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Home My WebLink AboutNELS KLEVEN Lot 2L..o DATE RECEIVED --" INSPECTION APPOINTMENTS ~'~'E TIME TIME DATE DATE DATE MUNICIPALII¥ OF ANCHOR^GF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~;~jlViRONMEN FAL ; -,.Y~[~CTION 825 L Street - Anchorage, Alaska 99501 (~) ENVIRONMENTAL SANITATION DlVlSlONTelephone 264-4720 hrPrltlrh DIRECTIONS: Complete all parts on pagB 1, Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PROPERTY OWNER MAILING ADDRESS PRQPERTY RESIDENT (If differenOfrom above) PHONE 2, BUYER ! ~HONE MAILING ADDRESS '~', -I-ENDING INSTITUTION PHONE MAILING ADDRESS · HEALTOR/AG~NT I PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION 6. TYPE OF RESIDENCE [] SINGLE FAMILY [~" MULTIPLE FAMILY NUMBER OFtBEDROOMS ~ One [] Four [] Two [] Five [] Three ~ Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * 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 log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SI'rE** PUBLIC UTILITY .YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED./~ 72-010(Rev. 6/79) ~ -/~ · .... /~ . /. I~J '~1~'L)) [ ~' THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX PERMIT NUMBER 2, WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~]Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS > TROVEDFOR BEDROOMS [] CONDITIONAL APPROVAL {letter must accompany certificate) [~ DISAPPROVED 72-010 (Rev. 6/79) RECEIPT Received From Address ACCOUNT J HOWPAID I ~l -- , , ~T,O~l LI ACCOUNT CASH 8K80~ Reclifprm CHEMICAL & GL LOGICAL LABORATORIES ,. ~,: ALASKA, INC. .... Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: E ] ] I [ I I I.D. NO. Water System Name Phone No. Mailing Address City State Zip Code Mo. Day Year SAMPLE TYPE: O Routine I-J Check Sample (for routine sample with lab ref, no. ['~ Special Purpose [] Treated Water E] Untreated Water SAMPLE NO. t LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY 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: EI Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst I *No ol colonies/lO0 m~ or NO of Positive porlions. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev, ~.976 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source Data Received Time Racalvaa p,m, Lab, No, Presumptive 1Omi 1Omi 1Omi 1Omi ZOml 1,0mi O.Zml 24 Hours 48 Hours ~.onflrmatory 24 Hours 46 Hours EMB Broth 24 hours: Broth 46 hours: Multiple Tube Report: [0mi Tubes Positlvefrotal [0mi Portions Membrane Filter= Direct Count Collform/100ml Verification: LTB BGB Final Membrane Filter Results Collform/3.00ml Rapor t~d By Date Time: a.m. I~~ 825 ~tl: Time Date Insp Pratt MUNICIPALITY OF ANCHORAC OF HEALTH AND ENVIRONMEN _ PROTECTION L Street, Anchorac~. Alaska 99501 264-4720 Date Received: February 22, 1978 11:15 a.m. #2: Time ~3: Time 2-24-78 Friday Date Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: Phone: 2. Property Owner: Leonard Peck Mailing Address: 325 Meyer Phone: 272-990~ Legal Description: N1/3 1/3 Lot 2 & 1/3 1/3 S1/3 Lot 2 Nels Klevin S/D 533, 601, 609, 617 North Klevin Street 4: Single Family Residence: ( ) Multiple Family Residence: (x) See notes on white sheet. 5. Well System: Individual well (~ Permit # Depth of Well Construction 6. Sewage Disposal System: On-site System ( ) Permit # Installed Septic Tank Size Absorption Area Public Utility (x) Installer Manufacturer Soils Rate Material Number of Bedrooms: Number of Bedrooms: Twenty-five. Community/Public System ( ) Well Log on File ( ) Bacterial Analysis ~>~t~o~L~ _ 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line 'Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: N1/3 ~/3 Lot 2 & 1/3 1/3 S1/3 ]Lot 2 Nels Klevin Comments: Affadavit Attached: Approved: '~". DiSapproved: Letter Attached: ( ) Date: Date: Department Worksheet: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEC'FION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAl. OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA Leonard Peck 2. Property Owner: 325 Meyer Mailing Address:_ 3. Name of Buyer:_ Jack Vandolaar 2423 Kensington Mailing Address: none-owner financing, 4. Name of Lending Institution: Mailing Address: Phone: CONV, Day Phone: 272-9902 Day Phone: 864-3178 5. Name of Realtor or Agent: La Vonne~ ~,~.--~ ~tat~ $.R.A. 365 D Mailing Address: N1/3,M1/3 Lot 2 and '~1/3, M1/3, 6. Legal Description: 344-9406 Phone: S1/3 Lot 2 Wel~ Klevin ~ubd. 533,601,609~617 North Klevin Location: 3 Duplexe% 10 Plex 7. Type of Facility to belnspected: No. Bdrms. 25 Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served ,Individual 16 X If Individual, depth of well Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3/76) MUNI ~ALITY OF ANCHORAGE POUCH 6-650 ® ANCHORAGE, AK 99502 · PHONE 279-8686 FINANCE DEPARTMENT CASH RECEIPT RECEtVED No. 407[ 6 DATE FROM , ADDRESS ., , ,,: ~ ~l$ AMOUNT REMARKS ZIP DES IP~ -- ~k-T~ Cost Ce, nte, r, W, A/~WO~----O~ '~ ~ I /~mount 40-007 (Rev. 1/77) White-- Treasury; Yellow-- Customer; Pink-- Book; Goldenrod- Department DISTRIBUTION: 06-1220(a} Rev. 1973 ~} ! ~ ,'J DATE ALk DEPARTMENT OF HEALTH AND SOCIAL St ~ES DIVISION OF PUBLIC HEALTH L.b No. INDIVIDUAL AND SEM]-PUBLIC BACTERIOLOGICAL WATI-'R ANALYSIS oPP,cE INDIVIDUAL [] SEMI-PUBLIC [~J~__ - CHLORINE RESIDUAL FPM REPORT RESULTS TO ',," L-t- NAME ADDRESS ' ~- '~ L, t')l ' ' ' CITY . r ~ ZIP CODE ADDRESS OF .SOURCE Analysis show~ this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Queslionable [] Sample 1oo long in transit; samole should not be over 48 hours old at examination la indicate relbble results. Please send new sample. [] Botlle broken in transil, 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 J~J~KJtchen Tap [] Bolhroom Tap [] Basemenl Tdp [] Other (List) Well- [] Dug ~ Drive~ [] Drilled [] Borec SOURCE: [] Spring [] Cistern [] Olher. Dug Well or CJstern Conslruction: Walls--[] Wood [] Concrele [] Melal [] THe Brick or Top -- L~ Wood [] Concrete [] Melai [] Open Top r~ Concrele LOCATION~ [] n Basement [] Basemen1 Offset [] Under House illin Yard [] Olher Building Sewer Septic DISTANCE TO: or Olher Drainage Pipe Feet. Tank Feet, Tile Seepage Cass- :laid __ Feet. Pit Feel, Pool Feel. Privy_ __Feet. Olher Possible Sources of Contamination MATERIAL: Building Sewer- [] Cast iron ~ Wood [] Tile [~ Fibre [] Asbestos - Cement [] Plastic Jolnt Material - Type GENERAL: Does Water Become Muddy or Discolored? [] Yes [] No When? Diameter of Well Depth Feet. Well Casing Length of Water Death Drop Pipe Frorr ]otlom Feet. PIJMP LOCATION: [] ]n Well ~ Basemenl [] In Basement J~ Room On Top [] Of Well ~ Olher PURPOSE OF EXAMINATION~ Illness Suspected? [] Yes New Source of Supply? [] Yes [] No Repairs to System? READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE [~ No [] Yes [] No Signature 0~-12~0 rb> BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1973 Dale Received __c--J': 'A~.>~/'/I" Time Received_ _/~ ~:p~m Lab. No Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1.0cc 24 Hours 48 Hours EMB AGAR Lactose Broth, 24 hrs. ~17 brs. -- Gram's stain Coliform Density (Most probable No. ~er 100cc) MF Results This analysis indlcales Coliform Orgcmlsms to be ' Absen