HomeMy WebLinkAboutCOLLEGE HEIGHTS BLK 1 LT 4A
MUNICIPALITY OF ANCHORAGE
/ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete alt parts on page 1. Incomplete requests will not be processed. Please allow ten (10) davs for processing.
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~ROPERTV.--RBSIDENT (If different from. above) i PHONE
,~ ~ ·
~12. BUYER ~1 ~ - PHONE
. -- - ' ' PHONE
MAILING ADDRESS
I~.' I,~E~3AL DESCRIP~.
~ One ~ Four ~ Other
~ '~ Two ~ Five
SINGLE
FAMILY
~ MULTIPLE FAMILY ~ Three ~ Six
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for al 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-SITE**
[] PUBLIC UTILITY
**If 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.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
~ INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY .
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
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:
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
[] OTHER
Absorption Area to nearest Lot Line
Septic/Holding Tank IAbsorption Area lSewer Line
Nearest Lot Line
5. COMMENTS
DATE
APPROVED FOR ~ BEDROOMS
CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
BY (Title) /
LEGAL DESCRIPTION
72-010 (Rev, 3/78)
P.O. BOX 4-1276
4649 BUSINESS PARK BLVD.
ANCHORAGE, ALASKA 9<3509
Drinking Water Analysis Report for Total Coliform Baderla
TELEPHONE
(gOT) 2794014
TO BE COMPLETED BY WATER SUPPLIER
PUBLIC WATER SYSTEM:
IT-T-
I.D. NO.
Public Water System Name<::Y
Mailing Address
City
SAMPLE DATE:
state
Mo. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
1~-8pecial Purpose
_) [] Treated Water
[] Untreated Water
SAMPLE
NO.
1
4
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
LABORATORY:
CHEM & GEO LABS OF AK., INC.
NAME
4649 BUSINESS PARK BLVD.
ADDFtESS
ANCHORAGE, ALASKA
CITY
Date Received ~-~ ~-~4~
Time Received ]~' ~::)~
Analytical Method:
[] Fermentation Tube
~< Membrane Filter
Lab Ref. No. Result*
No. of colonies 1100 mi. or No. of Pol~lllve portlonl.
READ INSTRUCTIONS
BEFORE
COLLECTING SAM PLE
Form No. 18-310 (3-78)
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected Source
D~3te Received Time Received p.m. Lab. No.
Presumptive 1Omi 10mi 10mi 1Omi 10mi 1.0mi O.lml
24 Hours
48 Hours
Confirmatory
24 Hours
'~48 Hours
EMI~ Broth 24 hours: Broth 48 hours:____
Multiple Tube Report:_ 1Omi Tubes Positive/Total 1Omi Portions
Membrane Filter: Direct Count Collform/lO0ml
Verification: LTB __BGB
Final Membrane Filter Results ~t~9 ~lOOml
Reported By .~,~'---.~~~ Date ~ ..- :~'~ ~Co,
August 24, 1978
National Bank of Alaska
Mortgage Loan Section
Pouch 7-025
Anchorage, Alaska 99510
SubJect~ Lot 4 Block I College Heights Subdivision
Donald Tetclaff Property
Before we may approve the request for sewer and water
approval, you will need to locate the well.
Approved construction would includes
well casin.~ tw91ve (12) inches above ground level, the
must not be in a pitland.~it must be sealed so that
If there are any further questions, please contact this
office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Sanitarian