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HomeMy WebLinkAboutNADINE LT 20C1 APPLI(' "NT FILLS OUT UPPER HAt ONLY Zip Code ~ealty Co. & A~nt (~ 2/. /?/ /,;f///P "Y Phone ~ddress Type of Resl~nce ~Slngle Family ~ Multiple Family No. of Bedrooms ~ Other Water Supply ~.lndividual ATTACH WELL LOG. A w¢l Icg is required for all wells drilled since .June 1975. ~ Community For wells drilled prior to lhat date, give well depth (attach Icg it available). ~ Public Utility Sewer Disposal ~Jndlvldual Year Individual Installed: ~ Public Ulility When Connected to Public Utilily: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time [)ate Date Date Date '~ Inspector Inspector Inspector Inspector , i, . Lz _~i ,, MUNICIPALITY OF ANCHORAOE mVJRO,~EN~AL PROT~CfJON ]¢~ ;~o APR RECEIVED -(4 ) APPROVED BEDROOM8 'OONDITION8 OF APPROVAL ( ) DISAPPROVED ( ) CON[~ITION,~L AP.,P~.OVAL' DATE Y-- Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72-023 (3182) CHEMICAL & GL LOGICAL LABORATORIES ,~,~ ALASKA, INC.~ TELEPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER /....~.0-;~.~,,,';;7.-~ Drinldng Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER I.D, NO. Water System Name Phone No. Mailing Address City j,; State MO. Bay Year Zip Code SAMPLE TYPE: [] Routine E3 Check Sample (for routine sample with lab ref, no. ' E3 Special Purpose ) ' ~ Treated Water [] Untreated Water SAMPLE NO, 3 l LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory ~ Samole too long ntrans~t: sample should not De over 48 nours old at examination to me,cate reliable results, Please send new semele Date Received Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref, No, Result* Analyst *No. of colonies/100 ml or No of Positive portions READ INSTRUCTIONS BEFORE COLLECTING SAMPLE;. 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RI[CORD Date Collected Stiurce _ Date Received Time Received p.m, Lab, No, Presumptive 3,Omi ;tOml 3. Omi 3. Omi iOrnl 1.Omi O.lml 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB. Broth 24 hours= _Broth 48 houri= Multiple Tube Report= t0ml Tubes Positive/Total 10mi Portions Membrane Filter= Direct Count Collform/100ml verification: LTB BGB Final Membrane FIIter-Re~ult~ ~ L Date Inspector Comments Time Date Inspector Date Inspector Conditional Approval Date Sewer Installed Soils Rating Permit No. Septic Tank Size Holding Tank Size Well To Absorption Area Well Log Received Well to Tank APPLICANT FILl. S OUT LOWER HALF,ONL~ Mailing Address Buyer Address Lending Institution ~.\ ~, /~ · KV~ ,& . kJ .-~/~,.wxj ~/-/ Phone Address ~t ~ ~_ T ~L~ I..~, ~.~4 'r ~ ¢ ~ . Phone Phone Realty Co. & Agent Address Street Location Type~ o.f Residence ,Z,~ Single Family [] Multiple Family [] Other No. of Bedrooms Wet.er Supply ~ Individual [] Community [] Public U~UIt~y ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg If available.) Sewage Disposal ~'3 Individual [] Public Utility [] Holding Tank Year Individual Installed: When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MECIIANICS ~ I ItELPERS @ · CHEMICAL & G~ LOGICAL LABORATORIES ..ZALASKA, INC. ~~'~ Drinking Water Analysis Report for Total ColifOrm Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I,D, NO, Water System Name Phone No. Mailing Address Zip Code City SAMPLE DATE: ~ MO. Day SAMPLE TYPE: E:~ Routine E] Check Sample (for routine sample with lab ref. no. [] Special Purpose State Year [] Treated Water [] Untreated Water SAMPLE NO. b LOCATION Time Collected Collected By ' TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: I~, 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: [] I=ermentatlon Tube [] Membrane Filter Lab Ref. No. Result* Analyst I I · ~ NO. O1 colonies/100 mi or No el Positive portions· READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-]220 (b) Rev.]*978 BACTERIOLOGICAL WATER ANALY.~HS RECORD Date Collected Source_ Date Received, Time ReCalve(t p.m. [.ab. NO PresumPtive ].Omi /Omi ].Omi ~,Oml 1Omi 1,0mi O,lml 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB Broth 24 hours= .Broth 48 hoars: Multiple Tube Report= 10mi Tubes Positive/Total ]*0mi Portions Membrane Filter= Direct Count Collform/3,00ml Verification: LTB ._BGB Final Membrane Filter Results Collform/ZO0~ll Reported By ,* ~ Date / ~ ' STANLEY BRUST & ASSOCIATES Engineers- l'lanners - Surve.;'or~ 131'7 Easl 74th Aver, ue Anchorage, Alaska 99507 (907) 349-6577 _EPI-lC ADEQUACY SYS-F E IV[ REPORT LEGAL DESCRIPTION ' LoT t--_~d'"//BLOCK, OR ......... SECT ION SUBDIVISION ALASKA IREQUESTED BY: I'YPE OF SYSTE~ ' · t¸ L.~ SEPTIC TANK - SIZE ........... GAt LONS ~ CRIB OR SEEPAGE PIT [] LEACH FIELD NUMBER OF BEDROOMS .~/~__-- SEPTIC TANK WAS PdMPED f~YES [] NO t GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Time of Inspection]~.]__ Date of ..... "~/_t/?-'~ Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Address: ........... ~-__.~__?/_~',~ (~. ~ ~_ Phone:~~ ~_ o .~ Prooerty ~ner: ~~~ Phon~ ~ Location: ~/~ 4Z7 Type of Facility to be Inspected: Number of Bedrooms: Well Data: A, l'yp e~~ C. Construction 7. Sewage Dtsoosal System: D, Bacterial Analysis Installed__~? B. Septic Tank: 1, o~ze /~-~m 2, Seepage Pit: 1o Size 2. Installer ~anufacturer Material~_~_~~--~ Dtsposal F~e]d: Total Length of Lines Distances: g. Well To; , Absorption Area Septic Tank , Nearest Lot Line '~2 · , Other Contamination .~. ~ .. Zi / ~ounclatien to Se?tic Tank~ Absorption A~ea to Nearest Lot Sewer Lines ReqJast for Approval of Inuividual Sewer & Water Facilities Page Two Approval '/slid for One Year From Date Signed Greater Anchorage Ares Borough, Department of ~nvironmen~al Quality DIAGRAM OF SYSTBM I certify that the information contained in this request for approval to be a true and accurat~ representation of the subject sewer and water facilities located at: Signed Date ADHW - I. AB - 2W DATE STATE OF ALASKA Dr'-'t, RTMENT OF HEALTH AND WELt' qE DIVISION OF PUBLIC HEALTH BACTER 0LOGiCAL WATER ANALYSIS Lob. No. OFFICE REPORT RESULTS TO, NAME AO[~RESS ADDRESS OF SOURCE SAMPLE COLLECTED BY DATE COLLECTED TIME COLLECTED pm Sample Collecled From [] I(ifchen Tap [] Balhroom Tap [] B~sement Tap [] Other Well- [] Dug [] Driven [] Orillod [] Bored SOURCE: [] Spring [] Cislern [] Olher Dug Well or Cistern Consfrucllon: Bric~ or Walls - [] Wood [] Concrete [~ Metal [] Tile [] Concrele Top - [] Wood [] Concrete [] Metal [~ Open Top LOCATION: [] In Basemenl [] 8asernenl Offsel [] Under House [] In Yard [] Other Buildlng Sewer Seplic DISTANCE TO: or Olher Drainage Pipe Feel. Tan~ Feet, Tile Seepage Cass- '- Field Feet, Pti Feet. Pool----.Foel. Privy Feel Olher Possible Soerces el Contamination MATERIAL: Building Sewer - [] Casl [] Wood [~ Tile [] Fibre [] Asbeslo~s Iron Cemenl [.] Plastic Joint Malarial -- Type GENERAL: Does Water Become Muddy or Discolored? [] Yes [] No When? Diameter of Well Depth Feeh well Casing Material Diameter Depth Lenglh of Water Depth Drop Pipe From goltom Feet. {n Utility PUMP LOCATION: [] In Well []8asemenlOIfsel In [] In 8osernent [] Room On Top [~ OI Well [] Other PURPOSE OF EXAMINATION: Illness Suspected? [] Yes [] No New Source of Supply? [] Yes [] No Repairs Io System? [] Yes [] No Records in Ibis office indicate this WATER SUPPLY to be of: Satldacfory [] Questionable [] Unsalidaclory Sanitary Status. Analysis shows Ibis Water SAMPLE to be: Satisfactory [] Questionable [] Unsotislaclory. Il an "Unsutislactory" or "Questionable" status is indicated tlbove you should fake immedlale action as recommended below. 1. Notify consumers water is polluted. Boll or chemically Irea~ this water as outlined in the enclosed leaflet "Drink Il Pure." --2, Increase chlorination sulficienlly Io meal recommended residual slandards, Determine source of contamination and tulle action necessary to maintain a safe waler supply at all times. 3. Check chlori~atlnn and other mechanical equipment. Make certain it is lunclioning properly. 4. I! alter checking equipment a dlsinlecting residual is not obtained, pier, se wire this olflce for emergency assistance or advisory services. S. This is a surlace water source and subiecllo pollution by man and animals. An approved water supply source should be developed, 6. Improve your [] spring [] dug well [] driven well [] drilled well [] cislern, .__7. Relocate your well Io a safe location in relationship to your sewage dlsposalsyslem. [] see enclosure g. Sample too long in Irarlsit; sample should not be over 48 hours old at examination to indicole reliable resulls, please send new sample. ~] Bollle Broken in transit, please send new sample. 9. Contacl your nearest [] Local Health Deparlment or [] Alaska Division of Public Health, sanHofion office lot bulletins, consultation and assistance. SANITARIAN'S REMARKS Signature READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD am Dale Received Time Received pm._ Lab. No. Laclos e Broth 10cc I Oct I 0cc 10cc 10cc 1.0cc 0,1 cc 24 hours 48 hours Brillionl Green 24 hours 48 hours EMB AGAR Luclose Broth, 24 hrs. 48 hrs.- Greta's slain Coliform Density (Most probable No, per 100cc.) MF results Present, . ..... Septe~nber 1Z, 1567 ( '' Anchor ag e-;]> '.Alaska - "" ~:~ ":?~'"-' ' ' '"" ' " ' ~" - ' '-'--: ZO' ' ' :' "'-~'-'; ~ .... ~' 'TU"~':'~:' ~....' ,:.:.~.;. .~ ...... - .. .. -. . , . ....~ ..:/: · .: diamete~-tes~ hole augered ~o - - formed a percolatio~ test in an 8' a. depth-of 4?9'"below surface elevation in the subject location, North of tke. South pro"perry line and 20' ~Yest of the East property line. ' ' . The base of the test hole was on the top of a well graded gravel 'layer Z' fla thickness with. a mmximum a§gre~a~e size of 3". The material underlying this layer isf of undetermined thick- ness consistin~ of silty gravelly sands considered '[o be pern~-iable. At the time--of this test no free ~vater was encountered in this test hole. [ ' '~ ' . _ ./.' ..3 ' The-percolation rate ~vas determined to be l' n~_inutes at the time, depth and location of th~s test. in 10 :~ ..--:. - Very truly yours :' ' ' ~ -" AL ASKA. 'T ES TLAB Brent. E.. Barnes, ]~. T. i~ppr oved: ' - ' ©ordon K. Skrede MORTGAGOR OR S?ONSOR "--'"~5/~75,:';-']%i:~ ' : -. ~ : ' ' J PROPERTY ADDR65S ur,no u~ts [ ~o~ooms -~t~ .. ~?~.; ~. BASeMeNT- ':~." ~ New installada~ ........... additional ::;: ~:-~:~ ~: .. '~ : ' ~. ~;-,. .... ~. -::: ;: :::.: : 4: ~: . :, / [-~:~s:~,:~'ls not' -sausfactor~_,2a~'~a dome~watev'supply for the- sub~e~ property'..: '_ - ' '- -.:_; ::. ~-:.'.:<- :. ',.': '~.~: It is:'~pi~on.'0f.~e~ ~ ~mt, 3~. Coun~;~ Lo~LDeparcmenc'~o~, Hmkh-thac.thi~ in~vidual se~a~e-dis~osai svs- .- - tern with proper maintenancer:~::m .......................... ; ..... : ::_, - ...................... : - .: :,~..- - ~ C~:'be.e~ to ~ncno~-~usfa~only;:and;'?5~:- -,:: - :"7: :~ ~nnot be-expected to fun~on 'satisfa~ofily' '. -':: ts- nor4~kdy to c~atm a~msamt~condkiom~,~,.'"t~v'-. · ~,,,~ p',.~i~.~ ...... =:~.77:T:~.~L.%,..m~''-: .Z. I have r~vie~ed cbc Fo:egainD ~n~ the Pe~inen~ Individual water-supplT,:v~tem be considered.: ~ Accepuble' ~_ Not AcceP=ble :. . " [~:[ 2ATE · SIGNATURe-: :: CHIEF ARCHFF~Cr DEPUTY' FOR CHI~? AR ~, I.T. CF -." H:ALTH AUTHORITY APPROVAL Sent By: RE/MAX OF EAGLE RIVER, INC.; 9076960214; May -24-02 1:50PM; Page 1/1 Nay 18, 2002 To whml1 It May Cicncern: As purchaser of lot 20C 1 Nadine, I plan to abandon the well and septic that are currently cn the property and hook up to public utilities. 13uysr acknowledges that currently we1 and sop probably axe in a failed state. yarco Za, a 0 . ri�s�a REM Nay 18, 2002 To whml1 It May Cicncern: As purchaser of lot 20C 1 Nadine, I plan to abandon the well and septic that are currently cn the property and hook up to public utilities. 13uysr acknowledges that currently we1 and sop probably axe in a failed state. yarco Za,