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Home My WebLink AboutSASSE Lot Cpasse. s In I�I Time APPLIL NT FILLS OUT UPPER HAL ONLY property OwnerPhone lk cry Mailing Address %I Zip Code Date Date Date Buyer Address Zip Code Lending Institution -i-) — Inspector Phone InspectorInspector PU, I Address I "', � I I Ll Zip Code Realty Co. & Agent Phone Address Zip Code I muNiciPALM Or Legal Description DFO r Street Location f Type of Residence C) El Single Family �Multiple Family No. of Bedrooms .. El Ether Water Supply `" jindlviduall cc—U ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Ul CommunityFor wells drilled prior to that date, give well depth (attach log if available). 0 Public Utility q 'CONDITIONS OF APPROVAL Sewer Disposal DISAPPROVED 0 Individual Year Individual Installed: '^Public Utility When Connected to Public Utility: Cy 171 Holding Tank LNOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time cry �1 1AC1, C(o Date Date Date Date � - � -i-) — Inspector Inspector InspectorInspector PU, " ��) Field Notes: 0 muNiciPALM Or DFO r C) 10 APPROVED BEDROOMS 'CONDITIONS OF APPROVAL DISAPPROVED CONDITIONAL APPROVAL' DATE Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72029 (31821 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER & 274-3364 5633 B Street or4s `•�'� ueORAMRIES Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: I.D. NO. water System Name Phone No. Mailing Address City State Zip Code SAMPLE DATE: L� CS1 Mo. Day Year SAMPLE TYPE: • Routine ❑ Check Sample (for routine sample with lab ref. no. t ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 2 I I 3 4 41 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Analysis shows this Water SAMPLE to be: ❑ Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit: sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result" Analyst L E= , v� L E= L L._. �1 LSI +Noof colonies/ 100 ml. or No. of Posi l ive portions. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collectod Source a. m. Date Received Time Received p.m. Lab. No. Presumptive loml loml10ml lOml loml 1.0ml 0.1ml ' 24 Hours 24 Multiple Tube Report: Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results. Reported By Broth 24 hours:- BGI _Broth 48 hours: _ 10ml Tubes Positive/Total 10ml Portions Coliform/100ml Date Coliform/100m1 p.m. "IJNICIPALITY OF ANCHORAGE ® ; DEPARTMENT of HEALTH AND ENVIRONMENTAL. �OTECTION 825 L Street, Anchoracrp., Alaska. 99501 264-4720 �- Date Received: October 21, 1977 #1: Time 9:30 am. #2: Time #3: Time Date 10-25-77 Tuesday Date Date Insp Willis Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND.WATER FACILITIES 1. Lending Institution Request: Coast Mortgage Company Judy Mailing Address: 4797 Business Park Boulevard Phone: 279-0665 2. Property Owner: Mailing Address: Wong, Fong Motokane Phone: Randall T. Hiraki 3. Legal Description: Lot C Sasse Subdivision 4: Single Family Residence: ( ) Number of Bedrooms: Multiple Family Residence: (x) Number of Bedrooms: Fo 5. Well System: Individual Well (x) Community/Public System ( ) Permit # Depth of Well Well Log on File ( ) Construction Bacterial Analysis 6. Sewage Disposal System: On-site System ( ) Public Utility (x) Permit # Installed Installer Septic Tank Size Manufacturer Absorption Area Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line JNICIPALITY OF ANCHORAGE Department of Health and Environmental Protection 825 L Street, Anchorage, Alaska 99501 264--4720 equest for Approval of Individual Sewer and Water hacil_i.ti_es 1 . Property Owner : WC�rJC� �IJG tp«N---,------ Mailing Address: 0�t1=� Phone: 2. Name of Buyer: -- Mailing Address: )a r Z"IFD Phone: 6I ro 0 4. 5 6. Al Lending Institution: Mailing Address: 479 02.0 Realtor/Agent : 11 LIZ,O Y31_VTj Phone _79 fak6.,r Mailing Address: 13I W• =l� ce i7 Phone : a7(c,-,P767 Legal Description: LOT �s�A"13pIVISI0l.)'�C7 Street Location: � 6k PLA Single Family Residence: ( ) Number of Bedrooms: Multiple Family Residence: (s4 Number of Bedrooms: Water Supply: *Individual Well X Public/Community System ( ) If Individual Well, well depth If Community System, name of system 8. Sewage Disposal System: *'tn-site System ( ) Public System --�4) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be in:i.t_i-aced. 3/77 Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description:: L � Comments: Lot C Sasse Subdivision �— r Affadavit Attached: ( ) Letter Attached: ( ) Approved: _�� +—" Date: Disapproved: — T Date: Department Worksh et: Ufv Ck_)P_jO �e 06-I220(a) Rey. 1973. _ ALAS1,.. JEPARTMENT OF HEALTH AND SOCIAL SERl,,vES DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC DATE- BACTERIOLOGICAL WATER ANALYSIS INDIVIDUAL ❑ SEMI-PUBLIC E], CHLORINE RESIDUAL PPM REPORT RESULTS TO NAME ADDRESS - - - CITY-- - - ZIP CODE ADDRESS - - - - - - _L-1 OF SOURCE - - - - Lab No, OFFICE Analysis shows this Water SAMPLE to be: ❑. Satisfactory ❑ Unsatisfactory ❑ Questionable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. ❑ Bottle broken in transit, please send new sample, SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY - SAMPLE COLLECTED BY - - — — DATE COLLECTED - TIME COLLECTED Sample Collected From - ❑ Kitchen Tap ❑ Bathroom Top ❑ Basement Tap ❑ Other (List) _ — Well— El Du (j0 ❑ Drilled Bored SOURCE: ❑ Spring Cistern ❑ Other-----__ Dug Well or Cistern Construction: Wells—[] Wood ❑ Concrete El Metal Tap — ❑ Wood ❑ Concrete❑ Metal 11 Tile Brick or LOCATION: Open Top F]Concrete ❑ In Basement ❑ Basement Offset-- - Din Yard ❑ Other ❑Under House Building Sewer Septic DISTANCE TO: or Other Drainage Pipe— Feet. Tank_ -Feet, 'File Seepage Cess - Field _ Feet. Pit ___ Feet. Pool Feet, Privy --.—.Feet. — Other Possible Sources of Contamination MATERIAL: Building Sewer- ❑ Cast Iron ❑ Woad ❑ Tile ❑ Fibre ❑ Asbestos ❑ Plastic Joint Material - Type Cement -- _ GENERAL: Does Water Become Muddy or Discolored? ❑ Yes ❑ No When? _ — Diameter of Well Depth Well Casing Feel. Material Length of — Diameter Depth Length Water Depth Drop Pipe From Bottom Feet. PUMP LOCATION:❑ IOffset in In Utility _ On To n Well ❑ Basement EI In Basement ❑ Room ❑ Of Well ❑ Other PURPOSE OF EXAMINATION: Illness Suspected? ❑ Yes ❑ No New Source of Supply? ❑ Yes p No Repairs to System? ❑ Yes ❑ No Signature — - R 10 Rev. 3 (20 :BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. READ INSTRUCTIONS Date Received am '— Time Received / — pm_Lob. No. ON REVERSE SIDE BEFORE COLLECTING SAMPLE Lactose Broth - IOcc lOcc 24 Hours lOcc s lOcc IOcc IAtt 1.Occ 48 Hours - _ --- Brilliant Green 24 Hours — 48 Hours --- -- MIS Lactose Broth, 24 hrs. Coliform Density MF Results Reported by _ This analysis indicates Coliform Organisms to be: --_ AGAR AB hrs.---- Date,. rs.___Date,. Absent — Present — Gram's slain -- (Most probable No. per 100cc) a.m. octobw, 116s 1977 ty(011qp Ponq Plot cAtil-te e Al- 13 ci 1) 9 5 () 1, o-, tm,uljcUl�rJwJ. Yl A IM "o (-" odeltition ki f()I:a Call e1pr( jjl)vO yo"ll: XCYjmt for _ qater -jppxc)val, the follawixW te",V4 oho wall L,3 p),r%,,-,-Z(-mjtly 11A a pit anel j 1 tite �jcj btu loo -low grok-mol. lcvol� mti!j well casin-91 neads- to be - 4,,t w(Avo(.1.2) lems1t; u in 'it, c uo Ll above gro ri I If -IV 1 vit ho Q. Ur � I i pc Soil, witl ty ti-lat 11not ,,4t� j4i11;oy* cin and armind tlko WeAl oasillq. "'1 t questicynilf plearic contz - ic t -horo are ink -LY I 'qI (�-ice tile; 2644-4720. SO,kuxjrokv 0 0-1/111h Coast -Hewt(ltt�JOY fj , 6797 Business - X