO~ paJo~ ~ 'lla~ gnG~ 'lla~ uaa]~G D 'lla~ palU~O ~ :tuoJj Xlddns sa~u~ lenpD!pul J~d/ '~' "~ *~ 'pooqaoqq~au u, ~tuolsn~ lou al~ ~ alu ~ Slla~ I~np,~puI W]ISI$ lldd~']llV~ IVflQIAIQNI--NOIIDldSNI dO 'saq~u[ 'laaj oJunbs 'JuaJ [] 'ap!s [] '~,uo~ [] :)~ au!| loI 3sa~uau haaj WIJ.SAS 1VSOdSICI':IOV/V~3S IvflalAIQNI~NOIJJ)IdSNI :10 ltlOd:lt] ADH-HSE-6 71 (6-58 Z",~ ..// INDIVIDUAL WATER SUPPLY i/:( ALASKA DEPARTMENT OF HEALTH /z//'"~"n5"J~'~¢ Section of Sanitation and llngineerlng om, lea ACTION ON REQUEST FOR BACTERIOLOGICAL WATER ANALYSIS Your recent request for all analysis of a sample from the Iudividnal Private XWater Supply serving~30'g, i'}h't 11 ~ ,'~ponar~ Alaska examination has been completed. Jo 8teph 230? Ohilligon Spenard, gla~ka Lab. 'No__ f~0.~ __ Soughcemgeral Regional Records in this office indicate this Individual Private Water Supply to be of__Satisfactory~"" Questionable____Unsatlsfactory sanitary status. Aualysis shows this SAMPLE to be_.~//_~Satisfactory Qnestionable UnsatisfactoW. If an "Unsatisfactory" or "Questionable" stares is indicated above, you shonld take im~nediate action as recommended below. 1. Boil or chemically treat yonr water supply to protect your family from water-borne diseases as outlined ia en- closed leaflet, "Drink It Pure." 2. Improve your spring--See bulletin HSE-6-2 3. hnprove your cistern--See bulletin HSE-6-3 4. hnprove 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 bnlletin 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 Health Department, Sanitation offtce for bulletins, consultation, and assistance. ~ 11. This is a sorface water source and subject to pollutiou by man aud animals. Au approved water supply source shonld be de~ped. / ~ , . ~ .. ~ SANITARIAN'S I EMARKS~--,. q .~. ,. ..... "-'?--.--~ . ' -- -- ,, / z . '-- '5/4( ' IiThls Form Must Be Filled Out Completely, INDIVIDUAL W~TliR SUPPLY AI,ASKA DF, PAItTMENT OF m]ALTH Section o! Sanitation and Engineering Pirate Look on lttevem og] Sh~t for S~ple Collection Request for Bacteriolog~l Analysis /..q~.~//___.~..,~. ~/ ~,. . ~b,~o .......................................... ~,.~. Water salnpl~ collected Dy ............................... ~.. ~~~'~5.....f~2.Tf.d?e.,Z ............... ~:...~... (Date) (Time) (Name~ person collecttn~ ssmple) Water sample collected from~ Kitchen tap; ~ Bathroom tap; ~ Basement tap; ,'~[] Other (list) ...... 5' ............................ =--x- ........................ ~ ........................................................... ~ (~a~ / :Box No. or street addresS' ' (City) ~" Please plae~ an "X" In the box before l~ms which b~t describe your water supply: SOURCE: Well -- ~ Dug, ~ Driven, ~ Drilled, [~ Bored / [~ Spring, [] Cistern, ~ Other (list) ........................................................................................... '. ................... ~ Creek, ~ River, ~ Lake, ~ Pond ............................................................................................................... DUG ~LL OR CISTERN CONSTRUCTION: Walls ~ ~ Wood, ~ Concrete, ~ ~tal, ~ ~ie, ~ Brick or Concrete Block Top -- ~ Wood,~ Concrete, {~ Metal, ~Open Top LOCA~ON: ~ In basement, [] Basement offset,/*~'Under house, ~ In yard Other .................................................................................................................................................................................... DIST~OE TO: Building sewer or other dralnag9 pipe .............. feet, Septic tank .............. feet, Tile field feet. Seepage pit .............. ~eet, Cesspool .............. feet, Privy ..............feet. Other p~sible sources of contamination (1Nt) ............................................................................................................................................. ~TEBI~,:Building sewer -- ~ Cast ffon, ~ 'Wood, ~ Trio, ~ ~bre pipe, ~ Asbestos cement Joint material -- Type ~ ............................................................................................................. GE~B~ INFOR~'~ON': Does water become muddy or dlscolored9 [~ yes,J~no When? ............................... "7~"'77 ..................................................... 5"~"7 ...................................... Diameter of well ............. ~..~ .............. ~.. ~ epth . .g.~-,~. ............................. feet Well casing materlal.~.~.~ dia note ~. ~Z depth ........ ~..~.[ ............. Length of drop pipe ~" . .............. Water depth fro~ bot~m / ........................................ feet Pump location: ~ ~ well, [j Offset In basement, ~ In basement [] In utility room, ~ On top of well [] Other (IMt) ........................................................................................................ Do you susp~tllnea~ from this supply? ~ ye~ '~ no . _ ,, / __ / PLEASE DRAW A SK~CH ~ ~E SPAOE BELOW. THIS 8KETOlt SHOULD SHOW LOCATION OF HOUSE, SUPPLY SOURCE, SEPTIC TANK, SE~R, DRAIN LI~8 OR O~g SOURCES OF POLLU~ON AND DIST~CES · S~N WATF~ SUPPLY SOURC~ AND ~_~OVE FAC~IT~S. ./ ! / )d N£1GI-t?3