The URL can be used to link to this page

Home My WebLink AboutCLAYTON BLK 1 LT 7A · ' I"./" MuJ~iCiP~,Li~ OF ANCHORAGE ..,.,,I~UNIOIPALITY OF ANCHORAGE DEPT. ©,-' i:~! '.,'..vi & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~II~RONME~T,~,L F;::O i ~CTION ' 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION JUN 8 979 Telephone 264-4720 D C / lEh REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~F~ [1~1~ DI~ECTIONS: Complete all parts on page 1. Incomplete requ~ will not be proc~. Plea~ allow ten {10) days for pr~sing. PHONE MAI LING ADDRESS PROPERTY RESIDENT (If different from above) PHONE MAILING ADDRESS / J ' MAI LING ADDRESS~ 5. LEGAL DESCRIPTION STR E ET LOCAT101'~ /'3o3 TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four ~ Two [] Five [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) /'~--~,i~)-'o~ ~ **1 f individual/on-site, give installation date If system is over two {2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~10(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR DIRECTIONS: INSPECTOR 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] IN DIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL [] OTHER Septic/Holding Tank IAbsorption Area ISewer Line J Nearest Lot Line 5. COMMENTS DATE LEGAL D~SC~;~PTION "' D FOR BEDROOMS ~ CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 3/78) /',N', ..~, ..... ,,,,:~,-n ALASKA g9..50'~, g0/, ?,',-i 41 ! 1 : ',' ,: L L.,VAN, June 22, 1979 Joe Luster % Steve Petreshock Dick Towens Company 835 D Street - Suite 201 Anchorage, Alaska 99501 Subject: Lot 7A Block 1 Clayton Subdivision The well serving the property must be upgraded by raising the steel casing twelve(12) inches above ground level and the well pit filled in with soil. An alternate is connecting the residence to the public water. This department will conditionally approve the property if provisions via escrow are made for the upgrade by August 15, 1979. If there are any further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Specialist LNB/ljw cc: Alaska First Mortgage Corporation 207 East Northern Lights Boulevard 99503 P.O. BOX 4-1276 ANCHORAGE, ALASKA 99509 4649 BUSINESS PARK BLVD. Drinking Water Analysis Report for Total Coliform Bacteria TELEPHONE (g0fl 279-4014 TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM: Public Water Syatem Name ~ Milling City State Zip Code MO. Oa-y ' Year,/ SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose ) [] Treated Water [] Untreated Water SAMPLE NO. LOCATION I Ir.f-) 2 4 I . I Time Collected TO BE COMPLETED BY LABORATORY LABORATORY: NAME ~ ' ~A~RESS CITY Date Received Time Received Analytical Method: [] Fermentation Tube ~, Membrane Filter Lab Ref.~No. I I ~ -%1' ~: ~,' · No. o! oolonl. 1100 mi. ~r No. ol p°alflve pof~o~l. Result* Analyst 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAM PLE Form No. 18-310(3-78) Date Collected Source ~ a.m. Date Received Time Received -- p.m. Lab. NO. ,Presumptive 10mi 10mi 10mi 10mi 10mi 1.0mi 0.1mi 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB. Broth 24 hours: Multiple Tube Report: Membrane Filter: Direct Count Verlflcat Ion: Final Memb~ Reported B~ Broth 48 hours: 10mi Tubes Positive/Total 1Omi Portions Collform/lOOml . BGB Date ~ ~'~/~'-~ ?,form/lOOml Time: / Y~--~ a.m. p.m.