HomeMy WebLinkAboutCREEKSIDE PARK #2 LT 12Ks' 6
.
L_I
ooc
I01
APPLIC"N FILLS OUT UPPER HAt 'ONLY
Prgperty O4¢ner ~C~
Address _ __~/ m~C~d~ ~ ~ ~ ~) ~ ZlpCode
Lending Institution ~ l / Phone
Address ~3 ~)0~ Zip Code
Raally Co, & l~nt Phone
Address ~ Zip Code
Type of Resi~nce
~ingle Family
~ Multiple Family No. of Bedroo~
~ Other
Water~pply
~ndividual A~ACH ~LL LOG. A w~i log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach I~ if available).
~ Public Utility
Se~e~sposal
~lndivid~l Year Indiv~ual Installed:
~ Public ~ility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time '~*~
Date Date Date (~ - ~'~ - ~9-,~
Inspirer Inspirer Inspirer Insp~tor
' MUNICIPALIW OF ANCHORAGE
{ } ~MS *CONDITIONS OF APPROVAL
, , RECEIVED
( ) CONDITIONAL APPROVAL*
DATE
BY:
Soils Rating Date ~wer Installed Well To ~sorption Area Well Log Received
Well to Tank Septic T~k Size
72-023 (3/82)
jCHEMICAL & G! 'LOGICAL LABORATORIES _F ALASKA, INC.
TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
Phone No.
Mailing Address
City State
MO. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ret no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
I
; I
, I
I
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
~o indicate reliable results. Please send
new sample.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
,Membrane Filter
Lab Ref. No. Result* Analyst
I r-TI
I F-FI
I
*No. of colonies/100 mi or NO of Positive 13ortions
READ INSTRUCTIONS
BEFORE
COLLECTING SAM PLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date CollectmJ Source
Lmo
Date Received Time Recelve~l
I~.umPt Ive ZOml 1Omi Il)mi 1Omi 1Omi t.Oml O.3ml
24 Hours
48 Hours
Confirmatory
24 Ho~r$
,48 Hours
EMB
Multiple Tube Report:
Membrane Filter: Direct Count
Verification: LTB
Final Membrane Filter R.ult$
Raper te;I By -
Broth 24 hours: Broth 4~ hours:
[Omi Tul)es Positive/Total [0mi Portions
Collform/t0Oml
BGB
/ Collform/200ml
,/" >* ~ ' Date ' " ' ~: ' '~
Time: a.m.
INDIVIDUAL SEWAGE AND WATER FACILITIES
' '-" ~. ~a~ .of person ~equesting approval
.... %,a~ of prope~y,owner-'~
L~y. al de scriptio~
Number .of~ J~rooms in house
Watem, Analysis:
a. Bact~ial
b. Detemgent
Well data:
b. Depth
c. Casin~ Size
de
Distance from well to closest existing~ or proposed:
1, gewer line ,
2, Septic tank
3, Seepage Area
4. Cesspool'
5. Property Line
Sewage disposal system,
a, Age of system
b, Septic tank capacity in gallons
Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc. .
c, Name of septic tank manufactum~.r
1. If "home made" show diagram on reverse side of this form.
d,' Disposal field or seepage pit size and type
1, Distance to proper~ty line
to house fOrtmdation
Percal~tio~T~st 'r~ults
f. Percolation Test performed by
Use tlc reverse .side of this form to show dia£ram. Diagram should include
'the foil.owing information: ppoperty lines~.well location, house location,
~!r~c tank location, disposal area location, location of percolation test,
a~ direction of ground slope.
9. The ~n~'~*~,~-n+{on on this form is true and correct to the best of my knowledge.
S~gnature of Applicant' '~'~te Signe~
T_qO BE FILLED OUT BY HEALTH DEPARTHENT PERSONNEL
The above described sanitary facilities are hereby approved, subject, to, the
~_6'llowin g c.on~lon.~! ....
The above described sanitary facilities are disspproved for the following
reasons:
Approval is valid for one year following the date of approval.
CPJ:cw
November 29, ~968
Dan Rapalee
Vetersn8 Adml~istration
0o Box ~399
Anchora~e~ Alaska 99501
SUBJECT = Sewage System,
7625 Dover Avenue, Lot 12,
Creekside Park Subdivision
Dear Wt. ~apalee {
Personnel of the Greater Anchorage Area Borough Health Department
in co-operation with the Pug Davis Realty have been unable to
determine the type of sewage facility serving the sub, eot location.
Whatever the system, it is presently functioning adequately and
according to the present o~ner, has always done so.
The home is presently served by City water and the subdivision,
along with others in the area, is slated for sanitary sewers in
the summer of 1969.
With a written agreement with the purchaser that he would make a
sewer connection when available, we would approve the present
facility until this connection is made. Finances for the connec-
tion could, no doubt, be arranged through money put in escrow.
Sincerely,
DAVID R. L. DUNCAN, W. D.
~edical Director
BY{
~avid B. Hark'nee's, sanitar~'~n
DBH/srr
cc= Pug Davis Realty
fi unicipMit
Anchorage
PO"~ C H 6-650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
DEPARTMENT OF ~IEALTH AND ENVIRONMENTAL PI'-~OFECTION
September 23, 1982
Leslie Williamson
First National Bank of Anchorage
1100 Muldoon Road
Anchorage, Alaska 99504
Subject:
Lot 12 Creekside Subdivision #2
Tony Prockish Property
A water sample was Obtained at the subject property
on September 22, 1982. The results show the water
is satisfactory.
If there are any further questions, please call this
office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw